Issue No. 2, April 2014

Intensive dialysis provides hope for healthy pregnanciesIntensive dialysis treatments in pregnant women with kidney failure leads to a higher proportion of live births than standard di-alysis care, according to a Sunnybrook-led study published Feb. 13 in the Journal of the American Society of Nephrology.

“Frequent and longer dialysis sessions dra-matically improve pregnancy outcomes, and should be considered for dialysis patients of childbearing age who want to become pregnant or who are already pregnant,” says Dr. Michelle Hladunewich, director of the Obstetric Medicine and Nephrology divisions at Sunnybrook, and the study’s lead author.

Pregnancy is often impossible in young women with advanced kidney disease because fertility declines as kidney disease progresses. “In the few women who are able to conceive while on dialysis, pregnancy is typically very complicated and can be dangerous for both mother and baby,” Dr. Hladunewich says.

Dr. Hladunewich and her colleagues com-pared a group of 22 pregnant patients un-dergoing dialysis in Toronto with a group of 70 patients in the United States. In Toronto,

young kidney failure patients were offered more intensive dialysis to help restore fertility, enabling some women to conceive. During pregnancy, the Toronto patients received on average 43 hours of dialysis per week, com-pared with only 17 hours per week in the United States.

The study found that for women dialyzed for more than 36 hours per week, the live birth rate was 85 per cent. In women dialyzed for 20 hours or less per week, it was only 48 per cent. In patients with established kidney failure at conception, the median duration

of pregnancy in the more intensively dia-lyzed group of women from Toronto was 36 weeks, compared with 27 weeks in American women, and infants were a healthier weight at birth.

“More intensive dialysis can improve preg-nancy rates and dramatically improve preg-nancy outcomes, while complications were few and manageable,” Dr. Hladunewich says. “This study provides hope to young women on dialysis who might want to consider hav-ing a family.”Sybil Edmonds

Randy Abalos and Racquel Delacruz with their newborn, Gabrielle Ivy, in October 2012. Gabrielle was the first baby born to an existing dialysis patient at Sunnybrook.

Improving ER care for people with developmental disabilitiesA new approach to caring for individuals with developmental disabilities (DD) officially launched in Sunnybrook’s emergency depart-ment on Jan. 23.

The initiative’s name is DD CARES and its aim is to provide emergency departments, community agencies, caregivers and people with developmental disabilities the tools and information that can make a trip to the emer-gency department a better one.

“Research tells us that these individuals are

more likely to visit the emergency department, and they are more likely to have repeat visits than the general population,” says Andrea Perry, registered occupational therapist and implementation facilitator for the Underserved Populations Program at the Centre for Addiction and Mental Health (CAMH).

“They also often leave the emergency depart-ment without a formal crisis prevention and management plan, and may experience dif-ficulty receiving support and follow-up in the community. DD CARES is working to

address these issues and gaps.”

Examples of how DD CARES can help in-clude: providing communication aids for pa-tients, providing staff education, development of new department protocols, and discharge packages for patients. This not only supports staff as they treat patients in emergency, it also enables people with developmental disabilities to be more involved in their health care.

DD CARES was developed by researchers and clinicians at CAMH and Sunnybrook as part of the Health Card Access Research and Developmental Disabilities program at CAMH. Led by Dr. Jacques Lee, Sunnybrook is the first emergency department to adopt DD CARES, and the goal is to roll it out to more hospitals in the coming months.

DD CARES also has a parallel effort work-ing with family health teams to implement best practice guidelines for the primary care of this population. To learn more about DD CARES, please visit www.ddcares.ca.Laura Bristow

Members of the DD CARES team include (left to right) Sarah Reynolds, registered nurse, Psychiatry Emergency Services, Sunnybrook; Darren Hefferon, emergency department information system administrator, Sunnybrook; Dr. Jacques Lee, emergency physician, Sunnybrook; Andrea Perry, registered occupational therapist, CAMH; Johanna Lake, postdoctoral fellow, CAMH; Ray Howald, clinical educator, Sunnybrook. Absent is Val Soper, social worker, Sunnybrook.

Heart surgery goes social at SunnybrookSocial media met the operating room on Feb. 20 as Sunnybrook live tweeted a heart bypass surgery to mark Heart Month and to educate the hospital’s community about heart disease and cardiac surgery.

Photos, videos and updates were posted in real time by a staff photographer and member of Sunnybrook’s web communications team during the live tweet. Questions were also fielded from the public, with the goal of help-ing to demystify what happens in the operat-ing room.

Dr. Gideon Cohen, chief of Sunnybrook’s Division of Cardiac Surgery, led the opera-tion. The hospital had consent from 57-year-old patient Lou to live tweet. Popular tweets included “The team is now stopping Lou’s heart with a potassium mixture. This protects and cools the heart, to reduce oxygen require-

ments. #SBheart.” The tweet was paired with a video.

“The response was absolutely overwhelming. We received hundreds of questions, and so many heartfelt good wishes for Lou and the heart team,” says Brent Creelman, senior digital media strategist and social media lead at Sunnybrook, who was live tweeting the procedure for over four hours. “Photos and video really made it come alive for the public. It was the next best thing to actually being in the operating room.”

The live tweet of the double bypass caught the attention of media, with coverage throughout Canada and from as far away as Australia. An archive of the live tweet is available at sunny-brook.ca/SBheart.Marie Sanderson

Sunnybrook’s social media lead, Brent Creelman, interacts with the virtual audience.

Grade 5s enjoy cyber visit after live tweetOn her way to school on Feb. 20, Aviva Dunsiger heard on the radio that Sunnybrook would be live tweeting heart surgery.

The Grade 5 teacher had just finished study-ing the human body with her class, and so she decided to “tune in” to the live tweet with her students.

The curious students asked so many questions that it was hard for Sunnybrook’s social media expert Brent Creelman to keep up. So Dr. Gideon Cohen offered to do a video chat with the students at their Ancaster school to answer any of their outstanding questions.

“I always look forward to talking to students and helping them better understand the heart, heart disease, and ways to live a heart-healthy life,” Dr. Cohen says.

Dr. Cohen spent lunch answering questions about the tools needed for surgery, how long

surgery takes, who else works in the operat-ing room and much more. Ms. Dunsiger says it was a terrific learning opportunity for her class.

“I think that Skyping with Dr. Cohen in-creased student knowledge about the human body and disease prevention,” she wrote on her professional blog. “This is an experience that the class will remember well past today.”Alexis Dobranowski

A Grade 5 student from Ancaster asks a question of Dr. Gideon Cohen (right) via Skype. Photo credit: Image on left courtesy of CTV News. Image on right by Doug Nicholson.

Nominations open for Sunnybrook Rose AwardSunnybrook Foundation is accepting nomi-nations for the esteemed Sunnybrook Rose Award. Do you know a deserving candidate?

The award, first presented in 2008, recognizes the exemplary efforts of volunteers who have rallied community support for Sunnybrook, as well as hospital staff for outstanding work to support Sunnybrook’s philanthropic objectives.

The deadline for submissions is May 30, 2014. For nomination criteria and forms, please visit sunnybrook.ca/RoseAward. For any questions, please contact Whitney Doldron at (416) 480-6100 Ext. 89539 or whitney.doldron@sunnybrook.ca. Completed nomi-nation forms and narratives may be emailed to Whitney or submitted to:

Anne Odette KayeChair, Donor Relations Committeec/o Whitney DoldronSunnybrook FoundationH361-2075 Bayview Ave.Toronto, ON, M4N 3M5

Previous Rose Award recipients include Dr. Marvin Tile, George Fierheller, Dr. Bernard Goldman, Liz Tory, Dr. Brian W. Gilbert, Marilyn Wright, Dr. Sherif Hanna, Terry O’Sullivan, Dr. Eileen Rakovitch, Virginia McLaughlin, Dr. Sandra Black and Derek Walton.

A health-care worker’s battle with cancer

Chris Lee, a medical laboratory technologist at Sunnybrook and survivor of bladder cancer, is surrounded by his supportive colleagues. To learn more about Chris’ health journey and struggle with cancer, as well as his fundraising efforts, please read his personal account online at health.sunnybrook.ca.

Personal Health Navigator

Doctor smartphone use: distraction or good medicine?The question: My son had what seemed to be an infection in his mouth. I took him to a walk-in medical clinic, and the doctor there had a look. The doctor took out his smartphone and started doing something on it, then announced his choice of an-tibiotic to prescribe. The doctor, by looking it up on his phone, kind of made me lose confidence in him. Was he just Googling? Is there some special site that medical professionals can access? Why didn’t he just know what to prescribe? My wife says it’s the same thing as if he looked in a book. But the use of the smartphone feels different. I mean, I could have looked at WebMD myself!

The answer: The doctor was likely access-ing one of the many new medical resources that are available online. But you shouldn’t be alarmed when your doctor turns to the Internet before writing a prescription. In fact, it’s actually a good thing.

“It means the doctor wants to be right as opposed to relying on his memory – memo-ry is fallible,” explains Dr. David Juurlink, a staff physician and drug-safety researcher at Sunnybrook.

It’s also a positive sign he looked up the infor-mation while you were watching him.

That indicates the doctor felt comfortable admitting he doesn’t know everything, “and that is a trait every physician should have,” Dr. Juurlink says. “The three most powerful words a doctor can say are: ‘I don’t know’.”

Indeed, a cautious approach – and the willing-ness to double-check – reduces the risk of the doctor making a mistake that could jeopardize your health.

From your question, it’s clear you feel very uncomfortable with the doctor relying on the Internet. It’s true there’s a lot of junk on the web. However, it’s also an invaluable source of data if you know where to look and you have the expertise to discern what’s reliable.

“Twenty years ago a doctor would have to pull a book from a shelf – and that book could eas-ily have been out-of-date,” Dr. Juurlink notes. “Now, in a matter of seconds, we can access information that is current and accurate. So why not use it?”

It’s impossible to say which specific website, or app, the doctor consulted to select an antibiot-ic for your son.

“There are many good websites that doctors can use as resources – some of them are free, and some of them are not,” he says. “Every doctor has a list of sites that they are comfort-able with, that they know how to navigate and they have found to be useful.”

In some cases, physicians are given special access to certain sites through their profes-sional organizations or hospital affiliations.

Dr. Juurlink says one of his favorite online resources, provided by way of Sunnybrook, is called UpToDate, an excellent resource that contains reference materials for physicians. “It is a spectacular resource,” he says. “If you can think of a condition, it’s in UpToDate.”

As a specialist in drug safety, Dr. Juurlink knows a lot about prescription medications. Yet he is the first to acknowledge that “there are more things I don’t know about drugs than I do know.” And today’s Internet allows him to fill in those knowledge gaps when a specific question arises.

In many respects, the recent expansion of online medical resources can be seen as an en-couraging development that has the potential to reduce medical errors.

So don’t be annoyed the next time your physician reaches for a smartphone. There is a good chance the doctor is tapping into the most current medical information that applies to you.

Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families, relying heavily on medical and health experts. Email your questions to AskPaul@sunnybrook.ca

Sunnybrook receives new support for Alzheimer’s researchA research trial led by Sunnybrook’s Dr. Sandra Black investigating the potential for hypertension drugs to slow the progression of Alzheimer’s disease is receiving support from a new funding collaboration between the Alzheimer’s Drug Discovery Foundation of Canada and The W. Garfield Weston Foundation.

“Hypertension has been suggested to be a risk factor for Alzheimer’s disease for almost 30 years, yet we have not adequately translated this knowledge into the clinic for the bene-fit of patients. Dr. Black’s study will begin to address this important issue in a novel study design, investigating the possibility that some anti-hypertensive agents may also be neuroprotective,” says Dr. Howard Fillit, executive director and chief science officer of the Alzheimer’s Drug Discovery Foundation.

“We are grateful to The W. Garfield Weston Foundation for their collaboration in funding this important work.”

Different classes of anti-hypertensive drugs may have different effects on the brain be-yond just blood pressure control. In this study, angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), will be compared for the treatment of hypertension in patients with Alzheimer’s.

“Our exploratory clinical study will compare ARBs versus ACEIs in a ‘face-off’ to slow brain degeneration in people with Alzheimer’s disease who are already taking medications to control blood pressure,” says Dr. Black,

executive director of the Toronto Dementia Research Alliance and director of the Brain Sciences Research Program at Sunnybrook Research Institute.

“We will use brain imaging, and measure cognition and quality of life over a one-year period to compare the rate of brain shrinkage in the people on ACEIs vs. ARBs.”

If positive, the study would lead to prac-tice-changing implications, especially for hypertension control in Alzheimer’s patients.

“With a new mandate to accelerate the de-velopment of safe and effective breakthrough treatments for neurodegenerative diseases, The W. Garfield Weston Foundation is pleased to support Dr. Black’s compelling research through ADDF-Canada,” says W. Galen Weston, chairman and president of The W. Garfield Weston Foundation.The Alzheimer’s Drug Discovery Foundation (www.alzdiscovery.org)

Surgeons keep learning at new workshopEven trained surgeons need to be the student sometimes.

General surgeons from across Ontario visited Sunnybrook recently to learn a new way of performing minimally invasive colon cancer surgery. And when they finished learning about this novel method in the lecture theatre, they tried it in the safety of the Simulation Centre.

Dr. Shady Ashamalla, a minimally invasive cancer surgeon at Sunnybrook, performed this novel surgery with a live video feed connected into the lecture theatre. Attendees watched, asked questions and received re-al-time answers from Dr. Ashamalla.

After the surgery, the attendees gathered in the Sunnybrook Canadian Simulation Centre, where they had the opportunity to practise the surgery using high-tech simulators.

Dr. Ashamalla says the effectiveness of this educational forum comes from its format – using advanced simulation technology to enhance the traditional lecture-style learning experience. The participants learned from

lectures, asked questions and participated in live surgery, and then tried it themselves on simulators.

“Now you don’t have to just sit and watch to learn,” he says. “We have the advanced simulation equipment so that surgeons can practice a procedure right away in a safe envi-ronment with no risk to patients.”Alexis Dobranowski

Dr. Shady Ashamalla, a Sunnybrook surgical on-cologist, and Dr. Stan Feinberg, chief of surgery at North York General, practise a new surgical tech-nique on an advanced simulator. Dr. Ashamalla was one of Dr. Feinberg’s students in medical school.

About the surgery: Dr. Ashamalla performed a laparoscopic right hemicolectomy with intracorporeal anastomosis for colon cancer. This means the right side of the colon was removed completely laparoscopically, with only tiny incisions, and the bowel was reconstructed the same way. The patient typically goes home within 48 hours (compared to five days with open surgery)

About the high-tech simulators: These machines are true laparoscopic towers, exactly as in the operating room, with mannequins instead of patients to operate on. The technical skills necessary to conduct this operation can be simulated on the synthetic bowel inside the mannequins, in order to master the technique prior to operating on patients. Johnson & Johnson and ConMed supported this initiative by lending Sunnybrook additional equipment.

Most Ontarians with COPD do not receive recommended lung testingJust one third of people with chronic obstruc-tive pulmonary disease (COPD) in Ontario received recommended pulmonary function testing to confirm their diagnosis, suggests a new study in the journal CHEST, led by Sunnybrook researcher and respirologist Dr. Andrea Gershon.

COPD is a manageable respiratory condition that affects eight to 22 per cent of adults age 40 and older. It is the fourth leading cause of death in Canada and one of the most com-mon causes of hospitalizations. Researchers studied all individuals age 35 and older who were newly diagnosed with COPD in Ontario between 2000 and 2010 using health administrative databases and found:

• Only 35.9 per cent of the 491,754 Ontarians newly diagnosed with COPD received pulmonary function testing.

• Older and younger people, those living in long-term care and those with stroke and/or dementia were less likely to re-ceive testing.

• People who had seen a specialist or had

other respiratory disease were more likely to receive testing.

• Older primary care physicians were less likely to order testing for their patients.

“We are still not sure why the rates of testing are low,” says Dr. Gershon, a scientist at the Institute for Clinical Evaluative Sciences. “Some potential factors could be doubts that some physicians hold about whether these tests really lead to better outcomes. It could also be a result of presuming those with stroke or dementia are physically unable to complete testing,” she says.

“A lack of testing could lead to people mistak-enly being told they have COPD when they do not. It could also lead to true diagnoses being missed. We hope this information will lead to targeted strategies that address barriers to testing and improve quality of patient care,” adds Dr. Gershon, who is also an assistant professor with the Departments of Medicine and Health Policy, Management and Evaluation at the University of Toronto.Laura Bristow

Sunnybrook neurosurgeon wins brain injury research awardDr. Leodante da Costa has been named the first international award winner of the GE and National Football League’s Head Health Challenge for his research, which seeks to more effectively determine the proper time to “return to play” in sports, and resume work or physical activity after mild traumatic head injury or concussion.

One of 16 winners in the first round of the challenge, da Costa’s research was select-ed among 400 entries from 27 countries. Winners each receive $300,000 in funding to advance their research.

“This funding will help us to extend our work in improving imaging diagnosis of patients with traumatic brain injury,” Dr. da Costa says. “With mild head injuries, such as a fall on the ice while playing hockey, head imag-ing scans often come back normal. Often the patient is walking, talking – might seem fine – and is sent home and told to go back to work after a few days of rest.

“But we know that 15 to 30 per cent of these patients will have more persistent issues with concentration, focus, memory and mood changes that will make it difficult for them to carry on with their activities.”

Dr. Leodante da Costa

Dr. da Costa’s research focuses on ways to detect and measure the ability of the brain’s blood vessels to respond in the event of head injury.

“Currently we can’t tell which patients are in trouble and which aren’t; these are the patients that come back and keep receiving the same diagnosis because we currently don’t have enough information to recognize them,” Dr. da Costa says. “Our goal is to be able to better identify those patients and athletes at risk of persistent symptoms and secondary injury af-ter concussion or apparently mild day-to-day injuries that can sometimes be missed, so we can be better equipped to diagnose, monitor response to treatment and guide decision making.”

Launched in 2013, the Head Health Challenge aims to enhance the understand-ing of traumatic brain injury and advance technology solutions to better diagnose and treat such conditions.Nadia Norcia Radovini

Sunnybrook taking scalpel-free surgery to the next levelSunnybrook researchers recently initiated a Phase 3 clinical study to advance focused ul-trasound – a form of scalpel-free surgery – to treat severe essential tremor, the most com-mon movement disorder.

“We are excited about continuing the process to revolutionize medicine by taking this in-novation to the next level for our patients,” says Dr. Michael Schwartz, a Sunnybrook neurosurgeon and lead investigator of the Sunnybrook-site trial that is testing use of the ExAblate Neuro Focused Ultrasound System.

Dr. Schwartz also led an early-stage Phase 1 clinical trial of the therapy at Sunnybrook from 2012-2013 that received worldwide media attention.

In this current trial, 72 patients are being en-rolled in up to eight centres around the world and randomized to receive either an ExAblate Neuro or sham (no) treatment.

The results of this multi-site trial are expected to support a submission of the technology to Health Canada and the U.S. Food and Drug Administration for regulatory approval of focused ultrasound to treat patients with es-sential tremor.

The study will likely build on promising pilot studies, including the early-stage trial conducted at Sunnybrook, demonstrating the preliminary safety and effectiveness of mag-netic resonance image (MRI)-guided focused ultrasound technology in treating target areas deep inside the brain.

“This study is an important step toward providing a unique, non-invasive alterna-tive treatment for patients who are severely disabled by essential tremor, a very common movement disorder,” says Eyal Zadicario, vice-president of research and development and director of InSightec’s Neuro program.

“The Phase 1 studies showed that patients experienced immediate and significant symp-tom improvement. We expect that the results of this Phase 3 trial will demonstrate long-term durable improvement and open the door of this technology to additional applications in the brain.”

MRI-guided focused ultrasound treatment is suitable for people whose severe medication-

resistant tremor interferes with activities of daily living like writing, eating and drinking from a cup.

“Focused ultrasound is an alternative to surgery with the potential for less risk of hem-orrhage, infection and brain damage,” says Dr. Neal Kassell, chairman of The Focused Ultrasound Foundation.

Referrals for the Sunnybrook trial can be faxed to 416-480-6085. More information about the trial and other international treat-ment centres can be found at: www.clinical-trials.gov (NCT01827904) and US.insightec.com.Nadia Norcia Radovini

Sunnybrook neurosurgeon Dr. Michael Schwartz is photographed in December 2012, speaking with essential tremor patient Tony Lightfoot, who took part in the groundbreaking Phase 1 focused ultrasound trial.

Group rallies next generation of Sunnybrook supportersUndaunted by a day of record-breaking snow-fall, enthusiastic members of Sunnybrook Next Generation (SNG) and their guests gathered to officially launch the volunteer group at Toronto’s Arcadian Loft on Feb. 5.

“SNG is an important volunteer group that will help engage a new generation of support-ers and leaders,” said Perry Dellelce, chair of Sunnybrook Foundation’s Board of Directors, in kicking off the evening. Recognizing the group’s importance, the SNG chair now sits as a member of the board.

“We know how important health care is to all the generations. Whether we’re looking after older relatives, visiting a friend who is sick or having our babies here, Sunnybrook is playing a central role in many of our lives,” SNG chair Michael Kaye told the gathering. Kaye represents his family’s third generation of Sunnybrook supporters.

This group of young professionals is working to engage a new generation of Sunnybrook supporters through awareness initiatives and

fundraising activities. Kaye told the gathering that SNG is confident it will meet or exceed its fundraising goal of $1 million over 10 years.

A number of guests at the launch have since approached Kaye to find out how they can get involved.

Dr. Jon Dellandrea, Sunnybrook Foundation president and CEO, lauded SNG’s dedication and urged them to be ambassadors by com-municating their passion for Sunnybrook to their personal and professional networks.

SNG is now planning its first signature fund-raising event for July 10. The day begins with The Waterball Cup golf tournament at Angus Glen and finishes with The Waterball party that night at the Arcadian Loft. This year’s proceeds will support the Schulich Heart Centre’s groundbreaking minimally invasive heart devices and procedures.

Visit sunnybrook.ca/waterball for informa-tion and to register. And follow SNG on social media: @SBNextGen on Twitter and Sunnybrook Next Generation on Facebook.Kathy Blair

Michael Kaye, chair of Sunnybrook Next Generation, speaks during the group’s of-ficial launch on Feb. 5. SNG is working to engage a new generation of Sunnybrook supporters through awareness initiatives and fundraising activities.

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Your Health MattersSunnybrook Health Sciences Centre

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P: 416.480.4040

E: news.articles@sunnybrook.ca

Your Health Matters is published monthly by the Communications & Stakeholder Relations Department and Sunnybrook Foundation. Submissions to Your Health Matters are welcome, however, they are subject to space availability and editorial discretion.

Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.2 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans. For more information about how Sunnybrook is inventing the future of health care please visit us online at www.sunnybrook.ca

Dr. Valerie Krym’s global work receives national and international awardsSunnybrook emergency physician Dr. Valerie Krym has been named a recipient of the College of Family Physicians of Canada Award of Excellence for 2013.

Dr. Krym received the award in recognition of her long-term and ongoing commitment to developing health-care systems and emer-gency services in areas where they are un-derdeveloped or non-existent. The president of the Ontario College of Family Physicians presented the award to her at the 51st Annual Scientific Assembly in Toronto in November 2013. The award is based on her global health work in Romania, Tanzania, Nepal, Rwanda and South Africa.

Also that month, Dr. Krym received an Award of Recognition from the African Federation for Emergency Medicine (AFEM) in Cape Town, South Africa. The award rec-

ognizes her contributions to the advancement of emergency care across Africa, as one of the federation’s founding board members.

In most African countries, emergency medi-cine is either very new or simply does not ex-ist. AFEM was founded in November 2009 to help support growth and development of emergency medicine in Africa. Dr. Krym helped develop the organization from the ground up, as well as a curriculum model for emergency medicine training, and launched The African Journal of Emergency Medicine. Dr. Krym has worked with the World Health Organization in Tanzania, and as an inter-national health consultant in Sri Lanka after the 2004 tsunami. In 2012, she conducted an emergency medicine needs assessment for the Ministry of Health in Rwanda, and helped its national medical board develop a regulatory

Dr. Valerie Krym receives the Award of Excellence from Dr. Jonathan Kerr, president of the Ontario College of Family Physicians.

framework to establish emergency medicine as a new specialty.

Dr. Krym is an associate professor in the Department of Family and Community Medicine and in the Dalla Lana School of Public Health, both at the University of Toronto.Laura Bristow

New clinic delivers cardiovascular follow-up care for momsOne week after delivering her son, Orla Smith wasn’t feeling quite right.

“I could hardly walk, which I thought was normal,” Smith says. She had actually devel-oped postpartum hypertension, which is high blood pressure that occurs after childbirth.

Smith was referred to Sunnybrook’s new 4P Clinic, which aims to help new moms lower their risk of developing cardiovascular disease. It is the first of its kind in Toronto.

“The clinic is for high-risk women who experi-enced complications during their pregnancies. We are able to address risks that may impact subsequent pregnancies, as well as long-term cardiovascular health,” says Dr. Karen Fleming, a member of Family Medicine Obstetrics at Sunnybrook.

Over the years there has been a transition in care, with deliveries now performed primarily by obstetricians and midwives rather than fam-ily physicians. “Information about a patient’s pregnancy is not necessarily available to family physicians or pediatricians, leaving the primary care provider unaware of important risk factors in mother and baby,” Dr. Fleming notes.

The clinic aims to bridge that information gap by collaborating with community health-care partners. A multidisciplinary team, includ-ing Dr. Fleming and a dietitian, runs the 4P Clinic, which stands for pre-pregnancy, preg-nancy, post-pregnancy and pediatrics.

Complications in pregnancy associated with increased risk of cardiovascular disease include pre-eclampsia, gestational diabetes, pregnan-cy-induced hypertension, intrauterine growth restriction and preterm labour. Women who experience pre-eclampsia are also more likely to develop Type 2 diabetes.

While these complications impact close to one in five pregnancies in Ontario, physicians and patients are not always aware of the long-term consequences of hypertensive disorders. Children born to women who experience these complications are also at increased risk of developing health issues such as obesity and diabetes.

The majority of cardiovascular disease, in-cluding heart attack and stroke, is preventable. “By making some healthy lifestyle choices and addressing pre-existing risk factors, women and their families can reduce their risk of de-veloping this disease,” Dr. Fleming says.

Women who deliver their babies at Sunnybrook can ask their care provider for a referral to the 4P Clinic.Sybil Edmonds