Hamilton researchers find one in five children have a mental health disorder

One in five Ontario children and youth suffer from a mental disorder, but less than one-third of them have had contact with a mental health care provider, says the Ontario Child Health Study (OCHS), a multi-year investigation by researchers at the Hamilton Health Sciences and McMaster University’s Offord Centre of Child Studies.

“That means there are more than a million Canadian children and youth with a mental health problem,” says Michael Boyle, co-principal investigator of the study.

Although the results echo a similar study from 1983 in terms of the number of children affected by mental health disorders, the team found that the patterns of mental health disorders among different sexes and age groups have changed.

For example, hyperactivity disorder in boys four to 11 years old jumped dramatically from nine to 16 per cent, but there has been a substantial drop in disruptive behaviour among males 12 to 16 years old from 10 to 3 per cent. There has been a steep increase in anxiety and depression among both male and female youth from 9 to 13 per cent.

They also observed that there’s greater recognition of the need for professional help for mental health disorders, rising from seven per cent in the original OCHS in 1983 to 19 per cent in the 2014 OCHS. However, the study team says that it’s difficult to estimate whether it is tied to the growing prominence of anti-stigma and mental health awareness campaigns over the past three decades.

In the past year, more than eight per cent of youth thought about suicide, and four per cent reported a suicide attempt.

In 30 years, the prevalence of any disorder increased in communities with a population of 1,000 to 100,000, rather than large urban areas, and there’s strong evidence that poor children are more likely to have a disorder if their neighbourhood is one where violence is more common.

The study also found that in the past year more than eight per cent of youth thought about suicide, and four per cent reported a suicide attempt.

The 2014 OCHS study included 10,802 children and youth aged four to 17 in 6,537 families. It replicated and expanded on the landmark 1983 Ontario Child Health Study of 3,290 children in 1,869 families.

“This study underscores the continued need for effective prevention and intervention programs,” says Kathy Georgiades, co-principal investigator of the study.

Boyle and Georgiades led the 2014 OCHS research team of the Offord Centre for Child Studies of McMaster University and Hamilton Health Sciences (HHS). Boyle is a professor emeritus and Georgiades is an associate professor of the Department of Psychiatry and Behavioural Neurosciences of McMaster and holds the David R. (Dan) Offord Chair in Child Studies.

This study was funded by the Canadian Institutes of Health Research (CIHR) and by the Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Children and Youth Services and the Ontario Ministry of Education.




Lilly flies a rainbow kite with her sister, Scarlet

The thing about cancer is… it doesn’t care

By Shelley Lewis

The thing about cancer is, it doesn’t care.

It doesn’t care about how healthy you eat, how much money you have, where you live, or how old you are. It affects everyone and can target anyone. In our case, cancer didn’t care that it picked on a sweet 12-year old girl, my daughter Lilly.

Lilly, Shelley, and sister, Scarlet

 

It didn’t care that her heart is bigger than her little body, her mind more creative than her hands can keep up with and her spirit more colourful than any rainbow. It didn’t care that she had plans to take on her very first babysitting job the next day, or have her first overnight camp experience the following week, or miss her family vacation to the Dominican Republic.

It didn’t care that she would miss her sisters 10th birthday or Christmas in her home with her family and every other celebration among friends and family. It didn’t care that it took her from her dog who adores her, her friends that admire her and her sister who is lost without her. It didn’t care.

But as with anything that attacks your child, you care more than anything, and you channel that care to nurture, love and protection. And that’s what I did as we began the fight on October 10, 2018.

In that second everything changed.

On that day, Lilly was diagnosed with acute myeloid leukemia.

As I sat behind Lilly holding her through my tears, I began to feel her body tremble with tell-tale signs of her own tears. I stopped and faced her. I tried to reassure her that we would do this. We can do this. She told me she wasn’t crying because she was scared. She was crying because I was scared.

In that second everything changed. If I couldn’t be brave for her, she couldn’t be brave. No more tears. Lilly even had a no tear policy in her room, she could kick you out if you cried.

A foot rash is what brought us to McMaster Children’s Hospital (MCH), but a cancer diagnosis is what kept us there for six months and five rounds of chemotherapy. It feels impossible to hand your child’s life over to people who were strangers just hours before, while trying to understand ‘parent oncology’, a degree you never wanted.

You immediately become a team. As a parent, you bring forth your knowledge and love for the child. The health care professional brings a wealth of science and medical practice. Together, you are a force to be reckoned with.

Lilly started treatment immediately. Shortly after, her hair started to fall out. Her sister bravely shaved her own head alongside Lilly. For the first time, I could see the sick. It had been hiding inside, but now it was before me and I realized we needed more strength.

As a parent you would shorten your life to extend theirs. I started to write. We wanted to channel all the positivity in the world in hopes she would feel the ripple effect to carry her each day. I was convinced she could feel it.

Lilly wanted a giant #lillystrong sign in her window to let the world know she was there and fighting hard. They knew, and the positivity followed.

Lilly holds up her strings of bravery beads Lilly receives chemotherapy

 

Kids in treatment collect bravery beads. They tell a story of their journey and are a testament to just how strong they really are. Lilly’s strand of beads reaches over 15ft long and has over 550 beads. These beads represent over 100 transfusions, over 40 needle pokes, over 40 tests, 29 days of chemo and countless procedures and dressing changes. They represent 159 days of a strength she never knew she had.

Each day, we carried the positive energy forward. On March 17, 2019, the luckiest of all St. Patrick’s days, Lilly left MCH through the same emergency doors she entered, cancer free. She has a long road to recovery ahead, but each and every day we are grateful. Through the brilliant minds at MCH and the endless support for Lilly around the world, we are able to say: The thing about cancer is, it doesn’t care. But we do, more than anything. We will never stop.

 

Shelley is mom to 12-year old Lilly, who was diagnosed with acute myeloid leukemia in fall 2018. Lilly continues to receive treatment at McMaster Children’s Hospital as an outpatient. 




Dr. Van Adel checks Stephanie's blood pressure

Stroke team saves two lives at once

When Stephanie was on the table in Dr. Brian Van Adel’s operating room, two lives were at stake. She was six months along with a baby girl, and was about to become the first patient at Hamilton Health Sciences (HHS) to have a clot retrieval procedure while pregnant. Not just the first in Hamilton, but one of the first in the world.

“I was just focused on getting Stephanie through this,” says Dr. Van Adel, a neurologist at Hamilton General Hospital (HGH). “I knew that if Stephanie was okay, the baby would be okay.”

“I was definitely in denial”

It was about 10:30 at night when Stephanie began to experience stroke symptoms as she got ready for bed. Her speech began to slur, and she drooled while brushing her teeth. The left side of her body became weak. The 35-year old didn’t know the signs of stroke, and brushed the symptoms off. Her partner, Reza, suggested they call 9-1-1, but she protested. He insisted, and they asked a neighbour to look after their 4-year old daughter while they waited for the ambulance.

“I was definitely in denial,” Stephanie recalls.

First responders spot stroke symptoms

Paramedics immediately identified her stroke symptoms and called ahead HGH, the regional stroke care provider for Hamilton and Niagara North West. This ensured the stroke team was ready when Stephanie arrived in the emergency department. Dr. Van Adel says that quick thinking made a big difference. When someone is suffering a stroke, millions of brain cells die each minute, so every second counts.

Stephanie was met in the emergency department by Dr. Van Adel along with Dr. Kelvin Ng. They agreed she was experiencing a stroke, likely as a result of a clot in her brain. Scans confirmed it. In most cases like Stephanie’s doctors use a special drug which dissolves the clot causing the stroke. However, the drug comes with a risk of excessive bleeding, which could be difficult to manage in a pregnant woman.

Surgery to remove the cause of the stroke while pregnant a first

The team decided Endovascular Therapy, more commonly known as EVT or clot retrieval, was Stephanie’s best option, although they had never performed it on someone having a stroke while pregnant before. The procedure involves inserting a tiny scope through an artery in the patient’s leg, and snaking it up to their brain. Then, they extract the clot with help from x-ray technology. It’s still a relatively novel treatment, and had only been performed on a handful of pregnant women in the world. But it was their best shot. Drs. Ng and Van Adel consulted with obstetrics at Hamilton Health Sciences’ McMaster University Medical Centre (MUMC) and they agreed the baby wouldn’t be at risk during the procedure.

Dr. Ng looks at Stephanie and Iris sitting on the exam table

Clot retrieval surgery requires the patient to lie very still while the scope is snaked through their artery and into their brain. Stephanie recalls being incredibly uncomfortable lying on her back. The dye used to illuminate her arteries was putting pressure on her eyes and she was in pain. “It was really intense,” she recalls. “But I still don’t think the seriousness of my situation had sunk in at that point.” Dr. Ng checked the baby’s heartbeat before and after the procedure, and an ICU doctor was on hand in case anything went wrong.

Dr. Van Adel successfully retrieved the clot from Stephanie’s brain. It was about the size of a grain of rice, and had been blocking blood flow to important parts of her brain. Because the team was able to retrieve it so quickly, Stephanie made a complete recovery.

If you suspect someone is having a stroke, call 9-1-1 immediately. Learn more about the signs of stroke in this short video.

“The last thing I remember from the room, was when Dr. Van Adel asked if I could give Dr. Ng a thumbs up with my left hand—the one that was paralyzed,” says Stephanie. “And I could.”

Stroke team meets the baby they saved

Three months after the clot retrieval procedure, Stephanie delivered healthy baby Iris at MUMC. Stephanie sees the team at HGH for regular checkups, and is doing very well. When she first brought the bright-eyed little girl in to meet the team who saved her life, there were few dry eyes in the room.

“It was emotional when the staff got to meet Iris,” she says. “It was very special. Because without them, things might have turned out very differently.”

 




Clive dancing with his wife outdoors

The thing about cancer is… it need not stop you from dancing

By Dr. Clive Kearon, thrombosis specialist at Hamilton Health Sciences. Originally published in the Canadian Medical Association Journal (CMAJ)

Four weddings and…

Last May, I received a diagnosis of metastatic melanoma. The chance of a good response to intensive therapy was felt to be slim and my life expectancy short.

In the weeks that followed, I had radiation therapy, met with palliative care providers, communicated with family and friends, visited lawyers and financial planners, reviewed end-of-life preferences, and was assessed for phase 1 trials. I also started a second checkpoint inhibitor and was advised not to travel so that complications, should they arise, could be dealt with rapidly. Our plans for the summer included four weddings.

The first wedding was in June. My aches and pains, poor appetite, and reduced energy were no worse and possibly a bit better than in May, which I found encouraging. I was not confident about taking to the dance floor. My body warned me to keep to the edge, avoid those with flailing arms, and keep one foot on the floor at all times. I was more than happy to comply.

The second wedding was in August. It was clear that my health had improved in the interval: I no longer needed analgesics; my appetite and energy had improved; and my nonspecific tumour marker levels had moved in the right direction. I was able to spend much of the evening on the dance floor, although my movements were sluggish. I still felt the need to keep clear of more energetic dancers, and I lacked endurance.

The third wedding was in mid-September. This was our daughter’s, and my wife and I had been worried that my health would be a problem. Happily, by August we were confident that I would be well enough to attend and that my illness would not overshadow the occasion. My daughter and I took foxtrot lessons in preparation for the father–bride dance. The day was everything that anyone could have hoped for. My bones no longer felt vulnerable and both my feet were more than happy to leave the dance floor. Our choreographed version of “Dancing Cheek to Cheek” fell apart early, but it didn’t matter. My daughter and I had a ball.

The fourth wedding was at the end of September. My checkpoint inhibitors were on hold owing to autoimmune complications and I was enjoying some steroid-induced euphoria. At the wedding, my batteries were charged, the music was great, and my rediscovered vitality was a bit of a liability to others on the dance floor. Eventually, when our designated driver decided that “enough is enough,” my wife and I were pried off the floor.

Clive dancing with his wife outdoors

 

In May, I felt I had a “scheduled death.” Now that my luck has changed and my response to treatment has been impressive, I no longer feel that way, although my future is uncertain. Many friends have commiserated with me about having to cope with that uncertainty. I assure them that, for me and my family, coping with uncertainty is welcome compared with the expectation of a predictable downward course.

This illness has reinforced for me that we are irreplaceable only to those who love us. When I was expecting an early death, my predominant emotion was profound sadness that I would be shortchanged on life and time with my family. And that my death would cause my family grief.

Fear of dying has not been a prominent emotion because, whatever it is I believe in, it does not include damnation or other forms of suffering after death. I like to think I have always been careful about work–life balance, but the scales have definitely shifted. Throughout my illness, I have been looked after with great care and compassion by all I have encountered, and having trust in the health care system has been very comforting for me and my family. I am also very thankful to be benefiting from a new class of drugs able to achieve outcomes in melanoma that were previously inconceivable.

The step-like improvement in my ability to enjoy myself at successive weddings over the summer was one of the clearest indicators to us that I was responding to treatment. I felt delighted to be alive and improving. At the fourth wedding, while out on the dance floor and feeling high on life, steroids and red wine, I could not resist bellowing into my wife’s ear over the din, “Four weddings and no funeral,” as we gave thanks for at least a temporary reprieve in my illness.




patient speaking to doctor on a laptop from her home

A virtual doctor’s appointment

Anna has ulcerative colitis and splits her time between her Toronto home and London, England. Having the option of checking in with her gastroenterologist Dr. Neeraj Narula in a virtual visit gives her peace of mind no matter where she is.

The 30-year-old is part of a pilot project into using video conferencing for appointments at adult ambulatory clinics at Hamilton Health Sciences (HHS).

“It was as if I was there,” says Anna, of her e-visit. “Dr. Narula is a terrific doctor. He answers my emails when I have questions or concerns but it’s completely different to see him and talk to him.”

The option of e-visits is a “luxury” she is grateful to have.

“I think it’s incredible. Turning on the computer is easy.”

“I think it’s incredible. Even though Toronto isn’t all that far from Hamilton, it’s very hard for me to make the trek when I’m not feeling well. Turning on the computer is easy.”

“E-visits make the appointment only about the patient’s health, not about the stress of getting there,” says Nate VandenDool, clinical manager of seven specialist clinics at HHS and project lead.

“In addition to improving the patient’s experience, we’re trying to demonstrate that e-visits reduce cancellations and no-shows because they are more convenient for patients and that they make better use of a physician’s time. We also think we can demonstrate they provide improved access to a specialist’s care, too.”

In addition, patients’ risk of being exposed to illness at the hospital is eliminated. It saves them time and money, and reduces their reliance on the physical hospital.

“If we can keep people well at home, with the proper access to specialty care, they will be less likely to visit the ER or be admitted to hospital,” says Nate.

 it gives a greater number of options for patients to engage in health care

The pilot is working with the Ontario Telemedicine Network (OTN) to test e-visits with patients in a number of areas throughout HHS. Participating patients are sent a link to connect to a secured call through the OTN portal on a computer, tablet or smartphone. Once the physician clicks in, the two are connected.

“There’s interest from physicians to use e-visits as an opportunity to optimize service delivery and efficiency,” said Dr. Ted Xenodemetropoulos, a gastroenterologist at HHS and physician lead on the e-visits project. “It’s an exciting and very personally fulfilling program.”

He says shifting routine follow-ups to an e-visit format allows clinics to reallocate premium time to acute, complex cases, which then don’t end up in the emergency department.

“This is a program that’s meant to allow for increased convenience while giving a greater number of options for patients to engage in health care. That’s extremely valuable.”


In addition to shifting clinic follow-ups to e-visits, HHS is exploring other applications for virtual care which may reduce visits to the emergency departments and support earlier discharge. This can be seen in both the SMArTVIEW project and REdireCT TAVI.




Dr. Robin Lennox and Dr. Rich Whitlock stand in front of Hamilton General Hospital

“Second Heart” could mean second chance for IV drug users

Pictured above: Drs. Robin Lennox and Richard Whitlock of Hamilton Health Sciences are leading a new initiative that aims to provide better support for patients with IV drug addiction once they leave the hospital.


For some people in our city, a proposed new project called “Second Heart” will mean getting a second chance at a healthier life.

In recent years Dr. Richard Whitlock, cardiac surgeon at Hamilton Health Sciences (HHS) and his team at Hamilton General Hospital have seen an increase in the number of patients needing surgery for a serious heart infection caused by intravenous (IV) drug use.

Endocarditis is an infection of the inner lining of the heart valves that can damage the heart and, for some people, requires life-saving surgery. Research estimates that as many as 10 per cent of deaths among people who use IV drugs involve endocarditis.

More and more often Dr. Whitlock and his team at Hamilton General Hospital, our region’s hub for heart care, perform surgery to repair damage caused by endocarditis in the hearts of people struggling with IV drug addiction. Too often, they recover from surgery and return to the circumstances that brought them to hospital in the first place, with little support to navigate toward a better path. That’s why Dr. Whitlock has teamed up with other professionals from across the community to form a new initiative aimed at bridging the gaps between hospital and the community for this vulnerable patient population.

The “Second Heart” project, currently proposed as a pilot study, would unite healthcare and social service providers to support a better transition home from hospital for patients after their surgery. The goal is to curb drug use and the need for repeat surgery and, ultimately, to prevent death.

The Second Heart pilot would involve health system navigators and peer support workers to connect and guide patients to community-based services after their operation, and to help them over some of the socioeconomic hurdles, such as housing, that may prevent a good recovery from surgery and addiction.

“We have a responsibility to help give our patients a second chance.”

Dr. Robin Lennox, co-lead on the project and co-head of inpatient addiction-medicine services at HHS and St. Joseph’s Healthcare Hamilton, says that as many as half of endocarditis patients don’t have a family doctor, which further complicates their ability to navigate services that could help them.

“We have to recognize that these patients that are getting these infections are just as deserving of high quality health care that’s targeted toward their needs,” says Dr. Lennox.

Currently, the team is making a proposal for funding that would support a pilot project to study whether increased collaboration between surgical and hospital teams and community providers leads to better outcomes in patients with endocarditis caused by IV drug use.

“As healthcare professionals, we always strive to treat the underlying cause of disease,” says Dr. Whitlock. “That’s what we fail to do with these individuals, which is to treat the addiction and put the right supports in place to encourage a healthier future.”

“We have a responsibility to help give our patients a second chance.”




Close up of a nurse checking a central line in a patient's arm

A united approach to central line safety

Central lines infections are one of the most common causes of patient harm in hospitals. That’s why Hamilton Health Sciences (HHS) is creating a system-wide plan to reduce them. We’re the first hospital in Ontario to tackle this issue on such a broad scale.

What are central lines?

Central lines are large IVs used to get medication into the bloodstream when a patient can’t take medication by mouth. They are very important, but come with a risk of infection because they create an opening to the bloodstream. Central line infections can cause people to become very sick, require lots of tests and procedures, and need to stay longer in the hospital. In some cases, people die of central line infections.

a standard way to insert, maintain, and monitor central lines

Creating the ‘HHS way’

Typically central line infections are only tracked in Intensive Care Units (ICUs) because that is where the majority of central lines are inserted. We know how important it is to have everyone on the same page, so we’re creating an enterprise-wide approach that will be used in all units at all of our sites. A team with representatives from across HHS has taken the best of what’s being done in pockets of our organization, and created a streamlined protocol for everyone to follow. There will, of course, be exceptions for unique cases, but the aim is to have a standard way to insert, maintain, and monitor central lines across HHS, and to track infections using a central database.

Sharing improvements enterprise-wide

The project team is creating a toolkit for staff to guide how they insert and clean central lines, and how they make decisions about when to remove them. The new protocol encourages staff to have frequent conversations about whether a central line is still necessary. The best way to prevent a central line infection is to remove a central line!

In the coming months, the protocol will be piloted in select units before being rolled out across the system.


Strategy in Action story contest graphicThis story was selected as a winner in our Strategy in Action contest, which asks teams across Hamilton Health Sciences to share how they are putting our strategy into practice.

This initiative supports Enterprise Approach, one of four strategic directions identified in Hamilton Health Sciences’ Strategic Plan. Enterprise Approach is about leveraging our collective strengths to think and act as one hospital.




MacKid DoraLee holding pom-poms

Caring for a family with complex needs

Tara and Amanda from Hamilton are well acquainted with the services at McMaster Children’s Hospital (MCH), as they have adopted multiple children with complex physical or developmental needs.

DoraLee’s Journey

Tara and Amanda’s third child, DoraLee, was born prematurely at MCH and spent some time in the Neonatal Intensive Care Unit.

“DoraLee was diagnosed with cerebral palsy (CP) shortly after her birth,” explains Tara. “She experienced brain bleeds that caused significant damage.”

Tara and Amanda first met DoraLee shortly after her first birthday. Although DoraLee was supposed to be fostered for only a short period, the family fell in love with her.

“In our hearts, we knew DoraLee needed to be a permanent member of our family,” says Tara. “We officially adopted her when she was two-and-a-half years old.”

“Every parent wants their child to be happy, to feel loved and to be accepted in the community.”

From birth, DoraLee received occupational therapy, physiotherapy and speech therapy through MCH’s Developmental Pediatrics and Rehabilitation Program (DPRP).

Now a teenager, DoraLee continues to receive occupational and physiotherapy at Ron Joyce Children’s Health Centre (RJCHC). CP causes extreme muscle stiffness and loss of motor control, and the therapy helps her move more easily. She also visits the Prosthetics and Orthotics Service for leg braces.

“DoraLee will reach her full potential thanks to RJCHC,” says Tara. “The Centre makes our lives easier and it’s comforting that they’re just a phone call away.”

Cheering for inclusivity

DoraLee currently visits RJCHC weekly to participate in the inclusive Cheer Squad.

“The Cheer Squad is fun, but it’s also therapeutic because DoraLee is able to stretch using her full range of motion,” says Tara. “The Cheer Squad also helps DoraLee develop her social skills and connect with kids her age.”

The family’s history with MCH

Tara and Amanda’s other children have also experienced the life-changing care of MCH and its RJCHC.

Their adult son was born with a rare genetic disorder that causes abnormal brain development. He received care through DPRP as a child, which included physiotherapy, occupational therapy and custom-wheelchair seating, in addition to many outpatient clinic visits at MCH.

Likewise, their adult daughter was hospitalized as an infant multiple times for encephalitis – an inflammation of the brain. She also received care throughout her childhood in DPRP.

“Every parent wants their child to be happy, to feel loved and to be accepted in the community,” says Tara. “MCH and RJCHC have played a significant role in helping our children achieve their hopes and dreams.”

The MacKids Walk & Wheel logo, presented by RBC logo

Join MacKid Ambassador DoraLee at MacKids Walk & Wheel on June 1, 2019! Register and fundraise at mackids.ca/walkandwheel.




A whole brain on a lab table

Awake during brain surgery

What started as a regular workday for daycare provider Julie Buitenhuis drastically changed when she fell to the floor having a seizure. The 22 year old from Norfolk County had never had a seizure before, had no family history and no known health issues.

The seizure lasted six minutes, a long time for someone with no history of seizures. Julie’s coworkers called 9-1-1.

She blacked out during the seizure, but shortly after Julie regained consciousness, she was on her way to the local hospital. She was confused and disoriented, and worried what had caused it. They began to run tests, and her worst fears were confirmed. The CT scan showed an unknown mass in her brain.

“All I could think was that this couldn’t be happening to me,” says Julie.

She was referred to Dr. Bill Wang, a neurosurgeon at Hamilton General Hospital. He confirmed the mass was in fact a palm-sized brain tumour. Julie was lucky they found the tumour when they did, as that area of the brain is tolerant to change and would continue to adapt to the tumour’s growth. Left unchecked, the tumour could have pushed further into important parts of her brain, causing lasting damage.

“Since Julie is young, the chances are higher for the tumour to return.”

A surgery on the horizon

The tumour needed to be removed. The problem was its location, directly beside the motor cortex of the brain. This area controls a person’s movement.

When removing a brain tumour, it’s important not to damage the surrounding tissue. Small amounts of tumour are left behind so the neighbouring brain matter isn’t destroyed. This was especially important in Julie’s case to ensure she kept all motor function. However, since her tumour originated from within the brain, leaving even small amounts could allow it to eventually grow back. It was best to take out as much as possible.

“Since Julie is young, the chances are higher for the tumour to return,” says Dr. Wang. “In order to give her the best possible outcome I wanted remove as much of the tumour as possible. So, I suggested to Julie that we perform an awake craniotomy,” says Dr. Wang.

This meant that Julie would be sedated unable to feel her scalp, but would be awake while Dr. Wang removed the tumour.

“I wanted the tumour gone by any means possible!”

“While mapping out the line between the motor cortex and the tumour, I would be able to ask Julie to move her limbs,” says Dr. Wang. “This allows us to safely take out more of the tumour than if the patient were fully sedated.”

And so, at the beginning of 2019 that’s what Dr. Wang and his team did.

“Even though I wouldn’t be able to feel the surgery, the idea of being awake terrified me,” says Julie. “But, I wanted the tumour gone by any means possible!”

Successfully removing the tumour

In preparation for the surgery, the operating team asked if there was any specific music she’d want to listen to that would help ease her nerves. To their surprise, she said Cardi B.

“I wasn’t sure they’d actually play Cardi B, but when they were ready to begin the surgery, they cranked it up,” says Julie. “On top of that they let me watch my favourite TV show from a phone. They really did everything they could to make me feel comfortable.”

The surgery went extremely well and she was able to go home the next day. She experienced minor, temporary weakness that is expected after this type of surgery, but it didn’t last long and her incision is now fully healed.

“we were able to remove almost all of the tumour”

“Julie was the ideal candidate for the awake craniotomy and despite how nerve-racking it can be, she did great,” says Dr. Wang. “As we had hoped, we were able to remove almost all of the tumour.”

Although Julie will need lifelong checkups to monitor whether the tumour grows back, there are no lasting effects from the tumour or the surgery.

“It has been a scary experience, but I think back to the day of my seizure and realize it could’ve been so much worse,” says Julie. “What if the seizure had come a few minutes earlier when I was driving to work?”

“Despite all that’s happened, I consider myself lucky. Plus, not many people can say they were awake during brain surgery and were well enough to go home the next day.”

Keep scrolling to view images of Julie’s tumour. Warning: some people may find these graphic.


Image of Julie’s tumour

Below is a photo of Julie’s brain after mapping the motor cortex. The letters identify the following areas of motion:

  1. wrist extension
  2. finger flexion
  3. finger extension
  4. elbow flexion
  5. shoulder elevation

Julie's brain during surgery with the motor functions labelled

To most people, the tumour isn’t noticeable so below is the same image with the tumour identified.

Julie's brain during surgery with the motor functions labelled and the tumour circled




Nurse placing electrode on an infants head while the infant feeds on a bottle

Up Close: Epilepsy Program

Over two millions Canadians live with epilespy, a physical condition characterized by sudden, brief changes in how the brain works.

Chemical and electrical signals are sent through the brain and central nervous system. Epilepsy can cause sudden spikes in electrical discharge that might end up in a seizure. The area of the brain that has this spike in activity will determine what happens during a seizure. A seizure can encompass a wide variety of forms like muscle spasms, blank stare, convulsions, uncontrolled movements and altered awareness.

At Hamilton Health Sciences, our pediatric patients are treated at the Comprehensive Pediatric Epilepsy Program (CPEP) at McMaster Children’s Hospital and adults are assessed at our Neuro-Ambulatory Clinic at Hamilton General Hospital.

In this Up Close photo series, we have a look at the process that patients go through to discover what is happening in their brain and the staff that help treat them.

If you enjoyed this photo set, have a look at other collections in the Up Close series:

Cogeneration Plant

Biomedical Technology

Open Heart Surgery

Prosthetics and Orthotics in Motion

Trauma Team Response




McMaster Children’s Hospital welcomes new president

Bruce Squires
Bruce Squires has been appointed the new president of McMaster Children’s Hospital.

Hamilton Health Sciences (HHS) is excited to announce the appointment of Bruce Squires as the new president of McMaster Children’s Hospital and vice president, women’s and children’s health for HHS. Squires is the current vice president of people, strategy & performance at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, ON. He will begin his new role at HHS on Thursday, July 4.

Squires’ appointment follows a thorough international search and recruitment process. As the unanimous choice of the selection committee, there was consensus that his passion, leadership experience and deep knowledge of Ontario’s health system will be essential to the continued success of Ontario’s fastest-growing and second-largest children’s hospital.

At CHEO, Squires led the introduction of Solutions for Patient Safety, CHEO’s continuous quality improvement management system, and was acting chief executive officer of CHEO for a period in 2018. His leadership of operational transformations at CHEO helped earn recognition for the hospital in numerous forums as achieving one of Canada’s top corporate cultures.

Prior to joining CHEO, Squires spent more than seven years as vice president, corporate affairs of the Canadian Medical Association. He was also chief executive officer of the Newfoundland & Labrador Medical Association. Bruce is also active on a number of provincial and national organizations, including as Chair of Children’s Healthcare Canada.

“Mr. Squires’ record of accomplishment leading change within the healthcare sector will make him a strong addition to Hamilton Health Sciences and McMaster Children’s Hospital,” says Dr. Wes Stephen, executive vice president, clinical operations and chief operating officer at HHS.

With Squires’ arrival, HHS and MCH recognizes more than a decade of contributions by out-going MCH president and HHS vice president Dr. Peter Fitzgerald, who has served MCH as a pediatric surgeon for more than 27 years and as the hospital’s president since 2008. Dr. Fitzgerald will continue to provide care for patients at MCH in the role of pediatric general surgeon following the transition of leadership in July.

“On behalf of Hamilton Health Sciences, I ask our local and broader community to join me in thanking Dr. Fitzgerald for his outstanding service to our organization, and in warmly welcoming Mr. Squires to Hamilton this summer.”




New program keeps staff safe and patients comfortable

Violence in the workplace is one of the top health and safety concerns facing Ontario’s healthcare sector today. At Hamilton Health Sciences, nine percent of injuries that are significant enough to require medical attention or time away from work relate to violent patient behaviours such as hitting, punching and verbal abuse.

“We have a moral obligation to our staff, physicians and volunteers to provide a safe work environment while, at the same time, providing the highest quality of care to our patients,” says Susan Fuciarelli, director of Health, Safety and Wellness. “In the past, we have used different strategies to communicate potential patient safety risks. Now we have a standard, more objective way to document and communicate it.”

Standard tools to address violent patient behaviours

HHS is implementing a program at all hospital sites this year to support staff and meet our requirement under the Occupational Health and Safety Act. The program is Behaviour Safety Risk Communication and Care Planning (BSR).

“Materials are encouraging open conversations about staying safe.”

The purpose of the program is to communicate standard approaches to planning care for the safety and comfort of staff, doctors and patients when a behaviour safety risk is identified. This helps reduce the risk of harm for everyone. It focuses on two important questions: “What do I need to know to keep the patient calm?” and “What do I need to know to keep myself and my colleagues safe?” It also standardizes screening tools and language across sites and uses visuals such as purple door signs, charting stickers, whiteboard magnets and patient wristbands to communicate risk.

Building on evidence

The program is based on evidence from literature, best practices from other hospitals and input from patients and families. A wide range of groups and specialties from across HHS contributed to the work.

“We built the program using evidence, and now we are also building our own evidence as we learn from one phase of the project to support the next,” says Elaine Principi, co-lead for the project.

Benefits for communication and care planning

The program was successfully implemented at Juravinski Hospital and Cancer Centre (JHCC) in 2018. Surveys with staff and doctors showed that since the program launched, their ability to identify patients who present a behaviour safety risk and plan for their care had improved. Over half of respondents said they felt less at risk from patients who displayed violent, aggressive or responsive behaviour and better supported by the hospital. They also described improved communication among their peers.

Jennifer Pringle, a registered nurse at JHCC agrees and says, the visuals help keep everyone’s safety top of mind. “BSR signs and other materials are encouraging staff, volunteers and families to have open conversations about staying safe.”

While the visuals have been a helpful tool, the BSR leadership team recognizes the potential stigma related to identifying patients with violent behaviours, particularly using a wristband. They continue to work with patients, families and staff around these concerns.

Working together to address stigma

“Keeping staff safe and minimizing patient stigma can be seen as competing priorities, but this program helps us address both,” says Elaine. “The care plan helps staff and physicians work together to keep the patient calm and comfortable. The stigma is really about our own judgement. Preventing stigma starts with our increased understanding of our patient and their needs.”

The program is currently being phased in at all HHS sites through training and consultation. The team is working with each unit to customize it to meet the needs of their patients and staff.


Strategy in Action story contest graphicThis story was selected as a winner in our Strategy in Action contest, which asks teams across Hamilton Health Sciences to share how they are putting our strategy into practice.

This initiative supports Enterprise Approach, one of four strategic directions identified in Hamilton Health Sciences’ Strategic Plan. Enterprise Approach is about leveraging our collective strengths to think and act as one hospital.