What you need to know about the “mystery virus” acute flaccid paralysis
An unexplained increase in cases of a rare “mystery virus” among children is causing concern across North America. Acute flaccid paralysis, also known as acute flaccid myelitis, is being compared to polio because it causes the loss of function in one or more limbs. Watch the video below to hear from Dr. Jeff Pernica, an infectious disease expert at Hamilton Health Sciences, on what we know about AFP, how to recognize it, and whether you should be concerned.
Acute flaccid paralysis (AFP) is a condition that affects the nervous system.
Side effects include children having difficulty moving their limbs, moving the muscles in their face and swallowing.
Our neurologists and infectious disease specialists are experienced in providing the care needed for this condition.
AFP is not a new condition, though it is rare.
There have been sporadic small outbreaks over the years, the last being in 2014.
Due to the rarity of the condition most parents don’t have to worry about it happening to their children.
To help prevent the condition make sure children are washing their hands and are up to date on all vaccinations.
Desk stretches to reduce pain and injury
What are desk stretches?
Why should you consider desk stretches? Making time for short breaks in your daily routine can reduce risk of injury. These “micro-breaks” should be taken before you start to feel pain, discomfort, or tiredness. That’s why it’s important to plan for them when you schedule your day.
Desk stretches don’t take much time. Other productive micro-breaks could be a quick walk up and down the stairs, or a walking meeting. These activities give your eyes and muscles a chance to recover if you spend a lot of your time at a computer. They improve blood flow, relieve tension, and reduce the risk of eye strain.
Learn more about stretching and moving more in your workday by watching this video with Janice Jaskolka, an ergonomist in Health, Safety, and Wellness at Hamilton Health Sciences.
A visual reminder in your workspace can help you remember to make time for short exercise breaks. The infographic below provides basic instructions for the stretches highlighted in the video, plus a few others. Click the poster to download a copy so you can keep it handy in your workspace.
Natural breaks from repetitive activities
Many of us need to perform repetitive tasks as part of our job. This could be typing for long periods of time, stocking products, or many other activities. There are a variety of ways to give your body a break from this repetition, in addition to desk exercises.
Micropauses are brief breaks to look away from your computer monitor, or pause what you’re doing and relax your arms at your sides.
A break from repetitive work might arise when you need to take a phone call, or when a coworker stops by for a discussion.
Deliberate changes in tasks can give you a break. Alternate between tasks that require different movements.
Formal breaks are important. During your coffee and lunch breaks, take time to relax and move around.
Rethinking your workspace
The way your workspace is organized can also have an effect on your body. Reorganizing items at your workstation can help to create a comfortable work space. A good way to start is to think about the items around you in terms of how frequently you use them in a work day.
As Ava got older, it became clear to her parents that she had lots of ideas she wanted to express, but no way of getting those ideas across. Her difficulties communicating caused a lot of frustration for both she and her parents. When they met with their team at Ron Joyce Children’s Health Centre (RJCHC), they learned there were tools she could use to express herself, even though she couldn’t speak clearly.
The Design Centre
The Design Centre has produced thousands of communication tools for children and adults in our area. This unique service combines clinical expertise with design talent to create items that help people learn and express themselves.
Deborah Barr, communicative disorders assistant, has been doing this work for 24 years. Over the course of her career, she has produced countless customized projects, and numerous copies of her most popular designs.
How it works:
A clinical staff member, such as a speech language pathologist, meets with a patient or family member to talk about their communication needs.
Together, they decide what types of aids might benefit them.
The clinician brings those ideas to Deborah in the Design Centre to see how they can be created.
Deborah identifies existing aids that can be produced for the patient, and/or designs new customized aids to meet the patient’s needs.
Certain aids are customized with photos and items from the patient’s life, such as family members or favourite foods.
The designs are printed, laminated, cut, and finished with binding or velcro, as needed.
The materials are shared with the family so they can learn how to use them.
The Design Centre produces a wide variety of visual materials including:
The Design Centre works with staff at Hamilton Health Sciences’ RJCHC, and with a variety of community organizations to supply visual materials for people who need them.
How to use an EpiPen
What is an EpiPen?
An EpiPen is an auto-injector device carried by someone at risk of having a severe allergic reaction, also called anaphylaxis, to various allergens like food, insects, medication, latex and other causes. Once administered, it automatically injects epinephrine to decrease the body’s allergic reaction. The drug works to relax the airways to help a person breathe easier, and works to reverse the dangerous decrease in blood pressure that can happen during an allergic reaction.
EpiPens are easy to use and can save a life. Four per cent of Canadians are estimated to have a food allergy. Once someone has had a severe reaction, they are at a higher risk of experiencing another. The risk is also higher for those with asthma. That’s why it’s important for those with allergies (and their caregivers) to always carry an EpiPen, in addition to having them stored in the places they frequent most: at home, work, cottage, school, camp, daycare, etc.
VIDEO: How an Epipen works
There are just two steps to using an EpiPen. Learn how to use one properly with Kirk Wong, a pharmacist at Hamilton General Hospital’s Hamilton General Drugstore.
To use an EpiPen on yourself…
Hold the pen in a fist with the blue end facing up to the sky.
Pull of the blue cap.
If the window on the side of the pen is clear, it’s ready to use.
Swing your hand back and push the pen into your thigh.
When you hear a click, hold the pen for five seconds.
On someone else…
Have them sit down and kneel beside them.
Complete steps 1-5 from the above list, pushing the pen into their thigh.
Once the EpiPen is injected into the thigh and you hear the click sound, hold it in for several seconds. An EpiPen can be used through clothing, even jeans. Once it is pulled out, the orange cover automatically extends to ensure the needle is not exposed. After using an EpiPen, always call 9-1-1 or go directly to your closest emergency department.
When should you use it?
Use an EpiPen at the first sign of a severe allergic reaction. Don’t hesitate. Reactions can happen within minutes or hours after exposure. It’s important to know the symptoms to look out for like swelling of the throat, difficulty breathing, skin redness, and fainting – every second counts.
Do you have to go to the hospital after?
Yes, using an EpiPen does not replace going to the hospital. You could have a second reaction or the effects of the medication could wear off. You’ll need to find out if additional medication is required.
Make sure you have another EpiPen with you when you leave the hospital. You’ll want to stay close by for the next 48 hours in case of another emergency.
Children and EpiPens
Those prescribed an EpiPen should carry it with them at all times. If your child has one, ensure their teacher and school have extras and are aware of how to use it. If kids are old enough, they can carry a convenient waste pack so it’s always on their body in case of an emergency.
Remember, EpiPens do expire so know the date and set a reminder when it’s time to get a new one (the expiry date refers to the end of the month).
Storing your EpiPen
Keep your EpiPen at room temperature, not in the fridge, and away from light. EpiPens can only be exposed to temperatures between 15 and 30 degrees. Remember not to leave your EpiPen in the car during hot or cold weather.
To be sure your EpiPen has been stored safety, check the solution in the viewing window and replace it if it’s discoloured or cloudy.
We’ve waited a long time for sunshine. But now that it’s here, how can we enjoy it safely?
There’s no such thing as a healthy tan. Stay sun safe this summer with these quick sun protection tips from skin cancer specialist, Dr. Elaine McWhirter.
Video: Sun protection tips
Melanoma is one of the most preventable forms of cancer. When discovered early, it can also be very treatable. But wait too long and melanoma can spread to other parts of the body, growing into the deep layers of the skin and entering the lymph system. Once it spreads to other organs, it can be extremely difficult to treat.
Beyond your control
A fair complexion: If you don’t tan easily or have fair skin, you’re more susceptible to UVR (ultraviolet radiation) damage. So are people with naturally blond or red hair, or blue, green or hazel eyes. Although melanoma is somewhat rare among people with very dark skin, they’re not immune so it’s important to protect yourself.
Family history: People with a first-degree relative such as a parent, sibling or child with a history of melanoma may also have an increased risk of developing this disease. The more close relatives you have with melanoma, the higher your risk.
In your control
Sun exposure: People who spend lots of time in the sun are at increased risk of melanoma. Frequent sunburns — even if they occurred years ago — increase your risk. While you can’t change the past, you can reduce your risk moving forward.
Tanning equipment: Tanning equipment can emit stronger UVR than the sun. In fact, people who use tanning equipment have at least a 25 per cent increased risk of melanoma. The risk increases with younger age of first use, and greater frequency of use.
Moles: Reducing exposure to UVR, especially early in life, can help to reduce the chances of developing moles. Most moles aren’t cancerous. Those signaling skin cancer are typically larger, have irregular shapes and less uniform colour than most moles.
MyCancerIQ: Visit MyCancerIQ.ca. This Cancer Care Ontario website offers a personalized risk assessment and action plan with tips and resources based on your personal risk factors.
How to be sunsafe
• Apply broad spectrum sunscreen, minimum SPF 30, and re-apply every 3 hours; more frequently if swimming (every 90 minutes).
• Wear wide-brimmed hats and sunglasses with UVA/UVB protection.
• A cotton T-shirt only has an SPF of about 3; so consider SPF clothing and swim-shirts.
• Cloud cover isn’t protective – the UV rays can penetrate through
• Shade alone isn’t sufficiently protective – especially with reflective surfaces such as water, sand and concrete nearby.
• Snow reflects UV rays so you’ll need sunscreen for your face in winter.
• The high UV index days are from April to October, from 10 am to 4 pm. If possible, plan outdoor activities around these hours. Otherwise, remember to use the tips above!
Learn how to do a skin check with Dr. Elaine McWhirter to check your body for moles that exhibit warning signs of skin cancer.
Drowning is a leading cause of injury-related death for Canadian children, and it often happens quickly and silently. Almost half of all child drownings occur in backyard swimming pools.
It’s important to enjoy swimming safely. Here are some backyard pool safety tips with our Dr. Karen Bailey, pediatric surgeon.
Make sure your backyard pool is a feature to enjoy, not a dangerous hazard for your family and friends.
All pools must be fully fenced with a self-closing, self-latching gate.
Young kids and weak swimmers should wear life jackets or personal flotation devices in and around the water.
Ensure there is adult supervision around the pool, even if the children can swim.
Have some safety equipment accessible including a reaching pole or ring buoy.
Always have a first aid kit handy.
Have a phone nearby to call 9-1-1 in case of an emergency.
Consider a safety net or removable mesh fence for added protection when the pool is not in use.
Enroll kids in swimming classes when they become of age.
Don’t leave toys laying around the pool that could entice kids to the edge.
Don’t let kids dive in until parents have checked how deep the waters are.
Life jackets and personal flotation devices
It is highly recommended for everyone to wear a life jacket when boating, or doing water activities in open water as nine out of 10 people who drown in boating accidents are not wearing life jackets.
Young kids and weak swimmers should wear a life jacket or personal flotation device when near or swimming in water, including pools and at the beach.
When a child wears a life jacket in the water it not only keeps them floating but can turn them from face-down to face-up. This is can help keep your child safe if they fall into the water.
A personal flotation device also keeps your child floating, however, it doesn’t turn them if they’re face-down. Please remember that water wings and blow-up toys are not considered personal flotation devices. They aren’t approved and therefore will not necessarily keep your child floating. Puddle jumpers are a popular swimming aid, however they’re also not approved so are best to be used under careful supervision.
If your child wears a life jacket, it’s important to ensure it fits properly. Here are some fitting tips with our Dr. Karen Bailey, pediatric surgeon.
Life jacket fitting tips:
Ensure you have the correct size.
Adult sizes are based on chest measurement and weight.
Child sizes are based on weight.
Check the label to make sure it’s been approved.
Check the life jacket for damage and ensure the zipper still works.
The fit should be snug so that it doesn’t ride up over your ears.
Life jackets for kids should have the following features:
A large collar
An adjustable waist strap
A strap that buckles between the legs
Bright colours and reflective tape
Each year test the life jacket not only to ensure it still fits, but to ensure it’s still effective
What to do if you suspect a child is drowning
Children can drown in as little as one inch of water. If you suspect someone is drowning (if they have stopped breathing or have trouble breathing), call 9-1-1 immediately and follow these steps.
Take the child out of the water and place them on their back with their head tilted slightly back to open the airway. Check if the child is breathing by placing your ear near their mouth and nose. Remember, gasping for air is not considered breathing. If they are not breathing, start CPR as soon as possible. Every parent should be very familiar with how to perform CPR.
Family member creates portable tracheotomy kit
It was a healthy pregnancy with no signs of trouble.
Then, a premature birth followed by a visit to McMaster Children’s Hospital (MCH) where a Paris, Ontario, family learned their daughter, Mara, had an absent pulmonary valve. This is a rare anomaly of the heart where blood does not flow efficiently, causing low amounts of oxygen.
It was a shocking experience for Mara’s father, Christian, in what should be one of the most joyful periods in a parent’s lifetime.
The experience, though, ultimately led to an important and innovative opportunity for hospital staff to use themselves and improve patient safety.
“I remember being in the room and first hearing her diagnosis,” says Christian. “My jaw hit the floor when I first saw diagrams comparing her heart to a healthy one. I didn’t know if I was going to make it.”
After their daughter underwent cardiac surgery, the family spent more time at MCH where they later discovered the child needed a tracheotomy—a surgical procedure that makes an incision in a person’s neck to clear the airway.
Shortly after Mara got the tracheotomy, she was ready to be discharged.
When a family is ready to leave the hospital, they visit with hospital staff to review some routine procedures to care for the patient at home.
Christian needed to learn how to manage Mara’s tracheotomy, including how to troubleshoot any problems with the ventilator. If it ever became inoperative, he needed to figure out how to fix it in the moment.
During the training he and his family received, the team went through a few hypothetical scenarios.
Christian pointed out one scenario where he would need instant access to all the tools to perform a safe operation. It was at this moment he came up with the idea to create an emergency “tackle box” kit that is easily retrievable.
“I started thinking, rather than spending time looking for different tools I need, I should have some sort of kit that’s ready to go with everything I need inside it,” says Christian. “Nothing would make my anxiety increase more than having to look for all this equipment while Mara is suffering.”
The process-driven father of two took his creation to Cindy Brennan, a respiratory care coordinator at MCH, who embraced it immediately.
“Christian’s kit changed the way we set up our rooms for tracheotomy patients,” says Cindy. “Families are the experts in their child’s care. It’s important to hear their perspectives and allow them to bring new ideas to us.”
The result delivered an improvement opportunity as part of the Continuous Quality Improvement (CQI) initiative, a new management system at HHS that enables staff to solve problems at the unit level. Many improvements aim to improve the patient experience or offer savings of time and resources.
It also showed how patients and families are involved in improving the way we provide care.
“There’s always been a commitment from staff to hear everyone out to make things better.”
Giving life to our patients
At Hamilton Health Sciences, we use more than 27,000 units of blood each year to care for patients and save lives.
Lives like 9-year old Angelica, who needs a blood transfusion every two weeks to treat her condition, Thalassemia. It’s an inherited blood disorder that causes her red blood cells to function improperly and die. Because Angelica has fewer healthy cells traveling throughout her bloodstream, she needs transfusions of donated blood to survive. She has been getting blood transfusions since she was in her mother’s womb.
“Angelica is considered a high user patient since her condition will require life long blood transfusions,” says Jennifer Wolfenden, one of Angelica’s nurses at McMaster Children’s Hospital. “She cannot live without them.”
Despite this, Angelica is outgoing and active. So much so that people are surprised to learn she has a medical condition. On top of it all, she keeps a positive outlook on her regular hospital visits, understanding the importance of her blood transfusions.
As Angelica puts it, “I need blood to live.”
Angelica is just one example of the crucial role of blood donations for our patients. While the care we provide improves and saves patients’ lives, we can’t do it without blood donors.
About donating blood
Donating blood can save a life – for cancer patients, trauma patients, transplant recipients, and others. Half of all Canadians will either need blood themselves or know someone who does. Learn about eligibility to donate and what to expect throughout the process through Canadian Blood Services.
React “FAST” to the signs of stroke
Strokes can happen to anyone, at any age. In Canada, someone has a stroke every nine minutes. A stroke occurs suddenly and, often, without warning.
A stroke happens when there’s a problem with the blood supply to the brain. There are two types of stroke: ischemic and hemorrhagic. An ischemic stroke is caused by the blockage of blood flow to an artery in the brain. A hemorrhagic stroke is caused by the bursting of a blood vessel in the brain. Brain cells can be damaged or die. This damage can have different effects depending on where it happens in the brain.
Stroke signs to look out for
If you think you or someone around you is having a stroke, it’s important to act quickly to improve the chances of recovery. The “FAST” acronym is an easy and memorable way to remember the major signs of stroke.
FAST stands for:
F – FACE – Is it drooping?
A – ARMS – Can you raise them?
S – SPEECH – Is it slurred or jumbled?
T- TIME – Time to call 9-1-1 right away
VIDEO: Dr. James Sahlas, stroke neurologist at Hamilton Health Sciences, demonstrate the “FAST” signs.
Seek medical attention immediately
Stroke is treatable. Even if stroke symptoms are temporary, it’s crucial to take action and seek immediate medical attention. You may have experienced a temporary blockage of blood flow to the brain called a “transient ischemic attack” (TIA). A TIA is a serious warning sign that a stroke may occur. If you have experienced a TIA, you should be referred to an outpatient stroke prevention clinic for early assessment, education and follow-up in order to prevent a stroke or another TIA.
Recognize the signs of stroke and act quickly by calling 9-1-1. “Time is Brain”: the sooner a stroke can be treated, the better the chances for a good recovery!
In 2015 Sonja Baker’s family grew from three to five when she gave birth to twin girls. Even as newborns the twins, August and Violet, had very different personalities, but both were outgoing, happy little girls.
“Of course all three of our girls have their own unique personalities, but it’s amazing how much you see the differences with the twins,” says Sonja.
But, when the twins approached age two, Sonja became concerned about some of the differences between them. Violet was cooperative, easy going and learning quickly, while August started to become less vocal and have more temper tantrums.
“When you have two that are going in opposite directions,” says Sonja. “It can be challenging to figure out how to get both to respond positively. I was starting to feel like I needed some help.”
“As healthcare professionals, can we influence kids towards a more positive path in development to set them up for success as early as we can.”
That’s when Sonja learned about a research study in Hamilton called “Making the Race Fair”. The study is exploring whether a program called the Family Check-Up can help decrease challenging behaviours and emotions in young children. The Family Check-Up program has proven to be successful in the United States, and this is the first time it’s being tested in Canada.
“Sometimes challenging behaviours can lead to greater problems as children get older,” says Dr. Terry Bennett, child psychiatrist at Hamilton Health Sciences and lead investigator of the study. “The idea of ‘Making the Race Fair’ comes from the concept that, as healthcare professionals, can we influence kids towards a more positive path in development to set them up for success as early as we can.”
Dr. Terry Bennett and her team at the Offord Centre for Child Studies of McMaster Children’s Hospital and McMaster University, have set out to enroll 280 families like Sonja’s who have kids between the age of two and four and are struggling “beyond the terrible two’s”. The Family Check-Up program works with parents on setting family goals and developing the path to achieve them. The study team follows up with families at 6 and 12 months to gauge their progress.
“Ultimately, we hope to follow the participants longer to see if early intervention benefits the kids well into their school age years,” says Dr. Bennett. “We know that early parenting practices influence kids’ ability to learn emotional self-regulation. If we’ve been able to assist in this area by the time they’re entering kindergarten, it should have spillover effects as they progress in to their youth.”
Any parent will agree that some days are more challenging than others. Dr. Bennett and her team hope that their work will help those kids who struggle more than others to be able to flourish just the same.
“Even if I have to guide my girls differently, I want to ensure they have the same opportunities in life,” says Sonja. “I want to see them grow up together as equals, as best friends.”
Research at Hamilton Health Sciences is conducted in partnership with McMaster University.
Amputee dad walks daughter down the aisle
After his leg was amputated, Rainer’s dream of walking his daughter down the aisle on her wedding day seemed almost impossible.
With only a few weeks to transition from his wheelchair to walking, Rainer worked tirelessly with Dr. Sharon Grad and the rehab team to make his dream a reality.
Rainer: Well, I have Type 2 Diabetes, I’ve had it since around, I think I was 40 or 41 years of age, so it’s almost 20 years.
Dr. Grad: There are certain circumstances that predispose people to have limb amputation and the one is Diabetes and Rainer is, indeed, diabetic.
Rainer: It happened real quick, August 28th I was admitted and I was told life or limb.
Dr. Grad: It’s difficult for everybody and it’s different for everybody. His amputation surgery was done in September, beginning of September 2017. I met him beginning of April 2018. He had been sitting in a wheelchair of that period time and he was, when I first met him, his affect flat, his mood low, he was very, very depressed because he was not where he wanted to be at this time.
Rainer: Well, Laura, she’s a great kid, man. I mean, I still call her a kid, I mean, she’s a grown woman, but I love her to death, I tell you. I think it was Dr. Grad asked me, “What are your goals?” And, the first thing that came out of me was, “My goal is to walk my daughter down the aisle.”
Dr. Grad: So, it’s really important to find what their goals are, and to see if those goals are realistic. So, when you can find the motivating factor for that individual that’s gonna help them on that road to healing, that is a gold ticket. You need to really capitalize on that and really try to grant that goal because if you can, that individual’s gonna be motivated. And, a motivated patient does well.
Rainer: Well, up until two weeks ago, I didn’t think it possible because I thought I was doomed to my wheelchair at that point.
Dr. Grad: Because, we wanted to reach this goal and we had literally weeks to do it, we got him casted the day after I met him. We then worked on a prosthesis for him that would fit. Within a week, we had him admitted to the program, so we cast in one working week, the prosthesis is ready and rearing to go, and they’re standing in parallel bars.
Rainer: They’ve done very, very well. Dr. Grad I think is amazing and Debbie in rehab.
Dr. Grad: He’s an inspirational story for all of us. I’ve been doing prosthetics for over 20 years, so stories like Rainer’s aren’t common and you kind of hold onto those things that give hope, right? So, we always try to create hope for our patients and this was his hope. So, he has truly been inspirational and he has really grasped at everything we’ve given him, he’s taken every opportunity, he’s worked to better himself in every way, so it’s really makes the team feel good about themselves and about him. Because, remember, he is a team member and he’s the most important team member we have.
Rainer: They’ll never, ever, ever know how much it means, you know. Because, it means the world to me. To me, and I think my daughter, too.
Helmet safety for kids
Did you know that head injuries are the leading cause of serious injury and death to children, particularly those not wearing helmets?
Knowing how to properly wear a helmet and which type of helmet to use when participating in sports and activities is very important to prevent brain injuries. 85% of brain injuries can be prevented if a helmet is fitted and worn properly. Parents play an important role in modelling proper helmet use and in helping their children play responsibly.
How do you know if your child’s helmet is fitted properly? Watch this video with Dr. Karen Bailey, pediatric trauma surgeon at McMaster Children’s Hospital.
Our McMaster Children’s Hospital is a partner in the Hamilton Helmet Initiative, a group of community organizations committed to increasing helmet use and skill development to reduce brain injuries in children. For more information, tips or to order a low cost helmet visit McMasterChildrensHospital.ca/HHI.
Additional helmet safety tips
Take care of your helmet to ensure it provides the best protection.
Store your helmet in a cool, dry place. Too much heat or cold can cause damage.
Before use, inspect your helmet for cracks, dents, cuts, separation between the liner and shell or any other damage.
Replace your helmet if it’s damaged or more than five years old.
Many common cleaners and sticker can damage your helmet shell and weaken the helmet.
Clean your helmets with soft cloth or sponge and a solution of mild soap and warm water.