Being Well Spring 2014 by Being Well

Helping you and your FAMILY live life …

well

SPRING 2014 VOLUME 9, ISSUE 2

CELEBRATING

10 YEARS OF CARDIAC CARE AT SOUTHLAKE REGIONAL HEALTH CENTRE

Publication Number 40036321

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Helping you and your FAMILY live life …

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SPRING 2014 VOLUME 9, ISSUE 2

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100,000 lives TRANSFORMED in 10 years Southlake’s Regional Cardiac Care Program

2 Message from Southlake 5 Well Notes Partners in Care 39 The right thing to do 40 Donations honour late club member 42 Marlene’s Meal Makeovers Oatmeal for the soul 43 Community Event Listing 44 Last Word Add life to your years and years to your life

feature stories 10 Dr. Jack Symmes It starts with one

21 The cardiac surgery team Pulling together for its patients

31 Dr. Remo Zadra Maintaining a personal touch

11 Dr. David Fell Cardiologist, would-be architect

22 Judge Clair Marchand’s verdict: Innovations save lives

32 Silvio Quattrociocchi For matters of the heart

12 Justine Bovenkerk Unlikely prizefighter

24 It takes a team to save a heart

33 Dr. Liane Porepa A bridge to the last frontier

14 Dr. Atul Verma Breaking new ground 16 Charlotte Adams Heart rhythm’s unofficial first 18 David Hughes A long road to recovery 20 Medical cardiology Every step of the way

26 Dr. Charles Peniston A leap of faith 27 William Ho Life and art bound in One Heart Beat 28 30-love in favour of Ed Gray 30 Dr. Peter Zeman We can’t treat it if we can’t find it

34 Ralph Courtney Setting course for the future 36 Dr. Zaev Wulffhart Proving the skeptics wrong 38 Dr. Lorne Goldman Innovation champion

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MESSAGE from Southlake

Dr. Dave Williams President & CEO Southlake Regional Health Centre

Neila Poscente President & CEO Southlake Regional Health Centre Foundation

Transforming the lives of 100,000 cardiac patients in 10 years For people in health care, there’s nothing more motivating than being told, “It can’t be done.” Ten years ago, the innovators behind Southlake’s Regional Cardiac Care Program heard those words over and over again. We proved those naysayers wrong! During the last 10 years, Southlake has built the third largest regional cardiac program in Ontario, where the expertise of the team and the innovative, leading-edge technologies and procedures rival those offered at any other cardiac program in Canada or around the world. 2

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Within a decade of its inception, the cardiac program has transformed 100,000 lives and emerged as a full-scale centre of excellence. It is considered one of the leading heart rhythm programs in the world. It has one of the most organized and internationally renowned state-of-the-art emergency management systems for treatment of heart attacks. Southlake surgeons are performing minimally invasive cardiac surgery and the program is implementing novel chronic disease management programs through the use of information technology and nurse mentoring. Southlake has also become a premier centre in clinical cardiovascular research. Our team is creating a legacy in cardiac care and earning a reputation for innovation and excellence around the world. This year alone, an estimated 10,670 people will receive cardiac procedures at Southlake—almost 6,000 catheterizations and 2,000 angioplasty procedures; more than 1,000 surgeries and 720 electrophysiology studies, including 600 cardiac ablations; and the insertion of more than 700 pacemakers and 340 implantable cardioverter defibrillators (ICDs). For these people, and the thousands before them, the development of this program represents world-class cardiac treatment closer to home. The Southlake Foundation, together with our many generous donors, has played a tremendous role in making this a reality, fundraising to finance crucial technology and advancements. Until this year, one of Southlake’s most innovative surgical procedures, transcatheter aortic valve implantation (TAVI), was made possible solely through donations from our generous community. One of the pillars on which the cardiac program’s phenomenal success is built is the interprofessional approach to patient care. Southlake has built a team of exceptional health care professionals who work side-by-side to establish and maintain the highest level of cardiac services. It does not matter who you speak with—nurses who deliver 24/7 care, pharmacists, nurse practitioners, physicians, educators, leaders or administrative support staff—everyone in this highly successful cardiac program says there are no egos here, that people pull together to get the job done. At Southlake, we owe a debt of gratitude to the Ontario government, which has invested approximately $620 million in the program since its inception. Equally, we owe a huge thanks to our Southlake communities, who, like our team, have demonstrated unrelenting support. There is a saying, that it takes a village to raise a child. In our case, it has taken the support of a world-class interprofessional team, a foundation, a collection of wonderful communities, a supportive government and, most importantly, more than 100,000 patients who have demonstrated their unstoppable faith. Together, we have built a cardiac program that is second-to-none. We can’t wait to see what the next 10 years will bring!

ESSENTIAL SOUTHLAKE CONTACT INFORMATION All hospital enquiries: 905-895-4521 Volunteering at Southlake: 905-895-4521, ext. 2104 volunteers@southlakeregional.org Careers at Southlake: 905-895-4521, ext. 2535 careers@southlakeregional.org To give us feedback on the care received: Patient Relations Office 905-895-4521, ext. 2290 For information on making a donation: Visit southlakefoundation.ca or call the Southlake Foundation at 905-836-7333

NEED A FAMILY DOCTOR? For a current list of physicians taking new patients: • Visit southlakeregional.org and click on “Healthcare Professionals” or call Southlake at 905-895-4521, ext. 6913; or • Visit Healthcare Connect at ontario.ca/healthcareconnect or call 1-800-445-1822.

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ASSOCIATE PUBLICATION MANAGER Lee Ann Waterman SOUTHLAKE EDITORIAL CONSULTANTS Andrea Griepsma, Claire M. Jones, Tammy La Rue, Kate Porretta CONTRIBUTORS Cody Storm Cooper, Jim Craigmyle, Cathy Jaynes, Joann Macdonald, Marlene MacPherson, Judy Murdoch, Lou Recine ADVERTISING DIRECTOR Debra Weller ADVERTISING MANAGER Laurie McDonald SALES REPRESENTATIVES Melanie Attridge, Robin Boswell, Jeremy Brown, Cathy Charpentier, Judy Fulton, Carola McKee, Trish Miller-Kostin, Michael Murphy, Braden Simmonds DIRECTOR OF PRODUCTION Jackie Smart GRAPHIC DESIGNERS Emily Ayranto, Pam Hickey DIRECTOR OF BUSINESS ADMINISTRATION Rob Lazurko DIRECTOR OF DISTRIBUTION Tanya Pacheco Beingwell is published four times a year by York Region Media Group, a division of Metroland Media Group Ltd., in partnership with Southlake Regional Health Centre Foundation. Copyright 2014. All rights reserved. No part of this publication may be reproduced without the written permission of the Publisher. Publication Number 40036321 The material in this publication is intended for general information purposes only and, while every effort is made to ensure the accuracy of the material, it does not constitute advice or carry the specific endorsement of either York Region Media Group or Southlake Regional Health Centre/Southlake Regional Health Centre Foundation. Readers are encouraged to consult their doctor to discuss their health concerns.

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well NOTES

B Y L ee ann W aterman lwaterman @ yrmg . com

I couldn’t help but draw parallels as we were putting together this issue of beingwell during the weeks of the Olympic Winter Games. I am not a sports fan in the traditional sense; I don’t follow any league play, amateur or professional, nor do I have any declared (or even unvoiced) loyalty to a specific athlete or team in any sport. I am a rather sporadic follower of the Olympics; I don’t PVR events to watch after work or keep tabs on the medal count. But I love to hear the stories: the family histories and childhood yearnings; the setbacks and triumphs; the competition and camaraderie. You know the ones I mean: The story of three Quebec sisters reaching the finals in the moguls event and finishing first, second and 12th. (The prepodium fist bump between Justine and Chloe DufourLapointe was one of my favourite images of the Games.) Or speedskater Denny Morrison winning the silver in 1,000m— only because teammate Gilmore Junio gave up his spot in the race. Or the German millionaire casino owner who, for the love of his sport and the competition, returned to curling after a decade in retirement, because he’d never made it to the Olympics. Or the Canadian Nordic ski coach who rescued a Russian competitor who had broken a ski.

In many ways, this issue of beingwell, a special edition to mark the 10th anniversary of Southlake’s Regional Cardiac Care Program, reminds me of the Olympics. Yes, the “wins”— getting the go-ahead from the province for the program, engaging the support of the community to make it happen, building a dedicated team of skilled professionals—are impressive. And the “golds”—firsts in Ontario, North America and globally for groundbreaking and lifesaving procedures— are to be celebrated. But, again, it’s the stories that resonate with me. The young mother—and her new baby—thriving thanks to a determined health care team that petitioned Health Canada to treat her with a device used in Europe. The innovative young electrophysiologist making a name for himself at a worldrenowned American hospital who took a chance on a new program in an Ontario community hospital. The experienced cardiologist who ignored the naysayers and took on the roles of visionary, architect, recruiter and cheerleader. The emergency services worker, Southlake’s first official cardiac surgical patient, who is still saving lives and playing hockey more than a decade after his bypass surgery. You’ll find these stories and more in this issue; I’m confident you will find them as inspiring as I did.

I hope you enjoy this issue. We welcome your feedback at beingwell@yrmg.com.

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Southlake’s Regional Cardiac Care Program

100,000 lives transformed in 10 years B y J ud y M urdoch

photograph y b y jim craigm y le

hen Ian Phythian woke up in the cardiovascular intensive care unit (CVICU) on Dec. 4, 2003, he was expecting to be alone. Well, perhaps his wife and daughter might be there, maybe even a nurse or two, but that was it. After all, Mr. Phythian was the first person to have cardiac surgery, a triple bypass, at Southlake so there was no one else to occupy a bed in the CVICU. Instead, what Mr. Phythian saw was a group of people dressed in business attire, all smiling from ear to ear. They were members of Southlake’s executive team and, as exciting as it was for Mr. Phythian to have had this lifesaving surgery closer to home, he would be hard-pressed to be more excited

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than these Southlake leaders. While so many naysayers said it couldn’t be done, Mr. Phythian was living proof that it could and would. He was one of many lives, more than 100,000 in fact, that would be transformed by the Regional Cardiac Care Program at Southlake in its first 10 years. Mr. Phythian’s surgery took place exactly five years after Southlake was designated a regional cardiac program by the Ontario government. With this surgery, the much-anticipated comprehensive cardiac program, which had already successfully implemented interventional invasive cardiology and arrhythmia programs, was officially launched.

Thinking About Your Options? Talk to an Expert. CARDIOLOGIST DR. ALLAN HESS

Drs. Jack Symmes and Allan Hess, Southlake’s two cardiologists at the time, remember the day the announcement was made. The hospital had been utilizing a catheterization lab, installed as a demonstration site by General Electric, to do coronary angiograms. Before that, patients had to drive to Toronto. “It was a one-hour test and patients were driving two hours to get it,” Dr. Hess remembers. So he and Dr. Symmes trained to perform these angiograms at Southlake. This triggered the start of a no-holdsbarred campaign. A team, led by then hospital president Dan Carriere, vice-president of patient services Patricia Norman and manager of strategic planning Eleanor Joyce, furiously assembled demographic data and statistics

and put together an impressive presentation to support Southlake’s need for a catheterization lab. They were thrilled when they were notified the Minister of Health and Long-Term Care was coming to Southlake to make an announcement. Dec. 4, 1998, the Minister stood in Southlake’s lobby and announced not just a catheterization lab, but an entire regional cardiac program. Residents of York Region, Simcoe County and Muskoka would, before long, have access to a full range of lifesaving cardiac procedures closer to home. Dr. Symmes, who was Southlake’s first cardiologist, remembers being told to savour this moment. It was unprecedented in the hospital’s history and, in his words, “beyond my wildest dreams.”

To learn more about the Regional Cardiac Care Program at Southlake, visit southakeregional.org.

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Dr. Hess, too, was shocked. “By asking for a catheterization lab, we were shooting for the moon,” he says. “But what we got was the sun and the stars, too.” Of course, having approval to build is completely different than actually succeeding. At the time, there was tremendous skepticism that Southlake would be able to put a program in place—skepticism that did not permeate the hospital walls. “Moving forward, we knew we needed someone who was administratively skilled,” Dr. Hess says. “Dr. Symmes and I knew we were good cardiologists, but we did not have the administrative skills to build a $100-million cardiac program.” They needed a major force and got it when Dr. David Fell, now Southlake’s vice-president of patient experiences, regional cancer and cardiac programs, signed on the dotted line to join the party. He was chief of staff at Scarborough Grace and, as Dr. Hess says, “just the man to take us from a Junior A hockey team to an NHL club.” Dr. Fell developed a clear strategy, creating a regional planning committee with administrative and physician representation from each of the community hospitals the cardiac program would serve. Consultants in cardiac surgery, angioplasty, anesthesia and more had a hand in developing what would, within a decade, become the third largest

“We have a strong place as a leader and innovator, not just a provider.” ELECTROPHYSIOLOGIST AND PHYSICIAN LEADER DR. ZAEV WULFFHART

cardiac program in the province. In addition, mentoring relationships were developed with St. Michael’s Hospital and the University Health Network to assist in ongoing planning. Hiring was a major priority. Southlake needed a strong and cohesive team that shared its vision. Leading cardiac surgeons, interventionalists, anesthetists, health care professionals and nurses with cardiac experience were integral to the program’s success. Immediately, the catheterization lab took on a key role, performing 500 procedures in its first year. Southlake partnered with 11 other hospitals in the area, hospitals that would call upon Southlake for advanced cardiac care for their patients. A pacemaker program was introduced and

the hospital budgeted to insert 200 pacemakers that same year, again looking to their partners for referrals. The final step was to find an area where the hospital could make a name for itself. “We made a strategic decision to have a fully developed electrophysiology program,” Dr. Fell says. “That was pivotal because the other centres were not focusing on this area and we felt that there would be a huge need.” Electrophysiology is devoted to the research and treatment of heart rhythm disorders (arrhythmias). At that time, people with heart rhythm problems were treated with drugs that were not very effective or had to travel to Toronto. In 2002, the electrophysiology laboratory opened and the team was ready to offer the full array of electrophysiology services.

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Along the way, the hospital initiated the first phase of a $109-million expansion project that would give a home to the cardiac program. Completed in 2003, the space provided two cardiovascular operating rooms, nine cardiac intensive care beds, 26 post-surgical inpatient beds, two cardiac catheterization labs, a room for pacemaker implantation, eight coronary care beds and 33 medical cardiology beds. The opening of the interventional program and the cardiac operating rooms in December 2003 represented a culmination in Southlake’s five-year journey to build a comprehensive program. With the completion of Mr. Phythian’s surgery, the goal of building a world-class cardiac centre for residents of York and surrounding regions was realized. “That was the NHL,” Dr. Hess says. Southlake now provided cardiac diagnostics, cardiac surgery, cardiac catheterization (angiograms), angioplasty, stents, pacemakers and implantable defibrillators. Dr. Hess was so confident in the program that when his own mother-in-law needed a mitral valve replacement, a complex cardiac surgery, she came to Southlake. When she woke up in CVICU five hours later and told him he should get back to work, he knew the decision had been the right one. Today, the cardiac program has grown to a team of 45 physicians, including cardiologists, cardiac surgeons, and anesthesiologists. It is the third largest program in Ontario and first in Canada for treating the most debilitating heart rhythm conditions and performing the highest number of electrophysiology studies. After more than a decade of building at a tremendous pace, the program is still growing, but in a different and exciting way. Research and technology is changing the face of cardiac care, allowing procedures and interventions to be done that would not have been possible a decade ago. “We have a strong place as a leader and innovator, not just a provider,” says Dr. Wulffhart, physician leader for the program. Southlake just received funding from the Ontario government to perform transcatheter aortic valve implantation (TAVI) procedures and is hoping to receive funding for other procedures, including the innovative valve program. These procedures are changing the lives of patients who were once considered inoperable. It is impossible for any of us to know what the future holds. What is certain is that the cardiac program and the health care team who serve it are committed to providing the next 100,000 people with the thoughtful and leading-edge that care this world-class program has built its reputation on.

SOUTHLAKE’S FIRST CARDIAC SURGERY PATIENT IAN PHYTHIAN, A LOCAL PARAMEDIC, IS STILL PLAYING HOCKEY AND SAVING LIVES 10 YEARS AFTER HIS SURGERY.

Where is he now? Ian Phythian’s story Ian Phythian was not a likely candidate to be Southlake’s first cardiac surgery patient. As a 54-year-old non-smoker with an active lifestyle, he was surprised to learn the pain he felt in his wrist and arm when he played sports could be tied to a heart condition, and even more surprised to learn he needed triple bypass surgery. Mr. Phythian was admitted to Southlake when a series of diagnostic tests revealed he had several critically blocked coronary arteries that would require urgent bypass surgery. On Dec. 4, 2003, when he was taken into the cardiovascular operating room, he was the first patient to see the room. After successful surgery, he was transferred to the cardiovascular intensive care unit (CVICU) and was awake and had his breathing tube removed that evening. He was sitting up in a chair the same night and discharged four days later. His time at Southlake, while not long, was life-changing, both for him and for a team of people who had worked so hard to make the cardiac program a reality. For most of them, this surgery represented the moment when they could say, “We did it.”

They could not have asked for a better first surgery patient. As an emergency services attendant, Mr. Phythian became a cheerleader for patients facing similar surgery, letting them know they too would get their lives back. He told them that in no time he was back to his active lifestyle playing hockey, skiing and gardening. Today, Mr. Phythian has not had any cardiac recurrence. He knows he is in good shape—as a paramedic and because of his medical history, he must undergo stress testing on a yearly basis. At the time of his surgery, he wrote to the local newspaper to say, “I hope the people of Newmarket and the surrounding communities are as proud of Southlake as I am, not just for its outstanding services but more importantly for its staff who are so professional, friendly and dedicated to supporting their patients.” His opinion has not changed. Because of his job, he is regularly in and out of Southlake’s cardiac unit. “I talk to a lot of people,” he says, “and I know that our cardiac centre is one of the best in Canada. I hear it from patients, I see it on the news and I see it for myself.”

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Dr. Jack Symmes

IT starts with one By JUDY MURDOCH

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J I M C R A I G M Y L E P H OTO G R A P H

When Dr. Jack Symmes first arrived in Newmarket in 1978, he was the only cardiologist between Toronto and Sudbury. At the time, Southlake Regional Health Centre was known as York County Hospital (YCH) and it was, in Dr. Symmes’ words, a quiet community hospital. Dr. Symmes had been a cardiologist for just a year and was completing his certification in general internal medicine. When he was hired, he was wrapping up a one-year contract at St. Joseph’s Hospital and, in order to begin offering cardiac services at YCH, he travelled to Newmarket every other weekend. YCH had a four-bed coronary care unit, complete with monitors but very little in the way of extra equipment. There was a treadmill for stress testing but no ultrasound. There was no cardiac surgery, no permanent pacemakers, no catheterization, no angiograms, not even any clot-busting drugs. Patients diagnosed with a heart attack were sent to Toronto. Even that was tougher as Hwy. 404 did not yet exist. Limited resources made diagnosis a challenge. “We could hear a murmur,” Dr. Symmes explains, “but we only had a stethoscope and it was difficult to determine where that murmur was coming from.” As a result, those patients too had to be sent to Toronto. Around 1979 the first echocardiograph machine was purchased and, along with bringing Dr. Symmes to Newmarket, signalled the beginning of advancing coronary care in the community. It was not until the late 1990s, though, that giant steps began to be made—thanks to the vision of then hospital president and CEO Dan Carriere, who believed local residents deserved access to advanced health care

services closer to home. After some specialized training, Dr. Symmes was able to perform coronary angiograms in a catheterization lab constructed in the hospital as a demonstration site. Everything changed when the fantastic announcement was made that the hospital was to receive a full regional cardiac program. “That was unbelievable, beyond my wildest dreams that this could happen in Newmarket,” Dr. Symmes says. “In no time, we went from what was perceived as a bit of a backwater hospital to a place people drove themselves to instead of calling an ambulance because they feared they would be taken elsewhere.” Along with the announcement came the reality that the entire cardiac program would need to be built from the ground up. Dr. Symmes, who loves being a cardiologist, knew that type of massive administrative undertaking was simply not his passion. “I was a community cardiologist,” he says. “What was needed was someone wellconnected who would take on the big leadership role.” Dr. Symmes cannot sell his forwardthinking short, though. In the 36 years he has been practising, he has left a big mark, both on

his own patients and countless others who have benefitted from the cardiac rehabilitation program his team developed. According to Statistics Canada, the cardiovascular death rate in Canada has declined by more than 75 per cent since 1952 and nearly 40 per cent in the last decade— largely due to research advances in surgical procedures, drug therapies and prevention efforts. Dr. Symmes believes stepping up prevention will be key to further reducing the death rate. “The progress in intervention is incredible,” he says. “We have all been moving forward so quickly we have simply not had the time to develop primary prevention strategies. We need to make time to accomplish this in the future.” A lot of things have changed since Dr. Symmes was the only cardiologist between Toronto and Sudbury, but his style of patient care is not one of them. After 36 years, Dr. Symmes still has a busy cardiology practice and patients who adore him. He takes the time to really listen, they say. It’s not surprising that, after all these years, many of his patients now seem like old friends.

Dr. David Fell

Cardiologist, would-be architect By JUDY MURDOCH

J I M C R A I G M Y L E P H OTO G R A P H

Dr. David Fell has many professional designations, but there is one he does not, though probably should: architect. Dr. Fell is, without a doubt, the architect of the Regional Cardiac Care Program at Southlake. While he would never say it, the 1.5 million people who can rest easy knowing they have access to cardiac care that is second-to-none owe him a debt of gratitude. Dr. Fell received his medical degree at Queen’s University in 1981, his internal medicine certification in 1986, his subspecialty certification in cardiology in 1987 and his fellow of the American College of Cardiology in 1990. Prior to joining Southlake in 1999, he worked as a cardiologist at the Scarborough Grace and Toronto Western hospitals for 12 years and was chief of staff at Scarborough Grace in 1998 and 1999. He has never wavered from his desire to stay in his home province, choosing to practise in Ontario because this is a place where everyone, regardless of socioeconomic circumstance, can receive health care. Dr. Fell came to Southlake after the hospital had received the go-ahead from the Ontario government to build a regional cardiac program but before it started to take shape. That was to be his challenge. “The Toronto hospitals wanted to make Southlake a satellite cardiac care program,” Dr. Fell recalls. “We knew we could make a greater difference to our patients if we did so much more.” When Dr. Fell arrived, there were two other cardiologists and a promise that the recently approved concept of a regional cardiac program would move ahead. People who were in the field at the time remember the derision and skepticism in the medical community regarding that plan. There was no real belief Southlake could ever attract the calibre of

physicians necessary for a quality full-service program. Again, that became Dr. Fell’s responsibility. Dr. Fell developed a regional planning committee with administrative and physician representation from each of the community hospitals this regional program would serve. They met monthly and brought in experts to ensure success from the get-go. Consultants in cardiac surgery, angioplasty, anesthesia and more had a hand in developing what would, within a decade, become the third largest program in the province. Much of the program’s success centred around three aspects: building a feeder market; finding a niche in the wide spectrum of cardiac care; and attracting great health care professionals. “We met with so many individuals and, with each one, had to sell the potential of what we were dreaming,” Dr. Fell recalls. The final step was to find an area where the hospital could make a name for itself. “We made a strategic decision to have a fully developed electrophysiology program,” Dr. Fell says. Interestingly, the course of that development was charted on the back of a napkin during a conference in Vancouver. Electrophysiology is a field devoted to the research and treatment of heart rhythm

disorders (arrhythmias). At that time, people with heart rhythm problems were being treated with drugs that were not very effective. “That was pivotal because the other centres were not focusing on this area and we felt patients deserved access to this new, innovative field of medicine,” Dr. Fell says. “With technology advancing this area rather quickly, we saw the potential and made electrophysiology a priority.” Ultimately, these decisions, and the decision to create specialized patient care teams, have led to the current success of Southlake’s internationally renowned cardiac program. Dr. Fell credits many of his colleagues and former administrative leaders for past achievements, including vice-presidents, Patricia Norman and Dr. Louis Balogh and director of the cardiac program, Janis Klein. Over the past decade, the cardiac program has grown to a team of 45 physicians, nine nurse practitioners, 310 nurses, 50 allied health care professionals and more than 40 clerical and support staff. Recently Dr. Fell became Southlake’s vicepresident, patient experiences, regional cancer and cardiac programs. Based on his proven track record and strong leadership skills, it’s safe to say these programs are in great hands.

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J I M C R A I G M Y L E P H OTO G R A P H

Justine bovenkerk, shown WITH DAUGHTER EEVA, RECEIVED the first MRI-SAFE DEFIBRILLATOR in north america, THANKS TO THE INGENUITY AND PERSISTENCE OF SOUTHLAKE’S HEART RHYTHM PROGRAM.

Justine Bovenkerk

Unlikely Prizefighter B y J udy M urdoch

When you meet Justine Bovenkerk, one of the first things you notice is her quiet, gentle nature. It’s only when you hear her story that you begin to understand Ms Bovenkerk has the courage and determination of a prizefighter. Some may remember Ms Bovenkerk from the spring 2013 issue of beingwell. In the short time since, so much has happened in her life, we wanted to revisit it for this special edition. Her story really is what heart is all about. In 2012, Ms Bovenkerk needed an 12

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implantable cardioverter defibrillator (ICD) to treat an inherited condition that affects her heart and could cause it to suddenly stop. Since she requires regular MRI scans, that ICD needed to be MRI-safe. “We were in a bind,” says Dr. Atul Verma,

Southlake electrophysiologist and medical director of the hospital’s heart rhythm program. “There were no MRI-safe defibrillators licensed for use in Canada. Our choices were to forego the MRI and use CT scans, which would have been less effective, or to use an MRI-safe pacemaker, which would not have provided the full protection against cardiac arrest that her heart needs. We didn’t feel good about either option.” Dr. Verma and members of the heart rhythm program at Southlake went across the Atlantic to find a solution. After learning about an MRI-safe defibrillator widely used in Europe, Southlake received Health Canada’s approval to use the device to treat Ms Bovenkerk. “I asked Dr. Verma about the cost and he smiled, saying I was now as expensive as the bionic woman,” she recalls. Once the go-ahead was received, the procedure truly became a team effort. “I remember being in Southlake, pacing the halls waiting for the device to arrive,” Ms Bovenkerk says. “As I was walking down the hallway I saw Dr. Verma with the company representative, who was carrying a plastic case.” She asked Dr. Verma if that was “it” and when he replied yes, she continued down the hallway and burst out crying because it was “finally going to happen.” On Christmas Eve, Dr. Verma went to Ms Bovenkerk’s hospital room to help prepare her for what would be ground-breaking surgery. Southlake’s team became the first in North America to insert an MRI-friendly ICD into a patient’s heart. Christmas Day, Ms Bovenkerk was home with her family, the only gift her then six-year-old son requested from Santa Claus. The cardiac condition Ms Bovenkerk has means her blood flow, and the precious oxygen that it carries, are severely reduced. As a result, over the years she had suffered a number of miscarriages. With her heart properly regulated and blood flow restored, it was not long until Ms Bovenkerk was pregnant. The biggest hurdle was undergoing testing to ensure that the baby would not carry the gene responsible for the cardiac condition she lives with. With a 50/50 chance, the waiting was terrifying. Thankfully, the results were negative and Ms Bovenkerk calmly settled into her pregnancy. That was not to be for long. With everything she had gone through, and because she was barely showing, Ms Bovenkerk did not tell very many people she was pregnant. They soon found out; Aug. 19, 2013, at just 25-weeks gestation, she gave birth to a very tiny 1lb, 7oz baby girl, Eeva. With her labour so premature, Ms

Bovenkerk was transferred to a Toronto hospital so the baby could be treated in an advanced neonatal care unit. Her ICD soon became the talk of the hospital. “They had never had a patient with an MRI-friendly ICD and they were not sure what to do with me during testing,” she says. She knew, though, there were no problems, at least not with her ICD. It was a rough road for Eeva and her family during those first few months as she fought for her life. “She was so tiny, she looked like a little Smurfette,” Ms Bovenkerk says. Her skin was so sensitive that she was unable to wear an identity band on her ankle. Ms Bovenkerk and her husband, Freddy, were not able to hold Eeva for the first 10 days. She was so fragile that the slightest touch caused her tremendous pain. Like her mom, Eeva turned out to be a fighter. Three months later, she finally came home and no one was happier than big brother, Hayden. He could easily have been jealous of his mom’s daily trips to the hospital but he never was. Hayden adores his sister and will do anything to help. And who wouldn’t? It is inspiring to see mother and daughter, who both fought so hard just to be here, living life. Everyone is breathing easier these days, but no one more than Mr. Bovenkerk, who admits that, before the surgery, when he woke up in the night, he would lean over his wife to make sure she was still breathing. These days, Ms Bovenkerk feels so much healthier, even with the ups and downs of the past year. She feels safe. She has felt her ICD kick in to slow her heartbeat down when it gets going too fast. She is confident it will save her life if need be. Perhaps it already has. Ms Bovenkerk lost her younger brother to the same heart condition, which had gone undiagnosed. Her other brother, who also has the disease, had an ICD implanted by Dr. Verma this past October. With everything she has been through, Ms Bovenkerk has great faith in the future. She is relieved knowing this genetic disease that had threaded its way through her family has now been halted. Both of her children, as well as her surviving brother’s two children, have tested negative for it. Neither have plans to test fate with more children. They are perfectly happy with what they have—a healthy, thriving family.

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Dr. Atul Verma

BREAKING NEW GROUND By JUDY MURDOCH

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J I M C R A I G M Y L E P H OTO G R A P H

After graduating from the University of Toronto in internal medicine and cardiology, Dr. Atul Verma attended the world-renowned Cleveland Clinic to study to become an electrophysiologist—a cardiologist specializing in the diagnosis and treatment of abnormal heart rhythms (arrhythmias), essentially the electrical workings of the heart. In 2005, Dr. Verma came to Southlake to continue the groundbreaking work he had begun in Cleveland. Much of Dr. Verma’s work centres around cardiac arrhythmia (irregular heartbeat), specifically atrial fibrillation (AF). Affecting millions of people worldwide, AF is a condition in which the upper chambers of the heart beat rapidly and erratically, affecting the heart’s ability to adequately pump blood to its lower chambers and the rest of the body. The condition is responsible for 15 to 20 per cent of all strokes and is a leading cause of hospitalizations. The most common treatment for AF is ablation or burning inside the heart. The resulting scar tissue helps return the heart to a regular rhythm. Since joining Southlake, Dr. Verma has helped put the hospital on the worldwide radar. AF ablation is a relatively new procedure and there are only a few centres offering it. Southlake has the highest volume program in the country and Dr. Verma receives referrals from across the GTA and Canada, not only for patients undergoing their first ablation, but also from patients who had the procedure at other centres and are looking for follow-up with Dr. Verma. “Techniques for ablation are consistently changing and improving,” Dr. Verma says. “A decade ago, our success rate was 50 per cent. Now we are at about 70 per cent and are getting better and better all the time.” Much of that consistent improvement is thanks to Dr. Verma’s research, which has focused on how to improve and refine these complex procedures to get the best results and minimize risks. Dr. Verma has authored or co-authored more than 70 articles and abstracts on

electrophysiology, ablation and arrhythmia and has received many honours and awards, including Southlake’s first Research Award of Excellence in 2012. One of his first major studies while at Southlake, Substrate versus Trigger Ablation for Reduction of Atrial Fibrillation (STARAF), proved there is a more effective way to treat patients with a severe arrhythmia than the current treatment methods. The trial followed 108 patients at four Canadian hospitals, including Southlake, and four European cardiac centres for one year. It compared three approaches to ablation and ultimately found the approach that yielded the best patient outcomes and likely improved the lives of countless people around the world. Dr. Verma is conducting a followup project. With trials complete, the team is now in its analysis phase. He is also co-principal investigator for an international research study of treatment methods for patients with heart failure and AF. Dr. Verma is a key member of a group of Canadian arrhythmia specialists recently awarded a major grant by the Canadian Institute of Health Research to study stroke prevention for patients with AF. As part of this $10-million, five-year study, Dr. Verma will colead the Optimal Anticoagulation for Enhanced Risk Patients Post-AF Ablation

trial, which will study whether eliminating AF in patients can prevent future strokes. For this research, 3,000 patients from Canada and Europe with successful AF ablation will have miniature loop recorders implanted under their skin and be followed for a minimum of three years. Not stopping there, Dr. Verma is waiting to hear if a group proposal to the National Centre of Excellence will be accepted. Dr. Verma’s portion of the proposal is to study novel forms of health care delivery and knowledge translation—in other words, how we can take the data we get from science and translate it to patients. “Long ago, we realized AF increases the chance of stroke, so how do we make this real for patients?” he gives as an example. It is estimated that only half of patients who are known to benefit from blood thinners are on them—because they are not prescribed, they don’t understand the risks or they simply don’t want to take the medication. “How do we get physicians to actively prescribe therapy to patients and make sure patients and physicians understand the risks?” Dr. Verma asks. These are exciting times in the advancement of cardiac care and Dr. Verma, thanks to a Southlake environment that encourages innovation, is in the driver’s seat for a lot of this progress.

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Lo u reci n e P H OTO G R A P H

More than 12 years ago, Charlotte adams, shown with daughters Sabrina and Juliette, received an implantable cardioverter defibrillator and was the first patient to undergo this procedure at southlake.

Charlotte Adams

Heart Rhythm’s unofficial first B y J udy M urdoch

It was Christmas Day 2001, when, with her two daughters close by, 32-year-old Charlotte Adams’ heart stopped and she slumped to the floor. Transported to Southlake, she spent the next few days fighting for her life. Doctors, knowing she needed an implantable cardioverter defibrillator (ICD), worked to have her transferred to a cardiac centre in Toronto for the procedure. But days passed with no confirmation on when that might happen. Ms Adams remembers sitting on her hospital bed in tears, worrying about her two little girls, aged eight years and 22 months. Concerned for his patient, Dr. Zaev Wulffhart, who had experience with these lifesaving devices, sought and attained 16

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approval from hospital administration to insert the pager-size device under Ms Adams’ collarbone. Unofficially, one might say, this was the start of the heart rhythm program at Southlake, a program that today is recognized provincially, nationally and internationally as a leader in quality, innovation and research in the treatment and management of electrical abnormalities of the heart. The program is led by medical director Dr. Atul Verma and manager Marianne Beardsall. Joining them are cardiologists, nurse practitioners, RN cardiac device specialists, electrophysiology technologists, triage nurse coordinators, research coordinators and support staff. It’s a big team, but everyone is

needed. Southlake is the highest volume centre in Canada for electrophysiology procedures. The heart rhythm or electrophysiology program was officially introduced at Southlake in 2002. At the time, this was not a field of treatment that other community-based GTA hospitals were developing. For most patients needing the services of this team, their diagnosis starts with an electrophysiology study. Catheters (thin plastic tubes) are inserted into different regions of the heart to study and map the electrical circuits. After diagnosis and mapping, an ablation procedure may be necessary. Wires are threaded through a vein in the top of the leg to the heart and electrical

energy is used to burn away the malfunctioning circuits and restore a healthy heart rhythm. Patients can return to normal life without the need for ongoing drug treatments. Sometimes patients, like Ms Adams, need an ICD. Should a life-threatening incident occur in the heart’s rhythm, this device can automatically shock the heart to return to a normal rhythm. Other procedures by this team include insertion of an implantable loop recorder to evaluate patients with unexplained symptoms of lightheadedness, dizziness or episodes of fainting; insertion of a permanent pacemaker to electrically stimulate and correct slow or irregular heart rhythms; cardioversion, a minor procedure performed to correct abnormal heart rhythms; implantation of a cardiac resynchronization therapy device that can decrease shortness of breath and improve symptoms in some patients with congestive heart failure; and a tilt table test to diagnose individuals who suffer unexplained fainting spells. The final component of the heart rhythm program is the ICD/pacemaker assessment and follow-up clinic. Patients travel to Southlake from great distances to receive these leading-edge procedures from doctors who are at the top of their field. With a high patient volume and having outgrown its two existing electrophysiology labs, this team will soon move to three new state-of-the-art labs being constructed at the hospital.

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Where is she now? Where is Charlotte Adams now? Living life as a grateful mom. She rarely has to visit Southlake any more. She makes the trip just once a year to have her defibrillator checked and its stored information about her heart function downloaded. In her words, she now leads a very normal life, but is always aware that her heart is her Achilles heel, “the weakest link in my body,” she says. However, her defibrillator has never had to kick in and she has loved the time it has given her with her daughters, now 20 and 14. “I owe Dr. Wulffhart and Marianne Beardsall my life,” she says.

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DAVID HUGHES, SHOWN HERE WITH WIFE BONNIE, RECEIVED LIFESAVING CARDIAC SURGERY AT SOUTHLAKE REGIONAL HEALTH CENTRE.

David Hughes

A long road to recovery B y J udy M urdoch

David Hughes remembers hearing the same words over and over again: “You promised me you would wake up.” The voice was distant and mired in fog, but still, his wife’s words got through. A lot has happened to Mr. Hughes in the last several months. It started with lower back 18

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PHOTOGRAPHY BY JIM CRAIGMYLE

pain that came on quite suddenly as he was sitting in a casino. Unable to rise from his chair, he called his wife, Bonnie, to ask her to pick him up. With his health steadily declining, a few days later they called an ambulance and headed to Southlake, never guessing what was to come.

The following day, Mr. Hughes met cardiac surgeon Dr. Carolyn Teng. “Mr. Hughes was so very sick,” she says. “At only 70 years old, he had so many health issues the cards were stacked against him.” He had an infection that had attacked two valves in his heart. Considering his complex

Dr. Carolyn Teng performed the high-risk surgery to save David hughes’ life.

medical history and severely weakened state, Dr. Teng and her team were going to try to treat the infection with antibiotics until it was safe to operate. Mr. Hughes suffers from myasthenia gravis, a condition that weakens the muscles, in particular the respiratory muscles. Along with a host of other issues, it causes breathing difficulties. As well, Mr. Hughes had undergone surgery requiring a sternotomy, which would have to be repeated. During a sternotomy, an incision is made along the sternum, which is divided to provide access to the heart and lungs. Reopening the sternum is a complicated process that requires working through scar tissue. Add to that an infection invading the heart tissue and the outlook becomes grim. “Every one of these conditions is bad,” Dr. Teng says. “In total, they are dire.” Within days, it became obvious the heart was failing and urgent surgery was needed.

But this surgery would be at a very high risk. To survive, he required invasive surgery to replace his aortic and mitral valves. This would require considerable reconstruction, complicated by his pre-existing conditions and the infection. “Dr. Teng was very up-front with us,” says Mr. Hughes’ daughter, Rhonda. “She told us that Dad had a 50/50 chance of surviving the surgery. Once out of surgery, he would be touch-and-go and the recovery would be a long road.” Dr. Teng asked Mr. Hughes what his wishes were. “I told her I have a lot to live for,” Mr. Hughes says. “I don’t want to give up, but I also don’t want to live like a vegetable. I want to survive this and I want to have a life.” With that, the decision was made. Behind the scenes, there was a team to assemble and planning to be done. Dr. Teng is a relative newcomer to Southlake, coming onboard full-time in 2011. She has nothing but praise, saying how unique it is that everyone pitches in without complaint. “Everyone does whatever it takes for the best patient care,” she says. “Once there is a care strategy in place, everyone steps up and

says, ‘Let’s do it.’” Mr. Hughes’ surgery was scheduled for Nov. 8. Even the short ride into the operating room would not be straightforward; on the way, he stopped breathing. “I am surprised how strong I was,” daughter Rhonda recalls. “I thought my mom was going to jump on his bed but I told her, ‘Mom they are going to take care of him, they are going to fix it.’” The surgery required the replacement of the two valves and extensive reconstruction of the heart where the infection had destroyed the tissue. After six long hours, one of two new valves began to tear away from the wall of the heart. “Dr. Teng described it to us as trying to sew tissue paper with a needle,” Rhonda says. After an additional four hours, Mr. Hughes was finally out of surgery. But, he was certainly not out of danger. Mr. Hughes had an uphill battle to stay alive. A week after surgery, the infection came back with a vengeance. “We had a family conference,” Dr. Teng says. “He was going downhill quickly and the next 48 hours were going to be crucial.” SP RI N G 2 0 1 4

Dr. BERNICE TSANG IS MEDICAL DIRECTOR OF THE IN-PATIENT MEDICAL CARDIOLOGY UNIT AT SOUTHLAKE.

medical cardiology: every step along the way For many cardiac patients, Southlake’s in-patient medical cardiology unit is the first crucial stop on the journey of diagnosis and treatment. These patients have come from the emergency department or another hospital. Most are in heart failure or have a rhythm disorder, coronary issue or valve problem. The goal is to determine the appropriate level of care and act on it quickly. For others, medical cardiology is where they receive care and education before returning home. For every patient discharged from Southlake, the expectation is their health will continue to improve without the immediate need of further acute care. The medical cardiology team works to give them the knowledge and

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skills to succeed. Sometimes a return to hospital, days, weeks, months or even years after discharge, is necessary. Medical cardiology is where these patients receive care when their cardiac condition recurs, changes or progresses. The interprofessional team, led by medical director Dr. Bernice Tsang and manager Wendy Clark, has a thorough understanding of cardiac conditions, allowing for accurate diagnosis and recommendation for treatment. “We are a leader in cardiovascular treatment of all kinds,” Dr. Tsang says, “not only because our health care providers are leaders in their area, but also because, as an institution, we are very collaborative.”

His family remembers that conference well. “I told Dr. Teng that my husband had promised he would not give up,” Mrs. Hughes says. “I was not going to give up either.” Mr. Hughes’ kidneys shut down and his liver function was impaired. “We were all really fearful Mr. Hughes was not going to make it,” Dr. Teng says. “There were a multitude of people—infection control, anaesthesia, neurology, cardiology, respiratory and internal medicine—all these people who had touched his life who were working hard to get his condition under control.” The decisions a family faces at times like these are overwhelming. There were so many bells and whistles going off on her husband’s machines that Mrs. Hughes began hearing them in her sleep. He needed a tracheotomy because his lungs were filling and his respiratory muscles were not strong enough to take him off the ventilator. “It was just another battle,” she says. She stayed with him every day, telling him all the news, especially about Toronto’s beleaguered mayor. When he finally woke up, the first thing he said was, “How is Rob Ford?” Remarkably, just short of three months after his surgery and after a Christmas celebration in the cardiac conference room with 20 family members including children, grandchildren and great-grandchildren, Mr. Hughes finally went home. His family members are so grateful for the care he received. They know it saved his life. His daughter Kim, who still has trouble keeping the tears from her eyes, remembers the nurse in the cardiovascular intensive care unit (CVICU) who knew there was an “extremely sick” patient coming down from surgery. Mr. Hughes had not arrived before she went home. The nurse told Kim afterwards that when she got home, she was so worried she called in just to see how he was. Then, there are the four floors of staff who were praying for him, the respiratory therapist who made him a giant snowflake craft, a nurse who made him origami art and the physiotherapists who worked so hard to help him stand and walk again on his own. And, of course, there’s Dr. Teng. “She’s our real life Christina Yang from Grey’s Anatomy,” say Kim and Rhonda. That character is described as being caring, sweet and smart, but with drive. That’s the sort of passion that this family feels separates Southlake from the pack. “When we perform surgery, we do so knowing that what we are doing is potentially changing someone’s life,” Dr. Teng says. “The minute you forget this is a person with people who love and care for them, you are doing them a disservice.” Dr. Teng knew they were all fighting for the same thing: that Mr. Hughes would have a life, nothing less.

the cardiac surgery team: Pulling together for ITS patients The Southlake cardiac surgery team, led by Dr. Charles Peniston, Dr. Daniel Kim and manager Christine Fitzpatrick, is second to none. Its surgeons are known around the world for leading-edge procedures and a high level of surgical skill. Within Southlakeâ&#x20AC;&#x2122;s walls, they are also known as brave. In the statistics-driven world of health care, every outcome is measured and recorded. â&#x20AC;&#x153;There is no other area in medicine that has more pressure to have good results,â&#x20AC;? says Dr. David Fell, Southlakeâ&#x20AC;&#x2122;s vice-president of patient experiences, regional cancer and cardiac programs. This can lead to a situation, which exists in some places in the world, where surgeons will not operate on high-risk cases. â&#x20AC;&#x153;I have seen many situations where I consider that our surgeons were very brave and the results have been tremendous,â&#x20AC;? he adds. Southlakeâ&#x20AC;&#x2122;s cardiac surgery team performs a number of procedures including highly complex coronary artery bypass, heart valve and aortic surgeries. Coronary artery bypass grafting surgery (bypass surgery) improves blood flow to the heart muscle. It was the first cardiac surgical procedure performed 10 years ago at Southlakeâ&#x20AC;&#x2122;s Regional Cardiac Care Program. During bypass surgery, a portion of a blood

vessel from the patientâ&#x20AC;&#x2122;s leg, arm or inner chest wall is used to bridge the blocked or diseased area and improve blood flow to the heart muscle. With aging or due to conditions present at birth, heart valves can degenerate; they may leak and/or become narrow. To compensate, the heart is forced to pump harder. This excess work can weaken the heart and cause shortness of breath, chest pain, increased fatigue, swelling of the ankles and legs, dizziness or fainting. If medications are no longer able to control symptoms, heart valve surgery may be recommended. Recently, Southlake introduced innovative aortic valve replacement surgeries to treat aortic stenosis, a condition in which the valve narrows and becomes stiff, restricting blood flow out of the heart. Transcatheter aortic valve implantation (TAVI) is a procedure that opens the diseased aortic valve by implanting a valve made from cow tissue. Equally revolutionary, sutureless or near-sutureless aortic valves are held in place with a titanium alloy â&#x20AC;&#x153;frameâ&#x20AC;? that

expands once it is released into the heart, providing a better fit due to its unique design. Southlake is one of few centres to offer both mitral valve surgery and minimally invasive mitral valve surgery. When the mitral valve hardens, it prevents blood from moving forward into the left ventricle of the heart. If the mitral valve is too loose, blood may flow backwards into the left atrium. In both situations surgery may be necessary. Minimally invasive mitral valve surgery is done through much smaller surgical cuts than open surgery. Southlake prides itself on its patient-centred approach to patient care. â&#x20AC;&#x153;All staff, nurses, doctors, paramedical staff, everyone,â&#x20AC;? cardiac surgeon Dr. Kevin Teoh says, â&#x20AC;&#x153;is very engaged in patient care. Patient welfare comes before ourselves and before the hospitalâ&#x20AC;&#x201D;patients are our top priority.â&#x20AC;? No matter how challenging or how routine the surgery, the Southlake team is fully focused on success.

Image of one of two sutureless valves in use at Southlake.

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While Southlake awaited provincial funding, TAVI procedures were funded by our generous community. Thank you.

An innovative-yet-risky heart surgery saved clair marchand’s life.

Judge Clair Marchand’s verdict:

INNOVATIONS SAVE LIVES by judy murdoch

photography by jim craigmyle

Clair Marchand is used to delivering verdicts. He was a Canadian Supreme Court judge until he retired four years ago at the mandatory retirement age of 75. Not quite ready to put his gavel down and live the “freedom 75” lifestyle, he presided over small claims court for an additional three years. Even when, at age 79, life forced his hand and he was faced with death, Mr. Marchand considered his verdict and, while certainly not his first choice, decided he was at peace with 22

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his fate. Turns out, this was the one verdict he did not have to make. During the last couple of years, Mr. Marchand knew there was a problem with his heart. Understanding it was “not that bad” though, he put off treatment. But when Mr. Marchand visited his family physician with drastically advanced symptoms—he could not walk, breathe or sleep—it became apparent that he was in need of intervention—and fast. Mr. Marchand was referred to Newmarket

cardiac surgeon Dr. Kevin Teoh, who immediately sent him to Southlake. Mr. Marchand required surgery to correct aortic stenosis, a condition that occurs when the aortic valve becomes hardened and does not function properly. Traditionally, patients with this condition are treated by replacing the aortic valve using open-heart surgery. In Mr. Marchand’s case, that type of surgery was considered too risky. His tenuous condition meant he was in need of transcatheter aortic valve implantation (TAVI), a procedure that opens the diseased aortic valve by implanting a valve made from cow tissue. Although less-invasive, TAVI is a complex procedure that is performed by a highly specialized team, including interventional cardiologists Drs. Warren Cantor and Steven Miner and cardiac surgeons Drs. Charles Peniston and Teoh. During his procedure, Mr. Marchand had his new valve guided to his heart though a small incision in his groin. Because of the weakened state of his heart, the innovativeyet-risky decision was made to support his heart function during the procedure with a heart-lung machine. “I will admit it was scary,” Mr. Marchand says. “I thought they were brave to try it.” The seriousness truly set in when Mr. Marchand signed a consent form allowing physicians to remove him from life support if they were unable to successfully migrate his heart function from the heart-lung machine. So, when Mr. Marchand was being wheeled into surgery, he said a final goodbye to his wife and meant it—whether she understood that to be the case or not. “I had a really bad heart, really suppressed,” he says. “I truly did not think I was going to survive the surgery, but I also knew I would die without it, so I had made my peace.” Mr. Marchand’s wife, Esther, says she had not. She was not ready to say goodbye to her husband. When, hours later, Mr. Marchand woke up, he was surprised and ecstatic. “There were a number of people in my room, celebrating the fact that I had survived,” he says. “It was like a party.” Even better, and equally as amazing, Mr. Marchand’s hospital recovery was short and relatively effortless. Today, Mr. Marchand says he feels like a new person. He can breathe, he can sleep, he can live. He has not been on his cherished sailboat for quite some time. Simply getting on and off was too much of a struggle. Now, he can’t wait until spring when he can board his

boat and take it out on the water. In the meantime, he is grateful to just be alive, being a husband, father and grandfather to his grandchildren, 11 and 13, whom he has every intention of seeing go through university. When Mr. Marchand last checked in with Dr. Teoh, he asked, “Am I going to see you in three years, five years, 10 years?” Dr. Teoh’s response: “140 years!” Mr. Marchand understands he is alive today thanks to a leading-edge surgical procedure, which, at the time, was not governmentfunded at Southlake, but was made possible thanks to the generosity of Southlake donors who are committed to investing in the hospital’s exceptional cardiac surgery program. Since then, Southlake has received provincial funding to perform TAVI, news that was met with much excitement and relief. “Southlake is clearly very patient-focused in its approach to care,” Dr. Teoh says. “The welfare of our patients is our top priority and there is an important role for this procedure in the spectrum of care for our patients.” Perhaps Mr. Marchand says it best with a verdict of his own. “Without TAVI, there is no doubt I would be pushing up daisies right now,” he says. CARDIAC SURGEON DR. KEVIN TEOH

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It takes a team to save a heart by judy murdoch

Imagine you are admitted to one of Southlake’s cardiac care units and someone says to you, “I will see you every day, coordinate your care with your entire health care team and, together, we will work to get you well again and home as soon as possible.” To someone who has experienced a cardiac event, these words are more than music to their ears, they are a symphony. In the Regional Cardiac Care Program at Southlake, this message is often delivered by a nurse practitioner, a registered nurse with advanced training, who is qualified to diagnose medical conditions, determine treatment, prescribe medications and make referrals in collaboration with the health care team. Marianne Beardsall joined Southlake in 2001 as part of a team working to establish the heart rhythm program. At the time she was a registered nurse, who was studying to receive both her master’s degree and her designation as a nurse practitioner—training that would become invaluable as she, along with many others, worked to build what has become Canada’s busiest heart rhythm program. 24

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“It quickly became evident that the key to success would be the development of an interprofessional team,” Mrs. Beardsall says. “This team, made up of health care professionals representing a range of clinical backgrounds, would work together to deliver the best care to patients in a seamless way.” Today, this approach has been adopted across the cardiac program and throughout the entire Southlake campus. It is also gaining the attention of large academic teaching hospitals across the province. “Interprofessional teams are truly dedicated to the patient,” says Janice Allen, director of the cardiac program. Nurses deliver round-the-clock care; physiotherapists safely mobilize patients; social workers provide emotional support; pharmacists reconcile medications, provide patient education and advise the team about new therapies and drugs; coordinators and managers facilitate flow and ensure access to care; technicians and technologists provide technical expertise; nurse practitioners play a key role in providing ongoing health care; and physicians provide advanced, leadingedge cardiac care.

“We’ve been referred to as ‘pioneers’ by some teaching hospitals for empowering our team members to work at their full scope of practice,” Mrs. Allen says. “Not only do our patients benefit from this team approach, it provides greater job satisfaction and is a more cost-effective way to deliver health care services.” Behind the scenes, team members regularly meet to develop strategies for challenging cases. “When we meet, it is to gain input from the entire team,” Mrs. Beardsall says. “This is a place to ask questions and to be heard, where everyone has an equal voice and the ultimate goal is to come to consensus on a care plan.” The patient perspective is always in attendance at these meetings, voiced by the person who is the closest care provider, whether that be the patient’s nurse, nurse practitioner or physician. Egos do not play a role in the interprofessional care environment. Instead, there is simply a group of talented health care professionals who respect each other and who, at the heart of the matter, are all there for the same purpose—to do exactly what is best for the patient.

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MEMBERS OF THE HEART RHYTHM PROGRAM TEAM (FROM LEFT): Jill Hodgson, Nurse Practitioner; Bonnie Whaley, Electrophysiology Technologist; Sue Sayewell, RN AND Triage Coordinator; Denise Tunney, Pharmacist; Kaylan Ward, Physiotherapist AND Manager; Marianne Beardsall, Nurse PractiTIoner AND Manager; Dr. Atul Verma, Cardiologist AND Medical DirecTor; Kellie Cooper, Clerical; Pat Edwards, Social Worker; AND Angela Forbes, RN.

WHEN YOUR LIFE IS ON THE LINE WHEN YOUR LIFE IS ON THE LINE

there’s no time to wait there’s no time to wait

MORE THAN 8,000 PEOPLE PER YEAR TURN TO SOUTHLAKE REGIONAL

MORE 10,000 PEOPLE PER YEAR MORE THAN THAN 8,000 PEOPLE CARDIAC CARE CENTRE FORPER YEAR TURN TO SOUTHLAKE’S REGIONAL TURN TO SOUTHLAKE REGIONAL ADVANCED CARDIAC PROCEDURES. CARDIAC CARE PROGRAM CARDIAC CARE CENTRE FORFOR As the Regional Cardiac Centre for ADVANCED CARDIAC PROCEDURES. ADVANCED CARDIAC PROCEDURES.

York Region, Simcoe County, Muskoka As for As the the Regional Regional Cardiac Cardiac Program Centre for Region and Dufferin County since York Region, Simcoe County, Muskoka York Region, Simcoe County, Muskoka 2003, Southlake’s Heart Rhythm Region Region and and Dufferin Dufferin County County since since Program is recognized in Canada for 2003, Southlake’s Heart 2003, Southlake’s Heart Rhythm Rhythm its world is class leadership in quality, Program Program is recognized recognized internationally in Canada for innovation and research. Currently for its world class leadership in quality, its world class leadership in quality, home to 21 active clinical trials, innovation and research. Currently innovation and research. Currently Southlake is a pioneer in cardiac care, home home to to 21 21 active active clinical clinical trials, trials, and has celebrated many world firsts. Southlake is a pioneer in Southlake is a pioneer in cardiac cardiaccare, care, and has celebrated many world firsts. and has celebrated many world firsts. OUR REGIONAL PATIENTS RELY ON THE HEART RHYTHM PROGRAM. OUR PATIENTSRELY RELYON ONTHE THE OUR REGIONAL REGIONAL PATIENTS Southlake is the highest volume HEART PROGRAM. HEART RHYTHM RHYTHM PROGRAM.

centre in Ontario for electrophysiology Southlake is is the the highest volume Southlake procedures. Heart Rhythm team centre in in Canada Ontario for electrophysiology centre members are international leaders in procedures. Heart Heart Rhythm team procedures. treating irregular heart rhythms using members are are international leaders in members ablation therapy – a revolutionary treating treating irregular irregular heart rhythms using technology which relies on guiding ablation technology ablation therapy therapy — – aarevolutionary wires into the heart to cauterize which relies which on guiding into the technology relies wires on guiding damaged tissue. heart treat rhythms. wires to into theirregular heart to heart cauterize damaged tissue. southlakefoundation.ca 905.836.7333 southlakefoundation.ca CHARITABLE BUSINESS NUMBER 13179 7540 RR0001 905.836.7333 CHARITABLE BUSINESS NUMBER 13179 7540 RR0001

BUT THE TWO ELECTROPHYSIOLOGY LABS ARE AT CAPACITY AND A THIRD bUT THE THETWO TwOELECTROPHYSIOLOGY ELECTROPHYSIOLOGY BUT LAB IS DESPERATELY NEEDED. LAbS ARE AT CAPACITY AND A THIRD LABS ARE AT CAPACITY AND A THIRD The two existing Electrophysiology LAb IS ISDESPERATELY DESPERATELYNEEDED. NEEDED. LAB

Labs are currently operating at The two two existing Electrophysiology Electrophysiology The existing 95% capacity and demand is at Labs are are currently currently operating Labs operating at going to rocketand upwards, because 95% capacity demand 95% capacity and demand isis going Atrial Fibrillation (AFib) cases Atrial to rocket upwards, because going to rocket upwards, because increase as people grow older. as Fibrillation (AF) cases increase Atrial Fibrillation (AFib) cases By 2015,grow the number patients people older.grow Byof2015, increase as people older.the with AFibofwill have doubled. number patients with AF will have By 2015, the number of patients Outdated equipment also needs also doubled. equipment with AFib Outdated will have doubled. to be replaced. needs to be replaced.also needs Outdated equipment to be replaced. THERE REALLY IS NO TIME THERE REALLY IS NO TIME

TO WAIT. TO wAIT. THERE REALLY IS NO TIME Sudden cardiac arrest is one of TO WAIT. cardiac arrest is one of Sudden

the the leading causes of death in Sudden arrest is one of leading cardiac causes of death in Canada. In Canada. In a single year over the leading of deathCanadians in a single yearcauses over 20,000 20,000 Canadians will have a stroke Canada. singleattributable year over to Atrial will haveIna astroke attributable to Atrial Fibrillation. 20,000 Canadians will have stroke Fibrillation. Southlake needsa to be Southlake needs to be prepared. attributable to Atrial Fibrillation. prepared. The foundation is raising The Foundation is raising $3.5 million Southlake needs to be prepared. $3.5 million to support an expansion as part of a $30 million expansion project to build is the third $3.5 EP Lab and The Foundation raising million project to build the third EP Lab update the EP equipment. as part of a $30 million expansion and update the EP equipment. project to build the third EP Lab and update the EP equipment.

NEW LAB CAPABILITIES •NEw NewLAb state of the art designs CAPAbILITIES. NEW LAB CAPABILITIES

gives state-of-the-art all 3 labs the flexibility New designs give New state of the art designs to perform any procedure in all three labs the flexibility gives all 3 labs the flexibilityto any lab any cardiac procedure in perform to perform any procedure in lab. • any Co-located recovery means any cardiac lab patients no longer travel to •• Co-located recovery means Co-located recovery means patients a separate unit after their no longer totravel a separate unit patients notravel longer to procedure after their procedure. a separate unit after their •• Advanced mappingsystems systems proceduremapping Advance enhance accuracy and outcome outcome of • enhance Advancedaccuracy mappingand systems of procedures procedures. enhance accuracy and outcome •• Revolutionary of procedures technologies Revolutionary technologies reduce reduce exposure to harmful to radiation for patients, • exposure Revolutionary technologies radiation for patients, physicians physicians and staff. reduce exposure to harmful and staff radiation for patients, physicians and staff ••

WE NEED YOUR HELP TO BRING WE NEED YOUR THE BEST IN WE NEED YOUR HELP TO BRING HEART RHYTHM HELPBEST TO BRING THE IN CARE TO OUR THE BEST IN HEART RHYTHM COMMUNITY. HEARTTO RHYTHM CARE OUR DONATE NOW. CARE TO OUR COMMUNITY. COMMUNITY. SP RI N G 2 0 1 4

Dr. Charles Peniston

A LEAP OF FAITH By JUDY MURDOCH

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When Dr. Charles Peniston arrived at Southlake in early 2004, he was wooed by the opportunity to be part of creating something new and impressive: a complete regional cardiac care program in a community setting and a commitment by a team of innovative cardiac experts to provide patients with the best cardiac care available anywhere in the world. It was a leap of faith. Dr. Peniston graduated from McGill University in Montreal in 1981 and completed his cardiovascular and thoracic surgery training in Toronto. In 1992, he joined Toronto’s University Health Network as a staff cardiac surgeon. During his 12 years there, he served as the director of clinical clerks for the Toronto General division, codirector of the cardiovascular intensive care unit and deputy chief of the division of cardiovascular surgery. With his impressive resume and spotless reputation at stake, Dr. Peniston knew the move to Newmarket would be worth it. “At the start, we were three cardiac surgeons raring to go, but the operating theatres were still under construction,” Dr. Peniston remembers. The program came rapidly on-stream and, with a steady increase in volume over the past decade, the cardiovascular surgery portion of the program has grown from 133 procedures in 2004 to 1,060 procedures this past year. It has been an exciting process. “It is not often you get to work with people who have so much faith in an organization,” Dr. Peniston says. “It is an honour to be part of building something new alongside cardiac specialists, nurses, pharmacists, physiotherapists and other health care professionals who all have one mission—to provide our

patients with exceptional cardiac care closer to home.” Today, as medical director of cardiovascular surgery at Southlake, Dr. Peniston marvels at being involved in the maturation of the program. “In the beginning, everyone was new,” he says. “Everyone came from elsewhere and, together, we have matured and gelled into a highly functioning cardiac program.” This is also a team that is leading innovation, developing methods to treat patients who may once have been considered beyond treatment. “A new class of valves that are easier to implant has revolutionized cardiac care for

elderly patients,” he says. “With our aging population and an increase in overweight and diabetic patients, we can anticipate the increasing need for innovative procedures such as this.” Dr. Peniston is also impressed by Southlake’s culture and the outstanding working relationships within the cardiovascular division this culture has nurtured. “We have open and honest dialogue amongst the entire interprofessional cardiac team about what is best for the patient,” Dr. Peniston says, adding any input at any level is welcome in order to improve patient care processes and outcomes. “It is a culture unlike any I have ever experienced.”

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One Heart Beat

Life and art bound together in a blip

B y J ud y M urdoch

william ho, a former southlake patient, is the world-renowned artist behind one heart beat, a painting (shown at top of page).

Years ago, William Ho was admitted to Southlake Regional Health Centre for treatment of his atrial fibrillation, a condition he didn’t even realize he had. Mr. Ho is the world-renowned artist behind the painting, One Heart Beat. Created with a single brushstroke, its simple meaning has transformed into a worldwide movement: Everyone in the world is connected through a heartbeat. “It is that common One Heart Beat that reminds us that we are human and responsible for each other,” Mr. Ho says. “The message of the One Heart Beat onestroke painting was in my heart for over 10 years, well before I realized I had atrial fibrillation,” he continues. “It is a passion for helping suffering people, particularly the children of the world, and the fact that all human beings are interconnected as one global family.” Recently Mr. Ho returned from the Louvre in Paris where, by special invitation, his art, including One Heart Beat, was exhibited. Mr. Ho has shared his message of global thoughtfulness and caring in centres around

the world, including on Canada’s Parliament Hill and at the United Nations headquarters in New York. When presenting his message, Mr. Ho asks audience members to place their hands on their chests to feel something very important, but very often taken for granted. “Yes! It is your heartbeat, my heartbeat, the very one heartbeat that all human beings share,” he says. “We all share the one heartbeat. When a child suffers in Canada or China, we all suffer. When a child gets hurt in Africa or America, we all get hurt. If someone dies in Haiti or India, part of us dies, too. All children, Haitian, American, African, Chinese, Indian or Canadian, all are our children. We have to love them!” Mr. Ho created the non-profit One Heart Beat Society, a movement to inspire people to nurture a world of caring. “My conviction and passion for One Heart Beat continues to grow stronger after I have had more chances to witness more suffering children and people around the world,” he says. “Remember, the only difference between live and love is the letter ‘I’ representing me

By JUDY MURDOCH

or my interests and the letter ‘O’ meaning others. We have to learn to care for others, share with others and love one another.” Mr. Ho’s beautiful artwork, One Heart Beat, has meaning for Southlake, too. “Everyone in the health care field understands the significance of that tiny blip,” says cardiac anesthesiologist Dr. Daniel Kim. “We wait for it and we take action to restore it. It is the difference between life and death.” So moved was Dr. Kim with One Heart Beat that he purchased a limited print and generously donated it to Southlake. Fittingly, it is on display outside the cardiovascular and intensive care waiting area. “I trust there must be a reason for my link with Southlake, not only medically but in terms of passion, vision, mission, action and significance,” Mr. Ho says. “Let us all treasure our heartbeats and the heartbeats of others, too.”

To find out more about One Heart Beat, visit oneheartbeat.ca, theonegallery.ca and williamhoart.com. SP RI N G 2 0 1 4

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30-LOVE

in favour of Ed Gray B y J udy M urdoch

PHOToGRAPHY BY JIM CRAIGMYLE

Ed Gray was playing a round of tennis in November 2013 when he felt, in his words, a bit “odd”. That was not surprising, really, for a couple of reasons. For one, Mr. Gray had undergone hernia surgery the month before and had certainly minimized the rest and recuperation period in favour of getting back to the tennis court. For the other, well, Mr. Gray is 83 years old. Call it the wisdom that comes with age, but Mr. Gray knew enough to postpone the rest of his match and instead head to his family physician’s office. “I just felt that if I continued playing, something bad would happen,” Mr. Gray says. After a series of tests, he was back to his favourite game a month later. In a clear case of déjà vu, Mr. Gray got that odd feeling again. This time, since he was playing doubles and didn’t want to let down the other players, he was going to push through and finish his match. Perhaps fate intervened when a fifth player showed up, enabling Mr. Gray to gracefully bow out and head home. As luck would have it, Mr. Gray had an appointment with a cardiologist the next day, a precaution taken after his last odd event. At Southlake’s urgent cardiology clinic, Dr. Remo Zadra asked him to take a treadmill stress test and an echocardiogram. “Dr. Zadra told me I was going to the hospital for a couple of days,” Mr. Gray says of the results of those tests, “and when I came out, my tennis game would be better.” He was to undergo coronary angiography, angioplasty and stenting to alleviate a double blockage in his right coronary artery. His situation had become more urgent with the presence of arrhythmia (irregular heartbeat) during and after his stress test. “Less than two hours after I saw Dr. Zadra for the first time in my life, interventional cardiologist Dr. Lorne Goldman was performing the procedure,” Mr. Gray marvels. One of his lasting memories is of a nurse asking him his level of pain—when he had no pain. “That’s what was so deceiving about my situation and what I caution my friends about,” he says.

Even while experiencing symptoms, Mr. Gray was never really able to put a finger on what exactly he was feeling. “It’s like taking your car into the dealer because it is making a funny noise, but not being able to explain where the noise is coming from or what is causing it,” he says. Mr. Gray was back home just two days after that fateful tennis match. “I thought I was bulletproof before the procedure,” he says, “but I feel even better now.” As a retired Air Canada pilot who was flying 747s from Toronto to London and Bombay, Mr. Gray is accustomed to having his health scrutinized. “Every year, I had to requalify seven times and have two full medicals,” he emphasizes. “They really make sure pilots are in top health, and I was.” Mr. Gray was wholly impressed with the treatment and compassion he received from Southlake. “Dr. Zadra called me a couple of days after I got home to check up on me,” he says. Mr. Gray was back for a follow-up appointment in early January and everything looked good—although he forgot to ask about a possible return to the tennis court. He contacted Dr. Zadra’s office. Impressively, Dr. Zadra called him back personally with an answer. He wanted Mr. Gray to sit out until at least March or April and, in the meantime, enroll in Southlake’s cardiovascular prevention and rehabilitation program. There he would continue to build his strength and perhaps learn from others who have had similar experiences. With any luck, Mr. Gray will meet cardiac program alumni and volunteer Frank Brathwaite, who had two cardiac procedures at Southlake. Mr. Brathwaite brings his positive attitude, even for his own heart disease, with him to the program and walks for hours with participants. Mr. Brathwaite has wrestled with heart disease for more than a decade, a journey that has seen ups and downs in his condition. His first experience was in 2003, noticing chest pains while raking leaves. As it turns out, he

interventional invasive cardiology

Ed Gray is looking forward to tennis season, after receiving cardiac surgery at Southlake.

was suffering from five blockages, two of which, like Mr. Gray’s, were treated with stents. Two years later, he suffered a major heart attack while in Fort Erie and requested to be air-ambulanced to Southlake for treatment. The outlook was dire, but his sense of humour and positive attitude never abandonned him. When a nurse asked him if he had any allergies they should know about, he replied, “I’m allergic to two things, bullets and heart attacks.” Humour and positivity played crucial roles in Mr. Brathwaite’s recovery and current outlook on life, something he tries

to pass along to other cardiac patients, like Mr. Gray. Mr. Brathwaite’s goal was to be able to return to his family’s cottage, a wateraccess-only cottage with 80 uphill steps from the dock to the front door. Mr. Gray’s is to get back on that tennis court. For now, and before he gets going in the cardiac rehabilitation program, he is taking advantage of Upper Canada Mall’s free mall-walking program. He chuckles at the mention of “free.” “It’s only free until the mall opens,” he jokes. Like Mr. Brathwaite, it is going to take a lot more than an angioplasty to make Mr. Gray lose his sense of humour.

You would not be wrong to say interventional invasive cardiology was where Southlake’s Regional Cardiac Care Program got its start. The hospital opened two state-of-theart catheterization labs in 2004, allowing the team to launch a formal interventional invasive cardiology program. A cath lab is used to perform angiograms, an intricate procedure that allows a cardiologist to guide a thin plastic tube called a catheter to the heart to detect narrowing or blockages within the coronary arteries. Once the catheter reaches the heart, a small amount of contrast agent (“dye”) is injected into the coronary arteries or a chamber of the heart. As the agent is injected, a series of X-rays is taken. Originally under the guidance of Dr. Sylvain Plante and then Dr. Warren Cantor, the program is now led by medical director Dr. Lorne Goldman and manager Heather Stewart. Procedures include percutaneous coronary intervention (PCI) or angioplasty along with angiography. Angioplasty, which is the procedure Ed Gray underwent, clears blockages within the coronary arteries. Depending on the location and severity of the blockage and a patient’s risk factors, a balloon, as well as a metal coil (stent), may be used during the procedure. The balloon is inserted at the site of the narrowing and inflated, opening the artery to improve blood flow to the heart. A stent is used to keep the artery open. So important and urgent is this step in treating some heart attack patients, Southlake has initiated a program, where paramedics from as far north as Barrie, west to Alliston and east to Durham Region come directly to Southlake if they have a heart attack patient stable enough to transport. Once they arrive, they bring the patient directly to a cath lab. The on-call cardiac catheterization team is ready to provide treatment. At times, the patient is transferred to the operating room to undergo emergency bypass surgery. Mr. Gray may have had no idea how important immediate intervention was. However, he is a living, tennis-playing testament to those who did.

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Dr. Peter Zeman: We can’t treat it if we can’t find it

Non-invasive tests offered at Southlake Electrocardiogram (ECG) Electrodes placed on the patient’s chest are attached to wires that are connected to a device that records the electrical activity of the heart. Exercise stress test This test records the electrical activity of the heart at rest, during exercise and after exercise. It enables doctors to see how a patient’s heart is performing during physical

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Dr. Peter Zeman, medical director of the non-invasive and ambulatory services team

activity and determine if the heart is receiving enough oxygen from its blood vessels. Echocardiogram Using sound waves (or ultrasound) to produce a moving picture of the heart, this test allows doctors to learn about the structure and function of the heart muscle, its valves and the flow of blood through the heart. The newest echo machine at Southlake has 3D capability, providing advanced images of the mitral valve, important for minimally invasive mitral valve surgery. Stress echocardiogram Combining a standard exercise stress test and an echocardiogram, this test can detect and/or assess the significance of blocked arteries by comparing ultrasound images of the heart before and after exercise. Transesophageal echocardiogram (TEE) Unlike a standard echocardiogram where the image is produced from outside the chest, this test produces an image from within. The doctor inserts a probe—a soft, tube-like device—into the patient’s mouth and down the esophagus until it’s positioned directly behind the heart. The probe has a transducer on the end that bounces sound waves off the heart to create moving images on a monitor. A TEE allows the doctor to obtain exceptionally clear images of the heart’s structure. Nuclear cardiac stress test For this test, a radioactive substance called a tracer is injected into the patient’s blood-

stream and highlights areas of the heart deprived of adequate blood flow. This test is also useful for patients who cannot exercise on a treadmill and provides additional detailed information not available with exercise stress testing alone. Cardiac computed tomography angiogram (cardiac CTA) Cardiac CTA scans combine the use of a sophisticated computer with a rotating X-ray device to create detailed cross-sectional images or “slices” of the heart. These slices are assembled in high resolution 2D and 3D images to non-invasively determine if fatty or calcium deposits have built up in the arteries supplying blood to the heart. Cardiac CTA can determine if symptoms of chest pain are caused by a coronary blockage. Cardiac magnetic resonance imaging (cardiac MRI) Safe, painless and valuable in diagnosing cardiovascular disease, cardiac MRI makes use of the magnetic properties of cells to create both still and moving pictures of the heart and major blood vessels. These images assist in determining the best way to treat people who have complex heart disorders. Holter and loop monitors Using highly sensitive electrodes that can pick up the heart’s electrical impulses, this test records a patient’s heartbeat for 24 hours to two weeks at a time. It allows the doctor to assess for irregular or unusually fast or slow heart rhythms.

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Dramatic progress has been made in cardiac care and interventions but the rise in patients with chronic heart diseases has fuelled the need for further medical innovations, especially for new diagnostic techniques. Borrowing from Southlake Foundation’s Images for Life fundraising campaign, We can’t treat it if we can’t find it, the noninvasive and ambulatory services team, led by medical director Dr. Peter Zeman and manager Terry Fair, is the backbone of Southlake’s Regional Cardiac Care Program, utilizing leading-edge technology to enable diagnosis of abnormal heart function, either through scheduled tests or a visit to the urgent cardiac clinic. Patients seen by this team have any number of typical or atypical symptoms. “There is a wide spectrum of how someone presents with heart issues,” Dr. Zeman says. “For some, it is a slow progression over the years. Others do not equate their symptoms with their heart. What is most important for people to realize is that not all heart disease presents with sudden crushing pain.” Dr. Zeman, with specialties in both cardiology and advanced cardiac imaging, joined Southlake in 2008. During his medical training, he worked in many communities across Ontario as well as undertaking subspecialty training in Washington, D.C. Today, alongside his colleague, Dr. Molly Thangaroopan, he is proud to be part of one of the largest community-based cardiac programs in Ontario. Along with diagnostic tests, this team also oversees the urgent cardiac clinic, a key component of the cardiac program’s ability to provide the right care at the right time. The clinic provides immediate assessment by a cardiologist to individuals who are experiencing chest pain or other serious undiagnosed cardiacrelated symptoms. Through diagnostic tests, such as electrocardiograms, exercise stress tests and echocardiograms, risk factors are identified and treatment plans developed.

Dr. Remo Zadra: Maintaining a personal touch

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cardiology division head Dr. Remo Zadra

Dr. Remo Zadra is an original, one of the first cardiologists to join Southlake as it launched its new Regional Cardiac Care Program. He joined Southlake as director of echocardiography and was recently named division head of cardiology. Those titles are fairly high level and fitting of Dr. Zadra’s abilities, but to his patients, Dr. Zadra is old school. That is likely one of the reasons he received Southlake’s Physician Award of Excellence in 2011. It is not uncommon to see Dr. Zadra provide a more comfortable spot for an elderly patient sitting on a bench in a waiting room or give a female patient an extra gown so she may feel more comfortable when going for testing. It is his phone calls, though, that have most of his patients buzzing; he personally calls patients he treats to follow up with them on their recovery. Dr. Zadra completed medical school at the University of Ottawa and received his internal medicine specialty training in Toronto. After a two-year cardiology fellowship in Halifax, he returned to Toronto for a fellowship in echocardiography. He then headed north to Southlake to develop the hospital’s echo lab, a key testing component for heart function. At the time, Dr. Zadra remembers, he had “no idea there was a city up here.” Dr. Zadra considers the echo lab vital in

helping his colleagues provide advanced services. This state-of-the-art lab performs patient testing to provide physicians with the highest quality information about the size and shape of a patient’s heart, how well its chambers and valves are working, how well blood flows through and if the muscle is performing properly. “The echo lab provides key information,” Dr. Zadra says. Take minimally invasive mitral valve surgery, which was recently introduced at Southlake and available in very few cardiac centres: “The technical resources in the lab allow surgeons to look at the mitral valve in a very advanced way.” Even with his own contributions, Dr. Zadra is amazed at just how far the program has come at Southlake. “We have developed an amazing electrophysiology program respected worldwide,” he says. “Our cardiac surgeons are remarkable; that they are undertaking cutting-edge surgeries is very exciting stuff.” Dr. Zadra credits the program’s success to the fact that there are no egos here. “Everyone just rolls up their sleeves and says, ‘Let’s get the job done.’” This is an atmosphere perfect for Dr. Zadra, a cardiologist committed to ensuring the cardiac program is indeed the very best and patients get the care they deserve when they need it.

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For matters Manageme

Silvio quattrociocchi credits southlake cardiologist Dr. Liane Porepa with saving his life

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At 47, Silvio Quattrociocchi had no reason to believe feeling unwell had anything to do with his heart. Assuming he had eaten something “off” at a restaurant the night before, he went to work figuring it would pass. Feeling worse as the day progressed, he headed home, stopping to get gas along the way. When he walked in the door, though, his wife took one look at him and realized he needed to go to the hospital. Along the way, he called his cousin who had eaten the same meal as he had the night before. His cousin was feeling fine. “That is when I knew I was having a heart attack,” Mr. Quattrociocchi says. As it turns out, it was a bad one. Within 30 minutes of arriving at Southlake, Mr. Quattrociocchi was undergoing an angioplasty and stent procedure to save his life. Soon afterward he was asked if he was feeling alright and replied yes. He remembers seeing defibrillator paddles in someone’s hands just before he went into cardiac arrest and lost consciousness. When he woke up again, his first words to his physician were, “I scared you didn’t I, Doc.” That day was an awakening for Mr. Quattrociocchi and the beginning of a new life with heart disease. He has since been admitted to Southlake twice more, once to have another stent inserted, a routine procedure. The second visit was far less routine. Mr. Quattrociocchi had very quickly gained almost 30 lbs and Dr. Liane Porepa, Southlake’s newest cardiologist and a specialist in advanced heart failure, knew it was fluid gain because his heart was failing. She was concerned Mr. Quattrociocchi may even be at the point of needing a new heart. “Sometimes, after a large heart attack, the heart does not adjust to the new normal,” Dr. Porepa says. “There is not enough output and fluid starts to build up.” Dr. Porepa brought Mr. Quattrociocchi back to Southlake to better understand the reason for his heart failure. She inserted a special intravenous line directly into his heart that continuously measures multiple heart pressures and heart output. This allowed her to carefully monitor a number of supportive heart medications and, most importantly, remove the large volume of

of the heart nt and rehabilitation are key B y J ud y M urdoch

P hotograph y b y jim craigm y le

fluid that had accumulated, in a safe and effective way. It was one of the first times the procedure was done at Southlake and it had a dramatic effect, allowing Mr. Quattrociocchi’s heart to come out of failure and resume adequate pumping. “Dr. Porepa saved my life,” he says. Now, back at home, Mr. Quattrociocchi is being followed by Dr. Porepa in Southlake’s heart function clinic. The clinic, part of the cardiovascular chronic disease prevention and management program, strives to keep people healthy and out of hospital by providing outpatient care to those who have congestive heart failure and are at high risk of being admitted to hospital. The interprofessional team includes doctors, nurse practitioners, and nurses who have advanced training in the management of heart failure, as well as a dietitian, pharmacist, social worker and exercise therapist. The program emphasizes education on managing disease by following medical advice and adopting a healthy lifestyle, early intervention of potential problems and ongoing assessment for progression to advanced heart failure. Since Dr. Porepa arrived at Southlake, the clinic has expanded to provide advanced heart failure triage and management to patients who may ultimately need either a heart transplant or a mechanical heart device. Southlake does not perform either surgery and historically people who have been identified as potential recipients were treated exclusively in Toronto. With her subspecialty in advanced heart failure and an excellent relationship with those Toronto facilities, Dr. Porepa is able to provide yet another valuable service closer to home for patients living with advancing heart failure. For Mr. Quattrociocchi, there was a time he thought he would need a heart transplant. Today, he is on the mend and scheduled to begin rehabilitation, participating in an exercise and education program designed to improve his overall heart health and help him make adjustments to his lifestyle. Ultimately, he is hoping it will help him get back to work. However, with the scares he has had the last few months, he is not going to rush it.

Dr. Liane Porepa: A bridge to the last frontier Dr. Liane Porepa completed her medical degree and internal medicine residency at the University of Toronto and her cardiology residency at the University of Western Ontario. She went on to complete a fellowship specializing in advanced heart failure, cardiac transplantation and mechanical circulatory support (mechanical heart) at the Cleveland Clinic in Cleveland, Ohio. It is this fellowship that brought her north to Newmarket. When Dr. Porepa came to Southlake in September 2013, she knew, despite her training in the management of patients with heart transplants and mechanical circulatory support, she was coming to a cardiac program that doesn’t offer these procedures. However, she had other plans to utilize her training—providing assessment and management support to patients in the Southlake catchment area who had, until now, had to travel to Toronto to receive care in an advanced heart failure clinic. These are patients who have been identified as potentially needing a heart transplant or mechanical assist device. As Dr. Porepa attests, this is a group growing in numbers. Heart failure can be the end result of other heart issues including valve, artery and electrical problems . When the heart muscle fails, it can’t pump or relax properly. While cardiologists and technology have gotten better at treating heart conditions, the heart is a muscle and sometimes it wears out.

At times, heart failure can be treated with medication; other times, greater intervention is needed. “I see mechanical devices as the last frontier of cardiac intervention,” Dr. Porepa says. Left ventricular assist devices (LVADs), sometimes referred to as mechanical hearts, are surgically implanted to pump blood from the left ventricle to the aorta. Some LVADs are intended for short-term use; others will stay with a patient for life, particularly to treat advanced congestive heart failure. Today, Dr. Porepa has her own cardiology practice and works with patients in the heart function clinic who may someday be a candidate for transplant or LVAD. Patients no longer have to travel to Toronto for advanced heart failure management. These patients can be assessed by Dr. Porepa and then referred downtown if the need for intervention becomes certain. Once intervention has occurred, patients can come back into Dr. Porepa’s care. She has become an invaluable bridge. This is a tremendous boost for these vulnerable patients and is a service Dr. Porepa would like to see extensively utilized. Recently she had a patient in severe heart failure referred to her by a hospital in the far corner of Southlake’s catchment area. Dr. Porepa assessed the patient and knew immediately that an LVAD was imminently needed. For this patient, the last frontier turned out to be a lifesaver.

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co dy s torm cooper photograph

RALPH COURTNEY IS PART OF A RESEARCH STUDY THAT WILL advance TREATMENT OF CARDIAC PATIENTS.

Setting course for the future

Southlake research making worldwide ripples B y J ud y M urdoch

Ralph Courtney’s lifestyle seems idyllic. Along with his wife, he lives year-round in Muskoka, Ontario’s cottage playground. On chilly mornings, he rustles up some logs from the woodpile and whiles away the day watching snow gently fall and wildlife forage for sustenance from his cosy home. But, as often is the case, around a silver lining there is a cloud. For Mr. Courtney, there are a couple: His home is on an island, so twice a year, when the ice is forming and again when it is melting, he is island-bound. And he has a history of heart disease and in the last decade has undergone three major procedures. In order to retain his island lifestyle, Mr. Courtney had to get his heart under control. And he did. Today, he is not only healthy, but he is part of a research study that will further the treatment of patients just like him in the future. In 2003, Mr. Courtney required quadruple 34

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bypass surgery, which was performed at a Toronto hospital. Shortly thereafter, he developed an irregular heartbeat—a common occurrence following bypass surgery. Diagnosed with atrial fibrillation, last year Mr. Courtney had a combined defibrillator/ pacemaker implanted. The device not only regulates heartbeat when necessary and intervenes when needed, its actions can be downloaded by holding what looks like a computer mouse over the left side of his chest. The resulting report indicates activity by day and colours it black if there is atrial fibrillation and white if not. Mr. Courtney was experiencing too many black days. So last October, Mr. Courtney underwent cardiac ablation at Southlake. In this procedure, wires are inserted through one or both groin muscles and neck to the heart. Once the abnormal electrical sites are identified, electrical energy is used to stop the abnormal circuit. The goal is to end the

disturbance of electrical flow through the heart, restoring a healthy heart rhythm. In Mr. Courtney’s case, electrophysiologist Dr. Atul Verma went through both of his groin muscles and neck and, when all was complete, the result was astounding. After his cardiac ablation, Mr. Courtney went from a strong proliferation of “black” days to a complete spectrum of white. “I have never seen a doctor so happy,” Mr. Courtney says. The success of Mr. Courtney’s procedure is thanks in part to research in the electrophysiology field, research in which a group of specialists at Southlake, Drs. Verma, Yaariv Khaykin and Zaev Wulffhart, have played a key role. Dr. Khaykin initiated the heart rhythm research program as the director of the Newmarket Electrophysiology Research Group eight years ago. At any given time, the group is undertaking anywhere from 20 to 25 studies. In some studies, the group takes the lead. In

J I M C R A I G M Y L E P H OTO G R A P H

others, they assist colleagues in other centres. Their research compares new technologies with conventional ones and learn ways to complete procedures more efficiently. In 2009, Dr. Khaykin led a research project that demonstrated combining two approaches to ablation resulted in a more effective option to treat irregular heartbeat. Interestingly, Dr. Khaykin was originally headed for a career in engineering but a shift happened somewhere along the way. “I didn’t just want to work with technology and develop technology,” he says, “I wanted to be able to apply technology.” He graduated from medical school and in 2004 came to Southlake to help launch the atrial fibrillation and complex ablation program, which has proven to be one of the most successful in the country. Dr. Khaykin’s own research interest is the development and application of new technology in electrophysiology. He was the first in the world to use cartosound, a technology placed inside the heart to view the heart chambers in real time using ultrasound, and perform 3D reconstructions of any of the heart chambers for ablation. Electrophysiologists are not the only talented health care providers leading change through research at Southlake. Southlake is one of the highest recruiters for Phase 3 clinical trials and is participating in anywhere from 40 to 50 trials each year. Phase 3 trials involve large groups of patients, allowing researchers to compare a new type of treatment with the original and also confirm its safety and effectiveness. Many specialists join Southlake knowing it will provide a rich culture of research and education. The interventional cardiology team has participated in 22 multi-centre trials, including evaluations of new drugs and devices and comparisons of different ways to restore blood flow to the heart following a heart attack or stroke. Team members have published several important and respected articles, some from studies done only at Southlake, others done in collaboration with other centres. Dr. Steven Miner co-led a study that revealed a connection among angioplasty, poor sleep and future significant heart issues. It has long been known that there is a connection between sleep disturbance and cardiac issues. With this research, a target group has been identified so that the next important steps of seeking solutions can be assessed. Landmark research by Southlake’s Dr. Warren Cantor has changed the way heart attack patients are administered treatment around the world. He spearheaded a study that found transferring heart attack patients to specialized hospitals to undergo angioplasty within six hours of receiving clot-busting

DR. YAARIV KHAYKIN INITIATED THE HEART RHYTHM RESEARCH PROGRAM AT SOUTHLAKE.

drugs reduces the risk of life-threatening complications. Furthering this research, patients within a one-hour transport time are now being taken directly to a centre that offers angioplasty, such as Southlake, and bypassing their local hospital. Now, with a patient’s consent, emergency medical services personnel call ahead to the hospital and bring the patient directly to the catheterization lab, where the team is standing by ready to perform an immediate angiogram or angioplasty. Even Mr. Courtney has now become part of

an international study, RAFT AF, which studies treatment methods for patients with heart failure and atrial fibrillation. Southlake research teams have huge trajectory impact here at Southlake and around the world but there is still a lot of research to be done. Can ultrasound produce 3D images? How can we save our hearts by sleeping better at night? Will controlling atrial fibrillation lessen potential for strokes? And, like in Mr. Courtney’s case, has the ideal way to treat atrial fibrillation finally been found? Only research can provide these answers. SP RI N G 2 0 1 4

Dr. Zaev Wulffhart

Proving the skeptics wrong By JUDY MURDOCH

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J I M C R A I G M Y L E P H OTO G R A P H

You have to give Dr. Zaev Wulffhart a lot of credit for joining Southlake back in 2001. At the time, Southlake had limited cardiac resources. It had recently received approval from the Ontario government to create a regional cardiac program, but few in the cardiac community believed it would actually happen. “Initially, I have to say, I was a bit skeptical,” Dr. Wulffhart admits. “Colleagues were telling me I was going to destroy my career.” Dr. Wulffhart was right to want to protect the career he had carefully constructed. He graduated from the University of Witwatersrand Medical School and completed his internship in Johannesburg, South Africa in 1984. When he arrived in Canada in 1986, he continued his training at Newfoundland’s Memorial University and Nova Scotia’s Victoria General Hospital. Coming to Ontario in 1992, Dr. Wulffhart completed an electrophysiology fellowship at St. Michael’s Hospital and in 1993, joined the Wellesley Hospital as director of the pacemaker and clinical clerkship training programs. He moved to Sunnybrook and Women’s College Health Sciences Centre in 1996 and during his five-year tenure, served as deputy director of the cardiac catheterization lab and director of arrhythmia services. Thankfully, Dr. Wulffhart did not listen to his detractors. Instead, he joined Southlake as director of the comprehensive arrhythmia program and became a charter member of a

steadfast group of believers who understood that patients in the Southlake catchment area should and would have access to stateof-the-art cardiac services. “I knew we could build the ‘Cleveland Clinic’ of the north,” Dr. Wulffhart says in reference to a top-ranked hospital for cardiac care in the United States, “and we did.” With the promise of performing advanced procedures in a leading-edge and innovative environment, Dr. Wulffhart was able to construct a team of top electrophysiologists, cardiologists who specialize in the electrical activities of the heart. They came to Southlake to perform atrial fibrillation and ventricular tachycardia ablation procedures and complex cardiac mapping, all of which were not, at the time, priorities at downtown Toronto hospitals. They also came to Southlake to lead

research and technology development. In a short period of time, this elite group nurtured partnerships with industry leaders and was able to deliver results quickly and effectively. The arrhythmia program soon gained provincial, national and international recognition. It began developing “worldfirst” advancements and changing the way electrophysiologists performed their craft around the globe. At Southlake, Dr. Wulffhart has continued to develop his career. After becoming chief of cardiology, medical director of the heart rhythm program and director of medical education, in 2013, he was appointed physician leader of the Regional Cardiac Care Program. In this position, Dr. Wulffhart will continue the forward momentum of cardiac care available to the greater community.

2013

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Dr. Lorne Goldman sees many “very sick” patients. “Often, their hearts are stopped or stopping,” he says. “We have to bring a lot of them back to life. It is stressful, but gratifying.” Dr. Goldman is the medical director of interventional invasive cardiology at Southlake and performs lifesaving catheterbased cardiac treatments such as angioplasty and stenting. Dr. Goldman received his medical degree from McGill University in 1994, completed his internal medicine and cardiology residencies at McGill and then a fellowship in interventional cardiology at St. Michael’s Hospital in Toronto. He worked as an interventional cardiologist in Spokane, Wash. for two years prior to joining Southlake in 2003. He was drawn to Southlake to continue the work he had been doing south of the border. “It was a good opportunity to come back to Canada,” Dr. Goldman says. “I missed being a Canadian.” Dr. Goldman knew Southlake was a good hospital with the potential to be a great hospital. “It was just the start of the Regional Cardiac Care Program and we all knew big things were ahead,” he says. “The stenting

program, cardiac surgery program, electrophysiology program, all those things were coming. It was an exciting time.” It still is, and with a busy cardiology practice, scheduled procedures and a great deal of time on-call, including every fifth night, Dr. Goldman is right in the thick of it. “We must be able to respond to emergency situations no matter what time of day,” he says. “During a heart attack, every minute is important.” In order to maximize the number of patients “brought back,” Dr. Goldman is part of an interventional cardiology research group working to develop best practices in his field. “I love being involved in trials,” Dr. Goldman says. “Every time a question is asked, the best answer is found through a clinical trial. That is how we innovate.” And, innovate they have. Today, studies completed by this research group have changed the way heart attack patients receive care all over the world. It is an amazing legacy, one which no doubt Dr. Goldman would have created whether he returned to Canada or not. Southlake, and the countless patients he has treated and saved, are certainly happy he chose Newmarket.

partners

IN CARE

The Right Thing To Do B y L ee ann waterman

Retired for nearly 20 years, Bob Burk might wonder how he ever fit owning and operating a business into his schedule. Life on “the farm”, as he and wife Sheila call the 75 acres of wooded property they own in Waubeshene, just east of Midland, includes tapping 100 or so maple trees in the spring, planting garlic in the fall and visits with their grandchildren. The Burks are active in the community, volunteering for causes important to them and attending local events. They also travel frequently, taking extended trips to all corners of the globe, including South America, West Africa and Southeast Asia. They make regular trips north to their cottage south of Parry Sound to enjoy the lake and south to Toronto for the theatre. A “heart adventure”, as Mr. Burk calls it, nearly a decade ago could have put an end to this active life—were it not for the treatment he received at Southlake. Mr. Burk, then 62, was suffering from headaches that developed into pain in the back of his neck. His family doctor sent him for a stress test. “After three minutes on the treadmill, I was done,” Mr. Burk recalls. “Usually, I can do the full 12 minutes.” He knew something was wrong and, sure enough, tests pointed to a coronary blockage. His physician put him on a rush list to see a cardiologist in Barrie. But before he could keep that appointment, Mr. Burk’s worsening symptoms brought him to the emergency room of the small hospital in Midland. Staff sent him by ambulance to Southlake, where the team at the then-new Regional Cardiac Care Program immediately recognized the urgency of the situation. The first time Mr. Burk met Dr. Lorne Goldman, the cardiologist was wearing jeans and a rugby shirt. Dr. Goldman said to give him five minutes to find more appropriate clothes

and they would begin what the Burks now understand would be a lifesaving procedure. Late that afternoon, Mr. Burk had angioplasty to clear the blockage and a stent (metal coil) inserted to keep the artery open— restoring normal blood flow to his heart. “It saved my life,” Mr. Burk says. ‘Southlake took excellent care of me.” “If it hadn’t been for Southlake, he would not have survived,” Mrs. Burk adds. During his recovery, Mr. Burk took Dr. Goldman’s advice about making heart-healthy lifestyle changes. He paid attention to what he ate and lost 20 pounds. He committed to regular exercise, including 16-to-25-kilometre (10-to-16-mile) bike rides three to five times a week during the warmer months. Three months after his procedure, the Burks were in Peru climbing Machu Picchu. The Burks made their first donation— earmarked for cardiac care—to Southlake Regional Health Centre Foundation that year, and have continued to give yearly. They have also seen friends and acquaintances benefit from the knowledge and expertise of the doctors and staff from the cardiac program. “We are so fortunate to have them, they’ve taken care of so many people,” Mrs. Burk says. “We’re truly lucky to have them.” Their support of Southlake is an extension of the Burks’ long-time passion for community health care. When he owned a Barrie-based robotics business, Mr. Burk initiated a program where employee contributions to Royal Victoria Hospital were matched by the company. He is currently championing plans to expand the emergency department at Georgian Bay General Hospital in Midland by soliciting support from local industry. The couple makes regular personal donations to all three health care facilities. Mr. Burk says there are a few reasons for this. One, he is grateful for the top-notch care he has received at his local hospitals. Two, he

BOB AND SHEILA BURK

knows financial contributions from the community pay for essential equipment. Three, he believes if you’re able to give, whether a lot or a little, it’s the right thing to do. “If our contributions enable someone else to have more time with their grandchildren, with their family and friends, that is really one of the most compelling reasons we’ve got for giving,” he says.

Focused on Your Health Aurora Cardiovascular Centre Dr. J. Bishinsky, FRCPC Dr. O. Ryzhak, FRCPC SPECIALIZING IN

Heart Disease 372 Hollandview Trail, #304 Aurora, ON Tel: (905) 713-1300 • Fax: (905) 713-1302 Appointments by referral only

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IN CARE

Donations honour late club member B y J oann macdonald

The staff and members of Aurora’s Timberlane Athletic Club are all too familiar with the importance of heart health. While the club’s community has a long history of charitable giving, it boosted its commitment to cardiac health after the sudden loss of club member Stephen Dupuis. Mr. Dupuis died unexpectedly of heart complications at the age of 52. “He was a very popular member with a big personality. Everybody knew him,” says Timberlane general manager John Ramsbottom. “It was very sad.” Although Timberlane began fundraising for Southlake in 2008, the death of Mr. Dupuis inspired staff and members to increase their efforts. Their first-year goal of $3,000 in 2008 doubled the following year to $6,000. In 2011, the club raised $34,000 through its Heart of Gold campaign in memory of Mr. Dupuis. “We really expanded the types of things we did for that campaign,” Mr. Ramsbottom says. “With Stephen and how much he was loved in the community, we were really able to grow into the community and triple what we had done in the past.” It is only fitting to pay tribute to the wellliked club member, notes Mr. Ramsbottom. Mr. Dupuis, who was the CEO of the Building Industry and Land Development Association, was somebody who regularly gave back to the community. He was a strong advocate for Habitat for Humanity and had been organizing a fundraising event before he died. 40

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TIMBERLANE STAFF AND MEMBERS SUPPORT SOUTHLAKE FOUNDATION, INCLUDING (FROM LEFT) Tamara Van Bakel, Dianne Ingwersen, Julie O’Neill, Sarah Cohen AND Allyson McLaughlin.

Since 2008, Timberlane Athletic Club has raised $81,000 for Southlake to support cancer and cardiac programs—and is well on target to increase the total to $125,000 by 2017. The bulk of the funds come from the club’s annual holiday season events, including a popular ladies luncheon. “It’s a team effort,” says assistant manager Dianne Ingwersen. “It’s over and above the regular day’s work. We’ve got some committed people. We work together to create a nice time for our members with the added bonus of presenting a cheque to Southlake at the end.” Timberlane staff are brainstorming ways to continue fundraising throughout the year. They are planning a tennis Calcutta for the spring. The event will team up strong tennis players with partners of lesser abilities. The teams will then be “sold” at auction, with the buyer of the winning team dividing proceeds with Southlake. Timberlane also supports cardiac health with its Heart Wise program, offering fitness classes for patients preparing for and recovering from surgery. The club worked with Southlake’s cardiac unit to develop safe and beneficial programming for people with heart conditions. Timberlane is proud to support Southlake’s Images for Life campaign. The club has designated funds for both the interventional radiology suite for cancer patients and the 3 Tesla MRI, which will benefit both cancer and cardiac patients. Ms Ingwersen has been on

tours of the hospital and has chatted with staff about equipment needs. “It has been an eye-opening process,” she says. “Medical equipment is very costly. It’s important to continue to fundraise for the hospital’s ongoing needs.” Neila Poscente, president and CEO of Southlake Foundation, explains the new equipment will allow more residents to get the tests they need at their local hospital. “Our Images for Life campaign will provide the essential new diagnostic imaging equipment needed to guide treatment of our patients,” she says. “Every year, thousands of people in our community travel to Toronto for care because Southlake’s MRI has a current wait time of over 100 days for non-urgent cases and does not have the capacity to provide advanced cardiac and breast imaging, needed by so many of our patients. A second MRI will let them get that care, right here in our community. “On behalf of our community, we thank Timberlane Athletic Club and membership for their leadership and commitment in helping us ensure Southlake is able to offer best in class cardiac care, right here, close to home.” Mr. Ramsbottom says fundraising for Southlake is a great fit for Timberlane. “We are fortunate to have a state-of-the-art facility right up the road that serves a lot of our members. It’s our hospital. The community of Timberlane giving back to York Region is one of the things I’m most proud of.”

I’M ALIVE BECAUSE I LIVE CLOSE TO SOUTHLAKE. PLEASE SUPPORT CARDIAC CARE AT SOUTHLAKE.

YOUR GIFT WILL HELP MORE DOG OWNERS LIKE BOB … LIVE LIFE … WELL. READ BOB’S STORY AT SOUTHLAKEFOUNDATION.CA SP RI N G 2 0 1 4

marlene’s

MEAL MAKEOVERS

Oatmeal for the soul If you grew up on a steaming bowl of oatmeal in the mornings, you can thank your parents for getting you off to a great start. Oats are loaded with a soluble fibre called beta-glucan, which has been proven to help lower cholesterol levels. Their antioxidant properties also help protect the healthy LDL cholesterol from free radicals. In this trio, we create a big batch of hearty oatmeal cookie dough that can be added to buckwheat pancakes or baked as is and made into ice cream sandwiches. BY MARLENE MACPHERSON

Cook Once Oatmeal Raisin Cookies Makes 5 dozen cookies

Produce 1 Oatmeal Cookie Buckwheat Pancakes Serves 4

Produce 2 Oatmeal Cookie Sandwiches Makes 6 sandwiches

Ingredients 750 mL (3 cups) rolled oats 250 mL (1 cup) whole wheat flour 5 mL (1 tsp) baking soda 5 mL (1 tsp) baking powder 2 mL (1/2 tsp) cinnamon 1 mL (1/4 tsp) ginger 2 mL (1/2 tsp) sea salt 175 mL (3/4 cup) room temperature unsalted butter 125 mL (1/2 cup) honey 175 mL (3/4 cup) brown sugar 2 large eggs 5 mL (1 tsp) vanilla extract 300 mL (1-1/4 cups) raisins

Ingredients 375 mL (1-1/2 cups) buckwheat flour 7 mL (1-1/2 tsp) baking soda 3 mL (3/4 tsp) baking powder 1 mL (1/4 tsp) sea salt 10 mL (1 tbsp) honey 2 eggs 375 mL (1-1/2 cups) plain yogurt 125 mL (1/2 cup) milk 125 mL (1/2 cup) orange juice 250 mL (1 cup) Oatmeal Raisin Cookie dough from Cook Once butter or oil for cooking

Ingredients 12 Oatmeal Raisin Cookies from Cook Once 375 mL (1-1/2 cups) vanilla frozen yogurt, slightly softened

Method Preheat oven to 350 Fahrenheit. In a large bowl, combine oats, flour, baking soda, baking powder, cinnamon, ginger and salt. With an electric mixer on high, beat butter, honey and sugar until pale and fluffy. Reduce speed to low, add eggs and vanilla and mix until just combined. Add dry ingredients, mix until just combined, then fold in raisins. Reserve 250 mL (1 cup) of dough in the fridge for Produce 1. Drop heaping tablespoons of dough onto baking sheets lined with parchment paper and flatten slightly. Bake until golden and just set, 13-15 minutes. Store or freeze in an airtight container. Reserve 1 dozen cookies for Produce 2.

Method In a large bowl combine dry ingredients. In a separate bowl, lightly whisk eggs and add remaining liquid ingredients, stirring until well blended. Add cookie dough to wet ingredients and stir until incorporated. Add wet mix to dry mix and gently fold. Ladle portions onto a hot, lightly greased griddle and cook until bubbles appear on the uncooked surface. Flip and cook for a few minutes more. Serve hot with maple syrup or agave nectar.

When choosing frozen yogurt for Produce 2, you can select a low fat version but be careful of low-calorie options that use artificial sweeteners. It’s better to have a few extra calories than a few extra chemicals. 42

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Method Scoop 60 mL (1/4 cup) of frozen yogurt onto a cooled oatmeal cookie and carefully smooth it to the edges. Carefully press another cookie on top to create the sandwich. You can take the back of a spoon and run it around the sides to create a smooth finish. Wrap in plastic wrap and put in the freezer for at least 30 minutes before eating.

Bradford resident Marlene MacPherson was a hurried and harried executive until she was diagnosed with breast cancer in 2008. She has since made her life about balance, family and wholesome, healthy food. For more information or to purchase her most recent cookbook, visit marlenesmealmakeovers.com.

Community Event Listings Polo For Heart June 20, 21 and 22 Gormley Polo Centre, Richmond Hill Information: poloforheart.org Supporting Southlake’s Regional Cancer Program

Optimist Club of Newmarket’s 2nd Annual Poker Ride Pre-Dance Saturday, May 24 Contact: Janice Asselstine, 905-895-0863, janiceasselstine@rogers.com; newmarketoptimists.org Supporting Paediatric Oncology THE LAKE RIDE Sunday, May 25 Information: thelakereview.com 9th annual Ballantrae Wine & Food Festival Monday, June 2, 2014 Tickets: philbannon.ca, 905-640-7422 Supporting Regional Cardiac and Cancer Programs JBD Financial Solutions Annual Charity Classic Wednesday, June 4, noon to 8 p.m. St. Andrew’s Valley Golf Club Contact: Blair Dunlop, 905-751-4237, jbdfinancialsolutions@gmail.com Supporting Southlake’s Regional Cancer Centre 7th Annual Walk of Life hosted by Southlake’s Cardiovascular Prevention and Rehabilitation Program Thursday, June 19, 6 p.m. Contact: Michelle Williams, 905-895-4521, ext. 5308, southlakewalkoflife.ca Help raise $40,000 to support local cardiac care.

Optimist Club of Newmarket’s 2nd Annual Poker Ride Saturday, June 21 Contact: Janice Asselstine, 905-895-0863, janiceasselstine@rogers.com; newmarketoptimists.org Supporting Paediatric Oncology Commport’s 5th Annual Charity Golf Tournament Thursday, June 26 Station Creek Golf Club Individual golfer fee $150; foursome $550 Information: commport.com/golf2014 Supporting Southlake’s Regional Cancer Program Wooden Sticks “Chip” In for Cancer Research & Treatment, in honour of Laurie Buckland Tuesday, July 8 Temagami Scramble, 8 a.m., includes buffet lunch Buckland Classic Pro Am 1:30 p.m., includes dinner Contact: 905-852-4379, info@woodensticks.com

Polo For the Cure WoMen’s Polo Tournament Sunday, July 20 (finals) Fox Den South Field, 13401 Leslie St., Richmond Hill Contact: Donna, uniquelyequine@sympatico.ca; poloforthecure.com Supporting breast cancer Orchard Beach Pro-Am Charity Tournament Tuesday, July 29, noon to 8 p.m. Orchard Beach Golf Course Contact: Corey Helm, obgcc@bellnet.ca, 905-4765910; Donna Cryderman, 905-895-4388, dcryderg118@rogers.com; orchardbeachgolf.com Supporting Southlake’s Regional Cancer Centre Products & services supporting Southlake Stretch Thrift Outlet and bin locations Accepting gently used clothing, housewares, furniture donations 6 The Queensway S., Sutton 26602 Hwy. 48 N., Sutton West Portion of proceeds support the Regional Cancer Program Benson Kearley IFG Insurance Brokers & Financial Advisors $10 to Southlake for every no obligation quote

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last WORD

by C athy J aynes

There are a lot of things you can’t control, but there are some things you can. Living a longer and healthier life starts by cutting out risk factors—smoking, stress, alcohol and physical inactivity, to name a few. All of these put you at risk for chronic illnesses such as heart disease and diabetes. Take control of your health by making small changes in the way you live. According to Public Health Ontario, we can add almost four years to our lives if we lower our greatest risk factors. Research says that 37 per cent of us need to become more physically active, 29 per cent need to improve our diet and 22 per cent have to quit smoking. Small changes not only have a big impact on our health, but on the health of our children and families. When adults model healthy behaviours, kids take these skills into their adult lives and have healthier futures. Showing children healthy habits early on is a powerful way to protect them from illness later in life. The Regional Municipality of York promotes four everyday choices for better health.

Be active together Find fun activities to do as a family to raise your heart rate and keep your heart healthy. Children aged five to 17 need at least 60 minutes of moderate to vigorous activity per day. Adults aged 18 and older need at least 2-1/2 hours per week. Being active can be simple and fun—take a walk after dinner, plan a hike in the beautiful York Region Forest, tune up your bike and take it for a ride in your neighbourhood or

ADD LIFE TO YOUR YEARS AND YEARS TO YOUR LIFE park your car a distance from your destination and walk a block instead. Don’t forget to check out your local parks and recreation centres for inexpensive physical activity programs and drop-in opportunities. Pedometers can be a fun tool to get you moving—they allow you to set goals, engage in friendly competition and measure your fitness level. Aim for 10,000 steps a day for maximum health benefits. Don’t have a pedometer? No problem! Check out York Walks!, a pedometer-loan program available in many local libraries.

Take time to eat together Eating together as a family—dinner, breakfast or snacks—usually leads to healthier eating. Get children involved with their own food choices too. Allow them to prepare meals with you and have fun cooking. For better health, work towards eating more fruits and vegetables. For healthy food ideas, tips or to sign up for email bulletins, check out Cook Up Some Fun! at york.ca/nutrition. Make smoke-free spaces where you live, work and play Tobacco use is the leading cause of death in Canada and has negative effects for all ages. Exposure to second-hand smoke is particularly harmful for children as it increases their risk of sudden infant death syndrome as well as heart disease as they become adults. To keep your family healthy, make spaces smoke-free where you live, work and play.

Do you have a public health-related question? Call York Region Health Connection at 1-800-361-5653.

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Talk about alcohol use Alcohol is the drug most commonly used by teens. Having candid and open conversations with children and teens can influence their decisions about drinking. When alcohol use is delayed, there is less chance of alcohol dependency later in life. To help your kids develop healthy life skills, be a good listener and have reliable information to share. This arms them with information to make healthy choices. Making everyday changes to your life and becoming a healthy role model will help you and your family avoid chronic disease. You’ll even have more fun along the way!

Cathy Jaynes is the director of the healthy living division at York Region Community and Health Services Department.

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