DAY IN THE LIFE
ON THE FRONT LINE
TOP SURGEONS
Dedicated residents push through tireless rotations, learning every step of the way
Lab techs are often the first to uncover the diagnosis that will change lives
Dr. Karl Logan is one of many drawn to the IWK by its state-ofthe-art ORs
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A BRAVE FACE The IWK’s first mid-face advancement surgery at the hands of Dr. Michael Bezuhly changes a life forever
A LOOK INSIDE THE IWK
COVER STORY
A brave face Logan Gibb was born with Pfeiffer Syndrome, a hereditary condition where the soft-spots in your head are fused together before you are born. State-of-the-art surgical treatment at the hands of plastic surgeon Dr. Michael Bezuhly at the IWK last May means Logan has a new lease on life.
By Lola Augustine Brown PAGE • 26
CONTENTS Attracting the world’s best surgeons
By Diane Merlevede
Pediatric orthopedic surgeon Dr. Karl Logan is one of many professionals drawn to the IWK by its state-of-the-art ORs and cutting-edge research PAGE • 6
A day in the life
By NADINE LAROCHE IWK residents prove their dedication through tireless rotations, knowing every moment makes a difference
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iagnosing depression D with a single test
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daily mission to protect A children in peril
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iscover the heart of D IWK volunteerism
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ediatric palliative care P expert demonstrates the true meaning of life
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iving the IWK $10 million G reasons to smile
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lessed by generosity: B a history of philanthropy
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F inding a natural latch with breastfeeding
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race against the world A to link measles receptor and cancer
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I WK doctor assists women a world away
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round-breaking G innovation from one tiny fish
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F rom chronic pain to living life to the fullest
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On the front line
By ELIZABETH PATTERSON Laboratory technicians are often the first to uncover the diagnosis that will change lives PAGE • 48
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Introducing Izaak IWK Health Centre 5850/5980 University Avenue )BMJGBY / 4 # , 3 iwkfoundation.org
Welcome to the inaugural issue of Izaak Magazine — an in-depth, behind-the-scenes, all-access publication highlighting the incredible, everyday happenings at the IWK Health Centre.
I know what you’re thinking — Who is Izaak?’ Simply put, Izaak is the man whose family helped solidify the IWK’s place in history; laying the foundation for what has become one of the most recognized tertiary care facilities in Canada. Izaak Walton Killam’s wife, Dorothy, left a legacy gift of $8 million for a new, modernized hospital which opened in 1970. Since that landmark gift, thousands of donors have stepped up to help the IWK continue to grow as a centre of health care excellence and innovation. Thanks to 28 years of Telethon campaigns, and many outstanding philanthropic moments such as a recent $10 million gift from Myron and Berna Garron, the IWK is here to ensure Maritimers receive the exceptional care in the exceptional facilities they deserve. We are thrilled to be partnering with the IWK to bring you the most comprehensive look at the people, the projects and the patients who, together, are the spirit of one of the most vital — and cherished — institutions in the Atlantic Provinces. The Chronicle Herald team knows the IWK very well, as does my entire family. My mother, Gay, has volunteered with the IWK Auxiliary for over 40 years — she is a warm and welcoming face to many at the IWK. My late brother, Will, was a patient of the IWK; since his death we have raised funds to help work towards a cure for epilepsy — the disease that tragically took his life. I am a mother to three children, all of whom were born at the IWK and have been back for various visits over the years. I have had the honour of serving as the Chair of the IWK Health Centre Board of Directors and have insight into the inner workings and integrity of this great place. These are my connections; I know you have your own. That is what’s so special about the IWK — we all have our own stories. Izaak will celebrate these connections and memories, and the reasons the IWK is a place we are all proud to claim as our own. Thank you for believing in the IWK. We hope you enjoy this first issue of Izaak and the many issues to come.
Sarah Dennis
The IWK Health Centre is the region’s leading health centre providing specialized, quality care to thousands of women, children, youth and families in the Maritimes and beyond. The mandate of Izaak magazine is to uncover and showcase the world-class care and research of the IWK so all stakeholders know and are proud to speak of the IWK as a national leader in health care excellence. Izaak will highlight the unique and critical role the IWK plays in the Maritimes and the importance of philanthropy to continue this mission. Published by: Herald Custom Media Chairman and Publisher: Sarah Dennis President and CEO: Mark Lever Director, Herald Custom Media: Jeff Nearing Editor and Project Manager: Lindsey Bunin Director, Design: Jayson Taylor Creative Lead: Joel Evans Graphic Designer: Julia Webb Director, Sales: Nancy Cook Account Executives: Tracy Skinner, Ken Tanner, Marie Reeves Contributors: Heather Laura Clarke, Lindsey Bunin, Lola Augustine Brown, Ken Cashin, Diane Merlevede, Elizabeth Patterson Photographers: Charla Jones, Paul Darrow, Christian LaForce, Scott Munn, 123rf, Siri Photography Cover Photo: Dr. Michael Bezhuly Š Paul Darrow Š The Chronicle Herald 2012 All rights reserved. No part of this book may be reproduced, stored in retrieval systems or transmitted in any form or by any means without the prior written permission from the publisher. The Chronicle Herald 2717 Joseph Howe Drive 10 #PY )BMJGBY / 4 # + 5 thechronicleherald.ca Printed by: Advocate Printing
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,QWURGXFLQJ 'DYH *XQQLQJ·V QHZ FKLOGUHQ·V ERRN Based on an inspirational song co-written by Dave Gunning & George Canyon, “These Hands” is a children’s book that teaches us that every person has the ability to be a hero of the human kind. The book features 17 vibrant, original illustrations by Meaghan Smith, as well as the lyrics and sheet music to the song. To find out more about purchasing the book, and supporting the IWK, go to: www.twspublishing.com
Attracting the world’s best Pediatric orthopedic surgeon Dr. Karl Logan is among professionals drawn to the IWK by its state-of-the-art ORs and leading-edge research
By Diane Merlevede Photos by Christian Laforce
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parent never wants to hear anything bad about their baby’s health, but that’s the position Melanie Lisson found herself in earlier this year. Her daughter, Quinn, was referred to the IWK from Fredericton when her doctor discovered that her hips weren’t developing properly. In a breech position when she was born, Quinn’s hip may have never been in the socket properly, the IWK’s Dr. Karl Logan explained to Lisson. Despite the unpleasant circumstances, Lisson says her worries were put to ease once they were admitted to the IWK. “From our first visit, we felt extremely well cared for with Dr. Logan,” Lisson says. “The process was incredible. We were with
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I have worked at the Great Ormond Street Hospital in London, and the Hospital for Sick Children in Toronto, and in my opinion our operating suite here is the best I’ve ever seen.” — Dr. Karl Logan
our orthopedic surgeon within a week and received a surgery date within two months — we couldn’t have hoped for better.” Following her successful innominate osteotomy with Dr. Karl Logan in September,
Quinn and her parents had a quick four-day hospital stay and were able to head home. They will return for periodic followups over the years, but the bulk of their worries are now dissolved. Dr. Logan is one of several pediatric orthopedic surgeons who have come to the IWK Health Centre after working at major hospitals in other countries and cities. The high quality of the IWK’s pediatric operating facilities was one of the attractions that led to his arrival in March of 2010. “There has been a huge investment in the operating facilities at the IWK, which are really second to none,” says Dr. Logan, who was born in the United Kingdom.
“I have worked at the Great Ormond Street Hospital in London, and the Hospital for Sick Children in Toronto, and in my opinion our operating suite here is the best I’ve ever seen.” Dr. Logan is proud to be part of a team of orthopedic surgeons who bring a lot of experience from around the world. “Dr. Ron El-Hawary trained at Texas Scottish Rite Hospital for Children in Dallas,” he says. “Dr. Jason Howard did his fellowship in Australia, New Zealand and Japan. And Dr. Ben Orlik recently returned from Los Angeles. It is a huge pleasure to work in such a collegial environment with like-minded people.” The Ron Joyce Operating Suite is one
of the many upgrades that IWK donors have made possible. It has seven operating rooms and state-of-the-art technology. “We have multiple flat-panel screens, on which we can display X-rays or imaging,” says Dr. Logan. “Everybody can watch what is going on, and the surgeon can clearly see what is going on from multiple angles. We have a bubble cam, a little camera we can move around the OR. People also can watch the operation without being in the room. We can send out to the conference room or anywhere within Dalhousie University.” Dr. Logan likes that most of the equipment in the operating room is suspended
Photos: Dr. Karl Logan (above, second from left) is one of several pediatric orthopedic surgeons who have come to the IWK after working at major hospitals. The Ron Joyce Operating Suite is one of the many upgrades that IWK donors have made possible. It has seven operating rooms and state-of-the-art technology. The facility makes it possible for surgeons to change the lives of pediatric patients, like Quinn Lisson, on whom he performed a successful innomate osteotomy in September (pictured).
from the ceiling and easily can be moved around the room, which helps to make operating easier. There also are special beds that allow doctors to take X-rays while the patient remains in the bed. Dr. Logan is now looking forward to a new research project with the team. The IWK’s Orthopedic Surgery Research Group was recently awarded $2.2 million from the Atlantic Innovation Fund toward the development of low-dose X-ray techniques to help assess and improve outcomes of pediatric orthopedic surgeries. “We have been awarded the grant to look at marrying two technologies,” he says. “In adult orthopedics, radiostereomet10 t FALL 2012 - WINTER 2013
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The work they’re doing is amazing. Having Quinn in the care of the IWK made all the difference in the world for us.” — Melanie Lisson, mother of patient Quinn Lisson
ric analysis, or RSA, tells you much sooner whether your joint replacement is going to continue to be successful or not. We hope that in pediatrics we are going to be able to utilize the technology in similar ways. EOS is an X-ray machine that takes X-rays from
two directions using a lot less radiation than a standard X-ray. Basically we are going to combine those two technologies for use in children.” “For example, in the case of a patient with scoliosis surgery, it may allow the patient to get back to regular activities much more quickly because the technique will tell us whether the spine has healed properly and fully.” Lisson couldn’t be happier with her daughter’s experience with Dr. Logan and his team. “The work they’re doing is amazing,” she says. “Having Quinn in the care of the IWK made all the difference in the world for us.”
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The IWK Health Centre is the NSLC employee’s charity of choice. My NSLC has dedicated employees and generous customers who have supported the IWK Telethon for more than 23 years. We’re proud to have raised over $1.7 million through the years and to have helped make a difference in the lives of Nova Scotia children,
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women and families.
ny, –Tiffa
NSLC New Waterford
my myNSLC.com
A day in the life IWK residents prove their dedication through tireless rotations, knowing every moment makes a difference
By Nadine LaRoche
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tephanie Aubrey knows play is an automatic passport to communication with a child. On one evening, she found herself piled into a patient’s bathroom with the patient, her aunt and rest of the care team — doors closed, and lights out — playing with turtle and ladybug nightlights. She recalls the stifled giggles and silliness — as well as the sense of trust and openness that the encounter created.
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Photos by Charla Jones
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As you’re walking down the hall, everyone recognizes you, smiles at you, and knows your name. At the IWK, you’re building a home from day one.” — Stephanie Aubrey
This is what drew Aubrey to pediatrics. Aubrey, beginning her third year in the residency program at the IWK Health Centre, has felt a longstanding connection to children that she ties back to her own parents’ professional choices; her mother is a nurse and her father, a teacher. Back in her fourth year of medical school, it only made sense for her to choose, and later
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fall in love with, pediatrics. The feeling of family the Northern Ontarian would find at the IWK, where she was assigned following graduation, was an unexpected bonus. “As you’re walking down the hall, everyone recognizes you, smiles at you, and knows your name,” she says of her colleagues at the hospital. “At the IWK, you’re building a home from day one.”
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Photos: Pediatric resident Stephanie Aubrey loves the rewarding work she does each day at the IWK Health Centre. She carefully reviews patient charts and becomes familiar with each patient as she treats them. As part of her rounds on this day, she shares a moment with six-month-old Xander James Boyd, and chats with 14-year-old patient Colton Chaisson. As with most health-care professionals, paperwork is a part of everyday life for the hard-working residents. Stephanie wraps up her notes before finishing her shift for another day.
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Anita Smith, an obstetrics and gynecology resident entering her third year, has found that same happiness within the IWK’s walls. “There’s a difference when you walk into the IWK,” says Smith. “Whether it’s the pediatrics side, or the maternity side, it’s brighter here. You recognize faces, you get a smile, you can say ‘good morning.’ It’s such a nice place to come to work.” 14 t FALL 2012 - WINTER 2013
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They come and go, and we come and go, but it’s really remarkable the kind of relationship you can form so quickly with someone because of the importance of a birth. That’s something really special about obstetrics.” — Anita Smith
Smith knew since her early days at Dalhousie University that she wanted to work at the IWK. She ultimately focused her studies on obstetrics and gynecology because of the variety it provided, and the chance to work with mothers and families during such an important time in their lives. The emotional magnitude of the birth experience still amazes this young resident. Despite the fleeting nature of her interaction
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with these patients a strong bond is created through this emotionally and physically exhilarating and exhausting experience. “They come and go, and we come and go, but it’s really remarkable the kind of relationship you can form so quickly with someone because of the importance of a birth. That’s something really special about obstetrics,” she says, adding that she’s looking forward to having her own patients when she finishes residency, and forging the strong relationships that exist between mothers and their obstetricians. For these residents, the learning and teaching roles are all around them. They are learning and getting direction from the senior physicians they work with, while also being responsible for passing knowledge on to the next generation of medical students who are also at the IWK as learners. As part of the IWK Health Centre’s greater mission to be global leaders in research and knowledge sharing, the hospital hosts 437 residents in nine different departments. Residents are fully-qualified medical doctors who have received their medical degree and are pursuing advanced postgraduate training. They are physicians, not medical students. They may care for you without supervision in areas where they are qualified. Often paired with these eager minds during their daily rounds, the residents are challenged to stay on top of their knowledge, ensuring they’re either ready to answer their questions, or willing to find the answers. For some, including Smith, this quick transformation from learner to teacher was a scary shift. But with her own experience in medical school not too far behind her, Smith has turned to the value she can provide to medical students, and works to equip the students with the small victories that will help soften the challenge they have ahead. From helping them decode the language of acronyms to being willing to say “I don’t know” and head back to the books together, Smith has taken up her new leadership role and uncovered the joy in it. Aubrey, too, admits to being challenged by the keen queries of the medical students, and says it motivates her to keep on learning. After all, it’s this passing of knowledge, alongside those moments of laughter with her young patients, that brings this resident her ultimate sense of achievement. “When I see a child smile, or teach something to a medical student, that’s when I know, at the end of the day, that I’ve accomplished something.”
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Photos: Third-year IWK obstetrics resident Anita Smith often starts her rounds before daylight. Her daily schedule is never the same — from routine natural births and women’s care, to scheduled C-sections and emergency measures, Anita’s job is often intense and always fulfilling. On this day, she takes part in Terra Simpkin’s scheduled C-section. Her afternoon includes another type of delivery — a presentation to fellow residents during a class at the IWK Health Centre.
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Depression detective tackles the genetic code
Dr. Kathleen Pajer and her team have developed a unique blood test in an attempt to pinpoint how and why this form of mental illness occurs
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ntriguing and provocative” is how Dr. Kathleen Pajer, Chief of Psychiatry at the IWK Health Centre, describes her research with long-time collaborator Dr. Eva Redei of Northwestern University in Chicago. Dr. Pajer’s arrival in Halifax last year did not happen by chance. After vacationing in Nova Scotia six years ago, Dr. Pajer decided it was a place she’d love to live and pursued professional opportunities in the province. The rest, as they say, is history. Now, in her role at the IWK, Dr. Pajer continues her compelling research, trying to determine how and why depression occurs. If she can do so, she and her international research colleagues will truly be leading in mental health research that can change the world. Through their extensive work, Dr. Pajer and her research team realized that the
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current method of diagnosing depression is subjective. So, they sought to find a blood test that could serve as an objective tool to determine depression. Their pilot study involved 28 patients — half of whom had early onset depression and half who showed no symptoms. This study resulted in the development of the first blood test to diagnose major depression in teens. “Right now depression is treated with a blunt instrument,” explained Dr. Pajer’s research associate, Dr. Redei, in a release about their findings. “It’s like treating type 1 Diabetes and type 2 Diabetes exactly the same way. We need to do better for these kids.” “This is the first significant step for us to understand which treatment will be most effective for an individual patient,” added Dr. Redei. “Without an objective diagnosis, it’s very difficult to make that assessment.
The early diagnosis and specific classification of early major depression could lead to a larger repertoire of more effective treatments and enhanced individualized care.” Their findings were published in the spring and were widely cited because it demonstrated that they found 11 genes that differentiated the two groups. To help explain the research, Dr. Pajer compared a person’s genes to an electrical panel in a house. Whether the genes — or the switches — are there indicate whether a person has a predisposition for something. Then, at some point in a person’s life the genes can be turned on or turned off. When genes get turned on or off, they either make proteins or don’t. This highly depends on an individual’s environment and includes many factors. “We discovered 11 genes in a panel that were
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able to mark early onset depression,” Dr. Pajer says. “This was an incredible discovery — one that we didn’t expect due to the complexity of the disorder.” Dr. Pajer’s research is critical to the mental health treatment underway at the IWK. In fact, her work will have a meaningful impact on treatment of children and youth now and in the years to come, in the Maritimes and around the world. “Everybody, including parents, is wary of treatment, and there remains a social stigma around depression, which in the peer-pressured world of teenagers is even more devastating,” Dr. Redei said. “Once you can objectively diagnose depression as you would hypertension or diabetes, the stigma will likely disappear.” Having a blood test that can detect depression earlier is significant because the
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We want to try to treat it early and identify it early. Early onset depression is the worst kind you can have. The earlier the onset, the more likely for a chronic course, the more likely that you’ll continue throughout the rest of your life to cycle into depression.” — Dr. Kathleen Pajer
mind is like clay. The longer you wait, the more it sets and it becomes less pliable. In her research on depression, Dr. Pajer has discovered that the longer she follows adults who have not been successfully treated,
the closer the depression cycles get and the harder they are to break. “We want to try to treat it early and identify it early,” Dr. Pajer said. “Early onset depression is the worst kind you can have. The earlier the onset, the more likely for a chronic course, the more likely that you’ll continue throughout the rest of your life to cycle into depression.” Early onset means the depression is diagnosed before the person is 26 years old. The next step is to compile a larger group of child participants. The research team will then measure the gene expression level of those who show symptoms against those who do not. “This next step will bring us closer to our goal of early intervention,” says Dr. Pajer. “We then anticipate more effective treatments and enhanced individualized care.” FALL 2012 - WINTER 2013 •17
Security specialists The IWK’s child protection team is meticulous in tracking down the answers associated with children and suspected abuse By Diane Merlevede
Photos by Paul Darrow
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r. Amy Ornstein loses sleep at night. As a general paediatrician with specialized training in child abuse and neglect, Dr. Ornstein works through her fair share of emotionally-charged and difficult cases. As a mother of young children, she says it’s never easy to see a child in peril. “The reason I lose sleep isn’t because of what I see, but more because of what I do,” she explains. “I don’t want to be wrong. There are implications if I don’t recognize the right signs or if I over interpret a situation. “I am meticulous about my work, so if someone is waiting longer than they’d like for my report, they’ll just have to keep waiting, because I am going to be certain of my recommendations before I move forward.” Dr. Ornstein’s days are spent working with care teams at the IWK, looking into cases of potential abuse — while at the same time, developing and running programs that she hopes will prevent such abuse from ever happening in the first place. After completing her paediatric residency training, she completed a fellowship at Sick Kids in Toronto in the area of child abuse paediatrics. While the sub-speciality isn’t designated in Canada, Dr. Ornstein became sub-boarded with the American Board of Paediatrics, and tested with the first class of certified physicians in 2009. She has been medical director of the IWK Health Centre Child Protection Team for eight years. Her team includes three physicians, a clinical nurse specialist, social worker, therapist, and psychologist. “I was drawn to this speciality because it’s so multi-disciplinary in nature,” she says. “We always need to think outside the box with the unique challenges we are presented.” Together, the team reviews cases that may involve physical, sexual or emotional abuse, neglect or exposure to family violence, and provides consultation to doctors in other areas of the province and beyond. Examples of children who may be referred to Dr. Ornstein are those who have an unexplained injury, like a broken bone or burn. “We don’t always make a diagnosis of child abuse. The most rewarding days are when there is another medical explanation and after
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looking at all the information we say, ‘I don’t think this was a child-abuse-related injury.’ ” In her work, Dr. Ornstein sees the impact that abuse can have on the child and family, not only immediately afterward, but in the months and years that follow. This, she explains, is where her passion for her work comes from. “After seeing the same patterns of cases again and again, you can’t help but think that there must be a better way. Preventing abuse in the first place is the best outcome.” Through her research focusing on the importance of prevention, Dr. Ornstein identified a need to support new parents who may often feel frustrated and unprepared to deal with their new baby’s crying. The Period of PURPLE Crying Program, which the IWK started to offer in February 2012, educates parents and caregivers about normal infant crying and healthy ways of coping. The ultimate goal is to prevent infant abuse. PURPLE is an acronym for the specific characteristics of infant crying. Every family who has a new baby at the IWK receives a DVD and booklet to watch and read in the
hospital, then can ask a nurse any questions, and take the materials home. The IWK Auxiliary has provided financial support and also has collected purple caps, knitted and crocheted by volunteers throughout the
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We don’t always make a diagnosis of child abuse. The most rewarding days are when there is another medical explanation and after looking at all the information we say, ‘I don’t think this was a child-abuserelated injury.’” — Dr. Amy Ornstein
Maritimes, so that every baby gets a cap as a reminder that their crying, though distressing, is a normal part of being a newborn. “We’ve had great feedback from families so far,” Dr. Ornstein says. “If this program helps just one family who is feeling frustrated and overwhelmed by their baby’s crying, I’ll be happy.” FALL 2012 - WINTER 2013 t19
When abuse does happen, it’s important to respond in a way that doesn’t cause further trauma to the child and family. That is the idea behind a major project underway to develop the SeaStar Child and Youth Advocacy Centre, the first centre of its kind in the Atlantic provinces. A small-scale trial version began at the IWK this fall. The vision is for SeaStar to ultimately deliver all of the services required to respond to an allegation of abuse or neglect in a more efficient and co-ordinated way that also is more child- and family-centred. This model provides the family and child with an advocate to help them through the process, and puts the services all in one place. “We want this to be a comfortable place that’s easily accessible to families. As part of our project plan we also are looking to create a tool kit that other regions can use to create their own smaller satellite centres,” says Dr. Ornstein.
The word PURPLE means that the crying has a beginning and an end. P – Peak of Crying Your baby may cry more each week, but most in month 2, then less in months 3-5. U – Unexpected Crying can come and go and you don’t know why. R – Resists Soothing Your baby may not stop crying no matter what you try. P – Pain–like Face A crying baby may look like they are in pain, even when they are not. L – Long Lasting Crying can last as much as 5 hours a day, or more. E – Evening Your baby may cry more in the late afternoon and evening. Photos: The Child Protection team reviews cases that may involve physical, sexual or emotional abuse, neglect or exposure to family violence, and provides consultation to doctors in other areas of the province and beyond. Examples of children who may be referred to Dr. Amy Ornstein are those who have an unexplained injury, like a broken bone or burn.
Warming hearts, sharing smiles Volunteers empower and comfort children daily across the IWK By Heather Laura Clarke Photo by Charla Jones
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gnes Aasvangen left her teaching position to take care of her ill husband, and when he passed away, she couldn’t bring herself to return to the classroom. “You need heart to teach Primary, and I didn’t have my heart for a while,” says Aasvangen. “But I really missed working with children. I get great joy out of their enthusiasm and honesty, and their love of life.” The Clayton Park resident decided to volunteer at the IWK Health Centre — and six
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years later, she’s one of their most devoted volunteers. As part of the “Read To Me” program, Aasvangen starts her shift in the emergency department and then makes her way around the hospital, reading stories to children. “Sometimes the children will be so sick that you think nothing will ever help them forget what’s going on,” says Aasvangen. “But then you start reading a story — and get the funny voices and faces going — suddenly they forget everything else. It’s really special.”
“A little boy having an ultrasound recently asked me to come in with him and read, and he didn’t even notice what they were doing. That’s the power of the written word.” Aasvangen also volunteers with the IWK’s School Services program — putting her teaching skills to good use as she tutors children on long-term stays. Aasvangen jokes that she’s “downright bossy” about decorating her little classroom around the holidays, and even drags in an artificial tree.
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Volunteer Agnes Aasvangen reads a story to four-year-old Cameron Grandy while at the IWK.
“You can only imagine — if you’re a child in the hospital long-term — how exciting it is to decorate a Christmas tree,” says Aasvangen. “They always make it look so beautiful.” Aasvangen says the IWK Health Centre is a blessing for families, and she’s “constantly amazed” by the caring, nurturing staff. “Whoever coined the phrase ‘angels of mercy’ must have been watching the emergency room at the IWK, because everyone is so patient and kind,” says Aasvangen. “And
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they’re always so appreciative of their volunteers. They never take us for granted.” No matter how busy Aasvangen’s schedule gets — between substitute-teaching, taking courses, and spending time with her grandchildren — she tries to be at the IWK Health Centre three times a week to volunteer. “I was in a period of grief, and volunteering really helped me overcome a difficult period in my life,” says Aasvangen. “This is very much a healing thing for me.”
She says people who love children should think about volunteering at the IWK Health Centre, because “you’ll get more out of it than you could ever possibly give.” “When you realize you’ve brought a child out of a place where their illness overtakes everything — and you can see that little spark in their eyes — I don’t even know how to express how much joy it gives me.”
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The meaning of life Pediatric palliative care staff put patient comfort and quality of life above all else
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my Clyburn’s four-year-old daughter Layla is very familiar with the walls of the IWK Health Centre. She has spent more than half of her short life in and out of hospital for treatment of spina bifida and its complications. More than two years ago, when Layla got very ill and doctors said she probably wouldn’t pull through, a nurse told Clyburn about the IWK’s pediatric palliative care program. The IWK’s award-winning pediatric palliative care team provides support to infants, children, youth and their families faced with life-threatening illness. Unfortunately, like palliative care, pediatric palliative care is often equated — incorrectly — with end of life care. “We approach it with a much broader perspective,” says Dr. Frager. “It’s more about treating symptoms and supporting patients, their families, and the health professionals who care for them.” “It is an unbelievable program,” the Westville, N.S. mother says. “It’s not only about pain management and quality of life, but they truly stand up for your child in every way possible.
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“A lot of people think palliative care is there for death, but they’re really there for life. Dr. Frager and her team do everything in their power to make sure Layla is comfy, happy and safe. It means so much.” The IWK’s palliative care team have arranged meetings involving all of Layla’s health care providers to ensure that everyone is on the same page to ensure her quality of life. “When doctors come and go, these people are the constant in your child’s life,” Clyburn says. “They stay overnights, are on call for us 24-7. This summer, they even arranged for Layla to go home to her own hospital for two months. The palliative care team were on the phone with us constantly and really listened. They made it work and we are so grateful.” This type of care embodies the passion and expertise of Dr. Gerri Frager, Medical Director, Pediatric Palliative Care Service, IWK Health Centre. Dr. Frager is a true pioneer in the field, and was one of the first to begin a pediatric palliative care practice in Canada. Her expertise is renowned. In fact, she and her team recently received the prestigious Rotman Award, presented by
the Sick Kids Foundation, for innovation in pediatric home care. “Layla and her health challenges are an excellent reflection of the broad scope of pediatric palliative care,” says Dr. Frager. “We have been involved in Layla’s care for almost three years now, challenging the misperception which equates palliative care with endof-life. Layla has had several times throughout her life where the possibility of her dying prematurely was very real. However, she can also be expected to live many years with her chronic conditions. Our hope is that, through sharing in her care, we can help Layla live in comfort and with good quality, while supporting her family through this.” Pediatric palliative care often takes place over months, even years, she says, and sometimes begins when the child is in utero, which means that the care begins even before the patient is born. That is, the caregivers discuss with the family the possible risks and outcomes of the pregnancy and provide care to the patient before they are born. “You are not just caring for the child,” says Dr. Frager, “You are caring for the family and the entire community that supports the child.”
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Dr. Gerri Frager, left, shares a quiet moment with her four-year-old patient, Layla MacDonald, centre, and her mom, Amy.
Photo by Scott Munn
By Ken Cashin
She adds that while providing pediatric palliative care can be demanding and emotionally difficult, she approaches it from a positive perspective. “I take it from the point of view of what can I do to make it better, what can I do relieve their pain, and what can I do so that the patient is not as stressed with breathlessness and other symptoms?” A key challenge for practitioners, she says, is the age range of the patients and the diversity of illnesses. About one third of patients are treated for cancer, while the rest receive care for various conditions, including congenital disorders. Dr. Frager says that people often think that talking about life-threatening illness makes the situation worse, but the opposite is usually true — families tend to find relief in discussing their feelings about the illness and talking about their worries. “Talking about it can make a world of difference,” says Dr. Frager, adding that it can help families plan for and come to terms with the realities and also help them focus on making the most of the time they have while their child is living. If families are not supported through the
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By Authors Name experience, she adds, it can be much more painful. “The support they receive can leave them with a legacy,” she says, “and a sense of not feeling regret.” An emerging field, pediatric palliative care has come a long way in its relatively short history, but is still facing significant gaps in care throughout the country due to inequitable funding from province to province. However, Dr. Frager says great strides have been made since she entered the field in 1995 when there were only two care centres in Canada. Now every province has a care service, except Saskatchewan. For Dr. Frager’s first 15 years working at the IWK, she was the sole physician provider of pediatric palliative care, on call 24/7. Now, the IWK has a team, including three physicians (sharing the job), a clinical nurse specialist, an administrative assistant, a volunteer coordinator and staff nurse. Dr. Gerri Frager was selected as a recipient of the Queen’s Diamond Jubilee Medal acknowledging the significant contributions and achievements she has made in our community.
One of the key areas of focus for Dr. Frager’s group is helping families bring a child home from the hospital to live out their lives in their own home with their family and friends around them. This often requires the support of home doctors and hospitals. This was the case with Layla. Being able to be at home, in her community played an active role in Layla’s health and well-being over the summer. “The team is really like family to us,” Clyburn says. “They are special individuals and made a huge impact in all of our lives.”
Editor’s note: Following the launch of Izaak magazine, Layla MacDonald became suddenly and acutely ill and as a result, she passed away at the IWK on November 2, 2012, surrounded by her family. Everyone at the Chronicle Herald, IWK Health Centre and IWK Health Centre Foundation wishes to extend their deepest sympathies to Layla’s family. FALL 2012 - WINTER 2013 •25
COVER STORY
A new lease on life for Logan IWK plastic surgeon Dr. Michael Bezuhly’s work in the Maritimes provides families with incredible, close-to-home care By Lola Augustine Brown Photos by Charla Jones
Photos: Logan’s parents are so very happy with the difference surgery at the IWK has made in their son’s life. “I’m excited for Logan’s future. I thought he was precious the way he looked before, but I know for his sake, he looks more normal, and that will make a difference when he is going to school … He can do all the things that a normal five year old can do. It is wonderful,” says his mom, Jean. 28 t FALL 2012 - WINTER 2013
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t’s been a big year for Logan Gibb. Like many other five year olds, he started school this past September, but there have been other memorable new experiences in the past few months too. He got to the beach for the first time, attended a playdate without his mom tagging along, and went on a sleepover — these are all things that Logan couldn’t do before undergoing surgery at the IWK back in May 2012. Logan was born with Pfeiffer Syndrome, a hereditary condition where the soft-spots in your head are fused together before you are born. What this has meant is that Logan’s midface, that is the area around the cheekbones, eyes and eyebrows, grows more slowly than the rest of him, and as a consequence he suffers from sinus issues and sleep apnea. This means that he looks physically different from other children his age, and beyond that, without surgical intervention, his brain would not have developed normally, resulting in issues with his intellectual development. Since he was three months old, Logan has had a number of health issues that have required lifesaving surgery and numerous stays at the IWK. When he was two years old, his sleep apnea was so bad that he suffered carbon dioxide poisoning and had to undergo emergency surgery that resulted in a tracheostomy tube being inserted to help him breath. Logan didn’t remember life before he had the trach tube, and his mother says that he believed he had been born with it. Having the tube meant that Logan always needed his mother, father or grandmother to care for him, because they were trained in dealing with it. Logan would have required an aide to care for him at school if he’d still had the tube in when he started. Removal of the trach tube was just one part of the complicated and grueling 16hour surgery that Logan underwent in May. Carried out by Dr. Michael Bezuhly, a plastic surgeon, Dr. Simon Walling, a neurosurgeon, and Dr. Paul Hong, an Ear Nose and Throat specialist, the surgery is called a Lefort III mid-face advancement, because it brings forward the bones in the face, and Logan was the first child to have such a surgery in the Maritimes. “One of the major reasons for doing the surgery was to remove the tube from his neck, with the other reason being to improve his appearance, in terms of his eyes, nose and the way his teeth lined up,” explains Dr. Bezuhly. “Although a previous surgery had expanded his skull, which was necessary to decrease some of that pressure on the brain to help it develop normally, none of the bones in his face were expanded so the middle part of his face was under-developed.”
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Logan’s surgery involved making a cut into his frontal face bones, and installing a metal halo around his head and face with screws attached, enabling the bones to be moved slowly forward, at a rate of one millimetre a day. “The process is called distraction osteogenesis, and because the bone is moved so slowly, the body creates more bone behind it, never healing completely until we stopped the process,” says Dr. Bezuhly. “By doing that you can create new bone. We expanded his cheekbones, eye-sockets and his nose. He still looks like he has a facial difference, but now his nose is much straighter and projects more, his cheekbones are further out and he no longer has a breathing tube in his neck.” Initially, Logan was supposed to have the mid-face advancement in Toronto, because that was the closest hospital that offered the procedure. But, because Dr. Bezuhly joined the IWK (he completed his medical 30 t FALL 2012 - WINTER 2013
L to R: Dr. Simon Walling, Dr. Michael Bezuhly, and Dr. Paul Hong with Logan.
Logan and his mom, Jean. Photos contributed by family
residency at Dalhousie before studying under some of the world’s greatest facial surgeons in both Toronto and Paris) he was able to have the surgery here in Halifax. This meant an awful lot to his parents, Jean Middleton and Craig Gibb, for several reasons. “We didn’t know anyone in Toronto, but we have friends and family in Halifax to support us. I ended up staying in the hospital with Logan for three months, and it is only a three and a half-hour commute from our home, and Craig’s work, in Saint John, so my husband was able to still work and come be with us on the weekend,” says Jean. This was Dr. Bezuhly’s first Lefort III mid-face advancement, but Logan’s parents weren’t worried. Jean says that from the moment she met him, she knew that Dr. Bezuhly was “a brilliant man” and she trusted him implicitly to operate on her son. Logan’s surgery went very well indeed. Dr. Bezuhly says that he is “ecstatic” at how it
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turned out. “To the casual observer, Logan still might look different, but everyone has their differences. We’ve got him onto the spectrum where kids aren’t teasing him at school, and he can live the life that he wants,” he says. Logan’s parents are so very happy with the difference this surgery has made to their son’s life. “I’m excited for Logan’s future. I thought he was precious the way he looked before, but I know for his sake, he looks more normal, and that will make a difference when he is going to school. He is able to be a kid now and just do whatever he wants, and not think, “Oh I can’t go play with water-guns, or I can’t go to the beach” in case I get water in my trach tube. He can do all the things that a normal five year old can do. It is wonderful,” says Jean. This won’t, however be the last surgery that Logan needs to deal with his condition. “With his Pfeiffer Syndrome, unfortunately, we are buying time. He is only five years old,
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and as we grow, our faces don’t stop growing until we are 18, so he is going to need more surgeries further down the line. But, this is a big step in terms of the major surgeries that
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To the casual observer, Logan still might look different, but everyone has their differences. We’ve got him on to the spectrum where kids aren’t teasing him at school, and he can live the life that he wants.” — Dr. Michael Bezuhly
he will require,” says Dr. Bezuhly, “I hope that Logan is going to avoid further surgeries until he is in middle school or even high school.” Since Dr.Bezuhly has chosen to work here, families that would have previously
travelled elsewhere for treatment are now able to access this expertise in the Maritimes in order to have their children helped by him and his peers. “We’re building a group here that can rival any of the craniofacial surgery centres in North America,” says Dr. Bezuhly, “And that’s the big thing for families, that they can stay close to home when their children need this kind of surgery.”
Photos: Logan Gibb is enjoying life as an average five-year-old boy — he spends time playing with friends, enjoys family time, started kindergarten and has even attended his first sleepover. Thanks to the IWK’s Dr. Michael Bezuhly, Logan has a new lease on life. FALL 2012 - WINTER 2013 t31
$10 million reasons to smile Myron and Berna Garron’s monumental donation will live on for generations throughout the IWK Health Centre
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heir beaming smiles engage you before they even start to talk. They are charming, finishing each others’ sentences, giggling and making eyes at one another. Kindred spirits, and married for over fifty years, Myron and Berna Garron’s legacy of generosity precedes them. Even though they became known to Maritimers just a month ago after making a $10 million donation to the IWK Health Centre, the meaning behind this Ontario family’s tireless support of Canadian hospitals harkens back nearly four decades. In 1976, when the couple returned to Canada from Montego Bay, Jamaica, with their son, Michael, who had been diagnosed with cancer, they turned to Toronto’s Sick Kids hospital for help. “I was told that it would be three months wait, so I went to the hospital and stood outside the operating room until I found a doctor who could look at Michael’s chart,” Myron Garron recalls. His tenacity paid off and Michael received wonderful care at the hospital until he passed away. That’s why, many years later, the Garrons were pleased to endow a gener-
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The IWK is recognized worldwide for its excellence in care for women and children. We are honoured to do our part to ensure the IWK continues to serve families for many years to come, and we truly believe everyone has the power to make a difference according to their means. We hope our contribution inspires others to support this special place in Atlantic Canada which is so critical to families.” — The Garrons
ous donation of $30 million to Sick Kids in support of their efforts in pediatric oncology. Now, the IWK has been blessed to come to know the Garrons in the same way. Originally from Westport, Nova Scotia, Myron Garron began a career with the Bank of Nova Scotia in 1952. He managed several
bank branches, including one in Toronto, where he met his wife, Berna, in 1957. The couple started a family, and Myron would later make a career change that led to a hugely successful automotive manufacturing business. “We still have very strong emotions about Michael, he was a good boy and we love him very much,” says Berna. “Back then, there was nothing we could do to show our gratitude and honour Michael’s memory,” Myron said. “We are extremely fortunate to be in a position now to help in this way.” At the official announcement, hosted at the IWK on September 28 and proudly attended by the Garrons’ two sons and seven grandchildren, president and CEO Anne McGuire announced that the Garrons transformational gift of $10 million to the IWK is believed to be the single largest private gift to health care in the Atlantic region. The donation will support the creation of a new acute mental health inpatient unit, a state-of-the-art neonatal intensive care unit, and a new suite of women’s health care facilities at the IWK. “The needs of a highly-specialized health
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By Lindsey Bunin
Photos by Sue Siri Photography
centre like the IWK are always growing and the standards for caring are always improving. It is our goal to not only keep up, but to exceed expectations and continue to provide Maritime women, children and youth with the world class care they deserve. This donation makes this possible,” said McGuire. The Garrons’ son Anthony’s four children were born at the IWK, giving the Garrons a special connection to the health centre. Over the past several years, they’ve visited the IWK, made donations, and talked with the IWK’s staff about ways a donation could help enhance care for patients and families. “Every time we are at the IWK, we are always struck by the utter joy and enthusiasm we see in the staff members we meet,” Myron said. “The IWK is recognized worldwide for its excellence in care for women and children,” the Garrons said. “We are honoured to do our part to ensure the IWK continues to serve families for many years to come, and we truly believe everyone has the power to make a difference according to their means. We hope our contribution inspires others to support this special place in Atlantic Canada which is so critical to families.”
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Blessed by generosity From its inception, the IWK Health Centre has depended on and been eternally grateful to each and every donor
1920s and early 1930s, O.E. Smith, a native of Cape Breton and a successful businessman, donated generously to the hospital, and a nurses’ residence was named in his honour. The auditorium in the current facility is named after Mr. Smith.
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It is of paramount importance that our donors understand how much good is achieved through their generosity. There should be a sense of pride that comes with each donation to the IWK.” — Dr. Alex Gillis, retired Chief of Surgery and former CEO of the IWK Health Centre
By Lindsey Bunin Photo contributed
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he IWK has a compelling case to make to donors, large and small. “Women and children are the core of our society,” says Dr. Alex Gillis, retired Chief of Surgery and former CEO of the IWK Health Centre. “There is a natural appeal there, but it is of paramount importance that our donors understand how much good is achieved through their generosity. There should be a sense of pride that comes with each donation to the IWK.” The IWK and its antecedent institutions were reliant on donations from the earliest days. In 1907, Frederick Corbett donated $10,000 towards the total of $18,200 that it cost to build the original Halifax Children’s Hospital. From the time it opened in 1909, the facility was heavily dependent on donors for its survival and growth. For example, the hospital didn’t have an X-ray machine for its first 25 years, and that addition was only made possible by a generous donor. In the late
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Gillis says that thousands of donors were largely responsible for keeping the institution in operation for its first 50 years until the advent of national hospital insurance in 1959. In 1965, Dorothy Killam’s donation of $8 million in memory of her late husband literally transformed the planning and function of the Izaak Walton Killam Hospital for Children, which opened in 1970. Gillis says he would be remiss to not reflect on the smallest donations that collectively play an integral role in the IWK’s fundraising efforts. “Other sources of money, chiefly taxes, provide Canadians with a good quality of healthcare. But the IWK Health Centre, as
Photo by Hal Phyfe/The Chronicle Herald Archives
an end-of-the-line resource, provides the extraordinary levels of care, teaching and research that are required to manage a wide range of highly complex and costly illnesses,” Gillis says. “Donors are leaned on because this cannot be done on tax dollars alone. Generous donors help to raise the bar. And they keep it there. The government and our donors are truly partners in helping the institution meet its Maritime mandate.” Donors like the Garrons. Gillis describes his experience with Myron and Berna Garron as “serendipitous.” The Garrons generously shared the single largest private donation to the IWK in September 2012 -- $10 million. “To be a part of the process with the Garrons was a unique experience that I was lucky enough to be included in from the beginning,” Gillis says. “They are such solid, wonderful people and the IWK is extremely blessed by their generosity. “The immediate, tangible benefits will be felt in the three key areas: child and adolescent mental health, neonatal intensive care and women’s services. It would be difficult to exaggerate the value of this gift to thousands of people from all across our region. And anytime a gift like that benefits certain areas of the Health Centre the entire wellbeing of the institution is positively impacted. Resources can be shared in ways that weren’t possible before this gift.” Massive donations are truly transformative. But every gift, regardless of size, does make a difference in the lives of women, children and families.
Although Halifax has been home to a children’s hospital since 1909, the original Izaak Walton Killam Hospital for Children opened in 1970, with the help of a generous donation of $8 million from Dorothy Johnson Killam, wife of the late Izaak Walton Killam.
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Together, our future will be stronger. The IWK holds a special place in the hearts of many. A national leader in health care excellence, we have been providing critical and specialized health care to women, youth and children for more than 100 years. Over these years, we have made great progress. But there is still much work to be done to achieve our goals of transforming the future of mental health care, critical care and rehabilitation, and achieving breakthroughs in research that will benefit us all. It is with your help that we will achieve these tremendous goals. Each of us possesses the power to help, to provide a lasting legacy to the IWK through planned giving. Your gift – big or small – will help make us all stronger. For more information on how to include the IWK in your estate plans, please contact Mary Theresa Ross, the IWK Foundation’s Manager, Personal & Planned Gifts. And if the IWK is already in your estate plans, we’d love to know that too. Mary Theresa Ross. Manager, Personal & Planned Gifts mary.ross@iwk.nshealth.ca 902.470.8240 www.iwkfoundation.org
Finding a natural latch IWK works to achieve a world standard in breastfeeding support
By Heather Laura Clarke Photos by Charla Jones
B
efore Michelle Richardson gave birth to her son, Luke, she was committed to breastfeeding her baby. But once the little guy arrived, she realized it was not as easy as it looked. “I had taken the classes and read the books, and thought I would put him to my breast and be like ‘OK, breastfeed!’ but there’s a lot more to it,” says Richardson. “You have to learn how to do it.” Despite the early challenges, she says the nurses at the IWK Health Centre were “so amazing and helpful” while she learned how to breastfeed Luke. In the end, both mother and baby got the hang of it — and are still going strong. “When things didn’t immediately go well, I never panicked about anything, because I knew they were right there to help me if I needed them,” says Richardson. “They were so fantastic.” Richardson enjoyed the fact that Luke was able to stay in her room. Diane O’Reilly, manager within the Women’s and Newborn Health Program at the IWK Health Centre, says babies “room in” with their mothers 24 hours a day in order to help establish successful breastfeeding. O’Reilly co-chairs the Baby-Friendly Initiative committee along with Kelly Chisholm. The committee members are helping the hospital earn the World Health Organization’s “Baby-Friendly Hospital” designation. “The IWK believes breastfeeding is the safest way to feed babies and young children, and that it provides many nutritional, immunological, social, and psychological benefits,” says O’Reilly.
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Michelle Richardson breastfeeds her baby boy, Luke Richardson, four months, at home in Halifax.
In order to receive the World Health Organization’s designation as a “Baby-Friendly Hospital,� the IWK Health Centre will need to prove they follow the following 10 policies: 1. Have a written breastfeeding policy that is routinely communicated to all health-care staff 2. Train all health-care staff in skills necessary to implement this policy 3. Inform all pregnant women about the benefits and management of breastfeeding 4. Help mothers initiate breastfeeding within one half-hour of birth 5. Show mothers how to breastfeed and maintain lactation — even if they should be separated from their infants 6. Give newborn infants no food or drink other than breastmilk, unless medically indicated 7. Practice rooming in — that is, allow mothers and infants to remain together 24 hours a day 8. Encourage breastfeeding on demand 9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants 10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic
Breastfeeding resources: Breastfeeding Community of Practice: www.breastfeedingcop.com Breastfeeding Nova Scotia: XXX GJSTU XFFLT DB La Leche League Canada: www.lllc.ca Public Health Breastfeeding Support Line: (902) 481-5852
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O’Reilly says breastfeeding provides short-term and long-term benefits for children, including a lower risk of developing asthma and inner-ear infections, as well as a reduced risk for diabetes and obesity. Breastfeeding mothers benefit as well — reducing their chances of developing ovarian cancer or breast cancer, and getting increased protection against diabetes and cardiovascular disease. BettyAnn Robinson, a clinical leader at the IWK Health Centre for the Family Newborn Adult Surgery Unit, says some new patients are surprised to find out there isn’t a nursery for the babies. The IWK has supported “rooming-in� for many years now. “Keeping a mother and baby together around-the-clock allows them to learn each other’s languages,� says Robinson. “The baby can communicate if he or she is hungry, and the mother can learn to recognize those cues.�
In order to receive their designation as a “Baby-Friendly Hospital,� the IWK needs to meet a complex set of standards, including ensuring the entire team supports its breastfeeding policy. Regular training and education sessions, along with newsletters, are a must to bring all staff on board. “You don’t have to be a health-care provider — we train our ward staff as well as our aid staff, because breastfeeding is an important part of the IWK experience for everyone who has contact with patients,� says O’Reilly. “We always want to ensure there is a positive energy about it, for all families.� While mothers delivering at the IWK Health Centre will be educated about the benefits of breastfeeding, O’Reilly says they are never pressured into it. The staff is careful to ensure consistent messaging from pregnancy through to final weaning, and pro-
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viding information about the breastfeeding resources available in different communities. “Our relationship with every family is based on respect and trust, so we respect any decision they make,” says O’Reilly. “We just want to be sure that we’re giving them all of the information they need, so they’re making an informed decision.” O’Reilly says the IWK also supports moms who choose not to breastfeed, because it implements “best maternal practices” such as skin-to-skin contact — which helps to regulate an infant’s temperature, heartbeat, and blood sugar, as well as calm them down. Out of all mothers who delivered at the IWK Health Centre in 2011, reports show that 85 per cent of them initiated breastfeeding. However, only about 56 per cent of Nova Scotia mothers practiced exclusive breastfeeding, and O’Reilly says that’s where they’re seeking to improve. “We want to know why some moms aren’t continuing the practice, and what barriers prevent it,” says O’Reilly. “We know
breastfeeding is natural, but walking is natural, too — and we still have to learn it.” O’Reilly says they are careful to ensure “consistency of messaging” from pregnancy through to final weaning, and providing information about the breastfeeding resources available in different communities.
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We know breastfeeding is natural, but walking is natural, too — and we still have to learn it.” — Diane O’Reilly, manager in the Women’s and Newborn Health Program at the IWK Health Centre
The IWK works with the Breastfeeding Community of Practice — a network of people who support breastfeeding women and their families in HRM. Their website includes a “Helping Tree,” which allows mothers to access local help and information.
The Helping Tree recently helped O’Reilly when an expectant mother telephoned the IWK to schedule her prenatal classes. The woman explained she’d like to breastfeed, but didn’t think she would have any local support — and O’Reilly was able to quickly provide some answers. “It’s important to know that when you run into challenges, there are supports in place.” The IWK Health Centre is currently reviewing their breastfeeding practices, and O’Reilly says in the coming months the IWK will sign a Breastfeeding Committee of Canada “Certificate of Participation.” “The journey to obtaining a BabyFriendly Hospital designation is a long one, as there is a lot of work to accomplish in the pre-assessment stage. When we do get assessed, it’s not just about them showing us what we may be doing wrong — it’s about celebrating everything that we’re doing right,” says O’Reilly. “It’s not about being perfect. It’s about doing the best we can. And it will continue to be a very rewarding journey.”
Killam Properties provides the IWK Health Centre with a furnished apartment for patient’s families. We’re happy to help! Killam Properties is one of Canada’s largest residential landlords and offers a variety of apartments and locations throughout Atlantic Canada and Ontario.
www.killamproperties.com
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A race against the world IWK researcher Dr. Chris Richardson competed in a global race to discover a connection between the measles virus and cancer — and won By Heather Laura Clarke Photos by Christian Laforce
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t was on a quiet Sunday afternoon in his lab at the IWK Health Centre that Dr. Chris Richardson made his incredible discovery. For the last six years, Richardson had been competing with research labs around the globe as they raced to discover the measles virus-cancer connection. “It’s like detective work,” says Richardson. “I’ve had a hand in discovering other receptors, so I was putting that experience to work — and I had recently tweaked the system to improve it, and try out some new ideas.” Richardson’s research showed that the cells of many types of cancer, including breast, lung, colon and bladder cancers are lined with protein receptors that the measles virus can attach to. “The measles virus can target the cancer cells, grow inside them, and ultimately break them down,” said Richardson. Richardson is a Tier I Canada Research Chair in Vaccinology and Viral Therapeutics
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and has been appointed to the Canadian Centre for Vaccinology at the IWK Health Centre. He’s been studying viral receptors for more than two decades, and on November 21, 2010, he says his “dogged determination” paid off. “I looked through the microscope that afternoon, and it was fantastic. The receptor popped right out,” remembers Richardson. “I let out a sigh, and my grad student said ‘You found it, didn’t you?’” Richardson and his team had discovered that a tumour cell marker PVRL4 (Nectin 4) is a receptor for the measles virus — suggesting that the measles virus could be used to help fight cancer. Richardson says this receptor is normally hidden away “between the cracks” of a cell, but it’s highly over-expressed on tumor cells in patients with lung cancer, breast cancer, colon cancer and even prostate cancer — making those types of cancer “a really good target.” The long-term goal would be to derive a
vaccine from the virus. The vaccine wouldn’t be preventative but could be used to treat cancer patients. “It would attack the tumour, start growing in it, then produce viral antigens in the tumour so that the immune system would see it as foreign and wipe the tumour out.” Richardson says this discovery is a huge step forward in cancer research, and that the treatment will ultimately change the way young patients at the IWK Health Centre — and around the world — are treated for cancer once it is available. He says the use of the measles virus to target cancer is “not entirely new.” In the 1970s, a missionary doctor in Africa discovered that young patients with lymphoma went into remission if they had a measles infection. Richardson suspects in the next five to 10 years, the treatment will be ready for the general public. Mayo Clinic researchers have taken the measles virus into human clinical trials. Dogs with cancer are also being
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By Authors Name Dr. Chris Richardson, left, and Ryan Noyce, background
treated, because the canine distemper virus closely resembles the measles virus. “It still has to go through safety trials, and we’ll have to tweak the virus to make it safer, and that’s going to take some time,” says Richardson.
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I looked through the microscope that afternoon, and it was fantastic. The receptor popped right out. I let out a sigh, and my grad student said ‘You found it, didn’t you?’” — Dr. Chris Richardson
Richardson says he’s passionate about pushing the project forward, because he’s “getting on in years” and is determined to see it through. “It’s not a matter of whether it’s going to work; it’s a matter of when.”
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Assisting women a world away Dr. Ron George travels to Africa throughout the year to provide much needed prenatal and labour care to the women of Ghana
By Heather Laura Clarke Photos contributed
Dr. Ronald George providing spinal analgesia to a mother-to-be in Ghana.
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r. Ronald George often witnesses women risking their lives to give birth in Ghana, where childbirth is truly a life-threatening experience. Conditions there are far different than those at the IWK Health Centre. “In Ghana, the maternal mortality rates are anywhere between 400 to 600 deaths per 100,000 live births. Unfortunately, during my brief visits to Ghana I have witnessed too many mothers die,” says Dr. George. “At the IWK, there is a chance I might see one or two deaths during my entire career.”
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Dr. George is an anesthesiologist in Women’s and Obstetric Anesthesia at the IWK and Associate Professor of Obstetric Anesthesia at Dalhousie University. He also works with a group called Kybele — a non-profit, humanitarian organization dedicated to improving childbirth safety through educational partnerships and hands-on teaching. Dr. George travels to maternity centres in Ghana two to three times a year as part of a team working to improve the care of women and children. He says Ghanaians know how
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Kybele members, Ron George and Amina Yakubu (blue uniform) with a group of midwives from Sunyani, Ghana following their neonatal resuscitation training. Amina is a midwife from Accra, Ghana. She works at the hospital in Accra where Dr. George started his work and now she travels to other regions of Ghana with the Kybele team.
unsafe childbirth is in their country and every one of them has been touched by a maternal death — whether it’s a sibling, or a close friend. Kybele partners with Ghana Health Services and local health care practitioners to work on education and the introduction of new, safer practices. The partnership between Kybele and Ridge Hospital in Accra emphasizes assessment, implementation, advocacy and the measurement of outcomes and has reduced the maternal mortality from 496 per 100,000 live births in 2007, to less than 250 per 100,000 live births in 2011. The partnership has also created a highdependency unit for high-risk mothers — women with severe preeclampsia or recovering from obstetric haemorrhage — other key causes of death in childbirth. Dr. George says their partners are “highly optimistic” with the positive results. Building capacity for health providers in Ghana to develop their own set of skills in their own environment is another key piece of the puzzle. An example is the creation of a nurse anaesthetist school within Ridge Hospital in Accra, something Dr. George is proud to have contributed to. “It has allowed us to ensure that obstetrics and anesthesia care is taught appropriately at the start of their careers,” he says. He also helps bring childbirth pain relief to women in Ghana — something he says is in high demand. On a recent trip, Dr. George met with a woman for whom Kybele had provided pain relief during the birth of her first child. Unfortunately, the team was back in North
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Over-crowded and under-supplied neonatal care unit. Kybele member (Laurel Bookman) doing impromptu teaching of neonatal resuscitation.
America when it was time for her second child to be born. “She told us how she had begged for pain relief during her second birth, but we were not there to provide it,” says Dr. George. “She kept asking when pain relief will be available
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Some of the babies aren’t named right away, because they don’t know if they will survive. ” — Dr. Ron George
for all women in Ghana. It was very moving to see that our efforts are appreciated.” Kybele is actively teaching and advocating for pain relief during childbirth. Dr. George says he’s “very thankful”
for the services he is able to provide women delivering at the IWK Health Centre in Halifax. “In Ghana, especially in remote areas, women die from very preventable things, and the rate of stillborn births is distressingly high,” says Dr. George. Always a moving part of his visits to Ghana, Dr. George was recently at the hospital during the weekly “first baby visit” for the new moms. “The mothers all show up in beautiful white dresses, which are traditionally their church outfits, and there is a lot of prayer and singing,” says Dr. George. “Some of the babies aren’t named right away, because they don’t know if they will survive. This is when they name their child, and celebrate that both the mother and baby have survived this initial week.” FALL 2012 - WINTER 2013 •43
How innovation is born Researchers like Dr. Jason Berman are using some of the world’s most unlikely sources to find the most miraculous cures
By Ken Cashin Photos by Charla Jones
W
hen it comes to medical research, inspiration can be a driving force. And, when that inspiration comes from a desire to make life better for young patients, ground breaking innovation can be born. Such is the case with Dr. Jason Berman. He is a world-leading pediatric haematologist-oncologist who runs a zebrafish research laboratory at the IWK Health Centre. His enthusiasm and energy is contagious as he discusses his first-of-a-kind research program in Halifax with the potential to provide unique cancer drug-testing services in zebrafish to pharmaceutical companies and cancer specialists across Canada and around the world. Dr. Berman looks for such answers in zebrafish — small striped fish that are remarkably similar to humans in their genetics and cell biology. Zebrafish are gaining international recognition in their ability to help researchers better understand human diseases. By studying blood-cell develop-
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In 2012, most children with cancer have a very good chance of cure, but often at the significant cost of toxic treatments with lots of complications. By better understanding the genetic and molecular factors underlying particular diseases using rapidly evolving technologies and innovative model systems like the zebrafish, we will be able to provide better, more personalized and targeted treatment that will result in improved outcomes and fewer side effects.” — Dr. Jason Berman
ment in zebrafish, Dr. Berman and his team are hoping to pinpoint the genetic changes that lead to leukemia. Dr. Berman treats children with cancer, including leukemia, lymphoma and solid tumours, as well as blood disorders like haemophilia and anemia. While many of his patients have acute lymphoblastic leukemia (ALL) and can be cured with current multi-agent chemotherapy, some suffer from more aggressive subtypes of ALL, such as T-cell disease (T-ALL), while approximately 20 per cent suffer from acute myelogenous leukemia (AML). Dr. Berman’s unique research approach focuses on these more difficult-to-treat forms of leukemia, using the zebrafish model to identify and test new potential treatments. “The zebrafish is a vertebrate and shares many of the same genes with humans,” explains Dr. Berman. “Because they are fertilized externally, are transparent, and reproduce in large numbers, they are a very
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useful tool for studying how changes in genes affect both normal development and the abnormal development that can result in diseases like cancer.” Dr. Berman and his team are currently testing different compounds in several cancers including: T-ALL, AML and sarcomas (common bone tumours in children) to identify new drugs or combinations that stop and reverse the abnormal cancer growth and kill the cells that start the cancer. “In 2012, most children with cancer have a very good chance of cure, but often at the significant cost of toxic treatments with lots of complications,” says Dr. Berman. “By better understanding the genetic and molecular factors underlying particular diseases using rapidly evolving technologies and innovative model systems like the zebrafish, we will be able to provide better, more personalized and targeted treatment that will result in improved outcomes and fewer side effects.”
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Reviewed by an international panel by the Beatrice Hunter Cancer Research Institute, Dr. Berman received Cancer Care Nova Scotia’s Peggy Davison Clinician Scientist Award in May 2011, which provides $100,000 per year for three years to build cancer research programs. Previously held by only one other individual, funding through this prestigious award is helping Dr. Berman use the zebrafish to study white blood cell development, mast cell biology, leukemia and solid tumours. The award, he says, is a great tribute to both pediatric oncology and the zebrafish model and demonstrates the support, faith and encouragement that Cancer Care Nova Scotia has in the potential of his research program to impact the future for cancer patients. “This award enables us to attract the best and the brightest from across Canada and beyond to work with us and establish our laboratory as an international centre of research excellence, fostering the training
of the next generation of leading cancer researchers right here in our province.” He says it gives hope to children who have to endure the challenges of chemotherapy. One such child is Olivia Mason, daughter of Tammy and Barry Mason of Bedford, N.S., who has been a patient of Dr. Berman’s since being diagnosed with AML in February 2011. “We know first-hand the struggles that children endure going through intensive chemotherapy to treat AML. The current treatment is very difficult and it is heartbreaking to watch your child endure this illness and treatment,” the Masons commented through Cancer Care Nova Scotia. “Olivia is strong and determined. We know she will make it. However, we anxiously await the day that Dr. Berman, and his team, announce that they have found an easier way to treat AML. With the Peggy Davison Award to Dr. Berman, we know that they are one step closer to that announcement.” FALL 2012 - WINTER 2013 t45
The moment that changed everything A box jellyfish sting drastically affected Liam MacCormick’s life — Dr. Jill Chorney of the IWK Health Centre’s Complex Pain Team is working to bring his suffering under control
By Heather Laura Clarke
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iam MacCormick was enjoying a lively family vacation in Jamaica last March. But his life changed suddenly during an afternoon snorkelling session when he was stung by a box jellyfish — one of the most venomous creatures in the world. Liam, who was 12 at the time of the sting, was still experiencing significant pain when he returned home to Halifax, and he was admitted to the IWK Health Centre. Clinical Psychologist Dr. Jill Chorney still remembers the intense level of pain Liam was experiencing when they first met. “He was in such excruciating pain that you couldn’t even go near his leg because of the breeze it would create as you walked by,” says Chorney. “He couldn’t always attend school or be involved with sports. His pain was affecting his entire life — and his whole family.”
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Chorney works on the IWK Health Centre’s Complex Pain Team — a part-time group, which includes another psychologist, two clinical nurse specialists, a physical therapist and the medical director, who is an anesthesiologist. Once Liam’s pain was somewhat under control — through a nerve block on his femoral nerve — Chorney and the rest of the Complex Pain Team began working with Liam and his family to understand the different kind of pain he was experiencing. “Most people understand acute pain, which happens when we break our leg or get surgery. We feel pain, get immediate treatment, and it goes away in a short time,” says Chorney. “‘Chronic pain’ is different. It means that even though your injury has healed, the body is still producing pain
messages. So the jellyfish sting turned into a version of nerve pain.” One of Liam’s therapies involved touching his left leg while using a mirror to trick his brain into thinking he was actually touching his right leg. He also used a computer program to distinguish between photos of right and left feet. “Evidence suggests that when kids — or adults — are having chronic pain on one particular side of the body, it can lead to changes in their brain,” says Chorney. “The brain gets a bit reorganized and interprets messages differently, so we need to retrain the brain.” Liam initially spent a month at the IWK Health Centre, and now he just visits every few months to work on techniques to cope with the pain. “We used cognitive behaviour strate-
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gies — not because the pain’s in his head, but because you can use the brain to send messages to the leg, telling it to turn down the pain signals,” says Chorney. “Relaxation techniques and deep breathing can also send messages to turn down his nervous system.” Liam’s dad, Rob MacCormick, says the IWK’s Complex Pain Team has had such a positive effect on the entire family. “He’s had setbacks when he was out of school for a while, and wasn’t able to walk. But he worked at it with his team — bit by bit — and he’s continued to move forward,” says MacCormick. “We don’t know where we would be without the IWK. To be able to get that ongoing support so close to home has been amazing.” Liam, who is currently a Grade 8 student at Georges P. Vanier Junior High in Fall River,
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He’s had setbacks when he was out of school for a while, and wasn’t able to walk. But he worked at it with his team — bit by bit — and he’s continued to move forward. We don’t know where we would be without the IWK. To be able to get that ongoing support so close to home has been amazing.” — Liam’s dad, Rob MacCormick
Nova Scotia, spent the summer paddling every day with the local aquatic club. “He had an amazing summer. Getting active has been a very positive thing for him, — plus he’s getting back into football now,” says MacCormick. “His coaches have always been very understanding with things he may not be able to do. But he’s not somebody you want to say no to!” MacCormick says Liam’s determination and strength have been inspiring to him, and that even during the hard times, he’s never regretted swimming and snorkelling in Jamaica. “He’s just been amazing through this whole procedure. He’s taken it on like an adult, and kept so positive,” says MacCormick. “Nothing will stop him from his goal of having a normal life.”
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On the front line Through the lens of a microscope, laboratory technologists are often the first to uncover the diagnoses that will change lives
Photos by Christian Laforce
By Elizabeth Patterson
E
ven in a job featuring some of the world’s most up-to-date technology, there’s nothing like old-fashioned human contact to put everything into perspective. “A child who has been sick for weeks may come into the emergency department. They’ll have blood work done and when we look under the microscope, we’ll find abnormal white cells count and see leukemia,” says Randy Veinotte, Manager of the Core Laboratory, Pathology and Laboratory Medicine at the IWK Health Centre. Laboratory technologists use microscopes to examine different body fluids, blood, and tissues. For example, when a patient has blood drawn for a CBC (complete blood count) and it is run through the analyzer, a blood smear is made and stained for review when results are abnormal. When reviewing a blood smear with a microscope the technologist is looking at the number and types of cells present.
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“The technologist can be the first person to see abnormal cells,” explains Veinotte. “Abnormal cells can be caused by different conditions like infections, malaria, sickle cell, or could reflect abnormalities in the
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What makes our laboratory so different is that we get to see samples from women, children and babies all under one roof — a very challenging setting, but also extremely rewarding.” — Randy Veinotte
bone marrow, pointing to Leukemia. So, you can see why this is such an important step … the earlier the diagnosis the quicker the treatment for the patient.” For Veinotte, information like this is a call to action for the hospital’s medical staff.
Every day, his team of laboratory technologists, assistants, and Licensed Practical Nurses (LPNs), are on the front lines, meeting with patients who require tests that can unearth every type of ailment imaginable. While some results may not be good, it’s still better than not knowing. “When you’re in a position of caring for patients, understanding your boundries is important. Yes, we’ve found something, but you have to believe maybe we’ve caught it in time,” says Veinotte. Veinotte says that this is what keeps everything at a very human level. “We’re lucky here at the IWK,” says Veinotte. “When we do the collections, we see the patient — what’s contained in that tube is the patient — it reminds you that every specimen is important.” As a teaching facility, the IWK labs host students from the Medical Laboratory Technologist program at NSCC, as well as
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Canada is born. Titanic sinks. World Wars. IWK opens its doors. ’72 Summit Series. Day after day after day. We’ve been there. Since 1824. And we continue to tell our stories.
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Medical lab technologists Terri-Lynn Lawrence and Frederick Jennings analyze patient samples for indicators of illness.
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laboratory assistants, and residents from different medical programs. “They all use our laboratory to help train their students and prepare them for life in the real world,” Veinotte says. “What makes our laboratory so different is that we get to see samples from women, children and babies all under one roof — a very challenging setting, but also extremely rewarding.” The Core Laboratory looks after chemistry and hematology is open 24 hours a day, every day of the year. It has a staff of about 30 people who provide test results on a daily basis to ensure patients get proper care. Besides tracking down illnesses, working at the IWK presents a unique set of challenges. The patients range from infants to elderly women and that means using different techniques. For example, collecting a blood sample from a newborn isn’t the same as getting one from a 35-year-old woman. For one thing, you need smaller tubes to collect the samples and you can’t take as much of a sample. If the samples aren’t taken properly at the beginning, it won’t necessarily yield a proper result. It all means that the staff must always operate at the top of their game. “We have individuals here who are very skilled at what they do,” says Veinotte. “It takes a special person to do this type of job.” Compassion and understanding for patients and their families are the most important aspects of the job. Veinotte says that seeing a patient get properly diagnosed, treated and then recover is one of the benefits of his position. “We are there for their care and we do get to see them get better. We get to see the full circle.”
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Helping kids be healthy inside and out. One in five Canadian children suffers from a mental illness*. Access to supportive programs and helpful information from experts can be a lifeline for parents, families and kids. RBC® is proud to support the IWK’s mental health inpatient unit for children and youth with a lead gift of $750,000 towards the redevelopment of the mental health inpatient unit and the launch of the Suicidality Training on Prevention (STOP) program. For our list of trusted resources, visit rbc.com/childrensmentalhealth.
Helping build a better future.
® / TM Trademark(s) of Royal Bank of Canada. * Archives of General Psychiatry. 1987; 44(9): 832-836.
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