Navigating Your Way Through Ontario’s Health Care System
N AV I G AT I N G Y O U R
HEALTH The New Model for Integrated Care
COBALT-60
How it's keeping us safe
NAVIGATEMAG.CA
FIBROMYALGIA Inside one woman's battle
AN INTRO TO: Naturopathic Medicine
ISSUE 1 2020
Publisher’s Letter Navigating Your Way Through Ontario’s Health Care System
There is nothing more important than our own and our families’ health, and with that in mind, we are so proud to publish Navigate magazine, created to help bring Ontarians relevant and personal information on ways to “navigate their way through Ontario Health Care System.” With all the changes to our health care system currently taking place province-wide, it can be difficult for the average family to find out where and to whom they should go for care, what options are available, and what they are entitled to through our Ontario Health Insurance Plan (OHIP). Basic medical rights can get lost in the changes to our system. I encourage everyone to get informed about the health care choices available to both themselves and their family members. With this inaugural edition of Navigate, we offer insight into the New Integrated Health Care Teams that are replacing the previous LHINs network. You can find an introduction to these changes in the story on page 12. Change doesn’t have to be scary, all systems can be improved, and this new way of doing things is a way to improve on all the great care options we currently have in this province. Let’s not lose sight of the fact that in Ontario we have free access to some of the best medical care and caregivers in the world. We are very lucky. We encourage you to take care of your own health and be your own advocate by learning about the options that are available to you. Find out about your options for discharge from a hospital on page 2, learn from a personal account of one woman’s battle with fibromyalgia on page 14, get a comprehensive introduction on how to navigate the Naturopathic Health Care System from Dr. Kate McLaird on page 16. I want this magazine to have the information you need to get the best care possible and to learn how to live as healthy a lifestyle as possible, no matter what medical challenges you are dealing with. I want to hear from Ontarians just like you about what you most want to read and learn about in this publication. I want to help you and all Navigate readers be able to ask your caregivers and doctors the right questions in order to receive the medical care you deserve. Write to me at audra@graymatterms.ca.
In good health and wellness,
Improving the
PUBLISHER Audra Leslie
E d it or ia l & D e s i g n PUBLISHING COORDINATOR Helena Barnett ART DIRECTOR Kat O’Donnell GRAPHIC DESIGN Cole Mendoza WRITERS Bailey Sargent Helena Barnett STORY CONTRIBUTORS Cathy Dandy Dr. Kate McLaird Jordan Higgins OPG PHOTOGRAPHY Shutterstock PROOFREADER Tim Prior PRINTING Barrie Press
Navigate is published by
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E d it or ia l No te
Audra Leslie, Publisher of Navigate Magazine Owner of Graymatter Marketing Solutions
The information provided in this magazine is for educational and informational purposes only. It should not be used as a substitute for the advice of a qualified and licensed practitioner or health care provider. The opinions expressed here are not necessarily those of Graymatter Marketing Solutions, its affiliates or parent company. Different views may appear in future articles or publications. Articles in Navigate are copyrighted and must not be reprinted, duplicated or transmitted in any way without permission.
INSIDE HOW TO PLAN YOUR HOSPITAL DISCHARGE.................................2
ANCIENT REMEDIES WITH MODERN SCIENCE................................4I m p r o v i n g t h NAVIGATING THE PUBLIC SCHOOL SYSTEM WITH CHRONIC ILLNESS..............................................................6 IF YOU'RE IN A CRISIS, MAKE THE CALL.......................................8 HOW COBLAT-60 KEEPS ONTARIANS SAFE..................................10 THE NEW MODEL FOR INTEGRATED HEALTH CARE IN ONTARIO.........................................................12 FIBRO WARRIOR: ONE ONTARIO WOMAN'S LIFE WITH FIBROMYALGIA....................14 INTRO TO NATUROPATHIC MEDICINE..........................................16 THE FLU AND YOU....................................................................18 ORGAN AND TISSUE DONATION: THE FACTS................................20
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How to Plan your Hospital Discharge
M
ost people who have spent time in a hospital might say that getting discharged is the light at the end of the tunnel. Returning home after a stay in a medical institution can be a significant transition, and proper steps must be taken to ensure the patient is truly on their way to recovery. But this can’t be done without following the proper steps of discharge planning. Families should be taking steps on the day of admission to discuss their discharge with their health care team; this could take place with either their doctor or nurse. With an idea of when the health care providers think they can go home, the family and patient can begin their planning for discharge right away.
Evaluation
The doctors, nurses, and other medical staff that tend to you during your hospital stay will assess you based on your abilities and your improvement. Whether it was surgery, a slip and fall, or perhaps something more serious like a heart attack or stroke, each hospital stay requires different consideration and recovery. The medical personnel want to be sure not only that you are fit to go home, but that it will be an environment conducive to your recovery. Ask to be assessed by occupational therapy (OT) or physiotherapy (PT) if you have had a significant change in functional status since admission. Both OT and PT have a wealth of resources and referrals for home discharge.
Discussion
The discharge discussion will be one of the most significant talks you have with your medical team, particularly after major surgery or an extended hospital stay. This is your opportunity to ask for expert opinion, voice your concerns, or simply discuss your feelings. The medical team is likely to look at your condition and overall health before you entered the hospital, where you are physically after your hospital stay, and what your personal health and recovery goals are over the next few months. Coupled with their expert opinion, they can discuss a rehabilitation plan that will help get you to where you want to be and where they’d like to see you. Social workers are an excellent resource who can coordinate complicated home discharge, especially if there are multiple factors involved such as housing, financial, and family situation concerns.
Planning
Planning for your discharge is what will help the transition go smoothly. Use this opportunity to map out the coming days, weeks, and months of your recovery. Consider all factors, establish your support 2 | www.navigatemag.ca
system, and put things in place so that you have what you need throughout your recovery. Ontario's Local Health Integration Network Home and Community Care Services provide Care Coordinators that can help with this stage of assessing for home care services. These services can include Personal Support Worker (PSW), nursing, PT, OT, speech language pathology, dietitian, and medical equipment supply.
Determining next steps
Should you go home? Or perhaps be transferred to another medical facility? Considering where to go next can be a tough, but crucial decision. Whether you need a live-in caregiver or the help of a relative, ensure your next steps are attainable and beneficial to your recovery. Most hospitals have home care coordinators available right in the hospital, including the ER. It is important to note that anyone can ask to be referred to home care—it doesn’t need to be done by the health care team.
Referrals
If another medical facility is considered to be a better option than returning home, it’s crucial to find the facility that’s right for you. But don’t just take what’s suggested. Take your time to research the option best for you. If it is in fact another medical facility, arrange a phone consultation to decide whether it’s a viable option. Look up places online to see whether you’ll be comfortable there. Remember, this is where you’ll be recovering—you want to feel like you are home, even if you’re not. Home and community care coordinators are able to refer you to service providers like meals on wheels, cleaning services and companions.
Arranging follow-ups
Follow-up tests and appointments are key to making sure your discharge is going as planned. It’s important that your doctor sees you’re progressing, recovering, and readjusting to life at home well. It’s also another opportunity to go back to the discussion step where you can ask for that expert opinion, voice your concerns, or discuss your feelings. A lot changes once you’re discharged, and making sure that you’re adjusting well mentally is just as important as seeing progress in your physical recovery. If you think you or your loved one is being discharged too soon, get multiple expert opinions. And most importantly, don’t leave until you or your loved one feels ready.
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In my home town of Parry Sound, Ontario, “It took one girl’s dream to bring together a community�. Before my sister, Dr. Rachel Higgins, O.D., lost her battle with cancer in August 2005, she and my mother Joanne started the R.A.C.H. 3-Pitch Baseball Tournament to bring together family and friends for a fun filled day, but to also raise funds and bring awareness to her disease. Over the 15 years that the event was held, our community raised over 1 million dollars for brain tumour research at the Princess Margaret Hospital. I lost my sister and brother to cancer at the ages of 25 and 31. At the age of 22, I was diagnosed with testicular cancer. When genetic testing couldn’t solve the riddle of these rapidly growing cancer cells, I didn’t know where to turn to find the answers. Maybe it’s the result of environmental contamination, stress, or neglected emotional trauma left unexpressed without a channel of release. Nine years have passed since a selfassessment led to the discovery of my cancer and removal of my left testicle a single day
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Our products are created not as an alternative to current medical practices, but as something that would be complementary to help people get back to what we all need to do daily: MOVE. We believe in the ability of our combination of LifeSpice Cacao Mushroom Blend and Dock Walkers Powerful Pain Relief to increase cognition, promote long-term brain health, and tackle inflammation and pain. Higgins and Phillips Innovations was cofounded by Kris Phillips, B.S.P., R.Ph. and myself, Jordan Higgins, B.Sc., in 2018, and from the beginning, we have strived to embody our corporate motto, “Inspired by Passion, Powered by Innovation, Backed by Science.” The preliminary anecdotal and blood analytical results obtained from a select number of LifeSpice customers suffering from diabetes have motivated us to initiate a pilot study, collaborating with Dr. Tom Higgins, M.D. and Hani Jaber, R.Ph., to
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Navigating Your Way Through Ontario's Health Care System | 5
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Navigating the Public School System with Chronic Illness The challenges of supporting a child or teen with a chronic illness are daunting. The fear, the exhaustion, the work to get a diagnosis and then to attend appointments takes a physical and psychological toll. What often gets forgotten is the additional stress of figuring out how a child can stay connected to schooling and not fall behind in a way that puts up roadblocks to future success. Navigating the school system to get accommodations and support either in school or while in hospital is a challenge many families and caregivers face. There are concrete ways a school can help children and families cope and stay connected to learning while treatment is ongoing, but few families know that it is possible or how it can be done. Families may struggle to stay connected to the school, to adequately explain the challenge, and to find an educator in the building who will take the lead on making learning possible during the illness. The Ontario Human Rights Code states that school boards have a duty to accommodate those who are facing mental or physical disabilities. This includes illness that prevents a student from attending school or causes the student to attend only parttime. Accommodations can take the form of reduced workload, access to learning online, support from the teacher or special education staff at school to ensure the student keeps up with the in-class learning, additional time to complete work while at school, and facilitating peer tutoring if the child and peers are old enough. It is common to hear from schools that resources are scarce and that some of these options are not available. The best way to work with the school to build an education support plan for the child or teen is to request a meeting with the teacher and principal to discuss the situation. It is wise to invite another adult to the meeting as an “ally”–someone who is not a parent/ caregiver but is concerned for the child’s wellbeing and is less emotionally involved. This person can function as a supportive pair of eyes and ears and take notes and keep track of “to do” items. If the child or teen is old enough and feels comfortable, they should attend the meeting to offer their perspective. Prior to the meeting, it is helpful to share with the school any documentation that is available about the child’s illness. This should be done with the child’s permission if she or he is old enough to understand, and it should not contain information that any family member feels uncomfortable sharing. The school is bound to keep what is shared confidential and that can be confirmed prior to sending the documents.
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Everyone should be clear at the outset that the purpose of the meeting is to create a collaborative plan to support the child while he or she is facing the challenge of a chronic illness. It is important to work with the following principles: 1) Collaboration is the key to effective support. 2) The Ministry of Education provides funding to support students with disabilities including chronic illness. It is the right of the child to be educated according to the Ministry and the Human Rights Commission. 3) If resources seem scarce, and the school does not feel they can provide effective support, the superintendent of the school should be contacted and involved in the discussion. School superintendents are responsible for helping schools carry out their mandate of educating all students and can access special resources. 4) There are others who can help bring the plan together including the superintendent of special education and the local school board trustee. 5) Finally, it is important that the family does not take on the responsibility of designing or implementing the support plan. Whenever it feels like things are stuck or the family is expected to make learning happen, the question to educators is, “What will you do to ensure my child continues to learn and maintain her/his place with peers?”. The education system is responsible for ensuring learning. Children and youth who are struggling with illness deserve supports that ensure equity–the ability to maintain their learning and their place in society with their peers. Families and educators can make this happen!
Promoting the Responsible Disposal of Medications and Sharps Did you know that in Ontario, the public can responsibly dispose of their unused or expired medications and used sharps free of charge at over 90% of community pharmacies? The Ontario Medications Return Program and the Ontario Sharps Collection Program are 100% industry funded and designed to give the public an accessible means to dispose of these materials. Free sharps containers are available at pharmacy counters. Sharps not placed into approved sharps containers are not considered safe for transport. Bleach bottles are not approved containers. Ontarians have access to the free 4.5 L sharps containers at over 3,500 locations province wide. Encourage patients to visit www.healthsteward.ca to find their nearest participating pharmacy for free sharps containers and disposal.
Cathy Dandy Cathy Dandy runs a consulting business that helps families navigate and advocate for their children in the public education system. Her experience working with families comes from 15+ years as an education activist, two terms as a trustee in the Toronto school system, a previous career as Director of Family and Youth Engagement at Kinark Child and Family Services, a master’s degree education at OISE, and raising three lively children. All three have emerged from the public system and are happily making their way in the world!
And remember: medications should not be flushed or poured down the drain. Remind patients that they should bring their unused and expired medications back to the pharmacy. Pills should be placed into clear plastic bags with their outer plastic and cardboard packaging recycled. Liquids and prescription creams should be returned in their original bottles.
www.cathydandy.ca Navigating Your Way Through Ontario's Health Care System | 7
, S I S I R C I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
If You're in a
l. l a C e h t e k a M
1 in 5 people will suffer from some sort of mental health disorder in their life. If you are experiencing a mental health crisis yourself, or you know someone who is, here is what you should do: • Call 911 or go to the nearest emergency department or hospital. • Contact a nurse at Telehealth Ontario at 1-866-797-0000. • For all mental health services in Ontario, call 24/7, toll-free 1-866-531-2600, to access support for mental health, addiction and problem gambling services. This is a free and confidential service. • Contact your doctor. • Find a local distress centre near you. Distress or crisis phone lines are open 24/7 and offer free, confidential, and anonymous telephone counselling and information. Mental health is more than the absence of a mental health condition or illness: it is a positive sense of well-being, or the capacity to enjoy life and deal with the challenges we face. Mental and physical health are fundamentally linked.
YOU A
notRE ALO NE!
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Some people worry about asking for help because there can be stigma around mental health problems. Asking for help means that you want to make changes. We should celebrate the courage it takes to speak up. Getting help is part of recovery. Building a support team is critical–no one should ever have to follow their journey on their own. • Talk with supportive friends and family. Share your feelings with them and let them be part of your team. • Talk to your family doctor. They are a great resource and can link you to other professionals, if needed. • Connect with community mental health clinics or organizations like the Canadian Mental Health Association (CMHA) for information, support, and services. • Call a help line. Some organizations also offer support online or through text messaging. • Learn more about mental health. You can find useful books, websites, and other resources through your provincial or territorial government and community agencies. • Connect with others who have personal experience with a mental illness and learn more about their recovery journey. • Talk with a member or leader you trust from your faith or cultural group.
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How Cobalt-60 Keeps Ontarians safe Sponsored by
For decades, Ontario’s nuclear generating stations have been the source of a product that keeps millions of people healthy and safe.
Molybdenum-99 in North America, ensuring a stable domestic supply of this critical product,” says Ken Hartwick, OPG’s President and CEO.
Aside from producing the clean, reliable energy we benefit from every day, Ontario Power Generation (OPG) and Bruce Power, together with Nordion, an Ottawa-based health science company, supply fifty percent of the world’s Cobalt-60, a radioactive isotope used to sterilize medical equipment and supplies, keep food products safe, as well as treat cancer and other diseases.
Given the effectiveness of Cobalt-60 for medical device sterilization, and cancer treatment, Canadian scientists are looking at other medical isotopes that can be produced in our CANDU nuclear power plants to improve the lives of Canadians. OPG is currently working on a project to produce Molybdenum-99 at Darlington Nuclear Generating Station. The more advancements in production and application of nuclear medicine, the better the results will be for personalized medicine.
Hospitals around the world rely on single-use medical supplies (syringes, gloves, masks, sutures, IV tubing sets, and many other supplies), which have been sterilized off-site using Ontario-made Cobalt-60. High Specific Activity Cobalt-60 is instrumental in radiation therapy treatment to shrink tumours. About 70,000 patients have undergone surgery using the Elekta Gamma Knife, used to treat head and neck cancers. The World Nuclear Association believes the demand for radioisotopes will continue to rise by five percent on an annual basis. OPG and Bruce Power signed a Memorandum of Understanding that will see the companies work together to ensure a steady long-term supply of Cobalt-60 as operations at Pickering Nuclear Generating Station wind down in the coming years. This includes working collaboratively to assess expanding Cobalt-60 production to OPG’s Darlington Nuclear Generating Station. “OPG has been producing Cobalt-60 since the 1970’s. As the demand for radioisotopes continues to grow, OPG is working to expand Cobalt-60 production to our Darlington Nuclear Generating Station. Last year we announced production of Molybdenum-99, a life saving medical isotope that helps to detect illnesses like cancer and heart disease. Darlington Nuclear will be the only source of
“Bruce Power is one of the world’s largest suppliers of Cobalt-60 used to sterilize 40% of the world’s single use medical devices and for the treatment of some forms of brain tumours. The investments we are making at our site will ensure a reliable and low cost supply of Co-60 to 2064. Bruce Power is also advancing an initiative to help produce Lutetium-177, a medical isotope used to treat prostate cancer. With demand for isotopes growing each year, Canada has a unique opportunity to expand and cement its leadership position in this innovative industry,” said Mike Rencheck, President and CEO of Bruce Power. That’s why power generators like OPG and Bruce Power, together with Nordion, are dedicated to ensuring there is a steady, reliable supply of Cobalt-60 for Ontario and the world. “This made-in-Ontario solution impacts the lives of people around the world every day,” said Kevin Brooks, President of Nordion. “We should all be very proud of our role in safeguarding global health.”
An aerial of OPG’s Pickering Nuclear Generating Station. 10 | www.navigatemag.ca
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A product of the nuclear fission that takes place inside a CANDU reactor, Cobalt-60 is produced by irradiating Cobalt-59 adjuster rods that have been inserted into the reactor. During this process, Cobalt-59 absorbs a neutron and a change occurs at the atomic level to become radioactive Cobalt-60. At each planned maintenance outage, the Cobalt-60 adjuster rods are removed, processed and safely loaded for shipment. As Cobalt-60 emits gamma radiation, it is an ideal isotope for medical and industrial applications. The isotope is also used to irradiate food products, ridding them of harmful bacteria, spoilage organisms, and insects without affecting the foods’ taste, colour, texture or nutritional value.
Harvesting Cobalt-60 which is a vital part of our health care system. Navigating Your Way Through Ontario's Health Care System | 11
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The New Model for Integrated Health Care in Ontario An Introduction to Ontario Health and Ontario Health Teams There is no question that Ontarians have access to an incredible health care system provided by some of the best health care workers in the world; but that doesn’t mean that there isn’t room for change and improvement. Long wait times, busy ERs, and patients having to worry about navigating the current system on their own without a proper support network, are all issues that need to be addressed. Patients and families find it difficult to navigate the current system. It may be a matter of not being able to find timely health care, due to long waittimes or inconvenient service hours. For others, it can be difficult to know where to go for the right kind of care. By not knowing how to access community services or waiting too long for a service because there are not enough available, many people reach a crisis point that leads them to the emergency department.
From here, local health care providers will be empowered to work as a connected team called Ontario Health Teams (OHTs). OHTs are groups of health care providers and organizations that are clinically and fiscally accountable for delivering a full and coordinated continuum of care to a defined geographic population. The OHTs will implement the plans from Ontario Health. The OHTs will provide a new way of organizing and delivering services to their defined population area. Under the OHT’s, the health care providers, including hospitals, doctors, and home care providers, will work as a coordinated team no matter where they provide care. This means that patients and families will have access to better and more connected services and will wait less for these services. Providers will work together to provide integrated care; integrated care looks at the whole person, not just the illness. Patients and caregivers will have access to help in order to navigate the system, to answer questions and to understand their circumstances.
Either way, too many patients are ending up in the ER, waiting hours for care that may have been more appropriately provided in a different care setting, or avoided entirely, by proactive and preventative measures. These challenges with navigation and timely access also contribute to the problem of hallway health care. Hallway health care is a term used when patients are waiting for a hospital bed in an unconventional location.
OHTs are a brand-new way of organizing and delivering services for patients; responsible for delivering all the care, understanding their health care and history needs and directly connecting them to the different types of care they need. As this model is phased in, OHT’s will coordinate and deliver services such as: primary care, hospital care, rehabilitative care, home and community care, residential long-term care, and mental health and addictions care.
Visiting the emergency room for health care that could be provided somewhere else happens frequently in Ontario, sometimes because it’s the only health care setting that is open 24/7. According to the 2018 Health Care Experience Survey, 41% of Ontarians who went to the emergency department and 93% who went to a walk-in clinic received care for a condition that could have been treated by their primary care provider.[1]
In addition to the clinical care services mentioned, the OHT changes will also incorporate the often overlooked social determinants of health. These can include adequate housing, access to transportation, poverty and low-income demographic concerns, and assistance for marginalized groups who may require social supports in addition to the typical clinical care providers.
Focus on preventative care initiatives and engagement with primary care providers could help reduce the number of people seeking care in emergency departments and hospitals. The current government is working towards making changes to help build a public health care system that will aim to improve people’s access to the care that they need, where they need it. Integrated care is key to improving patient care, experience, and outcomes. The goal is to create better, faster, more connected care for patients, regardless of where they are in their health care journey.
Patients will have help in navigating the public health care system 24/7. Teams would support continuous access to care and the transition as patients move between one provider to another, even to receive care in different locations or health care settings.
By consolidating the current model of multiple health care agencies and organizations into a single agency, Ontario Health, the province can oversee health care delivery and provide support to enable better quality care for patients. This is an agency with a formal Board of Directors that will facilitate all the planning at a provincial level. Organizations that would be transitioned into this new model include: Cancer Care Ontario, Health Quality Ontario, eHealth Ontario, Trillium Gift of Life Network, Health Shared Services Ontario, and Local Health Integration Networks (LHINs). Resources for this article:
Under the OHT model, patients will continue to be able to choose who provides their health care and have better access to choices available through technology. This could include secure access to digital health services, access to electronic health records, and virtual care options. By expanding digital care options, care providers will be able to quickly access information such as specialist advice and clinical support. OHTs will be established in phases across the province. At this time, there are thirty-one OHTs that have been granted approval to bring forward a full business plan; after which, site visits and further approvals will take place. There are forty-five more OHTs to be added in at the next phase.
[1] Ministry of Health and Long-Term Care. (2018). Health Care Experience Survey (HCES), April 2017 – March 2018. http://www.health.gov.on.ca/en/public/publications/premiers_council/report.aspx | https://news.ontario.ca/mohltc/en | https://www.ontario.ca/page/ontario-health-agency http://www.health.gov.on.ca/en/news/connectedcare/ | http://health.gov.on.ca/en/pro/programs/connectedcare/oht/
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As the province works to build a health care system centred around patients, Ontarians will continue to contact their current health care providers
FAQ’s of the new OHT Health Model How will OHTs improve patient care? Integrated care is a key component to improving patient care. The goal is to create better, faster, more connected care for patients, regardless of where they are in their health care journey. Example: A patient needs home care when they leave the hospital. With an OHT, this patient will know before they leave who their home care provider will be, what they will be doing, and when they will arrive. If complications arise for the patient after they leave the hospital, they can be treated by the most appropriate provider within their OHT rather than having to return to the emergency department. What is changing? The goal is to improve the health care experience so Ontarians will have one integrated team of health care providers working together to meet your needs, a medical record that both the patient and the provider can access easily and help to navigate the public health care system 24/7. What is staying the same? During this transition to the new system, Ontarians can continue to access the care they need from the providers they trust. Health care services patients receive will remain uninterrupted. Patients will still go to the same doctor and will have the ability to choose their own provider. Ontarians should remain confident that what is paid for by OHIP today will be paid by for OHIP going forward. What services will the OHTs offer? At maturity, under the OHT model, the following services will be coordinated and delivered to meet individual health care needs:
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Primary care Hospital care Rehabilitative care Home and community care Residential long-term care Mental Health and Addictions Services and care
How will the OHT coordinate care need from different providers or settings?
Providers will have the ability to safely access a patient’s health care record and share it with other members on the team to ensure seamless health care even as a patient is discharged from one provider to the next. The OHT will:
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know the patient’s health history be aware of health care services in that patient’s area help the patient navigate the system 24/7 ensure referrals get to the right place receive and share health records with the patient, including test results provide digital options such as online access to health records and virtual care.
For answers to other questions, visit: https://www.ontario.ca/page/ improving-health-care-ontario as usual to receive the services they need. Until the new model reaches maturity, contact for health care services remains the same. Patients who are supported by providers who may become part of the OHT would not need to sign up or go through any administration process. They would simply experience greater access to care and support from a broader network of other physicians and interprofessional providers, working together as a team. Contact information for health care services remains the same: • If you have a health concern or for your everyday health care needs, continue to contact and visit your doctor, nurse practitioner, community health centre, family health team, or Aboriginal health access centre as the first step. • For medical emergencies, call 911 or go to the emergency department. • To get fast, free medial advice, 24/7, call Telehealth Ontario toll free at 1-866-797-0000 or toll-free TTY at 1-866-797-0007. • For home and community care, contact your care coordinator for any questions about your care. For information about the services in your local community and referrals, call 310-2222 (English) or 310-2272 (French)—no area code is required. • To access community mental health and addictions services, call Connex Ontario at 1-866-531-2600 or Kids Help Phone at 1-800-668-6868. Navigating Your Way Through Ontario's Health Care System | 13
FIBRO WARRIOR I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
ONE ONTARIO WOMAN’S LIFE WITH FIBROMYALGIA Brenda Ferri was diagnosed with fibromyalgia in 2012. She had finally won the fight for a conclusive diagnosis, but her fight with the neuroimmune disorder was just beginning. Ferri first noticed recurring pain in late 2010. Having a complicated medical history already (Ferri was diagnosed with Legg-Calve-Perthes Disease at fourteen and had a total hip replacement at thirty four), she brushed it off as the typical aches and pains of getting older for as long as she could. Eventually, though, it started to detract from her ability to function in daily life. Ferri recalls physically struggling to get out of bed, but when she started experiencing sharp pains while trying to shower, she knew she had to act. Ferri’s first step was to make an appointment with her family doctor. However, her widespread and unidentifiable pain led to a less than satisfactory diagnosis. The doctor suggested, perhaps dismissively, that given her age and extenuating history of poor health, she was probably just getting arthritis or depression. She was prescribed a painkiller and sent home without being tested at all. Despite following her doctor’s instructions, the then-forty-four year old continued to experience widespread pain. As a survivor of Legg-Calves-Perthes disease, Ferri was no stranger to pain. Commonly arising in children between the ages of four and eight, the disease involves the partial death of the hip joint, causing hip and leg pain and reduced mobility. She was sent to Sick Kids Hospital in Toronto as a young adolescent and had to endure two surgeries to prolong the life of her hip. Despite the illness complicating her childhood, Ferri was a spirited and athletic person in her youth, playing baseball well into 14 | www.navigatemag.ca
her thirties. But life with her damaged hip grew too difficult when she became a wife and the mother of two young children, causing Ferri to finally have an artificial hip replacement surgery in 2000. Many survivors of Legg-Calve-Perthes disease do suffer from arthritis later in life. Those diagnosed later in childhood, like Ferri, are at increased risk of future problems because the bone is more mature, and therefore less capable of healing than in younger children. These facts may explain why Ferri’s doctor was so quick to leap to a diagnosis of arthritis and depression (mood disorders are also common in those who have experienced life-changing surgeries). However, Ferri’s hip replacement was a total success, allowing her the mobility she needed to spend time with her children and the freedom to be herself. This new pain, ten years later, was something wholly different. Convinced she had been misdiagnosed and still struggling with chronic pain, Ferri returned to the doctor the following year. She explained that the pain didn’t feel like the joint pain of her youth, or even muscle pain, but rather nerve pain. Her determination was successful, but fleetingly so: she was sent to do blood work, but when her results came back normal, she was again dismissed with nothing but a low-grade painkiller to show for it. At this point, Ferri had to seek a second opinion. In early 2012, Ferri started seeing a rheumatologist. She was subjected to numerous tests to eliminate possible causes of her symptoms, but each just confirmed what the rheumatologist already knew: Ferri was a sufferer of fibromyalgia. Finally, she had an answer. Her chronic pain wasn’t in her head; it wasn’t depression; and it had little or nothing to do with her surgical history.
But her journey was far from over. Fibromyalgia is a complex disease to diagnose, and even more difficult to treat. The disease is often miscategorized as an autoimmune disease, but it actually originates in the brain rather than the immune system. Though researchers believe the disease operates by amplifying pain signals that are sent to the brain, much remains to be learned about how and why people get it. There are some links between trauma survival and fibromyalgia diagnoses, but many of those diagnosed with the disorder cannot identify a specific trigger event. Women are also more vulnerable to fibromyalgia than men. Based on this somewhat murky understanding of the science behind fibromyalgia—is it an autoimmune disease? A mental illness? A chronic pain disorder?—there’s no known cure, and treatment plans often have to target each symptom individually. The primary symptoms are chronic pain, fatigue, and a form of cognitive difficulty colloquially known as “fibro fog.” Though her diagnosis did give her the information she needed to seek treatment, Ferri’s search for a medication that actually helped was a difficult one. Moving quickly from Cymbalta to Lyrica to Gabepantin, Ferri found that each of these drugs, regardless of whether they helped with the pain (or, as in some cases, barely made a dent), had side effects that were simply not worth it to her. Now a grandmother, Ferri was more determined than ever to keep her energy up and have a fulfilling life; this meant that the extreme lethargy and weight gain that Ferri experienced while on these drugs was a hindrance she wasn’t willing to tolerate.
those who could not manage without the charity’s support. Her experience with her own disability enriches her career and gives her the passion to keep going, though it can be hard working with fibromyalgia. Along with the Tramadol for the pain, Ferri keeps an extensive set of notes and to-do lists to cope with the forgetfulness of “fibro-fog.” With nearly ten years since her diagnosis, Ferri is still going strong, but she believes in fighting for a better future, not just for other fibrowarriors but for everyone who has to navigate the Ontario health care system. One of Ferri’s most difficult battles now is advocating for her mother, recently diagnosed with dementia and placed in a nursing home. Ferri can see her own past struggles to be heard in the health care system reflected in her mother’s inability to communicate her needs and receive adequate care as a senior. Through Ferri’s battle with fibromyalgia and all the other health problems she’s experienced, either first or secondhand, this is the message she carries with her: “My hope is that our health care system will become easier to manoeuvre through than it is now. My hope is that our seniors will be better taken care of than they are now. My hope is that our children will be better taken care of than they are now. My hope is that my kids and grandkids will have easy access to doctors and specialty doctors if they are sick... I guess I see the future as hope. For me I will wake up every day and continue to do what I do no matter how hard it is… One day at a time. I am a fibro warrior and will keep on fighting.”
Finally, after half a dozen failed medication regimens, Ferri discovered that Tramadol was the best drug for her quality of life. Tramadol is a synthetic opioid painkiller. Though the medication is most often used in post-operative patients, Ferri felt Tramadol produced fewer negative side effects while effectively managing her pain. Though she was initially apprehensive about using painkillers in the long-term, Ferri has accepted that this is the best way for her to live the life she wants to lead in her fifties. Now fifty-three, Ferri is an experienced “fibrowarrior.” Her daily routine involves lots of rest, knowing her limits, and relying on her family. She works with the St. Catharines branch of March of Dimes Canada, an organization which provides resources to Canadians with physical disabilities. Ferri’s job helps people with disabilities live independently, particularly Navigating Your Way Through Ontario's Health Care System | 15
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Hi there! My name is Dr. Kate McLaird, and I am a licensed Naturopathic Doctor practicing in Toronto, Ontario. I have been given the honour of being your guide in navigating your health care from a naturopathic medical perspective within the Navigate publication. We will be exploring evidence-based natural therapies which you may not have realized were available to you. I thought I would start with answering a few of the most frequently asked questions I come across and encourage you to reach out to Navigate Magazine with any others you have. What is Naturopathic medicine?
What do Naturopathic Doctors treat?
Naturopathic medicine is a system of medicine that has been practiced in North America for over 125 years. It is a form of primary health care that utilizes research supported natural therapeutic methods and substances that support the body’s natural ability to heal.
Naturopathic Doctors are primary health care practitioners. They are trained to treat virtually all health concerns from acute to chronic, pediatric to geriatric, and physical to psychological. Naturopathic Doctors work with three main groups of people:
Naturopathic doctors have completed eight years of post secondary education with four years focused in Naturopathic medicine–so you are in very capable hands! Naturopathic medicine is a regulated profession under the Regulated Health Professionals Act (RHPA). This is the same governing body which regulates physicians, surgeons, nurses, and other allied health professionals. More specifically, the College of Naturopaths of Ontario (CONO) regulates the naturopathic doctors practicing in Ontario.
• Patients who are looking for disease prevention and health promotion. • Patients with a range of health concerns and no clear diagnosis. • Patients with chronic and severe illnesses.
What should I expect when receiving naturopathic care? Naturopathic Doctors have the luxury of time, with a first visit typically being an hour in length. This allows the practitioner to integrate several symptoms or conditions you may be experiencing to identify underlying causes and explain why you may be feeling the way you are. We see this as a privilege within the Ontario health care system since appointments with your family doctor are often time restricted. I like to think of ourselves as the detectives for your health, always trying to get to the bottom of things instead of sweeping symptoms under a rug–eventually there won’t be any more space under that rug! 16 | www.navigatemag.ca
What are Naturopathic medical therapies? Our treatments unfortunately do no come in a convenient compact form of a single pill. Because the tools in our toolbox are natural forms of medicine, it is common that we recommend a combination of therapeutic approaches individualized to your case. The goal is to treat the root causes of disease and address preventable risk factors to attain long term sustainable health. • Clinical nutrition–You do not necessarily need to eat a ton of kale everyday! • Botanical and Nutritional supplements–Not all are created equal! Working with an ND ensures you are taking quality products, at the correct dose for therapeutic benefit–or else it truly is just expensive urine. • Acupuncture–ten to twenty acupuncture needles can fit into the syringe used to deliver a vaccine–you can barely feel the prick they are so tiny!
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• Homeopathy–Commonly integrated within the medical field in Europe and safely administered alongside pharmaceuticals. • IV therapy and B12 injections–Bypassing the gastrointestinal system is necessary to deliver certain vital nutrients at high concentrations and can really help people feel better, faster. • Bioidentical hormones–Very effective and safe method to “stay cool” through menopause and decrease cardiovascular and osteoporosis risk in menopausal women. • Counseling and Lifestyle medicine–I wish I could put exercise/movement, sleep, and stress management into a pill form!
How can I find my nearest Naturopathic Doctor in Ontario? The Ontario Association of Naturopathic Doctors is the best place to start. At the top of the webpage, there is a dropdown menu labeled “Find an ND?” You can narrow your search to a city and postal code, and further with a medical area of focus, language preference and if you need a practitioner who offers home visits. www.OAND.org If you are searching for a Naturopathic Doctor elsewhere in Canada, the Canadian Association of Naturopathic Doctors (CAND) is a great resource. www.CAND.ca
Do you run testing to assess and monitor treatment? We will recommend both standard blood work (like your family doctor) as well as specialized testing such as urinary or salivary hormone panels, SIBO breath testing, stool analyses, and food sensitivity panels, depending on what would be most helpful to fast-track and monitor treatment progress for each case. Do I have to stop taking my medication or stop seeing my medical doctor? Unquestionably not! In fact our medicines complement each other! We are the only health care practitioners who are trained to safely and effectively combine prescription medication with natural health products and can help address and minimize possible side effects of medication, help decrease the dose of a medication, and correct nutrient depletions which can occur. We encourage all patients to have and maintain a relationship with their own family doctor and/or specialists and value an integrative and collaborative care model in order to provide the best possible care. We are trained to recognize, respond, and refer in medical emergencies and to reach out to your medical team for therapies and diagnostic testing that fall outside our scope of practice.
Dr. Kate McLaird is a registered Naturopathic Doctor who is eager to help you better understand how natural forms of medicine can help you reclaim your health and enjoy a symptom-free life. After completing an honours degree in Life Sciences at Queen’s University, her studies continued at the Canadian College of Naturopathic Medicine, where she achieved her 4-year post graduate doctor of naturopathic medicine (ND) and completed a 12-month clinical internship at the Robert Schad Naturopathic Clinic (RSNC) with focused training in pediatrics. In addition, she completed an internship at the Brampton Civic Naturopathic Clinic, the first Naturopathic Clinic within a hospital setting in Canada, and is well versed in herb-drug interactions and emphasizes the safety and importance of collaborative medical care. She has since dedicated her practice to naturopathic family medicine, and holds areas of clinical interest in gastrointestinal conditions and hormonal health, as well as continues to foster her paediatric focus in ADHD and the Autism spectrum. She holds additional certifications in nutritional IV therapy, bio-identical hormone prescribing, as well as facial rejuvenation acupuncture. Dr. McLaird is known for her compassionate nature and persistent drive to help you feel your best and stay your best!
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I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
The and Anyone is at risk for getting the flu (also known as influenza).The flu is an acute respiratory infection caused by influenza viruses which circulate in all parts of the world. Help protect yourself and others in your family and community by recognizing the signs and symptoms of the flu, usually characterized by sudden fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), loss of appetite, sore throat and a runny nose. Most otherwise healthy people will recover within seven to ten days without requiring medical attention. However, the cough can be severe and can last two or more weeks. In others, influenza can cause severe illness or death especially in people at high risk. The flu causes about over 12,000 hospitalizations and 3,500 deaths in Canada each year. Those at high risk of complications or severe illness and death include:
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Pregnant women, children under the age of five years, the elderly, individuals with chronic medical conditions (such as heart disease, asthma, liver and kidney disease or diabetes), and individuals with immunosuppressive conditions (such as HIV/AIDS, or those receiving chemotherapy or steroid treatment).
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Health care workers are at higher risk of acquiring influenza virus infection due to increased exposure to the patients and risk further spread particularly to vulnerable individuals.
Influenza spreads easily especially in crowded areas like schools and nursing homes. When an infected person coughs or sneezes, infectious droplets containing viruses are dispersed into the air and can spread up to one metre, infecting those that breathe them in. The virus can also be spread by hands contaminated with influenza viruses. The virus can live for up to forty-eight hours on hard surfaces like countertops, door handles, keyboards and phones.
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Flu season in Ontario usually occurs from late fall to early spring. The time from infection to showing signs of illness, called the incubation period, is on average two days. Keep in mind that you are still contagious even if you are not showing symptoms during this incubation period. It is recommended to get the flu vaccine as your best defense before the flu season begins, as it takes about two weeks to take effect. The flu vaccine is safe and has been used for more than sixty years world-wide. The flu shot is recommended for everyone six months of age and older. Here in Ontario the vaccine is free and readily available from your doctor, nurse practitioner, and many pharmacies and local public health units. The vaccine is available in an injection form or as a nasal spray. Individuals should discuss with their doctor or health care provider about which option is best for them. Because there are several types of Influenza viruses, the vaccine is updated regularly due to the constantly evolving nature of the virus. WHO (World Health Organization) and the Global Influenza Surveillance and Response System (GISRS) continuously monitors the influenza viruses circulating in humans and updates the composition of influenza vaccines twice a year. Therefore, it is very important to get your vaccine updated every year. Among healthy low-risk adults, the influenza vaccine provides protection, even when circulating viruses do not exactly match the vaccine viruses. However, among the elderly, influenza vaccination may be less effective in preventing illness but can still reduce the severity of disease and incidence of complications and deaths. Vaccination is especially important for people in the high-risk group and for people who live with or care for the people at high risk.
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Apart from vaccination there are personal protective measures to avoid and minimize spreading of the flu like:
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Regular hand washing with soap and water for a minimum of 5 seconds along with proper drying of the hands afterwards.
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Good respiratory hygiene–covering mouth and nose when coughing or sneezing or using tissues and disposing of them correctly; if no tissue is available, cough/sneeze into upper sleeve, not on hands.
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Stay home! Early self-isolation of those feeling unwell, feverish and having other symptoms of influenza is important.
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Avoiding close contact with sick people. Avoiding touching one’s eyes, nose, or mouth. Clean and disinfect hard surfaces and shared items.
If you are experiencing flu symptoms and are not from a high-risk group, you are advised to stay home to minimize the risk of infecting others. Treatment focuses on relieving symptoms such as fever, getting lots of rest, and drinking plenty of fluids. If symptoms are not improving or worsening, then seek medical attention. You can also call You can also call Telehealth at 1-866-797-0000 to talk to a registered nurse twenty four hours a day, seven days a week. You do not need to provide your OHIP number, and all information is confidential. (Information sourced from the World Health Organization, https:// www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal), and the Ontario Government website, https://www.ontario.ca/page/ health-care-ontario)
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I m p r o v i n g t h e L i f e o f t h e E m e r g e n c y R o o m H e a l t h c a r e Wo r k e r
Organ and Tissue Donation: The Facts Today in Ontario there are over 1,500 people waiting for a lifesaving organ transplant. This is their only treatment option. Every three days someone will die waiting for a transplant. More than 85% of Ontarians are in favour of organ donation, but only one in three have registered their consent to donate.
You can help by registering your consent for organ and tissue donation. • One donor can save up to eight lives through organ donation and enhance the lives of up to seventy-five more through the gift of tissue donation. • Age alone does not disqualify someone from becoming a donor. The oldest organ donor was over ninty and the oldest tissue donor was over one hundred. There’s always potential to be a donor; don’t let your age stop you from registering. • Your current or past medical history does not prevent you from registering to be a donor. Individuals with serious illnesses can sometimes be organ and/or tissue donors. Each potential donor is evaluated on a case-bycase basis.
Registering to be an organ donor only takes a few minutes and can be done online at BeADonor.ca. Make sure to talk to your family about your wishes. 1. You will need your Ontario Health Card number and your date of birth (you must be sixteen years of age or older). 2. You can register online at ServiceOntario or in person at any ServiceOntario centre. Trillium Gift of Life Network is the Ontario government agency responsible for organ and tissue donation and transplant. Call 1-800-263-2833 or visit www.beadonor.ca or www.giftoflife. on.ca/en/ today for more information. Register today. You could save a life.
Blood Donation: Be A Life-Line Half of all Canadians will either need blood or know someone who needs it. The need is always there. Donating blood is something you can do today to ensure that someone else is waking up healthy tomorrow.
Canadian Blood Services collect blood, plasma and platelets from over 13,000 donation events every year. They have 35 permanent donor centres and over 4000 mobile donor centres across Canada.
The standard blood donation is approximately 450mL, a little less than two cups. This amount represents a very small portion of the blood in a person’s body; the average adult has about five litres. The entire process to donate blood takes just over one hour.
Visit the website, https://myaccount.blood.ca/en, to learn more. If you have questions or are unsure about your eligibility to donate, please call to speak with a trained health professional at 1.888.2.DONATE (1.888.236.6283).
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Helping prevent infection? That’s within our power. OPG doesn’t just generate electricity. We also generate Cobalt-60, a life-saving isotope used for sterilizing medical devices like syringes, IVs, mechanical heart valves and surgical instruments.
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