The power of imaginationand how Mckenna Lumley has coped with two big health challenges

On the Cover Mckenna Lumley enjoys a day playing with her Lego collection. From fairies to ice cream mountains, Mckenna’s vibrant imagination has helped her in coping with two health challenges. Read more on page 12.

The power of imaginationand how Mckenna Lumley hascoped with two big health challenges

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Table of Contents

Patient Experiences

Did You Know?

At Issue

Research & Innovation

You Asked Us

LHSC is the home of:• CSTAR (Canadian Surgical Technologies and

Advanced Robotics)

• Fowler Kennedy Sport Medicine Clinic

• London Regional Cancer Program

• Children’s Health Research Institute

• Lawson Health Research Institute

• Children’s Health Foundation

• London Health Sciences Foundation

Who We AreOne of Canada’s largest acute care teaching hospitals, London Health Sciences Centre (LHSC) cares for the most critically ill patients in the region. Located in London, Ontario, Canada, LHSC encompasses:

• University Hospital

• Victoria Hospital

• Children’s Hospital

• Byron Family Medical Centre

• Victoria Family Medical Centre

• Kidney Care Centre (at Westmount Shopping Centre)

LHSCinsideSpring 2016

03 Mindy Williamson speaks out

Mindy Williamson coped with uterine fibroids for more than 20 years until robotic surgery offered her a minimally invasive option and a shortened recovery time.

06 “I got my life back”

Severe hip arthritis left Brenda Devries immobilized in her mid-40s. Read about how her life changed after two total hip replacement surgeries allowed her to regain full function.

12 The power of imagination

Mckenna Lumley is a bright and imaginative girl who has dealt with two major health obstacles in her young life: a brain tumour at age four and a scoliosis diagnosis at age eight.

15 Solving the mystery

LHSC is the regional centre for forensic pathology in southwestern Ontario. From autopsies to criminal trials, learn how pathologists and their teams help the coroner and the police to solve criminally suspicious cases.

08 Going digital: how electronic patient records are improving care

Electronic patient records hold many benefits for patients. Learn which information systems LHSC has put in place to improve care.

14 Probiotics give new hope to premature babies

The neonatal intensive care unit at Children’s Hospital is using probiotics to combat the devastating effects of necrotizing enterocolitis in premature babies.

16 Preventing falls in older adults

Falls among older adults can have a devastating impact on quality of life. Read about how you can prevent falls in home and the community for yourself or your loved one.

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London Health Sciences Centre800 Commissioners Road EastPO Box 5010, London, Ontario N6A 5W9Ph: 519-685-8500

PATIENT EXPERIENCES

W hen Mindy was pregnant with her son at the age of 27, an ultrasound revealed she had uterine fibroids, a common condition in women where non-cancerous tumors shrink

and grow according to levels of estrogen and progesterone in the body. While uterine fibroids affect a large number of women in different patient populations, they differ in severity.

“Oftentimes women are unaware that they have fibroids because they vary in size and symptoms,” explains Dr. Robert Di Cecco, Mindy’s obstetrician/gynecologist at London Health Sciences Centre (LHSC). “In the case of large fibroids, symptoms may include pain or pressure in the pelvis that can affect the bladder or rectum. They can occasionally be quite noticeable – in some women you can see a mass arising out of the pelvis.”

When Mindy still looked and felt like she was pregnant after giving birth, she knew something was wrong.

“The one fibroid was as large as a baby’s head and it felt funny,” she recalls. “After I had my son, it caused a lot of pain, and so much so that I’d be walking through the mall or going up Richmond Street and I’d be doubled over.”

While the pain was difficult to handle for a couple of days each month, she felt normal the rest of the time. The most definitive treatment for fibroids – a hysterectomy – proved too emotional a decision to make. When she would periodically seek medical attention, the treatment option did not fit her future plans.

When Mindy Williamson was first diagnosed with uterine fibroids more than 20 years ago, she had no idea what they were or the toll they would take on her life. Now a well-known personality in the local media industry, Mindy is using her voice to speak out about the dilemma she faced as a young mother with a promising career, while at the same time confronting a challenge that put both her health and livelihood at risk.

Mindy Williamson speaks out

Continued on next page

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What are uterine fibroids?Uterine fibroids are benign growths of smooth muscle within the uterus. Symptoms include abnormal and prolonged vaginal bleeding, pain in the pelvic region, pressure on the bladder and rectum, and pain during intercourse. A large number of women who have fibroids may not notice any symptoms at all. Fibroids can continue to grow until a woman stops producing their stimulus, estrogen and progesterone, usually around menopause.

Treatment options for uterine fibroidsWhile women may notice symptoms associated with fibroids at any age, women in their thirties and forties typically receive medical intervention. A hysterectomy is the most definitive way to treat fibroids. Depending on the size and location of the fibroid, some women may opt to have only the fibroids removed. Without a hysterectomy, there is potential for other fibroids to grow because hormones continue to trigger their growth. At LHSC, some women also have the option of uterine artery embolization, done by an interventional radiologist, which obstructs blood flow to the fibroid. This can reduce their size by killing the tissue.

A new medication, Fibristal, is now available in Canada which helps to shrink fibroids and manage symptoms. This is the first time that a medication has been available to shrink fibroids on a long-term basis.

Community supportDid you know LHSC was the first hospital in Canada to use surgical robotics (2003) and now offers the greatest breadth of robotic surgery in Canada? Did you also know that none of it could have happened without generous donor support through London Health Sciences Foundation (LHSF)?

Donors to LHSF played a critical role in funding the first three generations of surgical robots at LHSC – the single-arm AESOP, the three-armed ZEUS and the last-generation da Vinci surgical robot – and donors will continue to play an important role by funding LHSC’s next generation da Vinci Si HD surgical systems. Learn more at lhsf.ca

“I would have ultrasounds and they would say, ‘it’s growing, you can have the surgery,’ and I would say ‘well no, I haven’t decided whether I’m going to have a baby again so for now, I’ll just suck it up.’”

It wasn’t just the potential of a growing family that concerned her. The demands of being a working, single mom did not allow for her to take the time off needed for the recovery process with such an invasive surgery.

“Having the surgery would have meant probably a 12-week recovery, and that just wasn’t in the cards for me,” she explains. “I’m in the entertainment industry, and if I step out for three months and somebody takes my place, the security for a working woman was a concern for me.”

For Mindy, the fibroids became more intrusive throughout her thirties. Episodes of pain grew to a week or two each month. This meant problems with digestion and carrying on with everyday activities. While she tried to maintain an active lifestyle, the fibroids made social and work-related functions more complicated.

“I remember I went on this canoe trip with friends of ours, an Easter paddle we do every year. I left the house

hoping it would be okay, because I knew I was going to be hunched over in a canoe for the better part of five hours. And it was a really uncomfortable day,” she recalls.

It wasn’t until 2013 when Mindy was working as an instructor at Fanshawe College that she had had enough of the pain. As she showed a student’s family around the broadcast centre during an open house, she suddenly felt as though she had been stabbed in the pelvis.

“I actually looked down to see if I had walked into something and impaled myself because the pain just caught me off-guard,” she says.

Mindy went to the Emergency Department at LHSC’s Victoria Hospital and learned that in addition to the large fibroids, she had an ovarian cyst that had to be removed. She was referred to Dr. Di Cecco, who told her of an option that was previously unavailable for which she could be a potential candidate: robotic surgery.

Dr. Di Cecco explained to Mindy that her surgery could be facilitated using a robot that he would control at a surgeon’s console. By using a minimally invasive approach, a patient does not require a large abdominal incision, which cuts down on recovery time.

“With the potential of such a short recovery, patients are pretty excited,” says Dr. Di Cecco. “When they know that the alternative was potentially an abdominal incision, the fact that they are able to have this done is positive.”

The thought of robotic surgery didn’t frighten Mindy. She actually felt excited at the prospect.

“I knew it wasn’t going to be Rosie Robot from the Jetsons coming in and cutting me up and stuff,” she laughs. “I trusted Dr. Di Cecco, and he just seemed excited at the prospect of his patients recovering so quickly.”

Mindy Williamson teaches her radio broadcasting students at Fanshawe College.

Mindy’s obstetrician/gynecologist, Dr. Robert Di Cecco.

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“I think with the technologies and expertise we have available in London, more people ought to know about this.”

– Mindy Williamson

Though she was nervous before going into the operating room, Mindy credits the surgical team with making her feel relaxed. Her surgery took longer than expected due to the difficulty of removing such large fibroids. An hour after the surgery, Mindy was awake.

“You know how when you go to the gym for the first time in a long time, and you do way more ab crunches than you should? That was kind of what it felt like afterwards. But I went home the next morning.”

Within two days, she was working from her home business, and was able to return to her job at Fanshawe a week later. She was able to go to the gym again and see results. The pain that she had put up with for more than 20 years had vanished.

Speaking out about personal health experiences can be an emotional and overwhelming process. Mindy believes that sharing her story can help to break the silence and the stigma surrounding women’s health issues.

“I think a lot of women suffer in quiet because that’s traditionally been what we do,” she says. “I’m a girl with a big mouth in this city. When I talk I find that people sometimes listen to me. I think with the technologies and expertise we have available in London, more people ought to know about this and how great your life can be. If you have a gift, you should use it to give back to things that have been important to you. It’s part of what goes with having a voice.”

“Utilizing the robot for certain conditions gives us another option for fibroid management. With the potential of such a short recovery, patients are pretty excited.”

– Dr. Robert Di Cecco

Visit us at inside.lhsc.on.ca

ONLINE EXCLUSIVE

Jennifer Van Bussel talks about physiotherapy for hip replacement patients.

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total hip replacement. As an inpatient procedure, Brenda was told she could return home the day after her surgery.

Jennifer Van Bussel is a physiotherapist who provides education and treatment to patients both pre- and post-operatively.

“When we see patients prior to surgery we go through a comprehensive assessment with them and provide them with any exercise that we may see fit to help them prepare for surgery, says Jennifer. “Exercising post-operatively is essential. The surgery itself is only part of the solution to regaining full function.”

Surgery on her right hip provided immediate relief. Brenda felt normal in three months’ time after sticking to a strict physiotherapy regimen.

In the months that followed, Brenda noticed that her left hip was becoming increasingly problematic. To her dismay, she was experiencing the same disruptions to her life all over again. She knew another surgery was likely ahead.

“Nothing really gave me relief. We have a hot tub, but even trying to get in was like a circus act!” she laughs. “You can take pain pills, but even when they work you always have pain in the back of your mind. I’d see people and put on a plastic smile and say, ‘Oh, I’m doing great!’ But really I wasn’t.”

Brenda didn’t feel nervous going into her second surgery – she felt that it couldn’t come soon enough. “I was so looking forward to not having pain,” she says. “I literally couldn’t function.”

Brenda’s surgeon performed her second hip replacement in 2015 using the same type of treatment plan as her right side. By this time, the approach had proven so effective that Brenda’s surgery was scheduled as an outpatient procedure, meaning she would return to the comfort of her home the same day as her surgery.

Many factors need to be taken into consideration to determine whether a patient is a candidate for an outpatient procedure. This involves an entire culture of everyone who is involved with the patient.

“The patient should have a supportive family and live relatively close to the hospital,” says Dr. Howard. “It is not simply the surgical steps in the operating room. It’s also about having physiotherapy intervene early, having the nurses know we’re trying to support getting the patient to their home environment the day of the surgery, and providing the education for the patient throughout the process so they know what to expect after their surgery.”

While the recovery time was longer for her left hip, Brenda was determined to resume a normal life.

“After the second surgery I went back to LHSC for physiotherapy for three weeks. I did the exercises they told me to do all the time, because I knew that doing them was going to help me. Each time I went back they gave me more to do. By the third appointment, they said I was in good shape and didn’t need to return.”

Keeping a positive outlook on the whole experience has been vital for her to grow personally and as a mother. It is a testament to her optimism that Brenda remembers that time in her life with fondness, despite how difficult it was.

“When you go through things in life, you figure out who you are and where your faith lies,” she says. “I have precious memories of my family doting on me. You really see people’s true colours when you’re in pain and how they help you. It’s kind of a bittersweet thing.”

“In the end, it was totally a relief for my family,” she adds. “They got mom back.”

Sitting in her bright country home on a sunny weekday morning, Brenda Devries, 46, seems content and at peace with the hustle and bustle of her busy household.

With a passion for working in her garden and going on hikes and bike rides, Brenda is an active mother of four. It is difficult to imagine that it was less than a year ago that Brenda was unable to do any of the things she loved due to immobilizing pain in her hip.

“I was not the mom I wanted to be, and I was not the person I wanted to be,” she says solemnly. “I went from being a fully functioning, hands-on mom to not being able to live a normal life. It was just impossible to function.”

It began with discomfort in her right knee. Brenda attributed the pain to working outside. Little did she know at the time that the pain was destined to take a leading role in her life.

“For people ultimately requiring a hip replacement, pain often begins in and about the hip, but could also radiate down towards the knee,” says Dr. James Howard, an orthopaedic surgeon at London Health Sciences Centre (LHSC). “Early on there is intermittent pain, perhaps after

activity, and as time goes on it progresses and can become constant.”

Brenda’s daily routine took longer and was more painful than she could handle. Even the task of walking up and down the stairs left her feeling exhausted.

“I would drag myself up using the railing. Whenever I would go downstairs I would bring a list with me so that I wouldn’t forget to do anything. But sometimes I would just stay in the basement because even going down the stairs was too much.”

As her discomfort became more intrusive and frequent, visiting a physiotherapist offered only temporary relief.

“I remember they would take my leg and stretch it out straight, and it would take the pressure off,” she recalls. “It was immense relief. I said, ‘wow, that feels great! Can you do that all day?’”

Using a cane and a walker around her house, Brenda attempted to modify her daily routine. Without the ability to get into her car, or to sleep comfortably at night, the pain was completely debilitating. But perhaps most disheartening was that Brenda felt that the important role she was meant to play was out of grasp.

“You feel bad as a mom thinking you’re not able to do things for your family. You just want to be able to do what you’re called to do and live the life you’re called to live.”

Brenda went to her family doctor for X-rays of her right hip. When the X-rays showed that she would likely need total hip replacement surgery, she was referred to LHSC in 2013.

At LHSC, Brenda learned that she was a candidate for a new approach to delivering care for patients with severe hip arthritis. At the time, LHSC’s orthopaedic team was working towards shortening the length of stay for patients requiring a

“I got my life back”How two total hip replacement surgeries helped a wife and mother regain control over her life and get back to what’s important

“I went from being a fully functioning, hands-on mom to not being able to live a normal life.”

– Brenda Devries

“Exercising post-operatively is essential. The surgery itself is only part of the solution to regaining full function.”

– Jennifer Van Bussel, Physiotherapist

PATIENT EXPERIENCES

Brenda Devries and her husband Gerrie enjoy a walk with their kids, Stacey and Justin, and the family’s dog Gizmo.

Continued on next page

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AT ISSUE

Going digital: How electronic patient records are improving care A patient with a long history of illness arrives at an Emergency Department. As health-care workers assess her condition, they learn that both her home and family doctor are several hours away. Large folders of her patient history comprising allergies, medications, past lab results, and various test results need to be sifted through. To make matters more complex, her records are stored at several care facilities across the region in different physicians’ offices, pharmacies, and other hospitals. To deliver the best possible care for the patient, doctors need to have parts of her record faxed over from different facilities. Chances are her record contains gaps in information.

With the significant volume of paper-based records that fill Ontario’s hospitals and care facilities, this is not an uncommon

scenario. Across the province, hospitals face scattered information points, redundancies in testing, and difficulties in coordinating information about patient allergies. Hospitals are addressing these problems by implementing a number of information systems that are contributing to the development of a more complete electronic health record.

London Health Sciences Centre (LHSC) has made strides towards implementing electronic systems that make aspects of the patient medical record digital. Why are these electronic systems valuable for anyone who comes to the hospital? How does technology allow for more informed health-care decisions? We explore three electronic systems that LHSC has implemented and the benefits and future opportunities they create.

Electronic medication ordering provides peace of mind for a patient and her family

It is an unfortunate reality that medication errors can happen in hospitals. This is an experience that Sharon Tambeau of Ingersoll, Ontario knows all too well.

“I’ve been coping with kidney problems for about 25 years,” she shares. “In that time I’ve had nine or 10 medication errors in hospitals. Wrong medication, wrong dose. It hasn’t happened recently, but it seemed that sometimes my medications weren’t being timed properly.”

As families of patients know, having a loved one experience any illness or treatment is a stressful process without having to worry about incorrect medications being administered. Sharon’s husband Paul has learned to manage her three or four hospital admissions every year. He’s also supported her through times where her care was not properly coordinated due to a lack of real-time medication history.

When Sharon learned that a system was coming to the region that was aimed at improving the coordination and administration of medications in the hospital, she admits that she was a bit hesitant to get on board.

“They told me I’d have this barcode on a bracelet that the nurse would scan. I thought, ‘How is this going to work?’ I didn’t understand how the checks and

balances would line up so they could be sure I was getting the right medication.”

When the electronic medication ordering system was implemented, Sharon was in the hospital in Ingersoll and London frequently for kidney infections. She also had spinal surgery at University Hospital. This gave her a first-hand look at how the system was working in both facilities, and exemplified the importance of regional hospitals being connected to the same system.

The system allows for Sharon’s medications to arrive a lot quicker when she’s in the hospital. When her doctor had to write out paper orders, it would take up to two hours for the order to be processed and for her medication to arrive.

“By the time I’m in the hospital, I’m in a lot of pain,” she says. “Kidney infections just pollute your entire body. Now, I’m getting that medication within 20 minutes to half an hour. That’s a huge change. My antibiotics get on board right away and I can start to heal faster.”

While Sharon knows that she will continue to cope with hospital visits, she and her family have some peace of mind with this aspect of her care. Sharon’s health-care journey reveals the reason that electronic systems can make a world of difference for patients.

“Before, I would have to be vigilant to check which medication they were giving me,” says Sharon. “I no longer have to do that. We’ve been able to let our guard down, kind of like relying on spellcheck on your computer.”

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ClinicalConnectTM: an Electronic Health Record viewerTHE PROBLEMA paper-based medical record contains a substantial amount of information over a patient’s lifetime, and may be stored in different care facilities. Health-care providers would have to sift through each available report and could still not be certain that the health record was complete.

As a result, patients would often undergo the same tests more than once. Patients would also wait for reports to be faxed from different care facilities in the region, or might spend a large amount of their clinic time waiting for test results and reports to be tracked down or interpreted.

THE SOLUTIONLHSC now utilizes clinical viewer called ClinicalConnect. Deployed by the connecting South West Ontario (cSWO) Program, the system enables over 37,000 doctors, nurses, therapists, and other health-care professionals across southwestern Ontario to securely access electronic patient information from the region’s 67 hospitals, four Community Care Access Centres (CCACs), four regional cancer programs and provincial clinical systems for laboratory tests and results, and diagnostic imaging.

For the first time, patient health information from across the continuum of care can be accessed in seconds from organizations using eHealth technology. The integrated electronic health record provides secure access to a comprehensive patient health record that includes allergies, medications, past lab results, radiology images, biopsy test results, and microbiology test results.

HOW DOES IT ALLOW FOR BETTER CARE FOR PATIENTS?Access to a more complete electronic medical record across the region means the elimination of redundant tests, the ability for patients to get tests done as close to home as possible, and for their clinic times to be spent discussing care plans rather than waiting for results.

Dr. Karin Hahn, a medical oncologist at LHSC’s London Regional Cancer Program, explains that the more that can be known about a patient’s tests and reports, the better support she has to make decisions about their care.

“In the past if a patient showed up in hospitals that weren’t connected on ClinicalConnect, that hospital would have no information on that patient’s story,” she says. “When was their last dose of chemotherapy? Where is their cancer? What could be explaining their symptoms? Having that information is crucial and it has improved care tremendously.”

Susan Rybanksy, a nurse clinician in paediatric endocrinology, has seen the impact that prompt access to medical information can have on patients in her care.

“Adults might find a blood test routine,” says Susan. “But children often have an emotional response to any test. So to be able to say to a child, ‘That’s alright, we have that result; no needles today!’ – you wouldn’t believe how happy they are and what a difference it makes.”

WHAT ARE THE NEXT STEPS?The cSWO Program, funded by eHealth Ontario, continues to work with clinicians and health-care providers to identify other electronic data that would enhance the patient information currently available through ClinicalConnect. To learn more, visit the cSWO Program page on eHealth Ontario’s website.

Nurses bring computer carts into patient rooms to scan medications into the electronic system.

OneView – Radiology imaging viewer THE PROBLEMPatients across southwestern Ontario rely on radiology specialists at LHSC, often travelling hours from home for treatment. Without a standardized medical image system, diagnostic images were stored at different facilities and had to be faxed to where the patient was receiving care. Often, patients or their family kept a collection of images on a CD, or physical copies of their film X-rays to bring to each appointment to ensure their specialist would have access to their most current images.

THE SOLUTIONOneView is a medical imaging viewer used by 70 hospital sites in southwestern Ontario as well as several independent health facilities. OneView is used by health-care providers to view radiology reports and images from across the region, such as hospital-based CT scans, ultrasounds, MRIs, mammograms and X-rays.

HOW DOES IT ALLOW FOR BETTER CARE FOR PATIENTS?Out-of-town patients can be saved the inconvenience of travelling a far distance to have diagnostic tests completed. Patients can visit a facility closer to home to have a test done, which can then be accessed by their physician at LHSC. Additionally, family physicians are able to call the patient’s specialist at LHSC if they have questions or concerns about the patient’s diagnostic images or reports. The system also takes pressure off of the patient to keep an up-to-date record of all their scans and results.

OneView has reduced redundant tests because patient images and reports are current and easily accessible. For patients undergoing radiation treatment, OneView prevents unnecessary exposure. This in turn reduces wait times for other patients awaiting tests and treatments.

Linda Heidenheim, a registered nurse at LHSC, says that using OneView allows patients to have some peace of mind at a critical time, and can expedite care decisions.

“If a patient comes in with a collapsed lung, for example, I can go into OneView and see images of when it started, how it was treated, and when it got better,” she explains. “I can see what’s going on before they even step into the clinic. This means their clinic time is focused on treatment rather than trying to figure out what the problem might be.”

WHAT ARE THE NEXT STEPS?Ontario’s four Local Health Integration Networks use a different diagnostic imaging viewer to access images and reports. In order to standardize the system across the province, eHealth Ontario is working to implement a common diagnostic imaging service. This will allow every Ontario hospital and community-based health-care provider to have access to the same diagnostic images and reports. For more information, visit the eHealth Ontario website.

Electronic medication order entryTHE PROBLEMIn a busy acute care hospital like LHSC, relying on handwritten prescriptions presents several challenges and inefficiencies, beginning with being difficult to read. They can take time to reach the pharmacy, and in turn, the patient.

Reliance on paper-based medication ordering can result in medication errors such as the wrong medication reaching a patient, too high or too low a dosage, or a lack of knowledge regarding a patient’s allergies.

THE SOLUTIONIn 2012, an electronic medication ordering system (HUGO) was implemented at LHSC and nine other participating hospitals in the region. Each patient now wears a barcode bracelet throughout the length of their hospital stay. Their physician enters medication orders into the computer, which is immediately received by the pharmacy and the resulting medication is blister-packed with a barcode on the front of the package. The patient’s nurse is able to scan the barcode on each patient’s bracelet, and then scan the blister pack. If the medication type and dosage match up with what the physician has ordered, the patient receives the medication and the event is logged into the patient’s medication history.

HOW DOES IT ALLOW FOR BETTER CARE FOR PATIENTS?With barcode scanning, the nurse is able to tell if the wrong medication has reached the patient. The system alerts the nurse if the patient has allergies to a medication, or potential drug interactions that could be harmful.

“We know from data that this has resulted in quite staggering decreases in medication errors,” says Dr. Robin Walker, Integrated Vice President of Medical Affairs and Medical Education. “Overall, errors are down by 30 per cent.”

Significantly, certain types of medication errors have been nearly eliminated at LHSC. “In some categories, particularly the category of wrong patient, wrong drug, we’ve now come close to eliminating that problem,” says Dr. Walker.

The health-care team is able to build a thorough medication history during a patient’s hospital stay that is logged into the system. Having such a record of how a patient has been treated allows for better decisions if care is needed in the future.

WHAT ARE THE NEXT STEPS?Several measures have been taken to optimize the system to improve usability across he 10 hospitals in the region that use the system. Plans to implement the system in more hospitals in the region are currently being discussed. Eventually, there is potential to move to a completely paperless clinical documentation system.

Electronic systems provide authorized care providers with instant, secured access to patient health information.

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“At first, she only kept it on for 10 minutes,” says Karen. “They only expected her to put it on for five minutes to try it. But when you’re the parent, at that moment you know your kid has to work up to wearing it for 20 hours every day. At first I was devastated. But it was amazing how fast she adapted to wearing it.”

Mckenna wears her brace during school and everyday activities, and also sleeps with it on. Mckenna has used the brace to convince kids at school that she has super human strength.

“One time a boy at school called me weak,” says Mckenna. “I knocked on my brace and said to him – ‘I’m not weak – I’m made of steel!’”

It appears that bracing has helped eliminate the need for at least one spinal surgery.

“The curve in the bottom of her spine has straightened out a bit,” says Karen. “It has progressed slightly on the top. We’re hoping that if surgery is needed in the future, there is the possibility that it will only be needed on the top of her spine.”

Sharing their story to empower othersThe family is grateful for the service they have received at Children’s Hospital.

“When Mckenna had her brain surgeries, we knew that Children’s Hospital was going to be a part of our lives for a

long time,” says Karen. “It isn’t a place where Mckenna is scared to go. Dr. Ranger and Dr. Carey must be so busy, but every time we’re there, they make us feel like we’re the only people they have to see.”

Mckenna is no stranger to accepting new challenges with positivity and humour. Perhaps what is most inspiring about Mckenna and her family is how, despite their difficulties, they count themselves lucky.

“We are fortunate. There are families who are far worse off,” says Karen. “We have a happy ending right now, and we have to use that strength to help the people who can’t talk about what they’re going through.”

Mckenna has been happy to share her advice with kids who frequently visit the hospital.

“I tell them that the hospital is filled with imaginary portals,” says Mckenna. “All you need to do is find your imaginary portal, go to your imaginary land when you’re afraid, and everything will be okay!”

In her most recent visit to Children’s Hospital, London Health Sciences Centre (LHSC), Mckenna imagined that she transported to a fantasy world.

As she entered the MRI machine, she envisioned an ice cream mountain made of giant scoops of flavours. “I took a bite out of it when I reached the top,” says Mckenna with a smile, demonstrating that she’s accustomed to keeping positive during trying times.

In January 2010, Mckenna began exhibiting flu-like symptoms. But her parents Karen and Brett weren’t convinced of the diagnosis of a seasonal flu. The symptoms were persistent for three weeks and no one else in the family was catching the illness. Pain in Mckenna’s neck was intensifying, and she was frequently dizzy.

Karen and Brett took Mckenna to their local hospital in Windsor for an MRI. When the phone rang later the same day, they knew it was serious.

“The doctor began asking me questions. I said, ‘Look, we were just in for an MRI and you’re already calling me. I need to know what’s wrong,’” Karen recalls. “She told me that Mckenna had a brain tumour and needed surgery immediately.”

Two life-saving proceduresThe same day, an ambulance was waiting at the Windsor hospital to transport Mckenna to Children’s Hospital, LHSC, which specializes in paediatric brain surgery. Dr. Adrianna Ranger, Mckenna’s neurosurgeon, explained it could not be confirmed if the tumour was aggressive until surgery was complete.

“It ended up being a pilocytic astrocytoma,” Mckenna declares, pronouncing the name of the tumour perfectly.

“Pilocytic astrocytoma is a benign tumour located at the back of the head in the cerebellum, occurring commonly in children under 20 years of age,” says Dr. Ranger. “They are often curable with surgery if located in an accessible part of the brain.”

Mckenna underwent 21 hours of surgery in two separate procedures to remove the full mass and remained in hospital for 34 days. Mckenna only remembers fragments of this time in her life. As Karen expresses the shock of what that time felt like as a parent, Mckenna provides comic relief for what was a very scary experience for the family.

“I remember the pizza, the ice cream... the chocolate milk!” she exclaims, referring to the food she had at the hospital after surgery.

Mckenna underwent physiotherapy and occupational therapy during her stay at Children’s Hospital to help her with fine and gross motor activities. Mckenna’s health-care team was pleased with her progress and was confident she had made a full recovery.

Mckenna returned to Children’s Hospital every three months for MRIs to monitor whether the tumour was growing back. Mckenna now only returns for follow up appointments on a yearly basis.

Over the next three years, Mckenna flourished with a passion for ballet dancing and the music of Taylor Swift. However, she began experiencing pain in her legs and feet in 2013, so Karen and Brett took her to their family physician who suspected Mckenna might have scoliosis.

She was referred to Dr. Timothy Carey, a paediatric orthopaedic surgeon in LHSC’s scoliosis clinic. The clinic

at LHSC sees children with spinal deformities from the entire southwestern Ontario region. When Dr. Carey showed the X-ray to Mckenna, Brett and Karen, they couldn’t believe their eyes.

“I kept repeating – ‘No, Mckenna Lumley’s X-ray. This is not Mckenna Lumley’s X-ray,’” says Karen. “Her spine was shaped like an ‘S’. We were shocked.”

Treatment for scoliosisDue to the 35 degree magnitude of the curve and Mckenna’s age, she would require a brace and regular X-rays to track progression of the curve.

“Mckenna is on the younger side of the patients we usually see with scoliosis,” says Dr. Carey. “The concern is the risk of curve progression increases when the onset is at an early age, due to the amount of spinal growth remaining.”

Bracing can be successful in stopping the progression of the curve while scoliosis patients go through growth spurts, preventing the need for surgery in the future. The thought of Mckenna wearing a brace for 20 hours each day was upsetting for the family. But when Mckenna saw that her brace was adorned with butterflies, she knew she could get used to wearing it.

“When Mckenna had her brain surgeries, we knew that Children’s Hospital was going to be a part of our lives for a long time. It isn’t a place where Mckenna is scared to go.”

– Karen Metcalfe

The power of imagination

“One time a boy at school called me weak. I knocked on my brace and said to him – ‘I’m not weak – I’m made of steel!’”

– Mckenna Lumley

12 13Mckenna with her parents, Brett and Karen, and her brother Blake.

Walmart Champion Child ProgramMckenna Lumley was chosen to nationally represent Children’s Health Foundation as the 2015-16 Champion Child, presented by Walmart. This Children’s Miracle Network (CMN) program supports the lifesaving work done annually at children’s hospitals across North America.

Mckenna embodies the bravery and resiliency exemplified by the 12 CMN champions across Canada who face difficult health-care challenges. A big thanks to Walmart for giving Mckenna the chance to share her story with the supporters who help to enhance care for the 400,000 kids who live in Children’s Hospital’s catchment area and may, at any time, rely on our paediatric health-care facility.

Donations to Children’s Health Foundation help bridge the gap between what government- supported health-care is able to fund and what is needed to help our paediatric patients recover with the best possible physical and psychological outcomes. Thank you to all of the donors who contribute to a culture of care that wraps itself around the lives of our kids.

Mckenna Lumley, 11, and her family have dealt with not one, but two health obstacles – a brain tumour at the age of four, and a scoliosis diagnosis at the age of eight.

Visit us at inside.lhsc.on.ca

ONLINE EXCLUSIVEMckenna sees Dr. Timothy Carey in LHSC’s specialized scoliosis clinic.

Learn more about how Dr. Carey and Sophie the giraffe care for patients.

PATIENT EXPERIENCES

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RESEARCH & INNOVATION

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ONLINE EXCLUSIVE

Dr. Mike Shkrum talks about forensic pathology at LHSC.

LHSC is the regional centre in southwestern Ontario for forensic pathologyIt is not uncommon for the practice of forensic pathology to conjure images inspired by popular television of the miracle-working detective who races against time to solve murders by finding damning DNA evidence and chase down criminals, all within a neat 60-minute timeframe (minus commercials).

Last year, nearly 500 coroners’ autopsies, including sudden natural deaths, accidents, homicides and suicides were completed at London Health Sciences Centre (LHSC). While television may sensationalize the practice, it does not make the work they do any less interesting.

Providing a vital community service to London and beyondFrom post-mortem examinations to criminal proceedings, forensic pathologists and their teams help play a pivotal role in determining how someone has died.

“Our work provides closure for families,” says Dr. Mike Shkrum, Forensic Pathologist and Division Leader for Autopsy Services. “It’s important for the coroner’s investigation and inquests, for the community at large, and public safety. If it’s a criminal matter, it’s important for legal proceedings as well.”

Post-mortem examinationAfter the coroner issues a warrant for a post-mortem examination, the case is presented to a forensic pathologist and his or her assistants. In criminally suspicious cases, police are directly involved in the autopsy to collect evidence.

The first step is establishing identity which is usually by visual means. Depending on the nature of the case – for example, a fire death – this can require different methods.

“LHSC has three odontologists who examine dental records,” says Dr. Shkrum. “Radiologists may also look

at X-rays taken during an autopsy which are compared to X-rays that were taken during the individual’s life. A tissue sample from a previous surgical procedure preserved in a pathology department can also be used as a source of DNA.”

Families may play a crucial role in identification by providing photographs, a physical description of their loved one, or even submitting DNA from a hairbrush or toothbrush.

Common tests during a forensic autopsy• Toxicology: collection of blood and urine samples

from the body to determine if there are drugs or poisons present.

• Biochemical analysis: a fluid sample taken from the eyes to determine if a fatal condition such as a diabetic complication is present.

• X-Rays: determine if there are skeletal fractures.

While many post-mortem examinations are completed within a few hours, other cases have taken the autopsy team an entire day or more.

A formal report is issued to the investigating coroner, the Regional Supervising Coroner and the Chief Forensic Pathologist at the provincial Forensic Pathology Unit in Toronto.

Testifying in courtA preliminary hearing determines whether there is enough evidence to proceed to trial. During hearings and the trial, the pathologist provides not only a cause of death but also an interpretation of other aspects of the case such as non-fatal injuries. Dr. Shkrum averages about five legal proceedings per year.

“The preparation may take a bit of time to refresh one’s memory. It’s almost like preparing for an exam,” he says.

While pathologists are usually called as a witness for the crown, their duty is to the court.

“We’re there to help the court, help the defense, the crown attorney, the judge, and ultimately the jury if it’s a jury trial,” he says. “We’re there to be an objective witness.”

One in eight babies born in Canada is born preterm. Many of these babies are at risk of developing a serious bowel condition called necrotizing enterocolitis (NEC). This potentially fatal condition occurs because the baby’s bowel is immature and is colonized by bad, instead of good, bacteria. These fragile patients can require surgery, multiple hospital visits and have serious long-term outcomes – a very stressful start to a new life for the child and parents alike.

To help babies avoid contracting NEC, caregivers in the Neonatal Intensive Care Unit (NICU) at Children’s Hospital, London Health

Sciences Centre are implementing a preventative measure which is low cost and simple – providing a probiotic supplement. Probiotics are live bacteria and yeasts that keep the bowel healthy and are especially good for the digestive system. Probiotics have been gaining popularity for their health benefits.

According to Dr. Henry Roukema, Medical Director at Children’s Hospital’s NICU, the cause of NEC is not well understood, but involves immaturity of the intestinal lining which allows harmful bacteria to cross into the bowel wall and bloodstream. Currently, there are not many effective treatments, so prevention is the best option.

In the last year, the NICU at Children’s Hospital started using a probiotic supplement for babies at risk for NEC – those born weighing less than three pounds and three ounces, or who are born seven or more weeks premature. Around 180 babies that fall into this category are admitted to the NICU each year, and on average nine of these babies develop NEC. Surgery is required in about half of all cases to remove the damaged part of the bowel, and devastatingly, one-third die.

Niko, a baby born 15 weeks premature and weighing only one pound and seven ounces, was the first baby at Children’s Hospital to receive probiotic treatment. Niko was at high risk for developing NEC due to his extreme prematurity. His parents, both physicians themselves, requested that Niko be given the probiotic FloraBaby™. Niko did not develop NEC and has continued to flourish in his development.

Probiotics have been in use in many NICU’s outside of North America for the past decade. Studies in these areas have shown a reduction in the risk of NEC and death by approximately 50 percent, as well as better tolerance to milk feedings, fewer days on intravenous nutrition, and shorter hospital stays.

Children’s Hospital is part of a national collaboration called EPIQ (Evidenced-based Practices for Improving Quality). Cindy Ulrich, Registered Dietitian and co-chair of the EPIQ NEC Outcome group, identifies the introduction of probiotics as one of several evidenced-based feeding related practices recommended by the national group to target a reduction in NEC cases among very low weight at birth babies. Children’s Hospital is one of roughly a dozen Canadian NICU’s that have implemented probiotics.

Recognized around the globe as a leader in probiotic research, Lawson Health Research Institute’s Dr. Gregor Reid was consulted throughout the implementation process by the NICU team. “The peer-reviewed published evidence in favour of probiotics is exemplary and certainly outweighs any risks in taking these products.”

The research study is about six months away from completion. To date, about 200 very low birth weight babies have received probiotic treatment and since implementing probiotics into the NICU, only four babies have developed NEC. This is a reduction of more than 50 per cent versus the number of cases expected.

Dr. Beth Ellen Brown, pediatric resident and Lawson researcher, will formally evaluate and report on the outcomes regarding this important practice change within the next year. Dr. Roukema recognizes the importance of this practice change. “There is minimal cost associated with probiotic therapy compared to the cost savings to be realized by preventing even one case of NEC.”

For Niko’s parents, Kristy and George, knowing that their baby was receiving a probiotic supplement gave them a peace of mind. “Niko is doing wonderfully. We can’t be more pleased with the outcome.”

Kristy and George pose with their son, Niko, who was the first premature baby to receive probiotic therapy in the neonatal intensive care unit at Children’s Hospital.

Probiotics give new hope to premature babies

“There is minimal cost associated with probiotic therapy compared to the cost savings to be realized by preventing even one case of NEC.”

– Dr. Henry Roukema

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Home check up

• Have an assessment done by a health-care provider so that your home meets your needs. Install appropriate grab bars and rubber mats and use walkers and canes.

• Keep your home well lit and free of clutter.

• Use a night light or keep a flashlight beside your bed.

Watch your step

• Watch for ice, cracks and uneven surfaces.

• Determine what level of assistance you need with transportation.

• Wear non-slip shoes and boots that fit well and seek treatment for foot problems.

Speak up about dizziness

• Talk to your doctor if you feel lightheaded or dizzy.

• Have your vision and hearing checked regularly.

• After lying in bed or sitting in a chair, clench your fists and move your ankles in a circular motion 10 times, then get up slowly.

• Dehydration can make you dizzy. Drink six to eight glasses of fluids including water each day, or as directed by your health-care provider.

Keep active

• Regular exercise and physical activity can increase muscle strength, improve balance and help prevent falls. Ask your health-care provider about the best type of exercise program for you.

Check your medication

• Once a year, have a doctor or pharmacist review all medications, including prescriptions, over-the-counter pills, vitamins and herbal supplements.

Risks in the home are the leading cause of falls among older adults

An estimated

1 in 3older adults fall each year in Ontario

In Ontario, there were

2,900 hospitalizations for fall-related head injuries among adults aged 65 and over in 2014/15

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ONLINE EXCLUSIVE

Learn about LHSC’s injury prevention program.

In the last 2 years,

falls were thecause of injury

in older adults seen at LHSC#1

In the last 5 years

over 500older adults

have been seen at LHSC with

severe injuries from a fall

How can I prevent a fall in my home or outside?Falls are the leading cause of injury-related hospitalizations among individuals ages 65 years and older in London-Middlesex. Many times, falls can be prevented by assessing individual needs and addressing health concerns that could lead to a fall. The following prevention tips are adapted from Finding Balance Ontario. Visit findingbalanceontario.ca for more information on tools and resources to prevent falls.