A Credit To Your Health, May 1999

Pregnant moms, premature babies and seriously ill children will benefit from a new regional program to be located at The Credit Valley Hospital. The development of the South Peel/Halton Child Health Network is in response to the Health Services Restructuring Commission's directive to establish a regional perinatal and paediatric network of health services. The goal of the Child Health Network is to improve the health and quality of life for children. Patient services will be provided at the highest standard possible. Independent of geographic location, services will be provided in a consistent and coordinated manner across the continuum of care. Most importantly to the patients and their families, their care will be provided as close to home as possible.

The cluster of hospitals in the South Peel/Halton regional network are:

* The Mississauga/Queensway Hospitals, now known as Trillium

* The Credit Valley Hospital

Because The Credit Valley Hospital is the site of the regional program, doesn't mean the other hospitals won't be doing their share of primary level obstetrics and paediatric care.

It simply means the higher risk pregnancies, births and paediatric patients will be transferred, in consultation with their "home" hospital, to The Credit Valley Hospital, where our professionals will care for them. The professionals at CVH will in turn, collaborate on the patient's care plan, with the tertiary centres in the Child Health Network.

The caregivers at the hospitals within the regions of South Peel and Halton, will become more involved in the continuum of care for their patients. They'll share educational and sub-specialty resources, outcome management and the ability to define the direction for high quality care for pregnant women, new mothers, newborns, children and families.

In all it's a win-win situation for the patients, the caregivers and the hospitals.

The establishment of the program at The Credit Valley Hospital is a tribute to the hospital's reputation for excellence in quality of care, service and utilization management. The network of services is known as the Child Health Network. The vision and strategy was developed by Metro Toronto and the GTA 905 hospitals to provide a more collaborative network for comprehensive care (see insets entitled, Vision and Values) . What that means is improved care and services that are closer to home for moms, babies and children up to age seventeen. Until now, women in high risk pregnancies and children requiring a sophisticated level of care, would be cared for at tertiary hospitals such as the Hospital for Sick Children, Mt. Sinai and Women's College Hospital in downtown Toronto. Even if they were outpatients, they often had to travel several times a week for treatment in Toronto. The development of the new regional services means many of those downtown visits will be eliminated. Patients will be able to receive treatment and follow-up care at The Credit Valley Hospital. CVH will provide secondary care and some subspecialty services, that until now, have only been available at tertiary hospitals. This will eliminate costly and time-consuming travel. And it will provide more of a comfort level for these patients who know specialized care is right in their own neighborhood.

The establishment of a regional service is better for our health care professionals as well. We all know that the more experience we have doing a job, the better we become at it. The regional program will create what is known as a critical mass of patients which allows our health professionals to develop specialized programs and skills to deal with patients requiring secondary and some tertiary level services. Our health care professionals are upgrading their skills to deal with the more sophisticated level of care.

As well, the tertiary specialists at The Hospital for Sick Children will be consulting with our professionals to determine the best plan of care for our new patients.

We've already taken on some of our new responsibilities even though official funding for the project has not been received. In April we opened our Outpatient Paediatric Medicine Clinic, which serves patients from our catchment areas who have been redirected to us from the Emergency Department or the General Medicine Clinic at The Hospital for Sick Children.

Pre-term infants who were delivered at tertiary hospitals will receive the remainder of their hospital care at CVH. The hospital is also increasing its capacity to deliver pre-term babies and the referral of high-risk antenatal patients from tertiary hospitals such as Mt. Sinai Hospital and Women's College Hospital. We'll also establish a high-risk antenatal clinic for the pregnant mom's assessment and follow-up closer to home. And we'll be doing more paediatric surgery.

To Top

CVH Pharmacy Staff Celebrate Pharmacy Awareness Week

By Heather Hadden

National Pharmacy Awareness Week was held across Canada March 1-7 1999 and the pharmacy staff at the Credit Valley Hospital were on hand to help celebrate. This yearly event is organized by the Canadian Pharmacists Association, the Canadian Society of Hospital Pharmacists and the Canadian Association of Pharmacy Students and Interns. There are several purposes to this week: to promote the role of the pharmacist to the community, to hold a community wide medicine cabinet clean-up and to launch this years theme: "Taking Your Medicine Well? Talk to Your Pharmacist!"

The medicine cabinet clean-up was publicised to all staff through the office automation message system each day encouraging them to clean out their medicine cabinets. The outpatient pharmacy under the supervision of Dennis Cazzin accepted any returned medication. Signs encouraging the public to do the same were posted and it was advertised in the Mississauga News.

Unused medications should always be discarded for several reasons:

-outdated medications are often ineffective and some medications are even toxic

-sharing of medications is always discouraged since different people respond to medications in different ways and may experience different side effects

- if your condition/illness recurs you should see your doctor for reassessment

- eye products are particularly dangerous to keep since the bacteria that was once present in the eye may grow over time in the vial and reintroducing this into the eyes could result in a severe infection or blindness

The pharmacists role has changed over the years. Now when a pharmacist gets a prescription for a drug they will make sure that the drug and dosage is appropriate for the patients disease/condition. The pharmacist will also make sure that new drugs will not interact with other drugs that you may already be taking. When talking to the patient the pharmacist will reaffirm what the drug is for, how it works, side effects that may occur and how to deal with these side effects, precautions while taking the medication, and drugs or foods to avoid while on the medication.

The interaction should not stop there- the patient should be encouraged to contact the pharmacist if any problems arise with their drug therapy.

The pharmacist in conjunction with the patient's physician(s) can very often make changes so that the patients quality of life is better while taking the medications.

Pharmacists in both the community and hospital setting give special attention to many groups of patients- the elderly who may be at risk of side effects or especially sensitive to medications; children; patients on a number of drugs; and patients with kidney or liver problems that may alter the excretion of drugs. Pharmacists are concerned with the safe and proper storage of medications which includes a dry cool place out of direct sunlight and out of the reach of children. Pharmacists will encourage parents to talk to their children about medications that may be in the house. The children need to know that medications are not candy.

The pharmacists responsibilty is also to ensure that patients take their medications exactly as prescribed. They may also give suggestions to simplify medication regimens and supply hints to remember drug times.

Pharmacists are very interested in education and prevention and assume this role as well. It is important to know that you should always "Talk To Your Pharmacist"- not only during Pharmacy Awareness Week but all year around!

**************************************************************************

Here's a short quiz to test your pharmacy knowledge. The answers are provided at the end.

1) Antibiotics can help cure colds & flu True False

2) I can stop taking my antibiotics as soon as I start feeling better. True False

3) As long as I take the right number of pills I can take them at any time of day True False

4) I can save leftover antibiotics for the next time I get sick True False

5) Incorrect use of antibiotics can lead to bacteria becoming resistant True False

6) The worst place to keep medicine is in the bathroom medicine cabinet True False

7) If you've missed a dose of your medication you should always double the dose next time

True False

8) "Generic" drugs are basicall lower priced copies of "brand name" products True False

9) The reason that some non-prescription drugs are kept behind the counter is so that people purchasing then will get advise from the pharmacist True False

10) Antibiotics can reduce the effectiveness of birth control pills True False

11) It is always best to use "broad spectrum" antibiotics to cover all possible causes of infection

True False

12) Some medications are better taken on an empty stomach. The best definition of empty stomach is:

a) when you feel hungry b) just before meals c) 1 hr before a meal or 2 hrs after a meal d) after a bowel movement

13) After the expiry date on the package, the medicine can be:

a) ineffective b) dangerous c) all of the above

14) The best way to get rid of unused or outdated medication is to:

a) flush it down the toilet b) throw it in the garbage c) take it to any local pharmacy for disposal

****************************************************************************

Answers:

1) False 2) False 3) False 4) False 5) True 6) True 7) False 8) True 9) True 10) True 11) False 12) c 13) c 14) c

To Top

New Chief of Family Practice

Dr. Clarkson The President and Chief Executive Officer of The Credit Valley Hospital, Wayne Fyffe, on behalf of the Board of Governors, is pleased to announce the appointment of David Clarkson, MD, CCFP. MHSc as Chief of Family Medicine.

Dr. Clarkson takes on the leadership of the Family Medicine Department at a time when family physicians are reconsidering their obligations to the local hospitals (see also "Family Physicians In Short Supply").

Fyffe said that "as the hospital takes on the additional complex regional programs, it is very important that we continue to have a strong family medicine presence."

Dr. Clarkson was born and raised in Mississauga. He began his general practice here in 1972 after obtaining his medical and post-graduate family practice training at the University of Toronto. He has been a coroner for the Province of Ontario since 1974.

In 1983, Dr. Clarkson returned to the University of Toronto to complete a Master of Health Science degree program. The epidemiology, public health and management theory training in that program led to a brief career as a medical officer of health for the Regional Municipality of Niagara. He found that he missed patient care and so returned to general practice at The Credit Valley Hospital in 1986.

While at our hospital, Dr. Clarkson has worked in the Emergency Department, chaired the Utilization Committee, the Ambulatory Care Committee and the Ethics Committee. He has spoken on behalf of the Foundation and at several clinical conferences produced by The Credit Valley Hospital. He is a previous secretary of the Department of Family Medicine and a former member of the Peel District Health Council.

To Top

Family Physicians In Short Supply In Hospital

By Wendy Johnson APR, Director, Community Relations and Communications

There’s a problem that’s been simmering among Ontario’s family physicians for the last few years. It’s a problem that could develop into a crisis at The Credit Valley Hospital, and other hospitals around the province. It has, and will, impact the health care of our patients. It has to do with a shortage of family physicians.

Hospital privileges, allow physicians to admit their patients to hospital. They agree to help, on a rotating basis, those patients who are admitted through the emergency department who do not have family doctors on staff. But the number of family physicians able to give their time to these patients is decreasing. "It’s a difficult problem to deal with," Dr. David Clarkson, the new Chief of Family Practice at CVH says.

"When a patient arrives in the Emergency Department, s/he is asked for the name of his family physician. Often the patient says s/he does not have a family physician. As a result, the patient is assigned a family physician from among the roster of family physicians with privileges at The Credit Valley Hospital. This creates a problem for the family physicians, most of whom, already have a full complement of patients in hospital, and full practices in their offices."

Dr. Clarkson notes as a result, many of the family physicians, both here and across the province, are relinquishing their hospital privileges. "This further compounds the problem," he says, "because then, when one of their patients ends up in the emergency room, they too are assigned to one of the remaining family physicians with hospital privileges. This causes an increased patient load for that physician, which in turn creates the possibility that they too, will decide to relinquish their privileges! It becomes a vicious circle!"

As the new Chief of Family Medicine, it will be Dr. Clarkson’s challenge to address this dilemma. "This is not unique to The Credit Valley Hospital," he explains. "Most hospitals in the province are struggling to deal with this situation."

What can you, as a patient, do to help? "Get your present family physician to join us here at The Credit Valley Hospital to participate in that important aspect of health care." Dr. Clarkson suggests. "Although there is a shortage of family physicians around the province, there are some who are taking new patients." A Credit To Your Health will publish a list of new physicians in this issue, and subsequent issues to help patients find a family physician.

"You should be able to look on your family physician as the person who can best assist you through the health care system." Dr. Clarkson explains. "He or she looks after you and your family on an ongoing basis. When you require specialist treatment, he or she will make sure you are referred to the best physician in the field. When you are in hospital, your physician will meet with you to discuss your care. Your family physician will also keep in touch with any specialists who may be seeing you while you are in the hospital."

To Top

FAQs (frequently asked questions) about Anesthetic

Q: What is General Anesthesia?

A: During general anesthesia, your anesthesiologist keeps you in a sate of carefully controlled unconsciousness with a mixture of very potent drugs, so that the operation is painless. Many people think that this involves the injection of just one drug. Actually, most general anesthetics require the administration of somewhere between three and 15 different drugs, depending on the complexity of the case.

Q: What is Regional Anesthesia?

A: Regional anesthesia involves injecting local anesthetics through a needles, which the anesthesiologist places close to the nerve or nerves supplying the region of the body involved in the operation. The skin and tissues that the needle goes through are also numbed with local anesthetic so that there is minimal discomfort associated with placement of the needle. Local anesthetic drugs stop nerves from working temporarily, so that no sensation and/or movement in the area of the body supplied by the nerve(s) occurs. This type of anesthesia is also called a nerve block.

Q: What is Local Anesthesia?

A: Local anesthesia refers to temporarily numbing a small area by injecting local anesthetic into the skin so that minor procedures, like stitching cuts, can be done painlessly.

Q: What is an Epidural?

A: The epidural space lies just outside the special covering or dura, which encloses the spinal cord and nerves. An epidural is a type of regional anesthetic in which a needle is positioned between the bones of the spine to allow the anesthesiologist to insert a small plastic tube (or catheter( into the epidural space. The needle is then removed and local anesthetic is injected through the catheter.

Q: What is a Spinal?

A: In a spinal anesthetic, a very thin needles is inserted between the bones of the lumbar spine, through the dura and into the spinal fluid. A small amount of local anesthetic is injected, which quickly stops the spinal nerves from working, so that there is no movement or sensation below that level of the body. The effect is temporary, lasting only until the local anesthetic wears off.

Q: Why Can’t I Eat or Drink Before Surgery?

A: Inhaling vomited stomach contents into your lungs is called aspiration and can be dangerous. Fortunately your body has an effective mechanism to stop this from happening. Unfortunately when you are unconscious this mechanism does not work, so it’s best that your stomach is empty when you have a general anesthetic. In emergency surgery when you may have eaten recently, your anesthesiologist will take special precautions to reduce the risk of aspiration. Even if you are booked to have a regional anesthetic, it is important to follow the instructions about not eating and drinking, just in case it becomes necessary for your to have a general anesthetic.

Q: What if I’m Allergic to Anesthesia?

A: Sometimes patients may think, or be told, that they are "allergic to anesthesia" because they have an unpleasant experience that they associate with anesthesia, for example nausea and vomiting. These are side effects of drug administration, not allergic reactions. A true allergic reaction to a drug usually produces hives or wheals on the skin, wheezing in the lungs, swelling of the mouth, throat or eyes, and sometimes a drop in blood pressure.

Information adapted from "Seeing You Through Your Most Critical Times: Information on Anesthesia and Anesthesiologists for the Canadian public from the Canadian Anesthesiologists’ Society."

To Top

I Saw Someone Do Something Good!

Submitted by: Grace Kiers, Service Dept.

I just received a telephone call from Heather Wood Bennett, Co-ordinator for Children's Bridge, an international Adoption Agency. They had a function in our Auditorium this past Saturday, for which a major setup was required as well as AV equipment. She wanted to let us know that the service provided was OUTSTANDING!! When the number of chairs was running low, the Environmental Crew quickly responded to the need. Tim Chevrier was very organized and the Hospital staff were so very welcoming!!

Letter & Drawing.gif (28261 bytes)

To Top

Your Kidney Programme at The Credit Valley Hospital

by Surinder Shokar RN and Susan Pattison RN

Dharam came into the predialysis / transplant office today. He had the biggest smile on his face. He looked like a kid who had just experienced ten Christmases rolled into one. "Well?" I asked him, "How are you feeling?" He looked at me, his voice almost choking with emotion, " I feel great, I feel just great!" You see, Dharam had just received a special gift. Dharam recently underwent a kidney transplant. A kidney transplant for Dharam meant a new lease on life, " I noticed a big change in my health the next day after transplant; I feel so much better," he repeated. It was almost as if he still could not believe that the transplant had finally happened.

Dharam was one of the lucky ones; he waited for just over 3 years before receiving his transplant. The average waiting time is four years. For Dharam, three years of an emotional roller coaster waiting for the phone call from the transplant hospital telling him that a kidney had become available, was over.

Patients awaiting a kidney transplant must receive life support treatment which may consist of either peritoneal dialysis or hemo dialysis. Dharam was educated on both dialysis type options and in consultation with his multidisciplinary medical team decided that peritoneal dialysis, a self care treatment at home, best suited his life style. Dialysis maintained Dharam’s health until a kidney transplant became available.

Dharam and I sat down and reflected on the past 3 years. I first met Dharam in the emergency department of the Credit Valley Hospital. He had just been diagnosed with chronic kidney failure and was apprehensive about how he would cope with this new challenge. Dharam had overcome many obstacles in his life; he was born with no legs. Dharam worked at the ‘Home Depot’ and was worried about fitting dialysis around his work. As it turned out, he need not have worried. "When they knew I was on dialysis, I explained the restrictions of time and they were very flexible with my part time hours, they were great," said Dharam. "The staff at the Credit Valley Hospital were also great, they were always there for me, helping me along the way".

The Credit Valley Hospital is a regional dialysis centre servicing the needs of people in the Peel and Halton community. The renal division consists of three programs: pre-dialysis, peritoneal and hemodialysis. The pre-dialysis program focuses on education and monitoring patients until the need for dialysis arises. At present there are 170 patients followed in this program. Patients are taught about the different types of dialysis, transplantation, blood pressure monitoring/hypertension. They are also taught the importance of taking their medication properly and diet counseling.

Community support is available through the Kidney Foundation sponsored "Renal Education and Peer Support Group (West)." This group meets monthly at the Mississauga Central Library.

The Peritoneal Dialysis Program teaches patients to manage their dialysis at home safely. Very often it is a lifestyle decision as to why this type of dialysis is chosen. There are 100 patients on peritoneal dialysis at The Credit Valley Hospital.

Hemodialysis at The Credit Valley Hospital has seen tremendous growth; expansion has occurred in the hospital and to three Satellite Units: Head Waters Health Care Centre in Orangeville; Peel Memorial Hospital in Brampton; and the Self-Care Sussex Centre in Mississauga. Despite the increases in dialysis facilities the need for further expansion continues. This increased need for dialysis has occurred due to more prevalence of diabetes and demographic shifts towards an older population.

The Hemodialysis Unit operates forty dialysis machines and three patients are dialyzed on each machine per day, therefore, 120 patients are dialyzed each day. Approximately, 250 patients receive treatment, which consists of each patient coming to the hospital for four hour treatments, three times a week.

Good health is maintained with a special diet, numerous medications and dialysis. A multidisciplinary team consisting of professionals such as nurses, dieticians, social workers, pharmacists and nephrologists work closely with the patient to enable him/her to manage their disease.

Although transplants are not performed at The Credit Valley Hospital, the hospital has an active transplant program that prepares patients for transplant and monitors the stable transplanted patents. At present, there are 140 patients being assessed or waiting for a kidney transplant.

Also, 85 patients who have had a transplant are followed in the transplant clinic.

Canada has the worst record for organ donation in the world, transplant lists are bigger and this means that the waiting time for a transplant is longer. Every one should discuss organ donation with their family because it is the family decision and not the signed organ donor card that determines organ donation.

The Credit Valley Hospital Renal Program pioneered pre-dialysis education and is a resource for newer programs. The Hemodialysis Unit is one of the largest centers in Ontario and the Peritoneal Dialysis Unit has won awards for excellence in care.

We are very proud of the many professionals who make up the multidisciplinary renal team, who constantly strive to provide the best possible care for our community.

To Top

May is Speech and Hearing Awareness Month

by Suzanne Hamilton, Speech-Language Pathologist

The month of May has been chosen by speech-language pathologists and audiologists as a time to raise public awareness of speech, language, swallowing and hearing disorders that affect millions of Canadians.

Speech-language pathologists identify and treat all types of communication and swallowing disorders while audiologists test hearing and recommend hearing aids as appropriate. CVH’s speech and audiology department sees children and adults, both inpatients at the hospital and clients from the community. As part of this year’s Speech and Hearing month, we would like to share some frequently asked questions and answers about communication, swallowing and hearing loss. If you would like more information, or suspect a hearing, speech, language or swallowing problem, please contact an audiologist or speech-language pathologist, or call the Ontario Association of Speech-Language Pathologists and Audiologists at (416) 920-3676.

Q: My mother recently had a stroke and now has "aphasia". She can say only a few words, but seems to understand everything. Is that common?

A: Aphasia is a language disorder that results in difficulty speaking and/or understanding language (spoken and written), and is caused by damage to the brain. Some individuals may find it easier to understand language than to express themselves. A speech-language pathologist can work with your mother and your family to provide intervention and strategies that help make communication easier.

Q: How much do hearing aids cost?

A: Hearing aids range in price depending upon the size of the aid. The smaller the size (and the more advanced the technology and circuit has to be), the higher the cost. The general price range is from $750 to $2000 for one hearing aid. There is a government "Assistive Devices Program" (ADP) that may subsidize 75% of the cost, up to a maximum of $500.00 per hearing aid.

Q: If my child is two years old, what kind of speech should he or she be using?

A: By two years of age, the average child is using two word phrases (e.g. "more milk"), can say at least 20 different words, and consistently uses the sounds i, o, u, p, b, m, n and d. A two-year-old can usually understand simple questions, bring you one object on command, and point to some body parts. The Credit Valley Hospital is a partner in the Peel Preschool Speech and Language Services program that provides communication assessment and intervention for preschoolers. If you would like more information, please call 820-7111, extension 2355.

Q: My father is 75 years old and seems to choke frequently while eating or drinking. Is this a swallowing problem?

A: The fact that you have observed repeated difficulty with eating and drinking is a sign of a possible swallowing problem. Swallowing difficulties (also called dysphagia) can occur at any age, and may have a neurological origin. A speech-language pathologist can assess whether or not there is a swallowing problem and provide management strategies. A referral for a swallowing assessment can be made through your family doctor.

Q: When you lose your voice as a result of a cold, is it better to whisper or to try to talk "raspy" (i.e. use your voice as it is?)

A: It is often best to use your voice the way it is rather than whispering when you have a cold. When we whisper, only one part of the vocal folds is used. This may result in stress to the vocal folds and may worsen your vocal quality. It is also important, however, not to OVERUSE your voice while you have a cold, and even more important not to ABUSE your voice (i.e. by yelling, using a loud voice or excessively clearing your throat) when you have a cold or at any time.

Q: My daughter will be three in June. She often says part of a sentence, then gets stuck on one word (e.g. Mommy, I want my b-b-b-ball"). Will she grow out of this? What can I do to help her?

A: Some preschool children go through a period of time when their speech is not as fluent and they have a hard time "getting the words out", often as language is developing rapidly. We recommend that you consult with a speech-language pathologist who can evaluate your child’s speech and language. The following suggestions may also be helpful:

Model a slow, relaxed manner of talking;
Use short simple sentences and vocabulary that is at your child’s level;
Use more comments and descriptors rather than a lot of questions;
Look at your child when he or she is talking to you; and
Pay attention to what your child says rather than how he or she is saying it.

To Top

Memoirs of a Community Representative Officer

by Helen Reilly, PR Specialist

As she hung up her hospital-issue jacket for the last time, her moniker -- "the face of Credit Valley" -- was retired as well. It's literally been twelve years on the front line at The Credit Valley Hospital for Sylvia Polachuk.

In 1989, Sylvia assumed the role of Community Representative Officer (CRO) and became a fixture in the hospital's main lobby. She was especially recognizable by the red coat she donned each morning along with a smile ready to cope with whatever the day had to offer.

Sylvia Polachuk Among her duties, Sylvia was responsible not only for the pleasantries of welcoming patients but also for dealing with the logistics involved in a hospital fire drill or alarm, code for a missing patient, and orchestrating preparations for helicopter transport of a patient.

Acting as a resource, providing direction and instruction where necessary, she was responsible for ensuring babies making the first trip home were packed into their car seats properly - and never hesitated to remind mom and dad to pack themselves in safely as well.

She also became familiar with many of the "regulars" - such as patients arriving by wheel-trans for outpatient treatment in the hospital's busy renal dialysis unit.

"I didn't know all the names, but I knew the faces," says Sylvia of the many patients she came to know over the years. "I really enjoyed my job; I never knew what to expect each day - I never knew what would come through the front door."

Among her memories, Sylvia recalls the early days when she brought her pet poodle Tiffany into the hospital to visit patients. "Tiffany had a tremendous effect on many of the patients. In fact, one gentleman became so close to her that he requested a picture of Tiffany be buried with him when he finally succumbed to his illness," Sylvia recalls warmly.

Once, several years ago, Sylvia approached a weeping woman in the hospital's main lobby. While Sylvia did only what came naturally to her, she had no idea what impact her gesture would have on this person's life. It was only years later that a happier looking woman approached Sylvia to thank her for sharing her time and a hug with a total stranger – a hug that helped convince the woman her consideration of suicide was perhaps not the only available option - someone cared about her.

Having no regrets about moving to London with her husband following his employment transfer, Sylvia admits she will miss the day-to-day interaction with the people she came to know as friends. "I am looking forward to the change of pace and travelling a little more with my husband in our recreational vehicle, but I'll miss the work and the people," she says.

The hospital's new CRO, Gary Sarina realizes Sylvia's going to be a tough act to follow. He's anxious to make the acquaintance of many of those who held Sylvia's friendship so dear. Gary looks forward to the challenge and excitement each day has to offer.

To Top

Michael's Story: Recognizing the Special Needs of Those Persons with Brain Injuries

He's young but he's old. He's full of things to say, but unable to say them. He wants to move, to experience life, like any young person his age, but his world of mobility has been cut off.

This is Michael's story --the story of a young man whose life has been permanently altered as a result of a motor vehicle accident which left him with a severe brain injury. He needs constant care. His communication is limited and as a result he often exhibits agitated behaviours such as screaming. He is frustrated to say the least. And this has frustrated his caregivers at The Credit Valley Hospital and often upsets other patients. Michael lives on the Continuing Care Unit, a unit designed for the frail elderly. But it is the only unit that provides the type of extensive nursing and physical care Michael requires.

The multidisciplinary team has been working diligently to find a solution that will be beneficial to Michael. Since he is very limited in the range of activities that he can sustain on his own, providing him with an appropriate level of stimulation has been challenging as has been the task of maintaining a high level of consistency in responding to his disruptive behaviours.

But help may be on the horizon. One of the hospitals' social workers contacted the Peel Halton Acquired Brain Injury Services (PHABIS) and together the multidisciplinary team and staff at PHABIS developed a proposal which was subsequently accepted for funding by the Long Term Care Ministry. A grant of $90,000 was given to PHABIS for the purpose of providing care to Michael.

As a result, PHABIS hired a behaviour therapist to work on a one to one basis with Michael. A therapist is available seven days a week to help CVH health professionals replace Michael's agitated behaviours with more adaptive ones.

In addition, Michael will have access to the modular services, such as a music group and peer support group, which are already available in the community for the brain injured.

The behaviour therapist has become part of the hospital's multidisciplinary team providing Michael's care. The hospital's psychologist provides direct supervision for the clinical aspects of Michael's care while the administrative responsibility and participation in the community program is the responsibility of Peel Halton Acquired Brain Injury Services.

Michael's program will be funded to the end of his stay in the hospital and PHABIS has been awarded funds to create a community home for those with similar severe disabilities. We anticipate that there will be a place available for Michael when this home has been established

To Top

Mommy I Bumped My Head and Other Childhood Malaises!

Head injuries, tummy aches, and bites were the topics of conversation at The Credit Valley Hospital’s Community Education Night recently. Lots of parents showed up with lots of questions for paediatrician, Dr. Donna Goldenberg, staff paediatrician, and Dr. Eric Letovsky, Chief of the Emergency Department. The pair gave a lively presentation interspersed with questions from anxious parents who were more than willing to share their children’s experiences from such interesting injuries as dog and people bites; high-flying spills from monkey bars and terrible tummy aches. There was a wealth of information that we thought you’d find information and useful so we’re going to summarize some of it for you. But perhaps the most important piece of advice was, always take your child to the emergency department if you’re worried about any kind of injury or illness.

What You Should Know About Children’s Head Injuries

A child learning to walk may tumble and bump his head. Usually this type of fall isn’t as significant as one from a greater height (such as falls from a change table). HINT: To avoid a fall from a change table, make sure you keep one hand on baby’s tummy whenever you take your eyes from him or when you’re reaching for something. HINT: Use ice to prevent or diminish swelling. Wrap ice in a towel, never put ice directly on skin.

Loss of Consciousness – the longer the length of unconsciousness, the more we worry. Most kids, even after a minor head injury, will vomit, usually within 30 minutes. Sometimes it’s simply because of the stress of the injury. If the vomiting persists, if the child is lethargic or you feel he’s "just not quite right" (confused, disoriented, not as alert) you should bring him into the Emergency Department.

What Will Happen in the Emergency Department

The doctor will feel the child’s scalp to determine if there is a skull fracture. The doctor will do a neurological examination (eyes, reflexes, strength, steadiness of walk etc.). NOTE: The majority of children with head injuries can be sent home as long as parents keep a watchful eye on their child. If the child has a persistent headache and/or vomiting, you should return to hospital.

Vomiting and Diarrhea

Usually parents biggest concern is that their child will become dehydrated. Often after a child vomits, he says he’s thirsty. Mom or dad gives him something to drink…the child guzzles the drink and then he vomits again! HINT: Give your child Gastrolyte, or Paedialyte to drink. It doesn’t taste that good, so the child will only take small drinks. This will diminish vomiting. DO NOT give your child over-the-counter medications to stop diarrhea. These will stop the body from getting rid of infection.

Your Child is NOT Dehydrated if:

If you can see a shiny reflection in his eyes (sunken and dull eyes are a sign of dehydration).

If your child has tears when s/he cries.

If your child has the usual number of wet diapers.

If his mouth is moist when you stick your finger in it.

Call your doctor or go to the hospital if:

You child has diarrhea and is less than six months of age.

Your child has bloody or black stools.

Your child starts to vomit and is still vomiting after four to six hours.

Your child has a fever (temperature greater than 38.5 C (101.5 F).

Tummy Aches

There are many reasons for tummay aches in kids. The following two are often difficult to diagnose:

Appendicitis
Constipation

Appendicitis is the inflammation of the appendix in the right lower side of the abdomen, although the pain may not begin there. The tummy ache will get progressively worse. It WILL NOT ease. It may be accompanied by a fever. The only treatment is surgery.

Pain from constipation is intermittent. It comes and goes. The bowel contracts in order to empty. When it does not empty, it cramps, but the pain will go away after about fifteen minutes. In order to avoid constipation, give your child prune juice, lots of vegetables and vary his diet so that he does not eat the same foods every day. If the pain is so severe that you bring him to the Emergency Department, an enema may be given.

Bites

Cat, dog and human bites are quite common. It is rare that the bite is deep enough to injure the tendon. The major concern is risk of infection.

Cats’ teeth make small puncture wounds which are very difficult to clean so the risk of infection in high. If a child is bitten by a cat, the doctor will usually give him antibiotics to prevent infection.

Dogs’ teeth make a more sheering type of wound. Because the wound is larger and more gaping it is easier to clean. The doctor will irrigate the wound with salt water and cut off any loose skin that’s around the wound. The doctor will probably not prescribe antibiotics when the bite is on the face or the hands.

If a child is bitten by another child or adult, there is a serious risk of infection. Humans carry many more bacteria in their mouths than either cats or dogs. The doctor will probably not suture the wound because the wound tends to get infected if it is closed. The doctor will probably prescribe antibiotics.

HINT: Remember to get a tetanus shot every ten years.

Watch for more helpful hints in upcoming issues of "A Credit to Your Health".

To Top

Health System Integration Initiative Approved

Patients suffering from disabling medical conditions such as stroke or as a result of injury, work very hard with their hospital caregivers to regain the use of their limbs. Once they reach a certain level of functioning they are able to return home. As delighted as they are to be back in their own surroundings, they may lose some of the skills they've relearned because of lack of professional support and encouragement. But that's about to change as a result of a new initiative that began with a meeting of community groups including The Credit Valley Hospital, Trillium and the Halton Health Care Services Corporation as well as representatives from the Peel Continuing Care Access Centre, Peel Public Health, South Common Community Centre, The City of Mississauga Parks and Recreation Department. Although each of these agencies provides a service their goal was to integrate resources to provide a seamless "continuum of services" for these individuals. The groups' focus is on wellness and the efficient use of all resources available to the patients, inside hospital and in the community.

A program was developed that integrates Credit Valley Hospital Rehabilitation and Seniors Day Program with services provided by the Continuing Care Access Centre and Mississauga Parks and Recreation. The program helps patients move from the therapeutic environment of the hospital program to community based services to allow them to build on the gains they made in therapy as well as to develop the skills and confidence to ensure continued independence. The Continuing Care Access Centre is exploring opportunities for providing follow-up services.

There are four phases of the program. Phase one is the hospital treatment phase (Phase I) where the patients receive occupational therapy, physiotherapy, speech therapy, recreational therapy, nursing and social work services as well as on going medical consultations from a geriatrician. While in hospital the patients also make use of other hospital services such as laboratory, imaging and diabetic education.

During Phase II the individual will receive therapies less frequently and will start the community program which will help them to use the skills they re-acquired during therapy. This part of Phase II will take place at the South Common Community Centre. During this transitional phase, the hospital rehabilitation staff will share their expertise with the community recreational staff and volunteers so that the program can be adapted to the specialized needs of the individuals. These persons are not "on their own" to continue to build skills and stamina but receive appropriate help and guidance in their efforts to resume pre-illness activities and to learn new ones. This is what's known as "continuity of care". It's a cost-effective and efficient use of hospital and community resource and results in the best outcomes for the participants..

The third phase focuses on health and wellness and independent re-integration of the individual into community activities. The professionals monitor how the individual is functioning through a variety of recreation, exercise and social activities tailored to the needs of the participants. The Community Care Access Centre will also refer appropriate clients to this phase of the program. Caregiver support and relief will be a key element and activities will be developed specifically for caregivers. In addition, education will be a significant component of all aspects of this program. Initially, education will be individualized and will focus on medical and functional concerns.

During the transition period (Phase II) and in the community portion (Phase III), educational opportunities will be more broadly based and will include sessions on topics such as osteoporosis, arthritis and stroke, as well as stress management, drug interactions, and use of sleep enhancement strategies. The educational initiatives will target both patients and their families.

The Community Care Access Centre and Senior Day Hospital have been developing common systems to improve information sharing and to establish common outcome measures to make sure the professionals and the participants are achieving their goals.

The program is being funded by the Long Term Care Division by the Recreation Analyst for Seniors Programs of the City of Mississauga Parks and Recreation Services. The program will cost $62,476 which will pay for a program coordinator to plan, implement and evaluate the program and develop a strong student training and volunteer component. In addition, the services of a recreation therapist and an exercise counselor will be required. The program will begin in the Fall, 1999.

To Top

Peel Regional Cancer Centre Receives Funding

By Wendy Johnson APR, Director, Community Relations and Communications

It’s official. Funding for The Peel Regional Cancer Centre has been announced and the promise of additional funding for an adjoining ambulatory care expansion has been received.

Rob Sampson, the MPP for Mississauga West, announced the $31.8 million from the Ministry of Health just minutes before his boss, Premier Mike Harris, called the provincial election. The total cost of the Cancer Centre is estimated at $45.4 million. The Ministry’s portion is approximately 70 percent of the total cost. The remainder will be raised in the community and through the Region of Peel development funds.

The new centre will provide radiation therapy for patients who currently travel to downtown Toronto or Hamilton for their treatment. The Centre will open with three radiation treatment machines. Space for an additional three radiation machines will be provided in recognition of the continuing growth in the region.

Wayne Fyffe, the President of The Credit Valley Hospital says its important that patients are able to access this type of care closer to home. "We are extremely pleased the Ministry has responded with the appropriate funding for the Cancer Centre. We will work closely with Cancer Care Ontario to integrate our operation with that of the new regional cancer centre."

Mr. Fyffe added how pleased he was to see "that the Ministry recognized the importance of funding not only the cancer centre, but the support services, such as laboratory and diagnostic imaging that will be impacted by the increased patient load." The Ministry allotted $14 million more than originally estimated by the Health Services Restructuing Commission to upgrade the support services.

The building housing the cancer centre will be integrated with expanded ambulatory care program space for renal dialysis and other medical and surgical services which will free-up much needed inpatient space in the existing hospital. Fyffe says he anticipates a funding announcement for that portion of the project soon, in order that the architectural drawings can be developed in unison with the cancer project.

To Top

P.E.N. Pals: Professional Excellence in Nursing

By Vanna Boghossian, Cathy Goacher and Mary-Agnes Beduz

The Credit Valley Hospital has a registered nursing (RN) staff, complemented by registered practical nurses (RPN) in our continuing care facility, which is unique in being able to provide complex health care from a holistic and wellness perspective. As patient advocates, nurses are key in organizing the best quality of care possible along the continuum from birth to death. Through education, networking, research and a team approach, nurses are prepared to care for the patient and family unit in a variable environment.

Our professional nursing staff function in many enhanced roles such as unit coordinating nurse, clinical cacilitators, preceptors and various resource nurse roles.

This year, Nursing Week was celebrated from May 10-16, 1999, and the national theme was "Partners in Healthy Aging".

Activities during the week included a variety of lectures covering topics such as skin care, joint replacement and mental health issues related to aging. A major highlight of the week is the presentation of the Annual Excellence in Nursing Practice Award. The Excellence in Nursing Practice Award is bestowed on individuals, working in staff nurse roles, who exemplify the philosophy of the nursing division. This year nurses were nominated by their peers, in recognition of their contributions to the nursing profession, through demonstrable excellence in clinical practice, education, leadership and quality initiatives. The 1999 Excellence in Nursing Award was presented to Debbie Berube, Maternal Child Services. Honoured nominees were Madoline Baluca, 1E; Sheryl Brimley, 3C; Carolyn Cordi, 1D Palliative; and Anna Spicer, SCN.

As we prepare for our future together, we look forward to sharing with you, our readers, the contributions our nursing staff make in providing quality health care at The Credit Valley Hospital.

To Top

Physicians Accepting New Patients

Dr. Adam Chen, 2000 Credit Valley Road, 820-4540

Dr. Andy Chen, 2000 Credit Valley Road, 820-4540

Dr. Gimiana Gindi, CVH Family Physicians After Hours Clinic, 2000 Credit Valley Road, 569-1393

Dr. Jan Gustafsson, 2000 Credit Valley Road, 828-7044

Dr. Andrew Ng, 3476 Glen Erin Drive, 820-3822

Dr. Nikki Powar, 3095 Glen Erin Drive, 828-0038

Dr. Ah-Kooi Soon, 3040 Palstan Road, 949-6798

Dr. Janet Vickers, 2300 Eglinton Avenue West, 820-8144

Dr. Manjit Virdee, 499 Ray Lawson Blvd., Brampton, 455-9374

Dr. Stuart Wood, 2000 Credit Valley Road, 828-7044

Dr. Robin Woollam, 3095 Glen Erin Drive, 828-6700

Dr. Ken Zhang, 1675 The Chase, 820-5023

To Top

Warning: Dangerous Curves Ahead

By Wendy Johnson APR, Director, Community Relations and Communications

The road to health care at The Credit Valley Hospital has some dangerous curves ahead according to the hospital’s year end statistics and future year projections. The hospital’s operating volumes have increased dramatically in many programs and services. Unfortunately, the hospital’s operating funds as provided by the Ministry of Health, have not kept pace with the growth.

The lack of an appropriate funding formula as it relates to growth was the subject of much debate during last November’s Kyle Martyn inquest. One of the recommendations from the inquest, was that the hospital and the Ministry embark on an external review of the hospital’s funding in order to develop a funding formula that takes into account the precedent-setting growth in the northwest section of Mississauga. The larger area served by CVH grew by 48% over the last five years. An additional 32% in growth is expected between now and the year 2003. The external review was undertaken over the last few months.

That kind of growth, though felt in every part of the hospital, has been most evident in the Emergency Department where patients arrive unexpectedly with anything from broken bones to deadly viruses. The seriousness of patients’ conditions (acuity) has increased dramatically over the last few years. As a result, many of the emergency patients require admission to hospital. But the nursing units have few, if any, inpatient beds to spare. The lack of operating funds to provide the additional tests and drugs to care for the increasing patient load, coupled with the lack of capital funds to expand our inpatient space to add more beds, has pushed the hospital and its caregivers to the limit. Too often emergency patients end up waiting on stretchers in that department until a bed can be found on a nursing unit.

Over the last year patients spent a total of 1977 days in the emergency department waiting for an inpatient bed. With only 365 days in a year, the statistic indicates how serious a lack of inpatient resources poses for the emergency department. Based on current population data, the hospital estimates patients could spend the equivalent of 3000 patient days waiting in the ER for an inpatient bed this year.

At the end of April the hospital received its initial Ministry of Health allocation for this fiscal year. "It was disappointing to say the least," hospital president, Wayne Fyffe acknowledged. "The interim allocation provides $1 million less than last year’s funding."

The 1998/99 operating budget, after additional transitional funding injections, was $83 million. The initial funding for the 1999/00 fiscal year will provide a budget of $82 million. The hospital says it needs an operating budget of $104 million. That means the current funding from the Ministry of Health fall short by $22 million.

Hospital Board Chair, Ian Cairns said he’s "concerned about the erosion of The Credit Valley Hospital’s capital funds. This money is to help fund capital projects such as the impending regional cancer centre and ambulatory care addition. We are dipping into those funds just to meet our budgetary obligations each month. Not only is that not smart business, it’s dangerous business because by doing so, we are threatening the future of those capital projects that we must complete in order to meet our patients needs."

Both Cairns and Fyffe are hopeful that the external review of the hospital’s current and projected operation will result in much needed growth funding so the hospital can continue to meet the demands of our patients. The final report of the external review committee is expected within the next few weeks.

To Top

Wayne’s World

by D. Wayne Fyffe, B.A., DHA, CHE

President and Chief Executive Officer, The Credit Valley Hospital

Fyffe When will the Cancer Centre open? I am asked this question regularly.

All hospitals in Ontario must have prior approval of the Ministry of Health before building additions. The first step is to receive approval of a comprehensive planning document called a "Functional Program"! It details the size and scope of the proposed programs and buildings, and provides a cost estimate.

On May 5, 1999 we received approval of the Functional Program for the Peel Regional Cancer Centre at an estimated total cost of $45.4 million. We are delighted because the approval includes initial installation of three radiation therapy machines plus three more rooms to be built so that we can easily install three more machines as the need increases within the rapidly growing population of the Peel Region and surrounding areas.

Now we are seeking approval to integrate this new building with desperately needed ambulatory care (outpatient) space. This integration will save construction costs and annual operating costs.

What’s next? When we receive approval of the Ambulatory Care Functional Program, we can ask our architects to prepare design drawings for the integrated facility. Then we will provide detailed specifications for each room. Then we will develop a construction tender document. When the construction contract is awarded to the successful bidder, we can put a hole in the ground.

Whew! Planning is hard work. Led by Ian Sinclair, Associate Vice President, Corporate Planning and Construction, teams of CVH staff, physicians, Cancer Care Ontario staff and architects have been busy visiting other cancer centres and ambulatory care centres so that we can observe the best design ideas. I am confident that when the Peel Regional Cancer Centre opens at the end of 2001, it will be the finest centre in Canada!

The integrated Cancer Care/Ambulatory Care Centre is our first priority. Many other important expansion projects are also awaiting approval of the Functional Program – eg. Child and Maternal Care, Mental Health, Rehabilitation, Complex Continuing Care, Surgery and other related programs.

We will continue to work with Ministry staff to fast track approvals and construction, and to ensure that our new facilities are large enough in size and scope of service to allow us to offer you "care closer to home".

Stay tuned!

To Top

Anesthesiologists Don’t Just Put You To Sleep!

By Wendy Johnson APR, Director, Community Relations and Communications

Most people, when they hear the term anaesthetist, or anesthesiologist, think of a person who puts patients to sleep before an operation. Well, they do that…but they do a lot more.

Dr. George Dyke is the Chief of Anesthesiology at The Credit Valley Hospital. He and his fellow anesthesiologists took time from their busy schedules, April 28^th to set up a public display and speak to patients and visitors at the hospital about the work they do. Dr. Dyke explained that Canadian anesthesiologists are specialist physicians in peri-operative medicine, critical care and pain management. They see patients through their most critical times in many areas of the hospital, not just the operating room. One of the most important discussions an anesthesiologist has with a patient is prior to surgery when s/he will discuss the risks, the benefits and safety issues in connection with the anaesthesia we’ll administer in the operating room. "We see up to 20% of our patients in the Preoperative Assessment Clinic to determine potential problems, treat them preoperatively and reassure the patients about the process."

He says most patients are anaesthetized intravenously. "Occasionally we use a mask with patients who are uncomfortable with needles. An EMLA patch – a local anesthetic ointment – can reduce the pain of the needle injection. We often advise parents to purchase these prior to their child’s operation. Another form of anaesthetic is the epidural/regional analgesia. This "freezes" the part of the body we are operating on but allows the patient to remain awake during surgery."

"We’re in the operating room watching over the patients, keeping them safe and comfortable during surgery," Dr. Dyke said. "But we’re also there after the operation, to keep patients free of pain as they recover from the anesthesia and the surgery. Sometimes we recommend a pain pump or ‘patient controlled analgesia’ for our patients after surgery. This allows them to monitor their pain and give themselves a shot of pain killer through their intravenous line, when they feel pain."

Dr. Dyke also noted that the Canadian Anaesthetists’ Society has changed its name to the Canadian Anesthesiologists’ Society. "This is to avoid any confusion with the term anaesthetist, which is used by nurse anaethetists in the United States. The term anaesthesiologist is a better reflection of the North American nomenclature and the broader technical scope of the specialty. "The term is also in keeping with other specialists such as gastroenterologist and endocrinologist," Dr. Dyke explained.

Dr. Dyke and his fellow anesthesiologists hope that by providing information about anesthesia and anesthesiologists they can offer a high level of psychological comfort to patients facing surgery and to those patients’ families and friends. Information about the Canadian Anesthesiologists’ Society is available on the web at www.cas.ca.

To Top