Healthier You Spring
2015
Don’t call me
crazy
How to stop shaming people with a mental illness by Vanessa Stewart
In s id e th is is s u e
The brain issue
(seconded by dad, Coquitlam Mayor Richard Stewart)
PARENTING: 8 signs of concussion A neurosurgeon’s guide to brain surgery DEMENTIA: Can you avoid it? A mother, daughter...and dementia How to make a healthy habit
Feeling gloomy?
1 Healthier You
Spring 2015
4
keys to emotional health – p. 28
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16
p.
Don’t Call Me Crazy b y Vanessa Stewart
5 ways you can help sufferers of mental illness – like me – feel unashamed Avoiding Dementia
The BRAIN issue
inside
Spring
2015
p.25
5 healthy habits to reduce your risk
Volume 1, Issue 1
The Ultimate Frontier ���������������������������������� Page 6
How to Perform Brain Surgery �������� Page 20
by Dr. Ryan D’Arcy A neuroscientist shares secrets of the brain and insight into what remains to be seen
by Dr. Mark Matishak If you’ve always wondered, here’s a quickie course from a neurosurgeon
8 ways to spot a concussion �������������� Page 10
dementia, mom and me ������������������������������ Page 26
A parents’ guide
Old Dog, New Tricks ������������������������������������ Page 12 by Samantha Tong How you can recondition your brain to form new healthy habits
by Pat Wrigley Advice about change and guilt in dealing with a parent’s dementia
Keys to Emotional Wellness ��������������� Page 28 by Dr. Davidicus Wong Skills to bolster your resilience to life’s challenges
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Healthier You Volume 1, Issue 1
published by:
Welcome to the first issue of Fraser Health’s Healthier You magazine, a partnership with Glacier Media.
By Michael Marchbank, President and CEO Fraser Health
Where can you find Healthier You?
“In doctors’ offices, walk-in clinics, pharmacies and other community settings, we will be waiting there too – keeping you company, and sharing stories and insight into health-related issues that matter to you.”
While you wait in doctors’ offices, walk-in clinics, pharmacies and other community settings, we will be waiting there too – keeping you company, and sharing stories and insight into healthrelated issues that matter to you. This first issue looks at the brain in all its glory – from the inside out with neurosurgeon Dr. Mark Matishak in How to perform brain surgery (page 20); to how it can rewire itself in Old dog, new tricks (page 12); to the harsh reality of dementia in Dementia, mom and me (page 26); and the challenges of mental illness in Don’t call me crazy (page 16). Each story sheds light on the breadth, and complexity, of issues we face each day. As Fraser Health continues to focus on delivering services that put each person, and their family, at the centre of all decisions about their care – whether in hospital or in community settings – I’m confident this will naturally improve not only their individual health outcomes, but those of the overall population as well. Health care is about people, and our job is to make sure we’re doing the best we can to improve the experience people have when they come to us. I hope you enjoy this inaugural issue. Look for the next one this summer. Our editorial team welcomes your thoughts and comments, so feel free to send them to feedback@fraserhealth.ca Happy reading.
4 Healthier You
Spring 2015
www.glaciermedia.ca
PUBLISHED BY FRASER HEALTH & GLACIER MEDIA
Copyright ©2015. All rights reserved. Reproduction without permission is prohibited. Fraser Health
Editor / Tasleem Juma Managing Editor / Bonnie Irving Content Advisors / Samantha Tong– Population and Public Health
Contributors / Heidi Cumberworth, Dr. Ryan D’Arcy, Shannon Henderson, Bonnie Irving, Dr. Mark Matishak, Amelie Nguyen, Trudy Robertson, Vanessa Stewart, Lisa Thibault, Samantha Tong, Pat Wrigely, Dr. Davidicus Wong
Glacier Media Group
Sales & Marketing / Ellyn Schriber Newsmedia Features Manager BC 604.861.1665 eschriber@glaciermedia.ca
Creative Director / Eric Pinfold
Advertisements in this magazine are coordinated by Glacier Media. Fraser Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. No part of this publication may be reproduced, reprinted, stored in a retrieval system or transmitted in part or whole, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior written consent of the publisher. Printed in Canada. Please recycle.
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The Ultimate
Frontier Neuroscientist Dr. Ryan D’Arcy shares secrets of the brain that he’s uncovered, and offers insight into what remains to be seen.
Meet Dr. Ryan D’Arcy, head of Health Sciences and Innovation at Surrey Memorial Hospital, as well as Surrey Memorial Hospital Foundation and Simon Fraser University’s BC Leadership Chair in Medical Technologies. Healthier You asked him to answer a few questions. Here’s what he sent us from his Neuro Tech Lab at Surrey Memorial Hospital. What is your specialty? I’m a neuroscientist who uses advanced technologies to help treat many devastating conditions that can impact our brains – like epilepsy, tumours, stroke, dementia and brain injury.
What fascinates you about the brain? We talk about space as the final frontier, but the brain is actually the ultimate frontier. It is simply the most complex and sophisticated phenomenon out there. It’s the essence of our minds, imagination, spirit, and potential.
How would you describe the mind? Is it different from the brain? Our minds are emergent properties of our brains – that is, our minds give rise to our conscious awareness. Often when our brains are damaged, it directly affects conscious awareness.
How would you categorize the disorders of the brain? One in three Canadians is affected by brain disorders and diseases over their lifetime. These conditions often drastically impact our most vital and precious abilities. Whether it’s the loss of memory in dementia, the inability to move following stroke, or the many more devastating impacts – we all rely on our brains’ vital functions each and every second of every day.
e are hearing more about the W ‘plasticity’ of the brain. What does that mean and what role does it play in the treatment of a brain injury like stroke or dementia? Plasticity basically refers to the brain’s inherent ability to rewire itself. It’s a key concept in recovery and rehabilitation of lost or damaged functions. After brain damage, we are now able to watch as the brain rewires itself to recover lost abilities, such as the ability to move our arms and legs after a stroke.
Can we see the rewiring process or measure it? We can, using advances in medical imaging to measure plasticity-related changes in the brain. These technologies allow us to monitor brain function for any improvements during intensive rehabilitation, which make it possible to provide the best treatment.
Why is it important to measure function? Brain function is our brain at work – our most powerful engines performing at their highest level. It’s critical to providing the best possible diagnosis and subsequently, treatments. By focusing on brain function, we can detect whether your brain’s performance has changed or not. When we identify brain vital signs, we can monitor them and track the brain’s recovery. continued on next page >>
Spring 2015
Healthier You
7
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How can we get this kind of information? We focus on the idea that vital signs are needed for the brain. There are vital signs for our hearts, so we are developing devices that provide these when there is a concern about brain function, and dysfunction. I often compare brain vital signs to blood pressure. If we can get something similar to 120/80 for brain function, then changes in this information will help to quickly identify treatments and monitor the return to normal performance. Currently, for example, we are working on devices that can do this following a concussion – it is similar to home blood pressure monitors. The goal is to make sure brain vital sign devices are available at any site they are needed. We are developing the technology for sporting venues, care homes, clinics, hospitals and any other key places in which there is a need. The people we serve in Fraser Health are getting access to advances like this, and we are working to ensure these discoveries get out, far and wide, across the world.
{ } “At Surrey Memorial hospital, we have labs with the most advanced medical imaging in Western Canada to ensure that BC residents get the best possible diagnostic and monitoring advances during treatments for brain conditions. This is truly a unique and important feature of Fraser Health.” – Dr. Ryan D’Arcy
In five years what will we be able to do about brain disorders that we can’t do now? It is never wise to make predictions when it comes to advances around the brain and the neurosciences. The reason is there have been so many in such a short time that odds or predictions will underestimate the future gains to come. It’s an amazing, and optimistic future when it comes to utilizing our brain power.
Will the brain ever give up all its secrets? Technology advances in the last two decades have opened up our brain’s universe in ways we are only now beginning to appreciate. It will be up to us to be able to fully understand and explore all there is in the brain.
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8 ways to spot a concussion
A parents’
guide
“Don’t tell Coach, mom, but when I fell and hit my head on the ice at practice today, I felt dizzy and saw stars. He won’t let me play if he knows that, and I just have to be there for the game on Thursday.” A statement like this should be a red flag for every parent. Dizziness and stars are not signs of a usual fall – your child may have a concussion, which can happen when a force, such as that fall on the ice or a football tackle or a car crash, stops the head suddenly and the brain continues to move inside the skull. Not every child is going to tell you about a fall or other injury, particularly if they don’t think they did any damage, and particularly if they’re a teen.
Even if you don’t see any cuts or scrapes, trust your instincts. If you notice any of the symptoms below, get them checked out by your doctor, who may prescribe a week or more away from the activity to rest the brain. Symptoms may not show up immediately so keep an eye out.
What to watch for: 1 Not ‘feeling right’ 2 Mild to severe headache 3 Dizziness 4 Loss of appetite 5 Nausea and/or vomiting 6 Excessive sleepiness 7 Difficulty remembering 8 Unusual irritability More information on concussions at
fraserhealth.ca/concussion
‘Have a Word with Yourself’ campaign about concussion: Fraser Health has partnered with The Community Against Preventable Injuries to raise awareness of concussion risks and management, and encourage individuals to be healthy, active and safe.
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old dog
New Tricks How you can recondition your brain to form new healthy habits.
T
wo years ago, Scott, a busy program director at Fraser Health, a graduate student, and a dad with two young kids, wasn’t eating well, weighed 40 pounds more than he should, was tired all the time, had high blood pressure and had cholesterol levels that were escalating. But when his doctor tried to refer him to the Healthy Heart Clinic, Scott decided he would try to fix his blood chemistry on his own. Coincidentally, Fraser Health was just launching a ‘Stairway to Health’ challenge to encourage all staff to improve their health by climbing the stairs at work rather than taking the elevator. Scott’s program team at Fraser Health’s headquarters in Surrey was determined to climb the equivalent of the distance to Mount Everest. His first climb up the 25-flight tower left him completely breathless. But he persisted, and kept climbing every day. Each time he made the climb he increased the number of times he completed the 25 storeys – from just once to twice then to three, five and eventually 10 times. His daily climb became a habit. At the end of the Stairway Challenge, Scott was consistently climbing 250 flights. He also started to eat healthier and committed to taking 10 minutes every night to make his lunch for work rather than resorting to take-out food.
12 Healthier You
Spring 2015
Scott, Program Director at Fraser Health.
By Samantha Tong
How to build a healthy habit and make it stick 1. Review your habits. Why do you want or need to change? What do you want instead? It’s important to know what the triggers are for your old habits and the reasons for changing your old habits so you can create the approach and environment that supports your healthy behavior to become habit. 2. Know your learning style. Do you like to set goals? Do you do better socially, like scheduling in walking or healthy cooking sessions with friends? 3. Start small and then build it up. For example, if you’re finding yourself sitting too much and want to move more, you don’t need to move with great intensity. The key is to move more and move as much as you can throughout the day. 4. Train and practice with intent and focus. When you practice the new behaviour with intention and repeat it over time, it’ll become habit and a part of what you normally do. 5. Pay attention to what changes are happening inside of you. This helps you to adjust your strategy as needed. 6. Know what positively reinforces your healthy behaviour. For example, you may find yourself wanting to eat something sweet every afternoon and chat with a colleague afterwards. Is it the social interaction or treat you need? How do you feel after connecting with a colleague in the afternoon without the treat? 7. Find others to join you. It’s more fun! Plus, you can support and help each other out along the way. Sometimes it’s tough starting out. For guidance about building new healthy habits, consult with your health professional.
Each time he did the stairs and ate a healthy meal, he started to become more aware that he felt better, had more energy and stamina to keep up with his young kids, could focus better, and was losing weight. He liked the changes and became more attuned to how his body was responding to these new habits. New brain connections What happened to Scott is an example of how our brains can change and adapt to new situations and form new connections throughout life. We call this brain ‘plasticity’. Through training or practice, our brains can be retrained to develop the healthier habits we always say we should have. Old habits are hard to break but it’s still possible to form new ones. Brain plasticity is also responsible for our ability to regain use of physical functions after a brain injury such as a stroke. Parts of the brain not normally linked with, for example, moving your right arm can learn to take over this function from the damaged part of the brain. By training and practicing the affected right arm, the brain connections start to strengthen again, sometimes in the same area that was affected by the stroke or in unaffected areas surrounding the damaged part of the brain. Our brains adapt to this change. In Scott’s case, every time he repeated a healthy habit, this reinforced and strengthened the brain connections for this new habit. Each time he gained a benefit, he was motivated to continue reinforcing these healthy habits.
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Today, in addition to doing the stairs, Scott goes to the gym and runs two to three times a week. He is medication-free and has kept off the 40 pounds he lost two years ago. His greatest reminder to stay active and eat healthy is being mindful of what’s happening inside – noticing the changes, feeling better and paying attention to his blood pressure. Our brains are complex yet powerful. What’s amazing is that they can adapt and modify to changing conditions or environments to develop new healthy habits.
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14 Healthier You
Spring 2015
2 medium carrots, chopped (approx. 1 cup) 1 large clove garlic 1 Tbsp fresh ginger 3 Tbsp seasoned rice vinegar 2 Tbsp sesame oil 2 Tbsp vegetable oil, plus about 1/4 cup for panfrying 1/4 cup water 1 tsp honey 4 circular rice paper wraps 4 skinless salmon fillets, 6 ounces each Fresh basil leaves, optional garnish 1. Prepare sauce: Blend first 8 ingredients together in a blender or food processor until smooth. 2. Prepare rice paper by dipping in a pan of very hot water until soft and pliable, about 15 seconds each. Place on a clean, dry work surface. 3. Place a salmon fillet on each of the rice paper wraps and spread with 1 teaspoon of the sauce. 4. Prepare packets by wrapping the first third of the rice paper over the salmon, tucking in the sides and then continuing to wrap and tuck in the end. 5. Heat a saucepan of cooking oil over medium-high heat. Careful of oil splattering, gently place the 4 packets in the pan. Cover and cook for 3-4 minutes. Flip the packets over and cook for an additional 3-4 minutes, or until lightly golden and cooked through. 6. Serve salmon drizzled with Carrot Ginger sauce and fresh, chopped basil. Accompany with steamed vegetables and a green salad for a complete meal.
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coverstory
don’t call me
5 ways you can help sufferers of mental illness, like me, feel unashamed
M
“
y name is Vanessa Stewart”. I started talking about my mental illness at the 2013 Ride Don’t Hide bicycle event. It was one of the rare times I had left the house to go anywhere that year, let alone to a mental health event. I hadn’t spoken to anyone about my mental illness and was having trouble doing activities I once loved due to the onset of depression. >> photo credit:
16 Healthier You
Richard Stewart
Spring 2015
Vanessa Stewart and her pal Acers: “I had defined myself by this mental illness and all the negative things I had heard about it…. I wish people would view mental illness as they would any other illness, so that those who suffer wouldn’t do so alone.”
I didn’t plan on telling anyone about my illness, and instead was very secretive about it, telling only my close friends and family. I had tremendous fear of being judged and looked down upon. Worries filled my mind, like what if I was singled out as the only one there with a mental illness. At the time, 18 months after my diagnosis, I was the only person I knew with depression. But I showed up, with my parents, very reluctantly. We unloaded our bikes and entered the event, and I was blown away by hundreds of helmet-wearing participants, all wearing Ride Don’t Hide bibs, most of which carried the name of a person they were riding for, a person they knew and loved with mental illness. I, of course, kept mine blank as I still didn’t want others knowing that I had shown up with this disease.
“It’s just like any physical illness and we need to treat it that way. I am a great person, illness or not; my illness shouldn’t define me.” – Vanessa Stewart I had no idea so many people were affected by mental illness and suffered like I did. It was mind-blowing for me. The ride was exhilarating. And shortly after we returned from the ride to the stadium, my dad was approached by a reporter. I’m used to reporters recognizing him as the Mayor of Coquitlam. And as usually happens, the reporter asked him what the event meant to him and his community. As dad started to answer, I stepped out from behind him to speak: ‘He’s here because of me…I suffer from a mental illness.’ No one moved. No one said a word. I started to tell the reporter about my journey, and then dad asked me, ‘Are you really ready for this, Vanessa?’, and I replied, ‘Yes…yes, I am.’ When my story came out in the paper a few days later, my sister and Dad posted it to my Facebook page. What happened next almost knocked me over. My fears and trepidations were quickly replaced by different emotions entirely. All the comments were positive and encouraging. Never in my wildest dreams had I thought so many people would support me and want to help me in overcoming this disease, including some who acknowledged their own struggles. I felt free, liberated, like a weight had been lifted off my shoulders. Like I no longer had to be ashamed of this label that had been attached to my entire life for the past year and a half. I had defined myself by this mental illness and all the negative things I had heard about it. I didn’t want to share it with anyone for fear of being judged, having it seen as a flaw, something negative,
or the result of laziness. Prior to my diagnosis, I knew almost nothing about mental illness. I didn’t know the types of mental illness, or even how many people were affected. It had been put into my own head that it was something to fear, that you had to be a certain kind of person to be affected. That it was just something that happened to lazy people, people who couldn’t manage, people who wanted time off work, people who were faking it. I was naïve. I was uneducated. From that moment on, I blogged, did interviews and spoke about how I wish people would view mental illness as they would any other illness, so that those who suffer wouldn’t do so alone. From then on I wrote freely about my mental illness. I shared to the Facebook world my hospitalization with a severe depressive episode in October 2014. I recounted the real struggles I had been having with stigma and fears surrounding my mental health. I was open and honest about answering people’s questions and didn’t hold anything back. I wanted to make sure people were educated as I had not been. I started the discussion. Healthier You magazine asked me to share, based on my experience, how I think the stigma associated with mental illness like mine can be erased. Here are my five suggestions for all of you who are lucky enough to be mentally well. 1. Think about your own perceptions about mental illness We don’t define people by their heart disease, cancer or broken arm. We sign their cast, we encourage and we help as best we can to accommodate them and their illness. We should do this with mental illness. It’s just like any physical illness and we need to treat it that way. I am a great person, illness or not; my illness shouldn’t define me. We should be able to look at the person and not judge based on an illness, but instead accept them for who they are. I think we all need to be a little more accepting of the differences we all bring. We all are judgmental, and I challenge you to try to be a little more open when talking to anyone about any struggle they are having. We don’t know others’ situations and if we take the time to listen, we’ll see that mental illness does not define a person. I have been there myself, feeling nervous about someone who boards the SkyTrain and sits next to me talking to themselves. But especially now, I try my best to be open-minded and to smile. Our perceptions of mental illness are important. Three years ago, I had no idea what depression was. Depression feels like a dark hole. For me, depression Spring 2015
Healthier You
17
was having no passion, no feelings, no drive to do anything; I have been so down that I didn’t leave my bed for weeks. It left me feeling like if the world stopped right then and didn’t ever start again it wouldn’t matter. It’s a sadness that I can’t escape or run away from. It is a darkness that takes me over, ruining hopes and dreams and turning them into dust, leaving me grasping in vain to find just a little bit of feeling. Keeping that in mind and offering compassion in that moment can help us all become more accepting of others’ differences. 2. Choose your words thoughtfully It’s not alright to joke about or label people with a mental illness. I am not ‘lazy’, ‘faking it’ or ‘sketchy’. I am not ‘crazy’, ‘bipolar’ or ‘cuckoo’. And I am not my illness. I am Vanessa Stewart, a person – daughter, sister and pet owner. I am 22 years old, I like hanging out with my friends, I study psychology and criminology, and I tutor at college. I am everything else besides a mental illness. I am having trouble right now. I am in a depressive episode and am trying to manage my life. But that doesn’t take away from all the positive things that I am. I am a hard worker, and am passionate, driven, and fun. I have a mental illness, but it does not define me. I am everything else besides my mental illness. Be careful when making suggestions. For a person with severe depression, it isn’t helpful to suggest that he or she simply ‘think happy thoughts‘, or ‘try to take on a hobby’; those types of suggestions only drove me deeper into despair, as I was left knowing that nobody understood. Please choose your words carefully and kindly. 3. Educate yourself, just a little Unfortunately, mental illness wasn’t in my high school curriculum, nor in my first-year BCIT Architectural Engineering program. Mental illness just wasn’t brought up. I didn’t know anyone who had it. I had never been affected by it. I was naïve, I didn’t know. And worse, I didn’t know that I didn’t know. Prior to my diagnosis, I had thought – like most people – that depression was when people got sad and just stayed that way. I couldn’t imagine how a person with a good life 18 Healthier You
Spring 2015
could feel intense sadness and depression. After I was diagnosed with major depression and anxiety in 2012, I started researching my condition; I learned that it’s the result of a chemical imbalance in my brain. And I learned, to my surprise, that sufferers can be successfully treated. If more people learn about mental illness and how it affects those who suffer, society can help reduce misperceptions and stereotypes, and can help those with these illnesses. 4. Offer support, even if you’re unsure what to say I count myself as fortunate that my family and friends came to visit me while I was in the psychiatric unit in hospital. We found it heartbreaking that not everyone had visitors. Some patients told me about how their families respond negatively to mental illness, how secrets must be kept. When you have a mental illness you’re simply ill; you shouldn’t have to suffer alone, in silence, for fear of being ostracized. So, if you don’t know what to say, then just listen. Be open and kind, and listen. Listening is key. Just being there for someone, even if you’re unsure how to help, can make a difference. Reaching out to those who are struggling with a mental illness can help their recovery. 5. Don’t be afraid to hear the truth It would be so great if all of us who have these issues could talk about our health, openly and freely, without fear of judgment. It would help make things feel ‘normal’ if when a friend asks, ‘How are you doing?’ we could honestly answer, ‘I’m not feeling well today, I’m feeling really down.’ The friend could then say, ‘It’s okay, we’ll work on it together’, rather than give uneducated advice, or write you off as just having a ‘down’ day. I want people to ask me how I’m doing and not be afraid of my truthful answer. If my arm was broken, nobody would be offended, nobody would shy away from it, nobody would change the subject. The only thing about this subject that needs changing is society’s attitudes, prejudices and judgments.”
online: BC Partners for Mental Health and Addictions
www.heretohelp.bc.ca Kelty Mental Health Resource Centre
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Ickert Dental Implant Centre We all knoW that oral health is important. We also knoW that bad or missing teeth make it hard, or even impossible, to enjoy healthy, delicious food Without embarrassment. and We knoW an unsightly or selfconscious smile When We see one. but, did you knoW that disease in your mouth can impact your entire body? infection, broken teeth, bleeding gums, severe pain: these problems affect emotional and physical wellbeing and can make life miserable. that’s when many people look for a dentist to call. for decades, dentists would simply repair a tooth or gum problem without understanding or treating the reason why the repair was needed. the problem with this repair-only approach is that, unfortunately, the cycle of repair usually continues, often until some or all of the teeth are lost. our practice uses a modern scientific approach for every patient. this systematic approach is called a medical model, because we determine a diagnosis for the cause of the problem prior to any treatment. our first question for you is always, “how can we help you?” because we want to understand what most concerns you. We then gather the necessary information to know what your oral problems are today, why they have developed, and what the risk
of future problems is likely to be. it is critical that your dentist understand this not only for your teeth, but also for everything that impacts your oral health: gums, jawbone, muscles, bite, and jaw joint, smile and medical conditions. We can then understand your risk for future problems, and design treatment to prevent or slow down future breakdown. our next step is always to share this understanding with you, our patient and partner in decision making, with the common goal of optimal healthcare. When teeth have been lost, dental implants can significantly enhance the quality of life and can be an excellent treatment option. While nature can’t be replicated perfectly, dental implants come very close, and are one of the most significant advances in modern dentistry. dr. norm ickert completed his general dental education at vancouver’s university of british columbia in 1982 and completed a master’s program in oral medicine and implantology, graduating march 2012 from the university of munster, germany. dr. ickert is the director of the ickert Dr. Norman Ickert dental implant centre, a referral practice limited to implant related dentistry. dr. ickert also teaches surgical implant dentistry at the kois center in seattle. dr. ickert is proud to limit his practice to comprehensive, aesthetic and functional rehabilitative dentistry, including both the surgical and prosthetic aspects of dental implants, as well as many other related hard and soft tissue enhancement procedures. When your treatment is finished, your oral health— including gums, jawbone, teeth, muscles, joints and esthetics—will be healthier, with less chance of future breakdown so you can function comfortably and smile with confidence for many years.
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how to perform
brain surgery
Here’s your chance to take a quickie course from a neurosurgeon at Royal Columbian Hospital. By Dr. Mark Matishak
20 Healthier You
Dr. Matishak, neurosurgeon at Royal Columbian Hospital, and his patient Shelley Turpin. Spring 2015
I
always say that fate led me to neurosurgery. When I was in medical school, my skiing ability began to deteriorate for no reason. From there, my walking declined and I ended up in a wheelchair. I was finally diagnosed with a spinal tumor and needed high-risk surgery to get my life back. I figured I would like to offer the same chance to others so I decided to become a neurosurgeon. Healthier You asked me to write about brain tumor surgery so here are my five easy steps to remove a brain tumor. But don’t try this at home.
Step 1: Diagnosing the Problem This is the hardest part. People don’t just come in off the street asking for brain surgery. The presence of a tumor is often signaled by a specific neurologic complaint, such as a change to vision, a loss of balance or walking ability, or memory difficulties. Often a seizure will be a sign of a tumor. And headache is a common symptom in about two-thirds of tumors. A tumor may be slow-growing such as a meningioma, the most common benign tumor we see. They can get quite large before they’re noticed because they can compress the surrounding brain. A malignant tumor may show up suddenly, with the development of weakness, or problems with thought processes.
“If I’m suspicious that there’s a tumor, a CT scan will show it and then an MRI will confirm its location more exactly. All sorts of other tests will be needed before surgery.” – Dr. Mark Matishak
Sometimes a tumor might be found during investigation of an unrelated complaint. For example, pituitary tumors, which are located in the pituitary gland roughly at the base of the nose, might turn out to be the ultimate cause of difficulty getting pregnant, loss of libido, menstrual irregularities, weight loss or gain, blood pressure problems, or visual disturbances. If I’m suspicious that there’s a tumor, a CT scan will show it and then an MRI will confirm its location more exactly. All sorts of other tests will be needed before surgery.
Spring 2015
Healthier You
21
(left) Dr. Matishak’s patient Shelley Turpin provided access to her surgery to help others who may face the same thing understand some of what they may encounter.
Step 2: Assembling the Team It takes a team to remove a brain tumor – surgeon, anaesthetist, scrub nurse(s), circulating nurses, operating room assistants, anaesthesia assistants, and cleaners. Basically, the anaesthetist keeps the patient alive during the procedure, and the scrub nurses assist the surgeon.
Step 3: Opening the Head Once the patient is asleep, their head is placed in a special device which prevents any movement so I can make precise millimetre or even micrometre movements without fear. I use a special navigational tool to pinpoint the exact location of the tumor so I can make the smallest incision and shorten the surgery time. The tool shows me the way using the MRI image of the inside of the brain in relation to the surface anatomy of the scalp, face and skull. We used to shave everybody’s head, but now we just cut some of the hair. Then we sterilize the scalp, mark the skull to guide us and drape it all to keep it sterile. In pituitary surgery we work through the nostrils. After I cut into the scalp and expose the skull, I have to make an opening big enough to remove the tumor. Usually I make one or several holes with a drill and then use another cutting device to cut between them to make a larger opening. Once the covering of the brain (dura) is exposed, I check with the navigation tool to confirm I’m in the right spot. Then I open the dura with a fine scalpel and scissors to expose the tumor. With some tumors (like Meningiomas) the dura is involved and has to be kept with the tumor itself and removed.
22 Healthier You
Spring 2015
Healthier You Book your ad now for our next issue! summer 2015 {july} ad booking: June 5, 2015
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Feeling gloomy?
Healthier You
Spring 2015
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keyS to emotional health
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ParEnTinG: 8 signs of concussion A neurosurgeon’s guide to brain surgery DEMEnTia: Can you avoid it? A mother, daughter...and dementia How to make a healthy habit
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Healthier You
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Step 4: Removing the Tumor This is the most delicate part of the procedure. The less we disturb the surrounding brain, the easier it is on the patient. If the tumor is on the surface of the brain, we separate it from the surrounding brain using special dissecting tools. If it’s below the surface, I have to cut the surface using a fine scalpel and forceps. These forceps allow me to perform bloodless surgery by coagulating the tiny blood vessels which weave through the brain. Once the whole tumor is showing, I can remove it in one piece if it’s small, or in pieces if it’s large. Depending on how well it’s ‘stuck’ to the brain, this can take minutes or hours. Sometimes I use a tool that liquefies the tumor while preserving the blood vessels that run through it. It can then be sucked out. I often do this for large meningiomas. The next step is to determine if the tumour is cancerous or not. To do this, a specialist comes into the operating room to take a tissue sample for analysis. Often we get an answer within 15 minutes.
Step 5: Closing the Head Once we’re sure there’s no bleeding, we can stitch the dura together using fine stitches. We then replace the bone flap and fix it in place using special titanium rivets that hold the skull solid. Muscle and scalp layers are then stitched or stapled together, and a head dressing is applied. The patient is then brought out of anaesthesia and taken to the recovery room for observation for the next four to six hours. Once stable, they are taken to the ward where they remain under close observation. And that’s it. It takes a team to remove a brain tumor – surgeon, anaesthetist, scrub nurse(s), circulating nurses, operating room assistants, anaesthesia assistants, and cleaners.
24 Healthier You
Spring 2015
To watch a video of this surgery: www.fraserhealth.ca/brainsurgery
Avoiding Dementia
5 healthy habits to reduce your risk
If you consistently maintain at least four of the following five behaviors – you don’t smoke; you eat a healthy diet; you maintain a healthy weight; you rarely drink alcohol; and you exercise regularly – congratulations. Your healthy lifestyle has been associated with a 60% reduction in your risk for dementia and a 70% reduction for other chronic diseases such as diabetes, heart disease and stroke, as compared with those who practice none of these behaviours. Those were the findings of the Caerphilly Cohort Study by researchers at Cardiff University in Wales that monitored the healthy habits of 2,235 men between ages 45-59 over a 35-year period On the downside, the study also found that few of the men actually followed all five behaviors.
Will you be different?
Reprinted with permission of Cardiff University
Spring 2015
Healthier You
25
Dementia,
mom and me
What I’ve learned about dementia, change and guilt might help others facing the same challenges.
By Pat Wrigley
I’m a manager in the cardiac program at Fraser Health. I’m also a wife, a mother, a grandmother – and I’m also a daughter, and have been a caregiver, to my mom, Joan, who has dementia.
I
share my story because I want to help other caregivers avoid some of the same pain, guilt and confusion I’ve felt as a result of this life-altering disease.
times – each time a doctor would raise the issue of dementia, mom would deny it and find another doctor. There has never been a formal diagnosis. Both my sister and I were being pulled in many directions – children, work, mom, dad and more – and without someone at home full time she was unable to live on her own. While dad was in rehab, we were fortunate to have mom assessed for residential care and placed on an emergency waitlist. Quite soon she received a bed and we were reassured that she would now receive the care she needed in a safe place.
Looking back, it seems now that my mom had dementia for many years before I realized it. My parents did a good job hiding it. They hid her illness, her obsessive shopping and hoarding pattern, and their financial debt. They also hid my dad’s own lack of support in the latter years of his life – physically, emotionally and financially. It was such a gradual process that I couldn’t pinpoint what was really going on with her. I was so confused when she said things like, “Your Dad’s dark socks are staining the carpet. He’ll have to remove all the carpet in our house.” My dad removed the carpet. She was quick to anger, quick to judge. She became reclusive when she was not aggressive, argumentative and volatile. I made the mistake of allowing the withdrawal to happen. I was not proactive. I did not find out the root causes of her change, which could have helped me help them sooner. History, love and emotions blur your judgment. I live today with the guilt that I never tried hard enough to find out the real reason she was changing. It was only after my dad fractured his hip and entered a rehab facility in 2010 that I understood that something was really wrong. During that time my sister, a home care nurse, and my husband and I assisted my mom in ‘shifts’ and I began to find little notes around the house with the words ‘dementia’ and ‘Alzheimer’s’. I now understand why my mom had changed doctors so many
“Living in the moment can be fun still,” says Pat. 26 Healthier You
Spring 2015
My advice to readers 1. Get nosey – If you feel something is wrong or different, be proactive and find out more. The earlier you learn what’s really going on, the sooner you can help. Had I known sooner, I could have found support to help mom adhere to her medication to reduce her symptoms of aggression and fear. I could have helped my dad pay his bills earlier, which would have improved their final years together. 2. Talk about it – Like my parents, many people newly diagnosed with dementia either live in denial or in hiding. Bringing it up will strain the relationship. But trust me, you can also strain your relationship if you don’t address it. There is only so much you can hold inside before stress and anxiety kick in. Approach your loved one, their partner or health care provider. The sooner you talk about it; the sooner you can get help. 3. Share your story – By sharing your story, you attract people who care and are knowledgeable in the area. For example, I shared my story and got connected to a local society run by a husband and wife; the husband had dementia. It’s empowering when we can speak up and get the information and help we need. 4. Reach out; you’re not alone – Caregivers who have help and support can cope better than those without support. If you don’t take care of yourself emotionally and physically, you will not be able to in turn care for your loved one. A few of the organizations that can help include the Alzheimer’s Society, Senior Resource Centres, and 8-1-1 Healthlink BC. Be proactive and search for good up to date information. Connections make life endurable. I reached out for support in several ways. I accessed Fraser Health’s Employee Support program. Coaching has been tremendously useful to help me clear my mind and cope with my work, life, family and mom. I have learned that it’s important to seek professional help rather than listen to the chatter from different viewpoints around you. By rebuilding myself physically, emotionally and spiritually, I have also gained the capacity to accept that my mom is aging with dementia. 5. Communicate in creative ways – You need to express your concerns so you can access the support and advice you need. If you worry about upsetting your loved one during a doctor’s appointment or similar, try writing a note to communicate the difficult information. This can help prevent outbursts of denial or further confusion with your loved one.
6. Follow social media – Get connected and learn more. I follow Fraser Health and other health authorities, Globe & Mail, and other medically inclined organizations on Twitter. I even tweet live! You learn things you would not normally learn, connect with cutting edge research, information, and most importantly, other people in your position. I’ve built a network of people highly involved in Alzheimer’s, cardiac care, complexity science and health systems change. They form a part of my social network and support. 7. Start planning early – Discuss with your family and come to an agreement about how to care for your loved one, how to share the burden, and how to pay for it. Do your best to balance family, life and self.
Where are we now? My mom is now 87 and in her fourth year at Rosewood Residential Care in Langley. I visit her for lunch on weekends and my sister takes her to the Fraser Health-sponsored Langley Senior’s Drop In Centre, which has senior-friendly activities. Often she comes to visit at home with my family. I listen to her stories about her childhood in Winnipeg and about my dad, her “best husband ever.” You may think it’s for her, but it’s actually for me too; I want to learn about her early life. With mom, living in the moment can be fun still. When you are caring for someone living with dementia, it’s never been more true.
‘Dementia’ or ‘Alzheimer’s?’ Dementia is an overall term for a set of symptoms caused by disorders affecting the brain. Symptoms may include memory loss and difficulties with thinking, problem-solving or language, severe enough to reduce a person’s ability to perform everyday activities. A person with dementia may also experience changes in mood or behaviour. Many diseases can cause dementia, the most common being Alzheimer’s disease and vascular dementia (due to strokes). Someone who has Alzheimer’s disease has dementia, but not everyone with dementia has Alzheimer’s disease.
For more info: Caring for Someone with Dementia, Alzheimer’s Society www.alzheimerbc.org/Living-With-Dementia/Caring-for-Someone-with-Dementia.aspx
Spring 2015
Healthier You
27
Feeling gloomy?
The Keys to Emotional Wellness Gaining mastery in four key emotional health skills can bolster resilience to life’s challenges
Dr. Davidicus Wong is Physician Lead of the Burnaby Division of Family Practice. For more information on their public health education series, check out divisionsbc.ca/burnaby.
Why does emotional health matter? Our emotions shade our thinking. When depressed, we think negatively about ourselves, others, our world and the future. Depression narrows our thinking and we don’t recognize our positive options. When anxious, we overestimate danger and challenge, and we underestimate our ability to manage. I see emotional wellness as a deep sense of meaning and purpose, an abiding sense of peace, the ability to manage the stress and transitions of life, awareness of your thoughts and feelings and the ability to manage them. Depression is a major cause of absenteeism and disability from work or school. Anxiety holds us back from doing what we need to do, from moving forward, from reaching out, and from giving our best to the world.
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Spring 2015
When we’re angry, we don’t think clearly or logically. We can’t see any other point of view but our own. An adult will act like a child, a 10-year-old like a toddler. We say and do things we later regret, like road rage. When depressed, we withdraw. We close ourselves off from the world. When anxious, we freeze. The Burnaby Division of Family Practice’s public health education series recommends four skills that can help you develop your own emotional health: 1 Practice meditation – Prayer, yoga, formal meditation and mindfulness are all effective ways of calming your mind, centering your thoughts and reflecting. By deliberately pausing, breathing and slowing our thoughts and actions, we become less reactive.
Begin each day with a prayer of thankfulness – this will help you see the positive throughout the day and empower you to seize opportunities to make a difference – and end each day reflecting on how you helped others and how others helped you. 2 Recognize unhealthy thinking and practice cognitive therapy – We are all susceptible to ways of thinking that negatively influence our perception of our circumstances. What thoughts trigger your emotions? Is there another way to look at the situation?
Examples of unhealthy thinking include, ‘all-or-nothing thinking’ (seeing all the bad in another person, in ourselves or the situation), ‘catastrophizing’ (imagining our fears, that the worst will happen), ‘excessive blame’ (of ourselves or others), and ‘mindreading’ (assuming we really know the motivations behind others’ actions). For more information about cognitive therapy, check out Christine Padesky and Mike Greenberger’s Mind Over Mood and Martin Seligman’s Authentic Happiness. 3 Visualize your goals – Turn your problems into goals. Instead of replaying the past or ruminating on the negative, think about what you want. When you are most relaxed, visualize yourself having achieved your goal, experiencing a sense of peace, and living a life rich with purpose and meaning. How do you feel? What do you see? What do you hear? Make it real!
4
Learn stress management skills
• Change your perspective. According to the 80/20 Rule, 20% of our reaction to a situation is related to the facts; 80% arises from what we bring from our past and how we conceptualize the present. • Identify your sources of stress. Recognize what you can change or control. Accept what you cannot change; assume responsibility for what you can. • Be a good parent to yourself. Go out and play; have a daily exercise routine; don’t skip meals and schedule regular healthy meals; get enough sleep; hang out with good friends; and connect in mutually positive relationships. • Live in accordance with your values. Gandhi said, “Happiness is when what you think, what you say and what you do are in harmony.” If the effects of stress, anxiety, mood or other psychological symptoms are having a significant impact on your performance at school, work or at home; your relationships, how you are taking care of yourself or your enjoyment of life, see your family doctor. Your emotions are an important aspect of your health. Resources: Canadian Mental Health Association – cmha.bc.ca AnxietyBC – anxietybc.com Mood Disorders Association of BC – mdabc.net
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Healthier You
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Breast Lift, Implants, Reduction
Neurosurgery (Spine/Disc)
64-Slice CT Scan
Nose & Eyelid Surgery
General Surgery/Hernia Repair
Advanced Ultrasound
Face Lift, Neck Lift & Body Lifts
ENT & Sinus Surgery
Digital X-Ray
Liposuction & Tummy Tuck
Male & Female Urology
Cardiac Angiography
Cosmetic Gynaecology
Gynaecology & Female Health
Colonography
Chemical Peel, CoolSculpting
Pain Management & Physiatry
Traumatic Brain Injury
Botox, Juvederm, Fillers & more
Bariatric Weight Loss/Lap-Band
Interventional Radiology
Podiatry/Toe & Foot Surgery Dermatology, Cardiology, Neurology Vascular Surgery (Veins) & more
WELLNESS PROGRAMS
CLINICAL CARE Urgent Care Centre
Executive Health
Workplace Health
Women’s Wellness
Family Practice
Cardiac Protection Plan
False Creek Healthcare is one of Canada’s most renowned private medical providers. Our centre is a unique, patient-centred, world-class healthcare facility, with all departments under one roof. With over 100 physicians and surgeons, and the most advanced medical technology, we can help you achieve your health goals.
False Creek Healthcare Centre is accredited by the College of Physicians & Surgeons of BC. Contact us to learn about your healthcare options
604.739.9695
falsecreekhealthcare.com
555 W. 8th Avenue Vancouver BC
facebook.com/falsecreekcare