NHL star Brandon Prust helps launch Kids Kicking Cancer in Canada

FALL 2013
Influenza unmasked –
how LHSC tackles the flu season
One dialysis patient’s
journey to independence
We are family – the dream of
family becomes a reality
NHL star Brandon Prust
helps launch
Kids Kicking Cancer
in Canada
Who We Are
One of Canada’s largest acute care teaching hospitals,
London Health Sciences Centre (LHSC) cares for the
most critically ill patients in the region. Located in London,
Ontario, Canada, LHSC encompasses:
• University Hospital
• Victoria Hospital
• Children’s Hospital
Contents
02 NHL Star Brandon Prust helps
launch Kids Kicking Cancer in Canada
Discover how Brandon Prust helped
empower sick children and youth to find
peace, power and purpose in the face of
disease with the Kids Kicking Cancer Program
11 We are family
Vince and Lori Londini’s dreams of a large
family almost shattered when they discovered
they both faced fertility issues. Learn how
The Fertility Clinic helped make their dream
a reality
04 Did you know?
LHSC’s pharmacy checks and balances are
helping make drug delivery safer
13 London researcher answers
the call to service
LHSC critical care physician and
Lawson Health Research Institute researcher,
Dr. Raymond Kao has made a groundbreaking discovery that will save lives on the
battlefield – and is named the first Chair in
Military Critical Care Research
05 Influenza unmasked
An inside look at how LHSC operates
under the pressure of ‘flu’ season
09 Driving through the roadblocks
Learn how the regional renal program
helped Debbie and Ted Worley navigate
dialysis treatment so they could find
freedom on the open road
14 On the Scene @ LHSC
See what we’ve been up to since our last issue
• Byron Family Medical Centre
• Victoria Family Medical Centre
• Kidney Care Centre
(at Westmount Shopping Centre)
LHSC is the home of:
•C
STAR (Canadian Surgical Technologies and
Advanced Robotics)
• Fowler Kennedy Sport Medicine Clinic
• London Regional Cancer Program
• Children’s Health Research Institute
• Lawson Health Research Institute
• Children’s Health Foundation
• London Health Sciences Foundation
15 You asked us
How to stay healthy while you travel to
escape the cold and snow
ON THE COVER:
Brandon Prust teams up
with Children’s Health
Foundation to launch
Kids Kicking Cancer in Canada
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F O L LO W U S
F O L LO W U S
NOTES FROM THE CEO
As health-care providers, in order
to care for patients we must also take
care of ourselves. This is especially
important during the annual influenza
season which is now upon us. It is
of the utmost importance that staff
and physicians receive their influenza
vaccination to protect themselves – as
well as our patients – from influenza.
I am pleased that LHSC has taken the
Children’s Hospital patient
Kiara Szabo has taken control
over her pain, thanks to the
help of Brandon Prust and the
Kids Kicking Cancer program.
important step this year of strengthening
I invite you to read more about how
its influenza immunization policy.
LHSC is tackling this year’s flu season,
This policy mandates that staff receive
and some of the innovative programs
a flu shot, and those who have not
we have in place to ensure we continue
– including family and visitors – will
providing exceptional experiences for
be required to wear a mask in patient
our patients.
care areas when the influenza virus is
As always, I hope you enjoy your
widely circulating in our community.
time “inside.”
This policy protects our staff, and most Bonnie Adamson
importantly protects our patients.
President & CEO
KICKING CANCER THEIR WAY
BRANDON PRUST AND
KIDS KICKING CANCER EMPOWER PATIENTS TO FIND PEACE, POWER AND PURPOSE
Kiara Szabo pulls air deep into her lungs until it looks like
her tiny chest can’t expand any further.
“Then you breathe in a little more,” she says softly to
Sensei Joel Ender.
Today, teacher turns student as Kiara shows him what
she has learned over the past few months through the Kids
Kicking Cancer program. They stand together in LHSC’s
Children’s Hospital, in full martial arts uniforms. Ender
towers above the 10-year-old as he follows her instruction.
Like many of the patients at Children’s Hospital, Kiara’s
curiosity was piqued by the senseis who have been roaming
the halls of Children’s Hospital since the spring. When a child
life specialist asked her if she’d like to learn martial arts as part
of the Kids Kicking Cancer program, she was keen to sign up.
Kiara is a natural – and a perfect fit for the program, as she
is exactly the type of patient that it was designed to empower.
Since being diagnosed with leukemia in 2011, Kiara has
struggled with fatigue, irritability, pain and a compromised
immune system. She’s missed out on social interaction at
school and has fallen behind in her studies.
“One of the greatest challenges for a child that has been
given a difficult diagnosis is that they become different
from their friends. Their life is different, not fair,” says Kids
Kicking Cancer Founder Rabbi Elimelech Goldberg, known
affectionately as Rabbi G.
“Kids Kicking Cancer really is a movement
of empowerment, our mission statement
is to ease the pain of sick children while
empowering them to heal physically,
spiritually and emotionally.” Rabbi G
Headquartered in Detroit, Michigan, Kids Kicking Cancer
is a non-profit organization that helps children with cancer
manage the stress and pain of their disease and treatments
through personalized coaching, instructed by volunteer black
belt martial artists. Children practice the techniques and
teach them to others to help reduce stress.
Since its inception almost 15 years ago, the program has
spread across the U.S. and the world – touching base in cities
such as Los Angeles, Florence and Jerusalem. However, it
was not available in any children’s hospitals in Canada until a
very special fundraising force – Brandon Prust – joined with
Children’s Health Foundation to launch it here in London.
Prust first began visiting Children’s Hospital as a London
Knight over a decade ago and the children made an incredible
impact on him.
“When you see the way they go about life it’s very
humbling. Just to be there and put a smile on their face is
what makes you go back,” he says.
Now with the Montreal Canadiens, Prust found himself
looking for a way to support London’s Children’s Hospital on
a larger scale. When he heard about the Kids Kicking Cancer
program, the decision to get involved was easy.
In 2012, he hosted a fundraising golf tournament under the
name of his charity, Prusty4Kids. With the support of other
NHL stars, Children’s Hospital staff and Children’s Health
Foundation, the inaugural event raised almost $130,000 –
more than enough to bring the program to London.
“We’re very proud of it,” says Prust. “You’re just trying to
help out…having the status I have as a professional hockey
player helps and it’s good to give back.”
Joel Ender, a local black belt martial artist, was one of the
first to volunteer with the program in London. He is one
of four local martial artists that made the cut through
the rigorous screening process and training program
that Kids Kicking Cancer and Children’s Hospital requires.
Since the start of this year, he has been participating in
twice-weekly rounds of Children’s Hospital inpatient and
outpatient clinics, where he sees four to five patients each
visit, on average.
Melissa Zurch, child
life specialist, talks about
the importance of
the Kids Kicking
Cancer program.
visit us at inside.lhsc.on.ca
02
DID YOU KNOW
RAISING HOPE FOR
CHILDREN……
At Children’s Health Foundation, raising hope
is more than a slogan. It’s a philosophy that
encompasses everything we do for children, youth
and their families from across Southwestern Ontario
LHSC’s pharmacy checks and
balances are helping make drug
delivery safer.
and parts of Northern Ontario.
All medications given to patients at LHSC
are provided by LHSC Pharmacy Services.
As one of Canada’s leaders in
progressive hospital pharmacy practices,
LHSC has a strong history of innovation
and operates under a rigorous process,
which helps ensure that the right dose
of the right drug is delivered to the right
patient at the right time.
Children’s is proud to be raising funds and hope
across the continuum of children’s health care,
supporting the highest quality treatments at
Children’s Hospital, London Health Sciences Centre,
Safety checks at each stage of drug delivery
rehabilitation at Thames Valley Children’s Centre,
and innovative research at Children’s Health
Research Institute.
Thanks to the incredible support of Brandon Prust
and Prusty4Kids, London’s Children’s Hospital is
Kids Kicking Cancer sensei Joel Ender leads Kiara Szabo through martial arts techniques that are
proven to reduce pain and anxiety.
An
accurate and up-to-date medication
history is completed by the medical
team, patient and/or family.
the first in Canada to bring Kids Kicking Cancer to
our young patients. This unique program teaches
stress and pain management techniques not only
“Kids Kicking Cancer has helped me,”
says her mother Roxanne. “By seeing Kiara have
power, peace and purpose over this horrible,
horrible disease – she can breathe through the
pain and take back control over her body.”
Since the launch, Kids Kicking Cancer
continues to gather momentum. Soon, the
program hopes to add off-site classes, as well
as expand into additional children’s hospitals
across Canada.
In addition, Prust plans to host his golf
tournament every second year in support of the
program, so that it may continue to help the
children and families from across Ontario who use Children’s Hospital’s services.
Kiara was one of the first patients to demonstrate the
“You want (the children) to be stronger in the heart
program’s effectiveness to Ender.
and in the mind. It’s going to help them and help their
Upon arriving at Children’s Hospital for a routine
families, as everyone gets involved with the breathing
appointment, Kiara’s mother Roxanne realized that she had
techniques – it can be a whole family thing,” he says.
forgotten Kiara’s EMLA cream – a topical anesthetic that
For Roxanne and Kiara, being involved in
numbs Kiara from the pain of the needles used in treatment.
Kids Kicking Cancer has had an incredible impact
Kiara had a choice. She could either wait the hour it
on both mother and child.
would take to get the cream, apply it and have it take effect,
“Kids Kicking Cancer has helped me,” says Roxanne.
or, she could go through the procedure without it.
“By seeing Kiara have power, peace and purpose over this
Kiara opted to forgo the anesthetic. Instead, she and
horrible, horrible disease – she can breathe through the pain
her mother used the techniques they had learned through
and take back control over her body.”
Kids Kicking Cancer.
Indeed, each and every day,
First, Roxanne walked her daughter
Kiara’s body is becoming her
through a relaxation technique called a
own again. October 25 marks a
body scan, and then Kiara used power
monumental milestone – her last
breathing to reduce the pain.
chemotherapy treatment.
“For the first time ever she made it
When asked what her plans are
through…without pain killers,” says Ender.
for the future, soft-spoken and
The effectiveness of this ‘mind
thoughtful Kiara talks about the
over matter’ technique is no trick of
school year, her love of science and
the imagination. When a child is
math, and, with a gentle smile states
empowered in their own treatment, Brandon Prust and Kiara Szabo
that she wants to be an oncologist.
the biological indicators of pain share a high-five.
become less present.
“Distraction is a proven and valid methodology for
Inside the Kids Kicking Cancer
managing pain or pain responses,” says Val Rousom,
techniques with Joel Ender
director of children’s care at Children’s Hospital. “Purposeful
breathing, mindful meditation, imagery and thinking
differently about the control one has over pain, empowers
children in a way that allows them to manage their own pain.”
03
visit us at inside.lhsc.on.ca
Processing the Order
Initial Assessment
to cancer patients, but other children faced with
chronic illnesses. Kids Kicking Cancer is just one of
the specialized paediatric programs that are funded
Patient’s
condition is reviewed by an
interdisciplinary team (e.g., physician,
nurse, pharmacist).
All
medications to be administered
to a patient require a prescription or
doctor’s order.
through community support.
Other examples of current programs funded
Prescriptions
are written by physician,
sometimes with help of pharmacist
based on:
through Children’s Health Foundation are:
• Art therapy: creativity and expression through
•w
hat drug
is best,
art to help young patients express their emotions
and gain a sense of control during what can be a
difficult and uncertain time.
•p
ossible drug
interactions
and/or side
effects and,
• medication
reconciliation
information.
A
nurse enters prescription into the
medication administration record (MAR),
which is used to document any time a
medication is given to the patient.
A
pharmacist comprehensively
reviews every medication order
before authorizing the technicians
to fill the order.
Technicians
enter order into
a system, which performs an
additional electronic check to ensure
no history of allergies to a drug or
drug interactions.
• Injury prevention: focuses attention on preventing
injuries — the leading cause of death in children
and adolescents — through education and awareness
• Therapeutic clown: Ollie the Clown uses
humour, laughter and spontaneity to help
improve families’ hospital experiences and
create a positive, hopeful environment.
Final Safety Check
Before administering the
medication the nurse must
verify 8 rights:
right
PATIENT
right
MEDICATION
to be given
right
REASON
right
DOSE
To learn more about how you can positively impact
the health of children, youth and their families and
support the Children’s Family, please visit
right
ROUTE
right
FREQUENCY
right
TIME/DAY of order
right
SITE
www.childhealth.ca.
04
Prescription information is sent
to the appropriate pharmacy
production area – either to:
A pharmacy robot (PACO) – using
bar-code technology, PACO can
dispense up to 10,000 doses
per day virtually error free.
OR
• Child life: helps children and their families
understand and adjust to the hospital environment
– reducing the stress and anxiety of their health
care journeys.
• Eating disorders shared care: supports our
regional health care teams who provide timely
support for children and adolescents with mental
health needs, while staying close to home.
Filling & Checking
the Order
Additional Check & Del
ivery
Medications for patients are dispensed
daily (instead of weekly),
so the nurse has
the most accurate and
current medication
and dosage available for
administration to
the patient.
Porters transport medications, which are
labelled in detail with
patient’s specific
information, to the nursin
g unit for the
nurse to administer.
Each patient has his or her own
personalized bin where
their medications
for the day are kept.
Nurse checks the medication against the
medication administra
tion record (MAR)
to ensure it is the sam
e medication that
was called for in the pre
scription.
The pharmacy technician at a filling
station. The technician receives list
of medications and picks proper
medications and doses manually.
These filled orders are reviewed by
a second technician.
OR
Intravenous medication go to a
special sterile location called a
clean room, which has monitors
and controls that ensure the
environment is sterile at all times.
Technicians perform double checks
on each other’s work to ensure
order filled properly.
04
PANEL DISCUSSION ON INFLUENZA
Influenza unmasked
Laurie Gould, executive
vice president of patient –
centred care at LHSC
Dr. Michael John, medical
director, infection prevention
and control and medical
microbiologist at LHSC
Dr. Gary Joubert, city-wide
chief/chair of the emergency
department at LHSC
number of visitors. Influenza has an
impact on the patient – not just on the
hospital. It has a significant impact on
the whole patient and family experience
when in the hospital.
Not to be confused with the
stomach ‘flu’ (which is an upset in
the gastro-intestinal tract), the ‘flu’
actually refers to the influenza virus,
which causes a respiratory infection
as well as headache, chills, cough,
fever, appetite loss, muscle aches
and tiredness.
Influenza is a serious matter.
Annually, the infection takes
between 500 and 1,500 lives
in Canada, with young children,
individuals over 65 and those
with other systemic diseases like
diabetes, cancer and respiratory
illness, being the most vulnerable.
How LHSC tackles the ‘flu’ season
During the months that stretch from November to May,
you will hear mention of the ‘flu’ season more often,
as health organizations across the nation urge the public to
sanitize hands, cover sneezes and coughs and get the flu shot.
05
Dr. Gary Joubert, city-wide chief/
chair of the emergency department
at LHSC, Laurie Gould, executive
vice president of patient-centred
care at LHSC, and Dr. Michael
John, medical director, infection
prevention and control and
medical microbiologist at LHSC,
are no strangers to the effects that
influenza can have on the function
of a hospital, as well as the
health of patients.
Recently, they joined us for a
panel discussion, bringing us
behind the scenes to unmask
the truth about how health-care
professionals at LHSC manage
the ‘flu’ season.
1. Explain how influenza season
impacts the hospital
Dr. Gary Joubert: The impact on
emergency services is significant.
Normal volumes at our sites are
around 180–200 patients a day at
Victoria Hospital (VH) and 130 each
day at University Hospital (UH).
During our peak flu season, volumes
at VH increase to about 250–300 adult
patients a day, plus another 20–30%
increase in paediatric patients and, at
(UH), volumes rise to approximately
175 patients a day.
While some patients are very ill
and may require the use of emergency
services and hospitalization, there are
others who are unwell but really don’t
need to be using emergency services,
so they may have to wait while sicker
patients are seen first. Plus, given the
high number of patients who are seen
in the emergency department every
day, patients without the flu, who aren’t
immunized, can contract influenza in
the emergency waiting room. This is
why we ask people to seek other health
care services unless they need to use
emergency services because of the
illness severity.
During influenza season, we still have
all of our normal emergency department
business and when we add the burden of
influenza on top of that, we don’t have
capacity within the system to have all
influenza patients use emergency services.
Laurie Gould: The biggest impact
is that patients fill up our emergency
department, but there are a couple of
other things that people may not know.
When influenza patients are admitted,
it puts pressure on the hospital with the
high number of patients who require an
inpatient bed. We have to isolate those
with influenza in separate rooms and
anyone coming in contact with them
must be gowned and gloved.
This concerns me from a patient and
family experience perspective because
patients who are isolated with influenza
may not get many visitors – or if they
do, they can only have a minimum
Get the facts –
not the flu
For more information
on influenza, influenza
immunizations and influenza
in the community, the following
resources offer reliable and
accurate information:
• Middlesex-London Health Unit
https://www.healthunit.com/
• Health Canada
http://www.hc-sc.gc.ca/hc-ps/dcma/influenza-eng.php
• Ontario Ministry of Health and
Long-Term Care
http://www.health.gov.on.ca/en/
public/programs/publichealth/flu/
Dr. Michael John: Certainly in the
laboratory, the flu season has a big impact
because many more respiratory viral
specimens are sent for testing. We also
do testing on weekends, which requires
us to bring in extra staff and there’s a
very significant cost associated with this
testing. Last year, we spent an enormous
amount of money doing the requisite
testing. There’s also a significant increase
in workload within infection prevention
and control as all these patients have to
be followed up and hospital outbreaks, if
they occur, dealt with.
2. It has been said that last year
was a particularly bad year for
influenza. Why is that?
Dr. Gary Joubert: It was an interesting
flu season. Usually we see the peak flu
surge towards the end of December
through January, and last year it started
in September, which was very early.
It caught us off-guard in terms of being
ready to institute some of our protocols.
The vaccine hadn’t been delivered from
the manufacturer yet, and the degree of
illness was much higher.
The surge came before public
health had any chance to intervene.
In addition, it seemed to be a very
virulent strain and the impact on patients
with comorbidities (i.e. the presence of
more than one disorder) seemed to be
much greater, so we were seeing much
sicker patients coming to the emergency
department than in other flu seasons.
These patients required more workup
and investigation.
Dr. Michael John:
I agree with all of that. One of the
things I have wondered about was
whether the 2009/10 H1N1 pandemic
flu played a factor. During the pandemic,
06
“You need to get vaccinated and if you do get the
we had really good immunization rates,
followed by much less illness than was
expected. As a result, there were a lot of
people the following season who just
stopped getting the vaccine. Of course,
what they forget is that pandemic may
have had less of an impact because
immunization rates were so good.
Providing another line of defense
against the spread of influenza.
Because transmission of hospital
acquired infections is a major
patient safety concern, Infection
Prevention and Control (IPAC) and
Occupational Health and Safety
Services (OHSS) at LHSC partnered
in 2009 to form the infection safety
champion initiative.
that experience – and what will
be different this year?
Dr. Michael John: Also, I’ve learned
that we will be getting the vaccine
earlier this year – and to expand
on what Gary was saying, the new
policy will be in all the city’s hospitals.
Once influenza is deemed to be
circulating the community, staff will be
required to either be immunized or to
wear a mask while providing patient care.
Unimmunized visitors will also be
asked to wear masks.
07
Dr. Gary Joubert
LHSC’s
infection safety
champions
3. What have we learned from
Dr. Gary Joubert: An important step
is that the hospital has gone to a staffwide immunization policy. Previously,
staff members have been asked to
voluntarily become immunized, but
this year we’ve created and implemented
a hospital-wide immunization policy.
Last year, this policy was only in place
for physicians and the immunization
rate increased from 40–50% to about
83%. Some areas, like emergency
medicine, were 100% immunized.
Now, with the policy staff-wide,
the immunization does two things:
it helps protect the individual, which
is important, but more importantly it
helps protect all of the patients we deal
with. You can be an asymptomatic
carrier of the influenza virus and be
spreading that while you’re working.
The staff-wide immunization policy
will give us what is called ‘herd immunity’
(i.e. the immunized population will help
prevent the spread of the virus).
flu, then you need to seek care at your family doctor first.”
Currently, more than 250 staff
members across various service areas
including nursing, respiratory therapy,
physiotherapy, environmental
services and many others, serve as
infection safety champions.
These individuals have a high
level of infection prevention and
safety awareness. In addition to
receiving regularly monthly training,
these staff members also have an
understanding of their own area’s
infection control and safety concerns.
Under a new policy, those who work in patient care areas who are not immunized must wear a mask – such as the one seen here on Dr. Michael John.
Laurie Gould: One of the most
important things we learned is to educate
staff that immunization is not just
about protecting themselves – it’s about
protecting every patient that they come
into contact with. This is about patient
safety. So, one of the things that we’re
highlighting in our education sessions is
myth busting around influenza vaccines.
Dr. Gary Joubert: Internally, our
organization has also looked at our
response to hospital occupancy.
We’ll now know what steps to take at
different levels of occupancy, so that
eventually we can occupy every space
in the hospital that is able to be safely
occupied for clinical care. We’re hoping
we never have to get that far, but we do
have a strategy.
Laurie Gould: To clarify – by
occupancy, we’re talking about how
busy the hospital is. Even when we
are full, we have to find emergency
department stretchers and inpatient
beds to put people in because we don’t
close the doors or turn people away.
So we have strategies now on how to
manage patients as they keep coming
into the hospital in a flu season.
4. When does the hospital start
preparing for the flu season?
Laurie Gould: We start advertising
and educating people before the flu
season, usually in early September.
We have a whole communication
strategy around awareness that flu
season is coming – that you have to
be diligent about washing your hands,
you have to get your vaccine and if you
don’t, our new policy is that you’ll have
to wear a mask in patient care areas.
We’re also making it easier for staff to
get their vaccine. Roving teams will go
around to each unit at different times,
giving peer vaccines so that all staff can
get immunized.
In addition to their regular job duties,
infection safety champions promote
a culture of staff and patient safety
through education, monitoring,
and formal auditing of principles
and practices related to infection
prevention and control across LHSC.
They are a resource to colleagues
and leaders in their area on items
such as isolation practices, hand
hygiene, additional precautions,
routine practices, and more.
Dr. Gary Joubert: I can also tell you,
that in the medical advisory committee,
which is the physician body that is
responsible for quality of care, we think
about it all year. We’re planning right from
the end of the season for the next super
bug. We think, “ok, this is what we’ve
done this year, what can we do next year to
make it a safer and better environment?”
Not only during the influenza
season, but all year long infection
safety champions aim to reduce
health-care associated infections
(HAI) and creating a safe
workplace through:
Dr. Michael John: We also have
a working group headed up by
occupational health, which starts meeting
early in the summer to plan the launch of
the hospital’s internal influenza campaign.
• making deviation unacceptable
• promoting personal accountability
for infection prevention
• harnessing peer influence/be an
influencer for change
• creating a team mentality where
reminding one another is the norm
5. If a visitor to the hospital
sees a staff member with a
mask on, is there a legitimate
reason why that employee
didn’t get their vaccine?
Dr. Gary Joubert: A past history of a
disease called Guillain–Barré syndrome,
which is a neuro-muscular disease,
or an allergy – either to the media that the
vaccine is carried in, and/or the way the
vaccine was prepared, are all valid reasons
why someone would not get vaccinated.
6. Are there any other impacts
to the staff around flu season?
Laurie Gould: There’s an impact on
their workload, for sure. When staff
members have to gown, glove and mask
to interact with isolated patients, it puts
a lot of burden on the nurses. It takes
more time and it uses up more resources.
The flu season is not business as usual –
it’s business as usual ‘plus’.
7. What happens at the hospital
that the public won’t see?
Laurie Gould: We have some experts
like Dr. John, who are part of a national
network that monitors influenza. If they
see something significant, they’ll notify
us and we’ll start to implement actions
to address it. For example, if they
started to see a new flu strain, then we
would be alerted.
Dr. Michael John: Yes, very much so.
We’re likely to find out if there’s flu in
the community by isolating it in our lab.
By the time we’ve got a couple of people
with influenza within the hospital,
it’s already circulating the community –
as they represent the tip of the iceberg.
We send the first couple dozen
isolates to the public health lab where
they’ll look at the type of influenza
strain and see if it is the vaccine strain
or any other strain.
Health Canada does the same thing
country-wide, tracking the strains
that are present across Canada and the
World Health Organizations does the
same thing globally. All of this data
is available. Some of it we have direct
access to and some is passed to us by the
Middlesex-London Health Unit, so we
know what’s going on.
Dr. Gary Joubert: The other piece
of information we get is whether or
not the vaccine matches the flu strains.
We can see how many patients who
were immunized actually got infected.
There’s a lot of information that goes
back and forth, and it’s readily available
– our Middlesex-London Health Unit is
excellent. I receive regular updates during
influenza season. The communication
process is excellent across the board.
8. What would you say to
someone in the community who
had some flu symptoms that
were quite bad – what would
your advice be to them?
Dr. Gary Joubert: I think that unless
you have significant comorbidities – in
other words, other diseases like diabetes,
COPD, congestive heart failure – that
you probably should seek care with
your primary health-care provider (e.g.,
family doctor) first. Because coming to
the emergency department, you’re not
going to get seen quickly when there are
lots of other people, and your primary
health-care provider has the skills and
tools necessary to care for you.
Obviously if you have symptoms
you’re extremely concerned about that
are outside of the normal influenza
illness, then I think it would make sense
to go to an emergency department,
realizing that you may have to wait.
9. What is the one message
that you’d want the community
to hear?
Dr. Gary Joubert: You need to get
vaccinated and if you do get the flu,
then you need to seek care at your
family doctor first. There are a lot of
unfortunate misrepresentations about
immunizations – get the real story from
the Middlesex-London Health Unit.
Laurie Gould: Get your flu shot, and
also, staff should encourage each other
to get vaccinated.
Dr. Michael John: Get your flu shot
and if you’re sick, don’t come and visit
patients unless it’s absolutely critical.
We’ll be working hard to ensure that
we can provide patients with the safe,
high-quality care that they require.
Dr. Joubert (left), Laurie Gould (centre) and Dr. Michael John (right) discuss how last
year’s heavy flu season has translated into new precautions and procedures for this year.
08
What is dialysis and why
is it necessary?
Dialysis treatment replaces the function of kidneys
for patients with acute or chronic kidney failure.
Generally, patients are classified as having kidney failure
when kidney function falls below 20%. In the case
of chronic kidney failure, the patient must undergo
dialysis for the rest of their life.
Driving through the roadblocks
treatments around their lifestyle, providing them with
freedom and flexibility.
After receiving six weeks of intensive training that
covered everything from using needles, hooking up access
lines, setting parameters on the machine, and cleaning and
maintaining the equipment, the Worleys were sent home to
put their learning to practice.
“At first it was scary,” says Debbie, as she and Ted recount
a few mistakes they made with wry smiles.
“The first thing they say is not to panic,” says Ted.
“So that’s the first thing we did,” adds Debbie with a laugh.
“But the Kidney Care Centre has a helpline and there’s always
someone there 24/7 to help you out.”
With the help of the regional renal program, With their minor blunders
Debbie and Ted took their home — and their behind them, they have now
fallen into a routine of shorter,
home dialysis — on the road.
more frequent treatments.
Each morning, seven days a week,
“Look who’s talking,” she retorts with a smile as a playful
Debbie spends two hours undergoing dialysis. The frequency
tension dances between them.
has made a difference that she can feel and Ted can see.
It’s clear by watching them interact, that Debbie and Ted
“You have more energy now,” says Ted as Debbie nods
share the special bond that exists between two people who
and mentions her love of running in the morning hours,
have been through it all together.
when the air is cool and crisp.
Ted moves about the machine with ease, explaining the
Now, wherever the Worleys may travel, staff at the
various functions and processes with in-depth knowledge
regional renal program ensure that the water quality at their
chosen campsite is up to standard for
use with the dialysis machine. They also
help ensure that Debbie has an adequate
supply of medications and that she can
access a test centre for her monthly blood
tests. A 24/7 phone line is available in case
they need to troubleshoot issues with the
dialysis machine.
This winter they will embark on their
longest journey yet – a four-month
trek to California where one of their
daughters is hosting her wedding.
It is just one of the many trips that the
Worleys hope to make as they wind their
way across North America to visit family
and see the places that they’ve never
been, untethered from issues of access to
This winter, Debbie and Ted will spend four continuous months on the
dialysis and limited only by the network
road, visiting family across North America.
of roadways that crisscross the continent.
Dialysis is necessary to help the body:
• Balance pH
• Balance body fluids
• Control electrolytes
• Remove waste
• Produce red blood cells • Regulate blood pressure
that could pass him as an expert. It is the second dialysis
machine that the Worleys have; the other has been installed
in their permanent residence. Debbie is now completely
free to conduct dialysis away from a clinic.
The couple is just two of almost 200 people in the
London region that the regional renal program has trained
to conduct their own home dialysis through the home
hemodialysis and peritoneal dialysis clinics. For motivated
patients, home dialysis allows individuals to tailor their
• Chronic Kidney Disease clinics and health education.
took their home – and their home dialysis – on the road.
This past June, technicians from the biomedical
division of LHSC installed a dialysis machine in the
couple’s 40-foot motorhome.
The tall white machine with tubes, filters, saline
pouches and containers of solution appears starkly
medical in contrast with the warmth of the coach’s
leather furniture, but the dialysis machine is a
welcome and comforting addition.
“Having it installed was one of the best decisions I could
have made for myself,” says Debbie.
“The couch was becoming her best friend,” says Ted.
Thanks to help from the regional renal program, Debbie Worley (left) can conduct her own dialysis while
vacationing in the 40-foot motorhome she shares with her husband Ted (right).
One dialysis
patient’s
journey to
independence
09
For Debbie and Ted Worley, spending time with extended
family is the ultimate retirement dream. With family members
scattered throughout North America, from Grimsby to
California, the journey to each home has the potential to become
an adventure in itself.
But before the Worleys could hit the highway – an act that
most of us take for granted – they first had to overcome an
incredible roadblock.
Debbie has polycystic kidney disease, a condition that she lived
with unassisted for almost 30 years until her kidney function
suddenly reduced to next to nil only a few years before Ted
joined her in retirement.
“When a patient’s kidney function falls below 20 per cent
dialysis can assist with the blood purifying functions that kidneys
would normally provide,” says Barb Dalrymple, coordinator
of the hemodialysis unit at LHSC’s Kidney Care Centre in
Westmount Shopping Centre.
Typically, dialysis patients spend four hours, three times a week
in a clinic undergoing dialysis treatment. The time commitment
is equivalent to a part-time job.
For Debbie to undergo treatment while travelling, it meant
sacrificing time away from family. In the instances that she did
undergo dialysis while travelling through the United States,
she found herself squeezed into appointments at odd times –
and after the treatment, too exhausted to do anything but sleep.
Through the regional renal program at LHSC, travelling
patients can have dialysis treatments coordinated around the
world, but in order to obtain complete independence while away,
the Worleys stretched their ingenuity one step further.
With the help of the regional renal program, Debbie and Ted
Debbie and Ted Worley bring
us inside their journey.
visit us at inside.lhsc.on.ca
About the regional renal
program at LHSC
With the goal of enhancing or sustaining health and
overall quality of life, London Health Sciences Centre’s
(LHSC) regional renal program provides comprehensive
care for approximately 950 chronic kidney disease
(pre-dialysis) patients and 760 end stage renal disease
(on dialysis) patients in Southwestern Ontario.
The program provides hemodialysis services in the
following locations:
• Victoria Hospital (serving acute, inpatient and
chronic patients);
• University Hospital (serving acute, inpatient and
chronic patients);
• The Kidney Care Centre (serving chronic patients);
• Eight additional regional satellite locations including:
Chatham Kent, Goderich, Hanover, Owen Sound,
Sarnia, Stratford, Tillsonburg and Woodstock (serving
chronic patients on an outpatient basis).
The Kidney Care Centre at
Westmount Shopping Centre
celebrates one year anniversary
Opened in November 2012, the Kidney Care Centre
at Westmount Shopping Centre is a London satellite
location. Previously located at South Street Hospital,
the centre’s new location within the community helps
promote a wellness environment and enhances the
patient experience.
The Kidney Care Centre provides the
following services and resources:
• In-facility hemodialysis treatment for chronic dialysis
patients on an outpatient basis.
• Peritoneal and home hemodialysis assessment,
training and maintenance.
• Aboriginal resource room containing Aboriginal
medicines, resources, information about Aboriginal
cultures as well as Aboriginal arts and crafts.
• Support centre for the regional satellite dialysis units.
10
“The lack of certainty and the lack of
control can be stressful as there is no
guarantee of success and there is a fear
of the unknown,” he says, adding that the
entire process of fertility treatments can
cause women to feel emotionally and
physically vulnerable as the procedures
they must undergo can feel invasive.
We are family
Hannah (top left) and Abigail Londini (top centre) enjoy fun and games on a sunny day with their parents Vince (bottom left) and Lori (top right) as their
sister Kayla takes a rest on their mother’s lap.
How The Fertility Clinic helped one couple’s dream
of family become a reality
11
Watching Abigail (8), Hannah (6) and Kayla Londini (3) chase each other
around the backyard in a heated game of tag, it’s hard to imagine that these
large personalities have such small beginnings – all three were conceived under
a microscope in a lab at The Fertility Clinic at LHSC.
Even harder to wrap one’s mind around is that both Hannah and Kayla were
conceived from frozen embryos, which were bathed in liquid nitrogen before
being carefully thawed, rehydrated and implanted into their mother’s womb.
While the story of the Londini family’s conception may read like science
fiction, fertility treatments, such as in vitro fertilization (IVF), are becoming a
necessary reality for a growing number of individuals who hope to start a family.
For Vince and Lori Londini, the discovery of fertility issues came as a
surprise. The young couple had been eager to start a large family, but after a
few years of trying, pregnancy was not happening as planned. Vince discovered
that he had male factor infertility – and they almost abandoned all hope.
For a few years, they tried to imagine a different future – living as just a
couple and exploring the world – but the desire for a family simply would not
fade, no matter how the odds seemed stacked against them.
“We decided we’d rather have tried and failed than not know,” says Vince.
“They are super helpful,” says Lori of the
staff. “They just walk every step with you to
make sure you know what is going on.”
So in 2003, they took their first step towards starting a family by setting an
investigation appointment at The Fertility Clinic at London Health Sciences Centre.
Unfortunately, they discovered that not only had Vince’s diagnosis not changed, but
that Lori also faced fertility issues.
She describes the discovery of blocked fallopian tubes as devastating.
“It was one more negative thing, one more obstacle to overcome,” she says.
The Fertility Clinic’s medical team explained that despite the challenges the
couple still had options, including a procedure to retrieve sperm, surgery to
unblock Lori’s fallopian tubes or in vitro fertilization (IVF) using donor sperm.
According to The Fertility Clinic psychologist Dr. Christopher Newton,
fertility patients can face some complicated and emotion-laden decisions.
The following egg retrieval procedure went as planned
and Lori’s eggs and the donor sperm were combined in the
lab, creating a number of embryos. Two were selected for
transplant into Lori’s womb and the others were preserved
through cryogenic freezing for use in later treatments.
“The worst time is the two weeks after the transfer and
before you find out if it’s worked or not. Two weeks felt
like forever,” says Lori.
While Vince was in Venezuela on business, Lori
became pregnant.
In understanding of these difficulties, The Fertility
“Not many men can say that,” he says with a laugh.
Clinic offers ongoing counselling services – under
The clinic delivered the good news to the couple
standard practice, a preliminary counselling session is
over the phone. “We just started crying, we were just so
provided before couples begin treatment.
happy,” said Lori.
After thoroughly examining their options from
When asked about the day their first daughter Abigail
emotional, spiritual and ethical angles, Vince and Lori
was born in March 2005, Lori says the day passed in a blur.
decided on in vitro fertilization (IVF) using donor sperm.
“She was born late in the afternoon and I just
remember that night,
“The donor sperm
not being able to sleep
decision was a big
and checking in on her
one,” says Vince.
to make sure she was
“Nothing would be
ok. She had dark hair
further from the truth
and was so cute. It was
than to say we picked
so amazing to finally
an option off the
see this little person
menu and went with
after all this time.”
it. We agonized.”
Less than a year later,
After selecting
Vince and Lori were
a donor whose
excited to try again.
attributes most
“I think I knew even
matched Vince’s,
before Abby was born that
Lori began the
we wanted to do it again
intensive process of Shy Abigail (left), outspoken Hannah (centre) and fiercely independent
–
basically we went back to
Kayla (right) share a close bond.
preparing for IVF.
the clinic,” says Lori.
In order to explain all of the considerations around
Their second daughter, Hannah was born in 2006 and
treatment, as well as answer questions, The Fertility
was later joined by younger sister Kayla, in 2010.
Clinic assigns a primary care nurse to each patient,
Now, with their family complete, the Londinis talk
who then acts as an advocate and an information hub
about the journey with words of amazement. “It’s hard
between the patient and the medical team.
to believe that at one point, my daughters were frozen
The Londini’s primary care nurse, Megan, walked the
embryos. It all seems too crazy to believe now that
couple through the entire IVF process, explaining what
they’re running around,” says Vince before noting that
their family is exactly like any other.
“This is the ‘normal life’ that we wanted, but we never
thought we were going to have,” he says.
“We just wanted to have a family with all the trials and
tribulations that come with it and now we do.
We survived the rollercoaster process of starting a family.”
“And we’re still surviving it,” Lori says with a laugh.
“It’s great, it’s amazing.”
About The Fertility Clinic at LHSC.
For over 35 years, The Fertility Clinic at LHSC has delivered
successful fertility treatment with a focus on personalized care.
As one of the few academic, hospital-based programs in the
country, The Fertility Clinic and its state-of-the-art-facility offer
patients several advantages:
• As part of the women’s program, The Fertility Clinic provides
comprehensive women’s health care – including consults to
medical genetics, maternal fetal medicine, surgical and medical
support, obstetrical and neonatology care.
• Dedicated and caring staff includes reproductive endocrinology
specialists, PhD scientists/embryologists, psychologists,
counsellors and registered nurses.
• Medical staff members are graduates of the Royal College of
Physicians and Surgeons of Canada’s accreditation programs,
ensuring the highest standard and quality of care.
• Affiliation with Children’s Health Research Institute,
Lawson Health Research Institute and Western University allows
innovative research and advances to further clinical practice.
• All resources – from fertility services to medical therapies – are
housed on-site, offering convenience, efficiency and continuity
of care for patients.
• The Fertility Clinic offers OHIP-funded fertility treatments, as
well as a competitive fee schedule for non-OHIP funded services.
The Fertility Clinic, a history of success.
Fertility treatment services were first offered at
University Hospital during the 1970’s. When The Fertility Clinic
was established in 1984, it became one of the first and largest IVF
programs in North America.
Since that time, approximately 5,000 babies have been born
through various treatment programs, and in the last 15 years
alone, more than 2,500 patients have participated in over 6,000
treatment cycles.
The Fertility Clinic, here for you:
The Fertility Clinic offers a range of fertility and gynecological
services, as well as advanced gynecological surgeries. With full
accreditation from Accreditation Canada, The Fertility Clinic
specializes in offering on-site assessment and treatment for:
• Primary and secondary infertility
• Third-party reproduction, including egg donation, gestational
carrier and donor sperm
• Male factor infertility including microsurgical sperm aspiration
• Endometriosis
• Polycystic ovarian syndrome
Lynda Hughes, lab technologist works in the laboratory at
The Fertility Clinic.
• Recurrent pregnancy loss
Lori could expect at each stage of treatment.
She also taught Lori how to perform self-injections,
which women must complete for approximately two
weeks in order to prepare the body to release eggs.
“Basically anytime there were results, she would give
me a call,” says Lori. “They are super helpful,” she says
of the staff. “They just walk every step with you to
make sure you know what is going on.”
• Early pregnancy assessment
• Management and treatment of uterine fibroids or anomalies
Take a deeper
look inside
The Fertility Clinic
visit us at inside.lhsc.on.ca
For more information, or if you suspect you may be
experiencing fertility issues, you can contact The Fertility Clinic
at 519.663.2966 ext. 1 or at [email protected].
12
RESEARCH
ON THE SCENE AT LHSC
London researcher answers the call to service
LHSC surgeons first in
Canada to use single
incision for living donor
kidney transplant
the kidneys, is combined with saline,
it can improve the flow of blood and
oxygen to injured tissue – preserving
it for longer periods of time and
allowing the injured individual a
better chance at reaching medical
treatment, including transfusions.
“Erythropoietin can be easily given
in the field through a syringe, and
helps preserve tissues while injured
personnel await transfer to definitive
care,” he says. The solution does
require refrigeration, but this obstacle
can be overcome in the field.
Having served in various
military units as a medical officer
since 1991, Dr. Kao’s dedication
to his work on and off the
battlefield is palpable.
“What
drives me is my passion for the
military and my understanding
of what our soldiers go through
Dr. Raymond Kao, pictured here in a Hercules aircraft, has uncovered the tissue-preserving ability
when they are wounded,” says
of erythropoietin – a discovery that will help save lives on the battlefield.
Dr. Kao. “These young soldiers
deserve everything we can do to bring them back alive, safe and in
For the past 10 years, Lawson Health Research Institute’s
a state where they can return to their families and friends and live as
Dr. Raymond Kao has applied his medical expertise, both as an
normal of a life as they can.”
attending physician in the critical care unit at London Health
Dr. Kao says accepting the first Chair in Military Critical Care
Sciences Centre and on the battlefield.
Research is humbling. The Chair is named after Group Captain
A member of the Canadian Armed Forces since 1977, Dr. Kao
G. Edward Hall. Although best known in the London area for his
has served in Bosnia, Africa and the Middle East. More recently,
service as Western’s University’s Dean of Medicine
and longest-serving president, another of Hall’s
“While military technology has advanced
great contributions to Canada was as a military
dramatically since the early days of war – getting
health researcher.
“If I can only strive to achieve a fraction of what
wounded soldiers back through the lines quickly to Hall
did during his career, I’ll be satisfied,” says
receive proper medical care and blood transfusions Dr. Kao. Hall’s research into the development
of oxygen equipment and protective clothing
– is still one of the greatest challenges today.”
for pilots made such a huge contribution to the
Canadian and Allied war effort, he was one of a
very few non-aircrew officers to be awarded the Air Force Cross.
Dr. Kao served four tours in Afghanistan-Kandahar as an Internal
The Chair, provided by the Canadian Armed Forces, will
Medicine and Critical Care physician and to Mazer-e-Sherif as an
help fund Dr. Kao’s ongoing research projects. Recently,
advisor to the Afghan 209th Army Medical Corp.
Dr. Kao has been studying the use of C-peptide in shock and
In recognition of his ongoing contributions to the military,
resuscitation. C-peptide is an insulin-connecting protein, which has
Dr. Kao was awarded the first Canadian Chair in Military Critical
anti-inflammatory and other protective effects on stressed organs.
Care Research this past January.
“Early results have been promising,” says Dr. Kao. “We have
Canada has a strong tradition of sending medical personnel to
found that it reduces both lung and gut injuries after hemorrhagic
war. Founded in 1904, the Canadian Army Medical Corps has
shock and fluid replacement.”
played an essential role in keeping soldiers alive. But, while military
Dr. Kao says his Chair position will allow him to be more proactive
technology has advanced dramatically since the early years of war –
and prepared for whenever and wherever the next conflict begins.
getting wounded soldiers back through the lines quickly to receive
“The Research Chair makes me much more enthusiastic to do
proper medical care and blood transfusions – is still one of the
as much as I can for the research and clinical work on behalf of
greatest challenges today.
the men and women who serve in the armed forces…we cannot be
“An evacuation takes time – usually 45 to 60 minutes to get
slacking off. When the time comes, we have to be ready – not only
soldiers out by helicopter or vehicles,” says Dr. Kao, whose research
military wise, but in support of our soldiers. Because of what I have
discovery bridges the gap between the time of injury and the point
seen in Kandahar, I feel our soldiers deserve the best we can give
at which care can be given.
them and that’s really the bottom line for me.”
Dr. Kao found that when erythropoietin, a protein produced by
13
Canada’s first robotic assisted single-site nephrectomy was
performed by LHSC surgeons on kidney donor Kelley Kunkel,
who underwent the procedure to provide her husband
Steve with a new lease on life. The surgeons performed the
procedure using the da Vinci robotic surgical system, which
allowed them to carefully extract the healthy kidney through
a small (4-6 cm) incision in her navel.
“By using robotic assisted lapro-endoscopic single site surgery
(LESS) on living kidney donors, we are able to minimize risk,
shorten recovery times, and return the donor back to their
normal day-to-day activities sooner,” said Dr. Alp Sener, who
performed the surgery with Dr. Patrick Luke.
Iron Man, meet Iron Man
When Carter Robbins was diagnosed with a stage three Anaplastic Ependymoma brain tumour at the
age of four, it was clear he would have a tough battle to fight. Five surgeries, a round of chemotherapy and
33 sessions of radiation later, Carter had not only fought a winning battle, but he had also earned himself a
nickname from his surgeon – “Iron Man”.
After a two-year period free from cancer, Carter – now seven – recently suffered a recurrence of his
tumour, and his superhero strength kicked in once again. To celebrate the end of his radiation treatments,
staff at LHSC’s London Regional Cancer Program arranged to have his favourite superhero join him in
sounding the ceremonial gong that each radiation patient rings when their treatments come to an end.
Dr. Kao receives the Chair in Military Critical
Care Research from Surgeon General BrigadierGeneral Jean-Robert Bernier on behalf of the
Canadian Armed Forces.
What is a Chair in
Military Critical Care
Research?
The Chair in Military Critical Care
Research is a three-year renewable
position. During the Chair’s tenure,
he or she is responsible for preparing
a three-year strategic plan, submitting
research proposals, and reporting
progress in accordance with the existing
requirements of the Surgeon General
Health Research Program.
The formalization of Captain (Navy)
Kao’s existing arrangements at the
Lawson Health Research Institute
into the position of Chair in Military
Critical Care Research will enhance
the credibility and visibility of military
health-related research interests across
the public and throughout academia.
The appointment of this Chair serves
to increase the public and academic
recognition of the Department of
National Defence/Canadian Force’s
existing investments in military health
research and enhances the interest
of other university medical centres
in providing them with clinical
opportunities and research support.
Finally, the establishment of the Chair
demonstrates the high calibre of
military health professionals and the
research they conduct.
Presidents Awards program recognizes the extraordinary people at LHSC
The President’s Award program recognizes remarkable people at
London Health Sciences Centre (LHSC) who demonstrate the core
values of trust, respect and collaboration through care delivered
to patients, interactions with colleagues, and the countless hours
given to helping others in the community. LHSC is also home to
dedicated innovators and leaders (both formal and informal) who
are committed to helping the organization reach its full potential.
At a special ceremony on June 7, LHSC President and
CEO Bonnie Adamson awarded five recipients with a 2013
President’s Award.
Pictured from left are:
Bonnie Adamson, Sandy Jansen, Janet
Robinson, Dr. Simon Levin, Dan Logie,
and Ruthe Anne Conyngham, Chair
of LHSC’s Board of Directors. Absent
from photo is Dr. Richard Owen.
Each winner’s name also now
appears on the perpetual plaques
honouring award recipients, located
in the President’s Gallery at Victoria
and University hospitals
Byron Believers surprise hospital visitors with paid parking
In memory of the friends they lost to cancer, sisters Kristin MacDonnell and Jody Wakelin MacDonnell founded the Byron
Believers for Sarah and Sue. Each year, the group hosts a yearly book sale out of MacDonnell’s garage, with the proceeds going
to local charities. This year’s sale raised $1,020 and the family decided to use the money to surprise patients and visitors at
LHSC’s London Regional Cancer Program with paid parking.
“We thought, wouldn’t it be fun to pay for parking (at the London Regional Cancer Program)?” says Wakelin, explaining that
she and her sister believed it would also be a great experience for their children to see the impact of their fundraising.
In only a few short moments, the group elicited smiles and words of appreciation from half a dozen individuals, including
one elderly woman who stopped to embrace the girls and thank them for their generosity.
14
YOU ASKED US...
Travelling somewhere sunny this winter to
escape the cold? The primary health care team
from London Health Sciences Centre’s
Victoria Family Medical Centre recommends
these healthy travel tips:
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