VITAL Magazine

VITAL Your Support.

Our Mission.

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one surgeon‘ s vision

Groundbreaking Discovery

Every Day Heroes

Why You Matter

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Cover photo by: Owen Thomas, Hamilton Health Sciences

VITAL MAGAZINE

A MESSAGE FROM THE CHAIR

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hile McMaster University is home to some of the greatest surgical practitioners, educators, and researchers in the entire world, the real MVPs of our great team are the charitable community members willing to support us in our many responsibilities as surgeons, teachers, and researchers. Community contributions cumulatively result in both small- and large-scale projects that allow us to teach, research, and operate at our fullest capacity.

The purpose of this publication is to showcase what we’re capable of with your support — to display some of the amazing, life-saving work that takes place within our Department every day and parlay it into further support from people like you. Your donations have the power to open doors that would otherwise remain shut — they let us explore different avenues that result in great advancements in the founding pillars of our department: research, education, and patient care.

Our Department is so multifaceted that a single donation — big or small — can contribute to the education of the next generation of surgeons, to the findings in some groundbreaking research study, and to the instalment of state-of-the-art technology, all with the goal of improving patient care both locally and abroad.

I am personally so honoured to serve as the Academic Chair of McMaster’s Department of Surgery, and am immensely proud of all of our faculty and staff. I consider it a privilege to witness the care, knowledge, and innovation that our team brings to our community each and every day. My hope is that what you see in the pages ahead will inspire you enough to also feel pride in the amazing work taking place in your community. Certainly you, your family, your friends, your colleagues, or your neighbours have been the the care of McMaster surgeons at one point or another. We’d love to hear from you if you have a story to share!

With your help, the McMaster University Department of Surgery can continue to save lives, make new discoveries, and push surgical practice forward. Thank you, from all of us, for being partners in advancing surgical care in our community and beyond!

Dr. Susan Reid Department Chair M c Master Surgery

Dr. Susan Reid Department Chair

Dr. Mohit Bhandari Associate Chair of Research

Dr. Stephen Kelly

Associate Chair of Education

Cathy Turner Director of Administration

Anne Lancaster Human Resources Manager

Marcy Murchie Finance Manager

Blake Dillon Communications Coordinator

Contributing Writers: Blake Dillon, Dr. Susan Reid, Ellie Stutsman

Contributing Photographers: Tina Depko, Jon Evans, Alexander Sviridov, Owen Thomas

VITAL Magazine is published once annually. For all editorial inquiries, contact dillonb@mcmaster.ca. For donations or related inquiries, contact willim6@mcmaster.ca.

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ABOUT US

Surgical Divisions General Surgery Cardiac Surgery Neurosurgery Ophthalmology Orthopaedic Surgery Plastic Surgery Urology

Surgery at McMaster University

McMaster University’s Department of Surgery is one of the largest purveyors of surgical education in the world. Our large faculty contributes extensively to our unique ability to provide specialty care for Hamilton and the surrounding communities through St. Joseph’s Healthcare and the Hamilton Health Sciences medical group. Committed to integrating innovative clinical care, world-leading research, and outstanding educational resources, the Department of Surgery aspires to maintain its reputation as a leading department in academic surgery both nationally and internationally.

Learn more about us online at Surgery.McMaster.ca.

Surgical Teaching Sites

Our faculty, staff, and students are spread across several different teaching sites throughout the Hamilton area, including the McMaster Children’s Hospital, St. Joseph’s Healthcare Hamilton, Juravinski Hospital, and the Hamilton General Hospital. By supporting us, you’re indirectly supporting surgeons, residents, fellows, research, and, in turn, patients at each site.

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VITAL MAGAZINE

Vascular Surgery Pediatric Surgery Thoracic Surgery Otolaryngology Head & Neck Surgery

WHAT’S INSIDE

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4 // News & Notes

18 // The Perks of Pediatric Health Care

6 // Needle in a Haystack

22 // Become A Supporter

10 // Every Day Heroes

23 // Claiming your Tax Credit

14 // A World Without Stroke

24 // Why You Matter

From new initiatives to grants to publications and beyond, we look back on the biggest stories of the year.

Dr. Saleh Almenawer and a team of McMaster researchers make a game-changing needle discovery.

Drs. Niv Sne and John Harlock recount the events of one of the most unsual days of their entire medical careers.

How McMaster University’s Dr. Richard Whitlock is exploring the possibility of a world without stroke.

Corus Radio’s Emily Szabo recalls her young son’s experiences at the McMaster Children’s Hospital.

Step-by-step instructions to getting involved with McMaster’s many surgical initiatives.

Some tips and tricks for tax season that will help you maximize your investment in McMaster Surgery.

Real stories from faculty and residents that show just how powerful donor support can be.

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NEWS NOTES

McMaster Surgeons Receive $14 Million in Funding for a Revolutionary New Study

McMaster University researchers Drs. Mohit Bhandari and Sheila Sprague, along side Dr. Gerard Slobogean of the University of Maryland, have received more than $14 million in funding as they prepare to launch a new research program in fracture management. The program, PREP-IT, is a joint initiative coordinated by the Centre for Evidence-Based Orthopaedics at McMaster and the R. Adams Cowley Shock Trauma Center at the University of Maryland.

This massive study will recruit almost 10,000 participants and these trials will take place at more than 20 hospitals across North America. Upon completion, PREP-IT will provide significant evidence to guide the prevention of surgical site infections as well as infections in open fractures. Funding was granted by the U.S. Patient-Centered Outcomes Research Institute, the United States Department of Defense, the Physicians’ Services Incorporated Foundation, and the McMaster Surgical Associates.

Social Media & Surgery

Dr. Anil Kapoor, Professor with McMaster University’s Department of Surgery, generated major buzz online last spring when he and a team of surgeons live-streamed a kidney transplant over Facebook. “The donor surgery and the transplant surgery both went off without a hitch,” Dr. Kapoor said in a statement after the surgery. “Both patients are doing fantastic, with the transplant working immediately and the kidney functioning well.” During the educational live-stream, which took place at St. Joseph’s Healthcare Hamilton, doctors fielded questions from online viewers, opening up the curtain to the wonderful, live-saving operations that occur in hospitals everyday.

The ground-breaking online event received mainstream media coverage from national news outlets like the CBC.

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VITAL MAGAZINE

McMaster home to Surgical Foundations Boot Camp A few years ago, McMaster’s Department of Surgery implemented an innovative, new program that prepares surgical trainees for residency. The two-week course, which rapidly develops surgical skills via a series of technical and non-technical simulations, workshops, and lectures, is now going into its third year of making our residents some of the most prepared in the world.

Investing in Childrens’ Vision

Dr. Kourosh Sabri and the McMaster Paediatric Eye Research Group (McPERG) recently unveiled their EYE-MAC vision-screening project. This multidisciplinary approach to vision screening will put trained screening volunteers in local schools, raise eye-health awareness among children through education, and connect kids with local eye doctors. Dr. Sabri is also spearheading a similar initiative, Operation Blue Sky, in which he and his team will make vision screening available to children living in aboriginal communities.

Celebrating 50 Years of Surgical Excellence

The McMaster University Department of Surgery closed out 2017 by celebrating its 50th anniversary.

Paying homage to the Department’s origins and looking ahead to its future, hundreds of current and former faculty, staff, residents, fellows, and friends gathered at the Sheraton Hotel in Hamilton, Ontario for a nostalgic night of good fun.

Dr. Sheila Singh Inducted into the Royal Society of Canada

The Royal Society of Canada recently inducted the 2017 class of innovators into the College of New Scholars, Artists, and Scientists, and among them was McMaster University’s Dr. Sheila Singh. The College is comprised of a handpicked selection of top mid-career scholars and artists in Canada, and, each year, a new cohort is invited to join. Dr. Singh, a paediatric neurosurgeon for McMaster’s Department of Surgery, was inducted into the College for being a highly accomplished clinician scientist and an internationally recognized scholar in the areas of stem cell biology and cancer research. “The College is a unique institution that is able to respond to the challenges of today through broad creativity and innovation,” said Cynthia Milton, President of the College of New Scholars, Artists, and Scientists. “The 2017 cohort certainly reflects this vision of engaged knowledge for the social good.” Dr. Singh is the first McMaster surgeon and only the eighth McMaster faculty member to be inducted into the College.

New Grant will help Optimize Patient Health Before Surgery

Dr. Waël Hanna, a thoracic surgeon and Assistant Professor with McMaster University’s Department of Surgery, recently procured a Hamilton Academic Health Sciences Organization (HAHSO) grant worth upwards of $182,000. This funding will be used by Dr. Hanna and his team to establish an all-new preconditioning program designed to optimize patient health before they undergo major lung surgery.

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NEEDLE IN A HAYSTACK

McMaster students and faculty members team up for a practice-changing research paper, and their findings are about to benefit patients, hospitals, and economies across the globe

By Blake Dillon Photos by Tina Depko/McMaster University

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VITAL MAGAZINE

W

ould you prefer to listen to music through your headphones or a gramophone? Would you rather send an email or a Morse code telegraph? Would you ever choose to buy a rotary phone instead of a cellphone? While Nineteenth Century inventions carved a path for innovation, their usefulness today is really quite limited. So why, then, do doctors, surgeons, and medical professionals across the planet opt for out-dated technology when performing lumbar puncture procedures? While the old “if it ain’t broken, don’t fix it” adage holds merit in some cases, the truth about conventional traumatic needles is that they are indeed broken.

In his recent Lancet-published paper, “Atraumatic versus conventional lumbar puncture needles: a systematic review and meta-analysis of randomised controlled trials,” McMaster University’s Dr. Saleh Almenawer has proven that using the needles considered practice standard for lumbar punctures can have considerable consequences not only on patients, but on doctors, hospitals, and the global economy, too — and that’s not hyperbole.

While conventional needles can be used to perform successful lumbar punctures, the small, triangular incision they leave behind in the dura — the thick membrane surrounding the nerves — can cause cerebrospinal fluid to leak and build up inside the body.

This sustained leakage often results in undue pressure on the spine and brain, which can cause severe, debilitating headaches. In fact, studies show that over one-third of all patients experience these post-dural puncture headaches.

Apart from the obvious impact that painful headaches can have on a person, return visits for treatment can be costly and problematic for busy doctors and hospitals. Couple that with the inevitable work absences from patients with post-dural puncture headaches, and you can start to see how this impacts the economy. With so many lumbar puncture procedures performed annually around the globe, we’re talking about hundreds of thousands of unnecessary headaches, hospital visits, and sick days occurring every year.

The good news? There’s a pretty easy fix for all of this. Dr. Almenawer’s findings, which pooled 27 years worth of data from 110 trials comprised of over 30,000 participants from 28 different countries, showed that while a series of factors such as patient posture, operator experience, and even bedrest position can potentially contribute to headache occurrence, the single most important and proven factor is the needle tip design used for the procedure.

“Switching to atraumatic needles can significantly reduce the incidence of post-dural puncture headaches,” says Dr. Almenawer, a neurosurgeon at McMaster’s Department of Surgery.

“Bottom line, this procedure was created in 1890 and we are still using the same needle that was used then!”

Where the two needles differ is how they penetrate the dura — the sharp edges of the tip of a conventional/standard needle cuts its way through, and the pencil-like point of an atramatic needle causes the tissue to dilate and contract around it. The result is a pinprick instead of an incision. The tiny hole left in the dura by the

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atraumatic needle makes it significantly more difficult for fluid to leak through, thus diminishing the frequency of headaches, readmissions, treatments, and sick days. Now, it’s important to note that atraumatic needles aren’t perfect — they won’t eradicate post-dural puncture headaches entirely — but Dr. Almenawer’s findings show that they will prevent them from occurring in up to 60 per cent of patients, which, by all accounts, is a hefty enough fraction to justify switching.

On top of that, performing a lumbar puncture with an atraumatic needle doesn’t take longer. There’s no additional risk added to the procedure. It isn’t more painful for patients, and it doesn’t require additional training for practitioners. Simply put: using an atraumatic needle doesn’t change the procedure at all. In fact, most people — practitioners included — probably couldn’t spot the difference between the two types of needles at first glance. The only knock against autraumatic needles is that they’re a bit more expensive than conventional needles, but Dr. Almenawer says even that isn’t wholly true.

“There was a really informative study out of the U.K., in which economists performed statistical analysis on this,” he says. “Their research shows that, while the atraumatic needles are roughly three times more expensive than conventional needles, hospitals will save way more money using them because they mitigate the costs associated with readmissions, treatment procedures, intravenous fluids, narcotics, and so on.”

Dr. Almenawer first stumbled upon the existence of atraumatic needles and their potential benefits two-and-a-half years ago while surfing around on PubMed, an online search engine that accesses a database of references and abstracts from life sciences and biomedical research. A small randomized trial that pitted atraumatic needles against conventional needles caught his eye, and opened the can of worms that cumulated with his groundbreaking meta-analysis.

“I remember thinking to myself that night, ‘what the hell is an atraumatic needle?’” Dr. Almenawer recalls. “I was amazed that I had made it this far and had never even heard of it.”

That Dr. Almenawer did not know about atraumatic needles or their use in lumbar punctures is not a surprise, though. Despite being developed almost 70 years ago, surveys of clinicians from around the world revealed that only a small fraction — as low as five per cent, estimates Dr. Almenawer — of practitioners had even remote awareness of their existence, let alone their effect.

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Perhaps even more impressive than the practice-changing potential of Dr. Almenawer’s findings is the fact that he pursued this research on his own time, away from his regular neurosurgical duties, with no funding.

Dr. Almenawer says that they were successful because they “built up a great team comprised of MD/PhD student Siddharth Nath, MSc student Alex Koziarz, librarian Laura Banfield, and statistician Forough Farrokhyar, all of whom are based at McMaster University.” They also consulted multiple clinical and epidemiological experts from different specialities both from McMaster and from around the world. “The team worked hard day and night for two and half years to get the results that we did,” Dr. Almenawer explains.

“I was in medical school and looking to get involved with neurosurgery,” says Nath, who was credited as first author on the Lancet paper. “I connected with Dr. Almenawer for research opportunities and he suggested working on this meta-analysis. At that time, I don’t think either of us really had any idea of how big this would become, but it just kept ballooning until it became something that, honestly, everybody needs to know about.”

“That’s exactly it,” adds Dr. Almenawer. “Everybody needs to know about this. Unlike most research, this study is unique because it’s talking to everyone — neurologists, anaesthesiologists, ER doctors, neurosurgeons, radiologists, paediatricians, general doctors, residents, and the list goes on. If you are a lumbar puncture patient, ask your doctor if they will be using an atraumatic needle. The implications of this study are huge — our data can help improve lumbar puncture patient care and make this procedure even safer.”

In all, the final publication included contributions from almost a dozen McMaster Health Sciences faculty members, including Drs. Almenawer, Waleed Alhazzani, Roman Jaeschke, Sunjay Sharma, Emilie Belley-Côté, Kesava Reddy, Maureen Meade, and Sheila Singh, among others.

Dr. Singh, in particular, says that “Atraumatic versus conventional lumbar puncture needles” is a landmark publication that will further solidify McMaster’s place as a global leader in innovation and research.

“The collaborative efforts of the team, especially Siddarth Nath and Dr. Almenawer, resulted in a monumental achievement,” she says.

“A publication in The Lancet is something most researchers aspire to achieve for their whole careers. They have made McMaster very proud with their important work.”

VITAL MAGAZINE

“The collaborative efforts of the team, especially Siddarth Nath and Dr. Almenawer, resulted in a monumental achievement... They have made McMaster very proud with their important work.”

–Dr. Sheila Singh

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EVERY DAY HEROES

It’s not every day that surgeons are called to perform surgery outside of the hospital, so when Dr. Niv Sne and Dr. John Harlock were rushed to the horrific scene of a partial dam collapse, you can imagine the cocktail of adrenaline, concern, and excitement coursing through their bodies.

Here, roughly one year after the incident, they reflect on what is sure to be one of the most unusual days of their entire medical careers.

By Blake Dillon

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rogreston Falls is a beautiful, serene place. Located just outside of rural Carlisle, Ontario, the private parkland is home to a harmony of plants, animals, and natural wonder. A tributary of Bronte Creek cuts through the area, spilling over a 54-foot-wide cliff that forms a classic wide-terraced curtain waterfall that many locals routinely gawk over. But, on July 21, 2016, that serenity was juxtaposed with horror.

Sixty-three-year-old Ben Paavilainen was called to Progreston Dam for a routine construction project. During his initial inspection, however, a huge concrete wall of the dam came loose and crushed him, pinning his body to the riverbed below.

In incredible time, police, fire, and paramedics were all on scene to attempt to rescue Paavilainen. Despite the fleet of emergency responders, however, the group was no match for the 25-ton concrete wall. Paavilainen was stuck.

Inset photos by: Jon Evans Lead photo by: Alexander Sviridov

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Stuck as he was, however, he was alive and well — or as well as he could have been given the situation. The plan was, if the slab could not be removed from Paavilainen, he would be removed from it. The first responders called the emergency unit at Hamilton General Hospital to see if they could get some surgeons on scene to help amputate the trapped civilian’s legs.

Dr. Niv Sne, a McMaster University trauma surgeon, clearly remembers receiving the call from the emergency physician who apprised him of the situation.

“The natural response when you learn of something like this is to start preparing the operating room,” he says. “But, for the first time in more than 15 years of doing this, they said, ‘no, no… you’re going out there.’ They told me that the emergency responders were concerned that there would be no way to pull the concrete slab off of the patient, and the poor gentleman would require bilateral lower-limb amputation.”

Dr. Sne’s first order of business was to decide who he’d bring along with him — enter Dr. John Harlock.

“Dr. Harlock is an esteemed vascular surgeon, and I called him without hesitation and asked him what he was doing,” Dr. Sne recalls. “He goes, ‘Not much. Just about to eat lunch.

What’s going on?’ I told him, ‘Put the lunch aside — we’re going out to the field to do a bilateral lower-limb amputation.’ His first reaction was, ‘Nah — you’re kidding.’ But I sadly wasn’t and we were on our way to the scene before either of us really knew it.”

Upon their arrival, both surgeons were completely awestruck by the extreme juxtaposition of the scene.

“It was kind of surreal,” Dr. Harlock recalls. “I remember there was a family of ducks swimming peacefully on one side of the river and a serious trauma unfolding on the other. It was crazy.” “It was totally picturesque,” Dr. Sne adds. “A beautiful site host to a horrible incident.”

The day was exceptionally hot, and, dressed in OR scrubs and running shoes, the two surgeons were ill prepared for the journey down to the foot of Progreston Dam. It’s a steep climb

VITAL MAGAZINE

Every Day Heroes is a campaign in which we celebrate McMaster surgeons who exemplify dedication, diligence, and courage all in a day’s work.

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“The OR can be quite chaotic...

But it’s my workplace. It’s what I’m used to.” –Dr. John Harlock

down along a path lined with jagged, moving rocks — a path tough enough to descend in proper hiking gear. But with the guidance of a few firefighters, the two surgeons were on scene and ready to operate.

For both doctors, the accident was far worse than imagined. Not only was the concrete slab crushing more of the patient than expected, but there was also another critical detail that neither Sne or Harlock were prepared for.

“He was awake,” Dr. Harlock says. “Awake. Aware. Alert. Talking.

Moaning and groaning. He was breathing on his own, and maintaining blood pressure.”

Performing a bilateral lower-limb amputation on a sedated patient in the comfort of a hospital operating room with the help of power tools is one thing for two experienced surgeons like Drs. Sne and Harlock. But, performing a surgery as complex as that on a patient who’s completely alert, lying in a river, and pinned to the earth by 25 tons of concrete using only a string-saw — the kind of saw you’d use to cut wood in a forest — was a completely different story.

Dr. Sne described the situation as “organized chaos.” He says that the first responders did an outstanding job of controlling the situation, but there were still far too many factors preventing them from simply swooping in and performing surgery.

As such, the first order of business for the surgeons was to intubate the patient.

“The OR can be quite chaotic,” explains Dr. Harlock. “People die. They come in bleeding from ruptured aneurysms or gun-shot wounds. But, even then, it’s still relatively controlled chaos. It’s my workplace. It’s what I’m used to. Performing any kind of surgery in a riverbed is a lot different.

You’re out of your comfort zone. So, when we got the patient intubated, things felt a lot more controlled and we were able to get to work.”

And get to work they did. The plan was to use a scalpel to cut through his muscles and nerves and use the string-saw to cut through the bone. Dr. Sne looked after the initial intubation and took control of the bleeding. Dr. Harlock cut down on the patient’s thigh to place clamps on his blood vessels. Together, they ensured his vitals were okay, that he was properly sedated, and that he was well looked after.

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“I knew then and there that it wasn’t going to be a nice amputation, being so high up on the legs,” Dr. Harlock says. “It would have been tough to get proper tissue coverage, and I was just going to do a guillotine cut straight down and do my best to repair it when we got the patient back to the hospital.”

Notice Dr. Harlock’s use of past tense. “Wasn’t.” “Would have.”

“Was.” Just as the surgeons were about to perform the amputation, they got word that a crane was approaching to help lift the slab off of the patient — music to their ears.

In a few short minutes, the crane was on site, attaching its pulley to the slab. Even then, though, there was more uncertainty than relief.

“My mind was racing,” Dr. Harlock recalls. “Is he bleeding out under the concrete? What state were his legs in? Would the concrete fall further onto his body if the crane slipped up at all? The whole situation was really tense.”

With the fire chief directing the crane, Dr. Sne, Dr. Harlock, and the rest of the first responders were ordered to temporarily vacate the area due to the very real risk of the slab tipping onto somebody else.

With all its might, the crane managed to lift the 25-ton slab about six inches off of the patient — just high enough for him to be slid out from underneath.

To both surgeons’ surprise, the patient’s lower limbs were in an okay state, all things considered.

“Because it was a true crush injury, all of his blood vessels were sent into spasm, meaning there wasn’t as much bleeding as you’d expect,” Dr. Sne explains. “We got him on a stretcher, put a tourniquet on his legs, and got him ready for transport to the hospital.”

At this point, Dr. Sne says there was a lot of communication with the hospital. They already had an operating room set-up; all they had to do now was get the patient there alive.

Dr. Sne travelled back to the hospital with the patient and the paramedics by helicopter, while Dr. Harlock went back in an ambulance with a police escort, which arrived at the hospital five minutes before the helicopter did.

VITAL MAGAZINE

“When the patient arrived, we bypassed emergency and went straight to the operating room,” Dr. Harlock says. “We had people from orthopaedics waiting there — people from plastics, too. Mix in Dr. Sne from general and myself from vascular and it was quite a team effort.”

After a lengthy operation, both legs were salvaged.

Although he suffered fractures in several locations, the patient didn’t require any significant amputation, except for a small bit of work on his right foot. Considering what was originally planned, this was a major win for both the patient and for the surgeons.

Alotgether, the whole excursion was just a few hours long. But with so much uncertainty and so many uncontrollable factors, the day seemed like an eternity for Drs. Sne and Harlock (and surely for the patient, too).

“In hindsight, there were a lot of things Dr. Harlock and I did not think about,” Dr. Sne says. “We now have a lot more protocols in place, in case something like this ever happens again. We got lucky that it was during daytime, and not the pitch black of night. We were lucky it was in the summer, and not the dead of winter. All things considered, I’m sure the circumstances could have been a lot different if the stars weren’t so well aligned.”

Lucky or not, the truth is Drs. Sne and Harlock acted heroically that fateful day at Progreston Falls.

They were calm in the face of chaos, and decisive in the face of urgency. If you ask them, they’ll tell you that they were just doing their jobs. Modest, yes, but also true — they were just doing their jobs.

And that’s what’s so amazing about it all. Every day, Drs. Sne and Harlock help people in need and save lives. For that and more, we’re proud to call them our inaugural Every Day Heroes.

“The natural response when you learn of something like this is to start preparing the operating room... But, for the first time in more than 15 years of doing this, they said, ‘no, no… you’re going out there.’” –Dr. Niv Sne

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EXPLORING A WORLD WITHOUT STROKE Dr. Richard Whitlock, a McMaster University cardiac surgeon based at the Hamilton General Hospital, is leading the charge as we step evercloser to a world without stroke

By Ellie Stutsman, PR Specialist, Hamilton Health Sciences

Lead photo by: Owen Thomas, Hamilton Health Sciences Read more “Explorers” stories at: weareexplorers.ca

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n a gloomy day last April, Richard te Boekhorst was doing yard work when the clouds above him threatened to open up. He sped up his pace in a race against the impending storm. In his haste, he stumbled and fell. He must’ve tripped on the hose, he thought.

What Richard didn’t realize was that he hadn’t tripped on the hose. He was having a stroke. It came over him as unexpectedly as the clouds above and, last he remembers, left him helpless on the ground as the rain began to pour. He was changed.

Before the stroke, Richard was a local 63-year-old financial planner who led a fastpaced, healthy lifestyle. He was your typical “type-A”, despite having atrial fibrillation (AF), a common condition that causes an irregular heartbeat.

People with AF have a higher risk of stroke since blood isn’t being moved properly through the heart, which can cause blood to pool and, potentially, form a clot. If a clot gets pumped to the brain, it can cause a stroke. Atrial fibrillation currently affects more than 350,000 Canadians. Age increases their risk of stroke and so as our population’s age rises, so do the number of strokes.

Dr. Richard Whitlock, cardiac surgeon at the Hamilton General Hospital (HGH) and researcher at the Population Health Research Institute, is exploring ways to give peace of mind to people like Richard, who live with the constant threat of stroke. It’s a challenge he and his team tackle every single day, and

“We think that, if we remove the left atrial appendage altogether, we can significantly reduce the threat of stroke for patients.”

–Dr. Richard Whitlock

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they’ve started with a small, seemingly innocent piece of the heart that’s actually proven to be an ideal breeding ground for dangerous clots.

The left atrial appendage (LAA) is a little pocket of tissue on the upper chamber of the heart that, as far as we know, has no real purpose. But, what is known is that the LAA is the main source of most blood clots.

Blood pools in its cozy pocket and forms in to clots which dislodge and can wind up in the brain.

“It a perfect storm for a stroke to occur,” says Dr. Whitlock. “We think that, if we remove the LAA altogether, we can significantly reduce the threat of stroke for patients.”

Through the Left Atrial Appendage Occlusion Study (LAAOS), Dr. Whitlock and his team remove the LAA in patients who are already undergoing open-heart surgery since it’s accessible, simple to remove, and has no impact on the primary procedure. There are 4,700 patients participating in the study across 20 countries.

They’ll be tracked for four years to see whether the absence of the LAA reduces the rate of stroke.

“The only risk to the patient is the initial surgery, which carries less of a risk than the alternative, a lifetime of being on blood thinners,” says Dr. Whitlock.

“This could have a dramatic positive impact for AF patients and, so far, the evidence is promising.”

If the study proves that LAA removal is a worthy and effective tactic in stroke prevention, it could become an option for people like Richard, and would likely inspire further research on whether it’s a method that can be applied beyond those with AF. Thankfully, moments after his stroke, Richard’s wife found him rolling in the grass in the pouring rain. He had been unable to get himself up off the ground – his whole right side was paralyzed, and he couldn’t call for help. His wife called 9-1-1, and soon after paramedics whisked him away to the General, the regional stroke centre for Central South Ontario.

Thanks to the all-around speedy response of his wife, his paramedics, and his care team at HGH, Richard got his motion back quickly, but still required months of speech therapy. He’s gradually returned to work, but at a reduced capacity. His energy level is far lower and he still gets stuck with his speech.

“Having a stroke has changed my life,” says Richard.

“My biggest worry is that it could happen again.”

Dr. Whitlock and his team are finding a way to make sure it doesn’t.

“The only risk to the patient is the initial surgery, which carries less of a risk than the alternative... a lifetime of being on blood thinners.”

–Dr. Richard Whitlock

For more stories on explorations at Hamilton Health Sciences, visit weareexplorers.ca.

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THE

PED

hea

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E PERKS OF

DIATRIC

alth CARE Whether they’re performing life-saving surgeries or routine procedures, pediatric surgeons provide a unique type of care for their young patients. Corus Radio’s Emily Szabo experienced this care first-hand last October when her six-year-old son, Ryder, visited McMaster Children’s Hospital for a small surgical procedure. Here, she recounts her son’s experiences and reflects on why she now thinks having highquality pediatric care so close to home is something people shouldn’t take for granted.

By Blake Dillon

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hen Emily Szabo’s sixyear-old son came to her with complaints about a small bump on his back, she didn’t think much of it. “We assumed it was just a little bump or scratch,” she says. “When you have a rambunctious little boy like Ryder, bumps and scratches are pretty much a regular, every day occurrence.”

But, as time went on, the tiny bump became a sizeable lump, which continued to grow bigger and bigger as the days passed. While even as it grew it didn’t look all that serious, Ryder pointed it out often enough to warrant a visit to the family doctor.

Szabo, 95.3 Corus Fresh Radio music director and host of their afternoon drive show, says that she’s glad she took her son to get checked out.

“Our family doctor reiterated that the bump likely wasn’t serious, but still suggested we visit the McMaster Children’s Hospital to get a second opinion,” she says. “That’s where we met Dr. Karen Bailey.”

The surgery itself was much shorter than Szabo or her son imagined possible, and they experienced no complications whatsoever.

“Ryder told me that the whole process was a lot easier than he thought it would be,” Szabo says. “He woke up feeling happy that his lump was gone and even more happy when he learned that he had a special after-surgery present waiting for him at home. His incision area healed very nicely and he was back to doing the things he loves — like playing hockey — in no time!”

In the grand scheme of things, Szabo knows that Ryder’s procedure was very minor. Just down the hall from where he had his lump removed, children of all ages continue to fight life-threatening illnesses and injuries — she understands that these children, their parents, and their families have it much, much worse than Ryder did. Still, though, being exposed to pediatric surgery was an eye-opening experience for her, teaching her and her family the importance of having high-quality children’s care available so close to home.

“I think pediatric surgical care is so important and I’m happy that such good care is available to us right here in Hamilton,” she says. “I

ryder

“Pediatric surgical care is so important...

I’m happy that such good care is available to us right here in Hamilton.”

–Emily Szabo Mcmaster children's hospital

Dr. Bailey, a pediatric surgeon and Associate Professor at McMaster University, diagnosed Ryder with some good news and some bad news. The good news was that his lump was not cancerous, dangerous, or even overly serious; the bad news was it would still require surgery.

As Dr. Bailey explained to Szabo and her son, he was experiencing a hair follicle issue that was causing a portion of his back to swell. She explained the procedure to them in lay terms, and was honest and empathetic throughout the entire process.

“Dr. Bailey was very kind and calm the whole time,” Szabo says. “She talked to us before the surgery and made sure Ryder was feeling okay about everything. I think I was feeling more nervous than Ryder was, but it was very re-assuring to see how calm and confident Dr. Bailey was about the surgery.”

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really appreciate the empathy of Dr. Bailey and all of the doctors and nurses we dealt with, because, even with such a minor and routine surgery, it was a very scary and unfamiliar experience for us. I can only imagine how important this kind of empathy is to parents with children going through a more serious surgery.”

In general, Szabo says that, all things considered, her experience at McMaster Children’s Hospital was a positive one, thanks in large part to people like Dr. Bailey.

“All of the care providers were professional, kind, and comforting,” she says. “Ryder’s surgeon comforted him during a time of uncertainty, his anesthesiologist made him laugh before the surgery began, and the nurse got him chatting about Halloween costumes. The nurses after surgery were very attentive and I felt incredibly comfortable with how they were monitoring him.”

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dr. karen bailey

emily szabo

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BECOMING A SUPPORTER

HOW TO

CONTRIBUTE

Six simple steps for getting involved with McMaster Surgery Step 1: Visit us Online

Check out our all-new donor portal at Surgery.McMaster.ca/Support.

Step 2: Choose a Type of Gift

Upon entering our site, the first decision you’ll have to make is whether you want to make a one-time donation or a monthly donation. Toggle between choices by clicking the checkmark adjacent to the one you’d prefer. By default, the form starts with “one-time gift” selected.

Step 3: Select Fund & Amount

We have a generic “Surgical Education Fund” designation set up to make matters quick and easy for our online donors. Simply type in your desired amount, and continue on with the form. All donations to the Surgical Education Fund will be used for our most pressing needs — could be research, could be resident resources, could be recruitment. However, if you would prefer to give to a specific purpose, simply type that purpose in the field provided and we’ll ensure your gift achieves its goal. Even if you’re interested in donating to a specific surgeon who helped you or your family through a difficult time, simply type his or her name in that same field and we’ll ensure your donation helps fund their surgical endeavours. Don’t see what you want to support? Call us! 905.521.2100 x44369.

Step 4: Enter your Personal Information

For this part of the process, we only need your first name, last name, and email address.

Step 5: Search for your Employer

Did you know that some employers will double or even triple their employees’ charitable efforts? Search for your employer in our database to see if yours is eligible for this amazing initiative.

Did You Know?

Through our site, it’s possible to donate on behalf of a loved one.

This makes for a great gift for the philanthropist in your life.

See Your Support In Action!

We love meeting our generous supporters. That’s why we encourage all of our donors to book a visiting session with our faculty. We’ll connect you with the surgeons you’ve chosen to support so you can tour the facilities you’re helping to fund, meet the next generation of surgeons that you’re helping to educate, and understand the life-changing research that you’ve made possible.

Step 6: Enter your Billing Information

The final step is to enter your credit card information. For the record, we see none of this information. All payments are processed by McMaster’s central advancement office so your info will not remain on file with us.

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Contact dillonb@mcmaster.ca to arrange your meeting.

TAX TIPS

CLAIMING YOUR CREDIT How to make the most of your investment in McMaster surgical excellence

In Canada, people who donate money to eligible charities, services, associations, or institutions are qualified to receive a charitable tax credit at the end of the year. Oftentimes, the return attained from these credits turns out to be a sizeable percentage of the total donation, ultimately reducing the donors’ financial output while still greatly benefiting the recipient. Consider it the government’s way of encouraging charitable activity.

McMaster University is an eligible institution, meaning all donations made to our department will be accompanied by a tax receipt — your golden ticket to money savings during tax season.

While it’s true that universities such as McMaster have multiple revenue streams, the reality is that none are as important as charitable donations. One five-minute walk around campus, and you’ll see entire facilities like the Michael G. Degroote School of Business or Ron Joyce Stadium branded with donor names, signifying just how pivotal their contributions are to our continued success.

Whether you’re considering giving a few dollars or a few thousand, this 101 guide will provide you with some helpful tips for maximizing your donations. Be sure to visit the government’s website or speak with a registered accountant to learn more.

Determining the Claim Amount

In any given year, Canadian citizens can make tax claims on all donations made on or before December 31 of the applicable tax year.

Additionally, you may claim any unclaimed donations made in the previous five years by you or your spouse or common-law partner. Calculating the total is a matter of simple addition, however, the amount you may claim is limited to 75 per cent of your net income.

Stacking Federal & Provincial Rates

All charitable claims are conveniently subject to two separate rates, which can be combined to the claimant’s benefit. In other words, the federal government will credit you with a certain percentage of your total donation, and the provincial government will do the same.

The Canadian Government’s website provides the following example: “Danielle lives in the province of Saskatchewan and has donated $400 to registered charities. The federal charitable tax credit rate is 15 per cent on the first $200 and 29 per cent on the remaining $200. Her federal tax credit is therefore (15% × $200) + (29% × 200) = $88. The provincial charitable tax credit rates for Saskatchewan are 11 per cent on the first $200 and 15 per cent on the remaining $200. Therefore, her provincial tax credit is (11% × $200) + (15% × $200) = $52. Her combined charitable tax credit is ($88 + $52) = $140.”

How Your Credit is Received

Since this is a non-refundable tax credit, it is not received as actual cash. Rather, any money earned from a charitable tax credit can only be used to reduce tax owed. In other words, if you don’t owe any tax, you won’t get a credit. However, if you do owe tax, your donations will help pay for annual taxes, which means any money that would have typically been spent on taxes will instead be saved for use at your discretion.

First-Time Donor’s Super Credit

Finally, if you’ve never donated before, then here’s one more reason to start: The government will supplement the value of all first-time donations by an additional 25 per cent!

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YOUR IMPACT

WHY YOU MATTER

First-hand stories that show how your support can make a difference

Dr. Sheila Singh

Pediatric Neurosurgeon

“Independent donations are inspiring because donors will typically only fund ideas that they believe in. This type of support liberates researchers and allows us to explore highrisk, high-reward projects. Often, the funding garnered from individual supporters results in groundbreaking discovery instead of incremental change. I personally use a lot of the donations that I receive to support student development so that the impact of the donor’s support is felt far into the future.”

Dr. Andrew Giles

Year-4 General Surgery Resident

“Thanks to the financial support provided by the Juravinski Surgical Fellowship Award, I was able to spend a year in Boston completing a Master of Public Health at the Harvard T.H. Chan School of Public Health.

This enabled me to work with leaders in the rising field of Global Surgery and establish the foundations for my future work in this area. Furthermore, I have already seen the research skills I have gained advance not only my research, but also that of my co-residents here at McMaster.”

Dr. Michelle Kameda

Dr. Kesava Reddy

“The Clinician Investigator Program provides an opportunity for resident physicians to enrich their professional development. The philanthropic donation of the Boris Family will support my PhD studies for the full four years, providing me with an amazing opportunity that would have otherwise not been financially feasible. I’m making the most of my time with the McMaster Stem Cell and Cancer Research Institute, and feel confident that I will graduate with the skills necessary to become a successful Neurosurgeon Scientist.”

“To provide state-of-the-art patient care, surgical practice needs to be supplemented with strong education and research initiatives.

It is difficult to achieve this without the philanthropy and altruism of our generous supporters. I have been fortunate to be associated with some remarkable individuals who are willing to help us achieve our objectives. Most of them do it anonymously — content solely with the knowledge that they have helped us help others. These individuals and organizations have my sincerest gratitude.”

Year-3 Neurosurgery Resident

Neurosurgery Professor

Special thanks to the donors who fund our endowed chairs and professorships

Every donation — big or small — enhances the education and clinical research carried out in McMaster University’s Department of Surgery. But some donors have gone above and beyond that and provided us with endowments, which permanently support surgical education at McMaster!

Our five endowed chair positions and our endowed professorship are important, charitably funded faculty positions that allow us to use funds that would otherwise not be available to us for additional surgical research, education, and patient care initiatives. The John A. Bauer Chair in Surgery is held by Dr. Susan Reid, The Mortgage Intelligence/GMAC Chair in Thoracic Surgery is held by Dr. Yaron Shargall, the Chair in Minimally Invasive Surgery and Surgical Innovation is held by Dr. Mehran Anvari, the Braley Gordon Chair in Urology is held by Dr. Bobby Shayegan, the Beamish Family Chair in Peripheral Vascular Surgery is held by Dr. Jacques Tittley, and the Juravinski Thoracic Surgery Professorship is held by Dr. Yaron Shargall. Together, these six endowed appointments empower us as a world leader in academic surgery. For that, we would like to extend a special thank-you to the estate of John A. Bauer, Mortgage Intelligence and GMAC Residential Funding of Canada, Johnson & Johnson Medical Products, David Braley and Nancy Gordon, the Beamish family, and Charles and Margaret Juravinski.

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