vim & vigour winter 2013

BournetoBournetoQuitQuittoQuittoAfter 17 years of puffing , MATT DAMON embraced a new smoke-free identity

THE PERFECT HOLIDAY

GIFT page 54

St. Josephs Honours Two Surgical Visionaries

DIABETES EDUCATION CENTRE MARKS 40 YEARS

Ending the Stigma of Not Criminally Responsible

WINTER 2013

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sjhc.london.on.ca

Renowned for compassionate care, St. Josephs is one of the best academic health care organizations in Canada dedicated to helping

people live to their fullest by minimizing the effects of injury, disease and disability through excellence in care, teaching and research.

St. Josephs is helping Rick live healthier.

Because every 7 minutes someone has a heart attack...

we are teaching people how to limit their risk.

THREE MONTHS AFTER HE UNDERWENT quintuple heart bypass surgery,

44 year-old Rick Ho was able to bike five km. At five months, he ran 10 km.

Rick calls the Cardiac Rehabilitation and Secondary Prevention Program

at St. Josephs completely transformative. From the edge of death, Rick

is more fit than hes been in decades. Visit our website to learn more about

St. Josephs cardiac rehabilitation program.

CARING FOR THE BODY, MIND & SPIRIT SINCE 1869

Renowned for compassionate care, St. Josephs is one of the best academic health care organizations in Canada dedicated to helping

people live to their fullest by minimizing the effects of injury, disease and disability through excellence in care, teaching and research.

St. Josephs is helping Rick live healthier.

THREE MONTHS AFTER HE UNDERWENT

44 year-old Rick Ho was able to bike five km. At five months, he ran 10 km.

Rick calls the Cardiac Rehabilitation and Secondary Prevention Program

at St. Josephs completely transformative. From the edge of death, Rick

is more fit than hes been in decades. Visit our website to learn more about

St. Josephs cardiac rehabilitation program.

CARING FOR THE BODY, MIND & SPIRIT SINCE 1869

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St. Josephs Health CareJOB DESCRIPTION

Cardiac V&V Ad Full page - InsideNovember Issue

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In announcing the award, the London Community Foundation describes him as a dedicated leader, mentor and com-munity builder whose actions in sup-porting numerous community groups demonstrate that he believes in helping people who are less fortunate by provid-ing them with the opportunity to reach their own personal potential.

Do You Have MeMorY ProbleMs?Do you have trouble remembering things? Are you 65 years old or older? Older adults interested in participating in a research study looking at the relationship between walking and cognition (how you think and reason) are invited to call St. Josephs Parkwood Hospital at 519 685-4292, ext. 2179. For those who meet the criteria, this is an opportunity for a com-plete memory evaluation.

125 Years of faitH anD caringSt. Josephs Hospital has reached a remarkable mile-stone125 years of faith and caring. On Oct. 15, 1888, the hospital officially opened its doors with 10 beds and a staff of four doctors and three Sisters of St. Joseph. From this mod-est beginning, the hospital would grow and change. Today, it is the cornerstone of what is now St. Josephs Health Care London, one of Canadas leading multispecialty academic health care centres. Then and now, it is a history of which St. Josephs is proud.

tHe figHt against influenzaThe statistics are staggering. Londons 20122013 influenza season saw 26 deaths, 297 hospitalizations and 472 labora-tory-confirmed cases. To fight against influenza, St. Josephs Health Care London is taking a new direction. In addition to the annual flu vaccination and education campaign of staff, physicians and volunteers, St. Josephs has adopted a new policy. When an influenza outbreak is declared in the com-munity, all non-vaccinated staff, physicians and visitors must wear a mask while in our facilities to prevent the spread of influenza. To view vaccination results at St. Josephs through-out the season, visit sjhc.london.on.ca/our-performance/quality-improvement-plan.

a Partner of DistinctionDale Brain Injury Services is the 2013 recipient of St. Josephs Health Care Londons Partner of Distinction Award. This award recognizes partnership and collaborationessential requirements of health care delivery and community ser-vice. Dale Brain Injury Services has been a valued commu-nity partner in the care of those living with acquired brain injury since rehabilitation began at St. Josephs Parkwood Hospital in the 1980s. The organization provides assisted living services in residential settings as well as a community day program. Together, St. Josephs and Dale work to ensure patients receive the support they need during their rehabili-tation journey.

a leaDer, Mentor anD coMMunitY builDerJeff Macoun, a long-time volunteer with St. Josephs Health Care Foundation, has been honoured with the Governor Generals Caring Canadian Award. The award recognizes Canadians who have made a significant, sustained, unpaid contribution to their community, in Canada or abroad. Known for his energy, enthusiasm and strong leadership, Macoun has made a substantial contribution to St. Josephs, the YMCA, United Way and other London organizations.

St. JoSephS Notebook

Helping HandsIndividuals and organizations are making a difference every day

On behalf of Dale Brain Injury Services, Sue Hillis, executive director, centre, accepts the Partner of Distinction Award from Marcie Grail, outgoing chair of St. Josephs Health Care Londons board of directors, left, and Dr. Gillian Kernaghan, St. Josephs president and CEO.

Jeff Macoun

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ConneCting With our Community

Focusing on Those We Serve

W ith the holiday season and a brand new year soon upon us, we at St. Josephs have much to be grateful for and even more to look forward to. The past year has been one of change and achievements on our journey to earn complete confidence in the care we provide, and to make a lasting difference in the quest to live fully. From the opening of our new Southwest Centre for Forensic Mental Health Care, to the launch of the inaugural Bust a Move for Breast Health, to exciting innovations in care and ser-vice across our programs, we are proud of what we have accomplished.This year also marked a special anniversary

for St. Josephs Hospital125 years of faith and caring. From humble beginnings, the hospital has grown to become a medical force in Canada and beyond while remaining committed to the values instilled by our founding Sisters of St. Joseph.The year ahead promises to be equally exciting. With the support of the com-

munity and the dedication of our excellent staff, physicians and volunteers, 2014 will see the opening of our new London mental health facility next to Parkwood Hospital and raising of the bar ever higher in delivery of care for patients and residents across St. Josephs.We could not do so without the generosity of our community that, every year,

steps up to support our Season of Celebration, which begins Nov. 15. Raising funds for patient and resident care comfort items, Season of Celebration is a heartwarm-ing tradition that brightens the holiday across our organization. Watch for the pink Lights of Caring to shine at all our sites.In this issue of Vim & Vigour, we highlight inspiring work that shows the great

diversity, impact and reach of St. Josephs expertise. The focus on those we serve is the key to our continued success and will remain paramount in the coming year in a continuing challenging and uncertain economic climate. To all who give of themselves for St. Josephsour staff, physicians, volun-

teers, health care partners and donorswe wish you a joyous Christmas and good health for the New Year.

Dr. Gillian KernaghanPresident and CEOSt. Josephs Health Care London

Michelle CampbellPresident and CEOSt. Josephs Health Care Foundation

Dr. Gillian Kernaghan, left, and Michelle Campbell

Vim & Vigour,TM Winter 2013, Volume 29, Number 4, is published quarterly by McMurry/TMG, LLC, 1-888-626-8779. Vim & VigourTM is published for the purpose of disseminating health-related informa-tion for the well-being of the general public and its subscribers. The information contained in Vim & VigourTM is not intended for the purpose of diagnosing or prescribing. Please consult your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines.

801 Commissioners Road EastLondon, ON N6C 5J1519 646-6085sjhcfoundation.org

If you prefer not to receive Vim & Vigour TM from St. Josephs Health

Care Foundation, please call 519 646-6085.

ST. JOSEPHS HEALTH CARE FOUNDATION

20132014 Board of DirectorsPeter Mastorakos, Chair John Haasen

Tim Brown Dr. Gillian Kernaghan

Michelle Campbell, President Dr. Roman Kozak

Lesley Cornelius Frank Longo

Michael Dale Ron Martindale Jr.

Ian Dantzer Margaret McLaughlin

Dr. Tim Doherty Theresa Mikula

Samira El-Hindi Rick Spencer

Dianne Evans Tania Testa

Mark Farrow Brian Waltham

Murray Faulkner Paul Way

Stacey Graham

ST. JOSEPHS HEALTH CARE LONDON

20132014 Board of DirectorsMargaret McLaughlin, Chair Paul Kiteley

Brad Beattie Gatan Labb

John Callaghan Ron LeClair

Kimberley Chesney Rev. Terrence McNamara

Dr. Robert DiCecco Dr. Mohan Merchea

Murray Faulkner Karen Perkin

Marcella Grail Scott Player

Phil Griffin Pat Pocock

Darcy Harris Bruce Smith

Dr. Sarah Jarmain Dr. Michael Strong

Margaret Kellow David Van Trigt

Dr. Gillian Kernaghan, President

Contributing WritersKelsi Break, Sara Cameron, Julia Capaldi, Sarah Dicker, Caitlin Holwell,

Amanda Jackman, Anne Kay, Dahlia Reich, Renee Sweeney

Editors in ChiefKathy Burrill and Michelle Campbell

EditorDahlia Reich

ProductionMcMurry/TMG, LLC

Publications Mail Agreement #41661016. Return undeliverable Canadian addresses to: 801 Commissioners Road East, London, ON N6C 5J1.

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53DEPARTMENTS1 Notebook Individuals

and organizations are making a difference every day.

2 Connecting with Our Community A focus on those we serve.

8 Faces Introducing two new St. Josephs board chairs.

46 Virtual Health Supportive apps, one supersmart heart chart and the worlds most clever piece of cutlery.

55 In Your Own Words A grateful patient shares her St. Josephs experiences.

56 Inspired to Give A familys legacy of commitment to St. Josephs.

FEATURES

4 Honouring Two of the Best An innovative centre is renamed for its visionary founders.

5 Care Within Reach Parkwood Hospitals operational stress injury service expands to Toronto.

6 Reclaiming Independence, Resuming Life Helping stroke patients reach their full potential.

10 Got Excuses? Skipping your screenings may be put-ting your health in danger. Stop with the excuses and put on that gown.

14 Managing Your Health with a DIY Tool KitApps and gizmos that can help control diabetes and heart disease.

18 Is It the Stress Talking? From heartburn to breakouts, heres how anxiety may affect your health.

20 The Wonderful World of GreensGreen vegetables can strengthen bones, sharpen your vision, even prevent birth defects. Eat up.

25 Knee-to-Know Basics This joint keeps you jumpingand walking , climbing and moving. Lets see how it operates.

34 Run for Your Life With a cancer diagnosis, exercising may be the last thing on your agenda. Heres why to reconsider.

38 Circle of InfluenceThe five people in your life who contribute to your overall health.

42 Special Delivery And you thought choosing your babys name was tough. Here are three other important birth decisions.

49 Relentless Scientific Curiosity St. Josephs imaging expert Dr. Frank Prato earns a prestigious international award.

50 Stop the Stigma, Know the Facts Clearing up misperceptions about a verdict of not criminally responsible.

52 Where Good Health Begins St. Josephs Diabetes Education Centre has been helping patients for 40 years.

54 Gifts of the Season Season of Celebration provides vital funding for a variety of St. Josephs projects.

ON THE COVERAfter 17 years of a daily pack-and-a-half habit, it waslove that persuaded one of Hollywoods true nice guysto put down the cigarettes. For inspiration, advice and a boy-meets-girl romance, see how Matt Damon quit smokingand how you can tackle it yourself.

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SPECIALBy DesignA custom-made gown for breast care patients is comfortable and versatile.

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The Hand and Upper Limb Centre (HULC) at St. Josephs Hospital in London has a new name in honour of two of Londons most widely acclaimed surgeons.

In a special dedication ceremony in September, the centre was renamed the Roth McFarlane Hand and Upper Limb Centre as a permanent tribute to its visionary foundersthe late Drs. James Roth (19512013) and Robert McFarlane (19272006).

The expertise, foresight, acumen, leader-ship and hard work of the two surgeons were the building blocks of the centre, which opened in 1992 and quickly became recognized interna-tionally as a leader in surgical innovation, excep-tional patient care, and teaching excellence, says Dr. Gillian Kernaghan, president and CEO of St. Josephs Health Care London. It is most fitting that the centre honours the ambitious vision of these remarkable surgeons, whose con-tributions continue to make a lasting difference in the lives of patients.

UniqUe Scope of ServiceSThe Roth McFarlane Hand and Upper Limb Centre is the largest of its kind in Canada and one of the most respected in the world. It is a com-bined orthopedic and plastic surgery unit spe-cializing in the care of patients with injuries or conditions of the hand, wrist, elbow and shoulder. Unique in its scope, the interdisciplinary team

of specialistsorthopedic and plastic surgeons, occupational and physiotherapists, radiologists, physiatrists, cast technicians, nurse practitioners, nurses, residents, trainees and othersannually handles about 35,000 clinic visits, 14,000 ther-apy visits and 3,800 surgical cases.

At the same time, cutting-edge research in four labs at the centre focused on bioengineer-ing, cell and molecular biology, clinical research and surgical mechatronics digs deep to further understand and improve treatment for injuries and conditions of the hand and upper limb.

The centres expert team works every day to ensure the legacy of Drs. Roth and McFarlane lives on, says medical director Dr. Graham King. The renaming is a well-deserved tribute to two exceptional physicians whose brilliance, leader-ship and mentorship gave us a remarkable centre of excellence that continues to thrive.

AcAdemicS And AthleticSDr. Roth was a leading orthopedic surgeon spe-cializing in hand surgery, while Dr. McFarlane was a Canadian pioneer in plastic surgery and hand surgery. As students at Western University, both were top athletes and football stars. Dr. McFarlane went on to hold five Canadian records in track and field and was the flag bearer for the Canadian Olympic team at the 1948 Summer Olympics. During their tenures as professors at Western, both trained many surgeons, who now practice all over the world. Recipients of numerous awards, the two medical giants col-lectively authored more than 171 articles and 73 book chapters.

An innovative centre is renamed for its groundbreaking founders

The Hand and Upper Limb Centre at St. Josephs Hospital in London has been renamed in honour of two surgical visionaries, the late Drs. James Roth, left, and Robert McFarlane, co-founders of the internationally recognized centre, now called the Roth McFarlane Hand and Upper Limb Centre.

Honouring Two of the BestBy Kelsi BreaK

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S t. Josephs Parkwood Hospital has mobi-lized to make it easier for veterans and active members of Canadian Armed Forces to reach the help they need for operational stress injuries.

The Operational Stress Injury (OSI) Clinic at Parkwood treats those struggling with post-traumatic stress disorder, anxiety, depression and addiction resulting from military service. The clinics vast catchment area stretches from Windsor to Pickering and north to the Owen Sound area. Within this area, many referrals are generated from the Greater Toronto Area (GTA).

To increase accessibility and reduce the num-ber of 200-kilometre treks people were making to London from the GTA, OSI outreach services were established in Toronto in 2011 by Parkwood psychologists Drs. Maya Roth and Alexandra McIntyre-Smith.

When we fi rst started in the GTA, we felt like two soldiers parachuting into unknown terri-tory, but with tremendous support from the OSI Clinic at Parkwood and our partners at Veterans Affairs Canada (VAC), we quickly rolled into action, says Dr. Roth.

ENSURING ACCESSPotential clients are assessed in the GTA to deter-mine whether the OSI Clinics services are right for them. If clients would benefi t from these ser-vices, psychological treatment is provided in the GTA and clients access additional OSI services at Parkwood, such as psychiatry, group treatment and family services.

Drs. Roth and McIntyre-Smith, in partner-ship with the VAC offi ce at Sunnybrook Health Sciences Centre, provide psychotherapy and assessment services to veterans at Sunnybrook. They also provide assessment and treatment to veterans and still-serving soldiers out of the VAC

District Offi ces in Mississauga and Scarborough. The OSI Clinic works closely with VAC in London and Toronto and across the remainder of its catchment area, as well as with the Canadian Forces, the Royal Canadian Mounted Police and community resources to ensure clients and their families have access to the right programs, ser-vices and supports.

Periodically, Drs. Roth and McIntyre-Smith return to the Parkwood OSI Clinic. Even though we connect regularly with London by video con-ference to consult on clients, its benefi cial to meet face-to-face to stay connected with the London team, says Dr. McIntyre-Smith.

Pleased with the success of the outreach efforts in the GTA, the Operational Stress Injury National Network recently leveraged the exper-tise of Drs. Roth and McIntyre-Smith to develop a similar outreach clinic in Halifax, Nova Scotia.

BY ANNE KAY

Parkwood Hospitals operational stress injury service is now available in the Toronto area

Care Within Reach

Psychologists Drs. Maya Roth and Alexandra McIntyre-Smith from the Operational Stress Injury Clinic at St. Josephs Parkwood Hospital serve the Toronto area as part of an outreach service.

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P eter Ashby was just 45 years old when he suffered a stroke. After treatment at a Chatham hospital, he came to St. Josephs Parkwood Hospital for inpatient rehabili-tation. The owner of a physiotherapy clinic that serves nursing and retirement homes, Ashbys unexpected fi rst-hand rehabilita-tion experience would give him a whole new perspective on life and the services his own company provides.Now that Ive had a stroke, Ill be a bet-

ter therapist because I can really under-stand and appreciate what my patients are experiencing.

The stroke/neurological rehabilitation inpatient program at Parkwood serves those who have had a stroke or are living with

BY ANNE KAY, PHOTOS BY PAULINE DEVILEE

Parkwood Hospitals stroke rehabilitation program helps patients reach their full potential

Reclaiming Independence, RESUMING LIFE

A DAY IN THE LIFE OF ST. JOSEPHS

ter therapist because I can really under-stand and appreciate what my patients are experiencing.

inpatient program at Parkwood serves those

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another neurological condition. An interdisci-plinary team helps patients reach their reha-bilitation potential, reclaim their independence and resume their lives. For a glimpse into this program so vital to stroke recovery, we follow Ashby throughout a routine day, which starts early and runs until 6:30 p.m., even on weekends:

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1 After a stroke, patients may grieve the loss of their life as they knew it. Counselling is a vital role of Parkwood Hospital social workers, like Colleen Churchill, seen here in a session with stroke patient Peter Ashby. We help them find the inner strength to move on, says Churchill, who also helps patients plan for discharge. Most patients continue outpatient therapy at Parkwood or through the Community Stroke Rehabilitation Teams for those living outside London.

2 Occupational therapist (OT) Stefanie Balcarras uses prism glasses to help Ashby open up his field of vision on the right side, which has been affected by the stroke. In addition to working on visual and perceptual skills, OTs help patients re-learn activities of daily living, such as dressing and cooking, adapt tasks and the environment to increase their independence and safety, and provide therapy to improve arm and hand movement and function.

3Ashbys stroke left him with transcortical sensory aphasiadifficulty understanding others and expressing himself. Here, speech language pathologist Becky Orenczuk helps Ashby access his words using visual cues.

4 Ashby and his wife, Sandi, spend a few quiet moments in the garden at Parkwood during a break in his therapy.

5 Having progressed well, Ashby needs only stand-by assistance from registered practical nurse (RPN) Sarah Pardy to get in and out of bed. In addition to nursing duties, RPNs also liaise with physicians on behalf of patients, participate in weekly rounds, and teach patients and their families self-care skills, such as ways to control blood pressure to help prevent another stroke.

6 One of Ashbys goals is to play golf again, so therapeutic recreation specialist Breanne Carr works with him on improving his balance on the putting green.

7 Physiotherapist Benj Gesink, seated, and Western University physiotherapy students Julia Findlay, left, and Simon Janik support Ashby while he works on balance, gait and regaining movement. In stroke rehab, the focus of physiotherapy is primarily on gross motor skills, strengthening and conditioning.

8 In the railway garden, raised flower beds give Ashby a chance to practice standing while gardening, with the help of therapeutic recreation specialist Breanne Carr.

9 Occupational therapy/physiotherapy assistant Cheri McGahan works with Ashby on arm movements and posture control. Helping patients with dressing and grooming is also part of McGahans role.

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Margaret McLaughLinIt was as a Toronto nursing student that Margaret McLaughlin first encountered the Sisters of St. Josephtheir influence and mastery in running a hospital, car-ing for patients and overseeing the young nurses in their charge. Today McLaughlin sits at the helm of St. Josephs Health Care London, founded by the pioneering Sisters 125 years ago. At this historic juncture, McLaughlin takes over as St. Josephs chair of the board of directors for a two-year term. A director and partner in Excalibur Communications of London, McLaughlin brings expertise in strategic communica-tions counsel to her role. She has also held senior positions in corporate communica-tions with the Province of Ontario and the Roman Catholic Archdiocese of Toronto, where she served as special advisor to the late Gerald Emmett Cardinal Carter. Her educational background includes gradu-ate studies in theology at the University of Toronto and at St. Peters Seminary in London.McLaughlin, a board member for the past

seven years who has led the boards Health Care Ethics Committee, chose to give of her time to St. Josephs because of what she saw in the staff, who truly embrace the mission and vision of the organization and live the values of respect, excellence and compas-sion, she says. Ready for challenges ahead, McLaughlin

hopes to build on the firm foundation of col-laboration between St. Josephs and its many partners across the regions academic health care system, focus on strategic planning to drive forward patient care, research and teaching, and find innovative solutions to the financial hurdles ahead. As chair, she sees a strong future for St. Josephs.

There are many uncertainties about how to sustain excellent hospital care and innova-tion during times of economic uncertainty. St. Josephs has strong pillars on which we will weather the challenges, work with oth-ers and continue to build on our legacy.

Peter MastorakosEnergy, experience and a commitment to suc-cess are qualities Peter Mastorakos brings to his newly minted role as chair of St. Josephs Health Care Foundations board of directors. A natural leader and skilled professional in the financial services sector, Mastorakos says he feels privileged to lead the foundations board.St. Josephs has a long history of provid-

ing excellent and compassionate care, and I am proud to be part of the volunteer team dedicated to continuing that legacy.Currently president and CEO of Ekaton

Wealth Management, Mastorakos will lend a wealth of knowledge to his volunteer position. He also serves as the executive entrepreneur in residence INVP (New Venture Project) at the Pierre L. Morrissette Institute of the Richard Ivey School of Business, has worked with Financial Executives International, and as part of the judging committee for the Business Awards at the London Chamber of Commerce.Born and raised in London and educated

at the University of Windsor and Western University, Mastorakos resides in nearby Lucan with wife Peggy and sons Dylan and Collin. Having served on the foundation board since 2009, Mastorakos is a long-time community volunteer across a broad spectrum of organizations, including minor league hockey, the Lucan District Lions Club, and the Heart and Stroke Foundation, where he received the Award of Volunteer for Excellence in 2007.

taking st. Josephs into the FutureTwo new board of director chairs bring a wealth of experience and a high level of commitment to their roles

Faces oF St. JoSephS

Margaret McLaughlin

Peter Mastorakos

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Well let you in on a little secret. No one loves to get a health screening.Are there people who dont fear nee-dles? Sure. But no one actually enjoyshaving a blood test.

In fact, I know of no woman who looks forward to her mammogram or a Pap test. And if I had a nickel for every person who is eager for a colonoscopy, Im pretty sure I wouldnt have a single nickel.

But even if there are a hundred things youd rather dothings that are far more fun than getting poked and proddedthere are few things you can do that are better for your health than getting your regular screenings.

But you have your reasons for skipping them. Right? Well, hear this.

I DONT HAVE TIME.

IT WILL HURT.

IM NERVOUS.

B Y S T E P H A N I E R . CON N E R

IM TOO BUSY.

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If youre skipping your health screenings, you may be putting your health in danger

GotExcuses?

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I DONT HAVE TIME. IM

SCARED.

I FEEL FINE.

IM NERVOUS.

SCREENINGS ARE UNCOMFORTABLE

AND PAINFUL.

I MIGHT HEAR BAD

NEWS.

EXCUSE I DONT HAVE TIMEYes, youre busy. Between getting the kids to school, caring for older par-ents and working, its easy to overlook your own health.

Plus, what happens if the imaging centre or the lab runs behind schedule?

Take a deep breath and remember why youre having these screenings in the fi rst place: To potentially give you more time with the people you love.

If the tests reveal a problem, youll be glad it was found early, when treatment is easierand yes, less time-consuming.

If youre a multi-tasker, take heart. A blood test takes care of many of your important screenings, including blood sugar and cholesterol, with just one draw.

In the end, says Beth Cowper-Fung, a primary healthcare nurse practitioner and the presi-dent of the Nurse Practitioners Association of Ontario, its a matter of deciding that your health is important to you. You will make time for something that is important to you, she says.

EXCUSE I FEEL FINE, SO ITS OK TO SKIP THE DOCTOROften, people feel fi ne and dont think its necessary to see a doc-tor. But some conditions, like heart disease, take years to develop. The earliest signs of heart problems stealthily appear much sooner. So, people who get regular screen-ings starting in their 20s are at an advantage.

If you learn that your blood sugar or cholesterol levels are in a potentially dangerous range, you can take steps early to bring those

Ontario, its a matter of deciding that your health is important to you. You will make time for something that is important to you, she says.

EXCUSE

SKIP THE DOCTOROften, people feel fi ne and dont think its necessary to see a doc-tor. But some conditions, like heart disease, take years to develop. The earliest signs of heart problems stealthily appear much sooner. So, people who get regular screen-ings starting in their 20s are at an advantage.

If you learn that your blood sugar or cholesterol levels are in a potentially dangerous range, you can take steps early to bring those

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numbers down. Not to mention that when people adopt healthy habits at a younger age, theyre likely to stick with them.

Cowper-Fung notes that men in particular need an extra nudge to get the doctors offi ce.

Men are far less likely to come in for screen-ing unless they have a reason, she says, noting that nurse practitioners really focus on illness prevention and overall wellness. So, when men come in for something more acutelike a back strain or an ear infection, for exampleits an opportunity to talk about their overall health and see whether theyre due for any screenings.

Waiting for symptoms of disease to develop is a dangerous risk: In some cases, it might be too late to do anything about it.

EXCUSE SCREENINGS ARE PAINFUL

AND UNCOMFORTABLEColorectal cancer is the third most common can-cer in Canada and the second leading cause of cancer death, according to the National Cancer Institute of Canada. But with screening, many of those deaths are preventable. Thats because if a screening fi nds polyps in the colon, the growths can be removed before they develop into cancer.

People older than 50 should talk to their doc-tors about screening, Cowper-Fung says. For people at high risk, colonoscopy is the screening tool of choice, while those at average risk may choose to have a colonoscopy (every 10 years is recommended) or a fecal occult blood test (FOBT), which can be at home, every two years. If the FOBT detects abnormalities, a colonoscopy will be needed.

But unfortunately, fear can keep people from getting their colonoscopy.

Most people complain about the prep. Theyve heard its unpleasant, Cowper Fung says.

And while she wont lie to patients and tell them its fun, its also not as bad as it is in their

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online

Access Our ExpertiseFor more information on the expertise of the

Osteoporosis and Bone Disease Program of St. Josephs Health Care London, visit sjhc.london.on.ca/osteoporosis .

Bone Up on BonesMore than 80 per cent of all fractures in people

over age 50 are caused by osteoporosis, which

costs Canadas health care system more than

$2.3 billion a year and those with the condition

a reduced quality of life. Its recommended that

all men and women over age 65 routinely have a

bone density test to screen for osteoporosis, as

well as younger individuals with certain risk factors.

At St. Josephs Hospital in London, the

Osteoporosis and Bone Disease Program provides

bone density testing and specialized outpatient

care for those living with osteoporosis and other

bone diseases.

When the St. Josephs osteoporosis program

began in the 1980s, osteoporosis was still often

thought of as a natural part of aging and defi-

nitely a womens issue, explains endocrinologist

Dr. Terri Paul. Things have changed. At least

one in three women and one in five men will suf-

fer from an osteoporotic fracture during their

lifetime. Fractures from osteoporosis are more

common than heart attack, stroke and breast

cancer combined.

Dr. Paul advises individuals to talk to their family

doctor about their risk for osteoporosis and rec-

ommendations for screening.

FdVVWI1386_12-46_Commons.indd 12 9/19/13 11:31 AM

heads. Plus, she can offer advice for making it a better experience.

I work with them in terms of comfort mea-sures, she says. I say, How can we make your prep day less horrible?

For women, the perception of pain might lead them to avoid mammograms. And its no wonder when you consider the description of a mammogram: having your breasts compressed between two plates. But heres some good news: A group of researchers at Wake Forest University found that mammogram pain is mildsimilar to discomfort caused by a pair of tight-fitting shoes or a mild headache.

And we all know how often we women choose to wear tight-fighting shoescertainly more than once a year! So, just remember: A mammogram could save your life.

ExcusE I mIght hear bad newsThats the denial piece, Cowper-Fung says. I talk about how curable it is if we find it early.

Heres the bottom line: Screenings identify diseases in their earliest stages, which is when they are most treatable.

Just think about how much better your life can be if its [detected] early, Cowper-Fung says. Its about stressing the importance of your health.

no more excusesSure, there are plenty of reasons to skip see-ing the doctor. But the truth is there are few things you can do for your health that offer a greater return on your time investment. And who knows, maybe with a new appreciation for the benefits of tests, youll start to look forward to these screenings. (Hey, theres nothing wrong with a little positive thinking!)

Lets do this thing!

Your Recommended ScreeningsNow that youre on board with getting your

screenings, lets talk specifics. Below is a list of

general recommendations for adults. If you

have increased risk due to family history or

other factors, your doctor likely will recom-

mend a different screening schedule for you.

Fecal occult blood test. Every two years, starting at age 50.

(Other screening tests are available and have

varying frequency recommendations depend-

ing on your risk factors.)

Mammograms (for women). Every two to three years, starting at age 50.

Pap test (for women). Every three years, starting at age 25.

Source: Canadian Task Force on Preventive

Health Care

im taking controL

of my heaLth!

W i n t e r 2 0 1 3 13


Diabetes and heart disease ha

ve a lot in

commonincluding your abili

ty to control

them. Weve packed these pag

es with

apps and gizmos that can help

MANAGING YOUR HEALTH

WITH A

BY ALLISON THOMAS

Tool Kit

YOUR HEALTH WITH A

Tool Kit

YOUR HEALTH WITH A

Tool Kit

YOUR HEALTH WITH A

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Evil Sisters?Why are heart disease and diabetes so similar? It could be because theyre

an extension of the same disease, says Aruni Bhatnagar, PhD, a professor,

an author and a cardiovascular researcher.

Bhatnagar and other researchers are studying both diseases as one

continuum known as cardiometabolic disease, and the connection

between the conditions is already being addressed in caring for patients.

Clinicians are now being asked to assume that if you have diabetes,

you already have heart disease, so thats how serious it is, Bhatnagar says.

Often, were on the hunt for a two-for-one deal. But heres one package wed rather avoid: diabetes and heart disease. The two conditions frequently come as a set because of shared risks, such as being overweight or obese, a sedentary life-

style, smoking, and high blood pressure and high cholesterol levels. But the upside is this: Along with those shared risks come shared ways to reduce or eliminate them. Well show you some of the

best strategies for reducing your chance for developing compli-cations from diabetes and heart disease, and give you the tools to make it all easier to manage.

GOALGOALGOALLose a few Lose a few Lose a few

poundspoundspounds

GOALGOALGOALEmbrace a Embrace a Embrace a smart dietsmart dietsmart diet

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Of all the risk factors for both diabetes and heart disease, weight may play the biggest role.

For type 2 diabe-tes, the central cause

is a chronic calorie surplus. We eat too much and dont expend enough, and its causing the epidemic, says Janet Bond Brill, PhD, RD, a dietitian and the author of Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse Heart Disease. But the research shows that losing even a small amountjust 10 per cent of your body weightcan help reverse the damage.

And, as you might imagine, those benefi ts only increase with a greater loss.

Weight loss can help with improving glyce-mic [blood sugar] control, with lowering blood pressure, and it improves blood lipid levels, says Shadab Rana, a senior specialist in Mission Information at the Heart and Stroke Foundation of Canada. And the greater the sustained weight loss is, the greater improvement in risk factors you achieve.

TOOL: Withings Smart Body Analyzer ($150). It might look like an ordinary bathroom scale, but this wizard will help you stay on top of your weight while also analyzing your body composi-tion, checking your heart rate, and automatically logging and tracking your data over time.

Finding the right eating plan to man-age diabetes and heart disease can be frustrating, because while experts easily agree on recommen-

dations like eating plenty of vegetables, they part ways on other guidelines. Should you go low-fat? Should you aim for low-carb?

The choice may not be as diffi cult as you think. The focus should be on using a balanced

approach, and that can be achieved following Canadas Food Guide, Rana says. And if a per-son has diabetes, its imperative that they talk to their physician or a nutritionist to chalk out a plan thats best for them based on their target blood sugar levels.

TOOL: DASH Diet app ($1.99). Originally designed to help lower blood pressure lev-els, the DASH (Dietary Approaches to Stop Hypertension) eating plan is a favourite among health experts for its rock-solid nutritional prin-ciples and simplicity. This app gives you more than 100 DASH-approved recipes that help you stick with the plan.


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FOR: SEE YOUR:

Regular health checkups and basic diabetes and heart disease care,

including glucose, cholesterol and blood pressure monitoring

Primary care physician

Specialized treatment for cardiovascular disease, the number-one

cause of death in patients with diabetes

Cardiologist

Specialized help with diabetes complications or managing advanced

disease

Endocrinologist

An annual eye exam to detect and prevent diabetic eye disease Ophthalmologist/Optometrist

Problems with kidney function that can lead to kidney disease and

dialysis

Nephrologist

Diabetic nerve pain and advanced treatment Neurologist

Problems related to neuropathy or general foot physicals to keep

feet healthy

Podiatrist

Depression and anxiety related to diabetes and heart disease Psychologist/Psychiatrist

A Team ApproachIt takes a team to manage serious conditions like diabetes and heart disease. Here are some of the key members you should consider adding to your roster.

GOALGOALGOALManage Manage Manage

your glucose your glucose your glucose levellevellevel

GOALGOALGOALKeep your Keep your Keep your

blood blood blood pressure pressure pressure

downdowndown

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TOOL: GluCoMo ($.99) tracks blood sugar levels, diet, and insulin intake, and can send the data to your healthcare providers to seek their feedback.

While diet and exer-cise go a long way toward managing blood pressure, many people also need medication.

Adopting a healthier lifestyle is

always the fi rst approach to reducing blood pres-sure. But if we see that it isnt helping and that blood pressure isnt being controlled, then we have to move on to medication, Rana says.

Blood pressure medications such as ACE inhibitors or ARBs can work to prevent blood vessels from narrowing, keeping them relaxed so that blood fl ows freely. The goal for healthy blood pressure is less than 130/80 mm Hg.

TOOL: Withings Blood Pressure Monitor ($130). You should have your blood pressure level checked at regular physician visits, but this device can keep track of it daily at home or on the go. Just plug it into your smartphone or computer

As people with dia-betes know, a high blood sugar level isnt the only problem they need to watch out for. Hypoglycemia is another.

You dont want your blood sugar to dip very low. If your blood glucose goes too low, youll get an allergic response, your heart rate would go up and you would have an increase in cardiac output, so we have to be particularly vigilant, says Aruni Bhatnagar, PhD, a cardiovascular researcher, a professor and an author. He notes studies that show intensive control of blood sugar can decrease the microvascular complications associated with diabetes, such as kidney and eye diseases and neuropathy (diabetic foot disease).

Generally, the Canadian Diabetes Association says, adults with diabetes should strive for daily fasting glucose levels of 4.0 to 7.0 mmol/L before meals and 5.0 to 10.0 two hours after eating.


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TOOL: Nike+ FuelBand ($149). This activity bracelet lets you easily track how active you are throughout the day and engage in friendly com-petition with your friends.

Ive given these to several people, and its actu-ally very useful, Bhatnagar says. You set your targets and if you dont have enough steps or activ-ity, you can do extra things to meet the goal.

GOALGOALGOALLower your Lower your Lower your cholesterol cholesterol cholesterol

levellevellevel

GOALGOALGOALMake fi tness Make fi tness Make fi tness a prioritya prioritya priority

W I N T E R 2 0 1 3 17

and strap on the cuff. From here you can record and track your readings over time, and even email data to your doctor.

Reducing blood cho-lesterol levels is an important goal for everyone, but espe-cially so when it comes to diabetes, Bhatnagar says.

For people with diabetes, its recommended that we treat high cholesterol more aggressively than you would treat it in non-diabetics. It takes a multi-facto-rial interventionmedication, exercise and diet, smoking cessation, and sometimes even vitamin and mineral supplementation, he says.

TOOL: MediSafe Virtual Pillbox app (free). This app helps you remember to take your pills, and it means business. In fact, if you dont con-fi rm that youve taken your meds, the app can be set to notify a relative or a caregiver as needed.

A combination of aerobic exercise and strength training for at least 30 minutes a day, fi ve days or more each week, is recom-mended as part of any diabetes management

plan. But those on insulin should seek expert guidance in developing a workout regimen.

Exercise has an insulin-like effect, so your blood sugar can drop dramatically, Brill says. Those who are insulin-dependent need to work with a health professional to prevent situations where their blood sugar drops too low.


An Inside LookIn February 2012, St. Josephs Hospital became home to Canadas first whole-body PET/MRI scannerthe most exciting and talked about development in imaging. Now, London area patients are reaping its benefits as it is used to diagnose and treat inflammatory diseases of the heart.Sarcoidosis is associated with inflammation of a number of organs, most importantly the heart and lungs, explains cardiologist Dr. Gerry Wisenberg, a researcher at Lawson Health Research Institute. One of the most important factors influencing the treat-ment of sarcoidosis is determining whether inflamma-tion is present, its extent, and whether scar formation has already occurred in the heart. The PET/MRI enables Dr. Wisenberg to gather information about these two processes at the same time and image their spatial relationships to each other. Using this informa-tion, he can guide therapy to decrease inflammation, reducing the possibility of scar tissue.

ONLINE Discover More

For more information on the advantages and potential uses of the PET/MRI in the diagnosis and treatment of patients at

St. Josephs Hospital, visit Lawson Health Research Institute at lawsonimaging.ca/imaging/node/71 .


More than

2.7 MILLION Canadians suffer from migraine headaches, Statistics Canada reports, many caused by vascular changes and muscle tension related to stress.

Men and women with

type-A personalities have double the risk of stroke than less-stressed people, according to a study in the U.K.-based Journal of Neurology, Neurosurgery & Psychiatry.

The Womens Health

Study found that

women with high stress at work had nearly double the risk of a heart attack compared with

women with lower

job-related stress.

Crave sugar and fat when

youre stressed?While stress can shut down

your short-term appetite, over the long term, your bodys

stress hormone, cortisol, increases appetiteand your

motivation to eat.

H eartburn. Headaches. Insomnia. Breakouts. You know the signs of stress. And the Canadian Mental Health Association and the Heart and Stroke Foundation have a few to add to the list: high blood pressure, anxiety, depression, diabetes and obesity.

Heres the frustrating part: Though you may know whats causing your stress, you probably cant eliminate the sources of itafter all, you cant just up and quit your job, leave your spouse and ignore your kids.

But heres what you can do: You can recognize that prolonged exposure to stress wreaks havoc on your health. You can understand its effects. And you can create a plan to cope.

Here are a few things to know about the impact of stress on your bodyfrom head to toe.

StressIS IT THE

WHAT ANXIETY COULD BE DOING TO YOUAND WHAT YOU CAN DO ABOUT IT | BY BART BUTLER

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The Womens Health

Study found that

women with high stress at work had nearly double the risk of a heart attack compared with

women with lower

job-related stress.

Chronic stress can suppress

body systems that arent

needed for immediate

survival. For example,

the digestive system may

not work normally,

possibly contributing

to heartburn

and even ulcers.

For people with arthritis, stress may worsen the pain. Some

research shows that

arthritis and rheumatism are more prevalent

in people who recently

experienced a stressful life event

(job loss, divorce) than in the general population.

Source: Statistics Canada

Stress is highest among Canadians ages

35 to 54.

23.6 per cent of Canadians age 15 and

older say that most days are extremely or

quite a bit stressful.

Common stressors were: Work

Finances Not enough time

Family

In studies, stress is associated with female reproductive failures. And psychological factors, including

stress, can lead to sexual performance problems for men.

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FdVVWI1300CND_18-19_Stress_Info_v2.indd 19 8/13/13 8:44 AM

QUIZ

Test Your Stress Smarts

The more you know about stress, the better equipped you are to fight back. Take

the Canadian Mental Health Associations Whats Your

Stress Index? quiz. Start by visiting cmha.ca/mental-

health/your-mental-health, then click Stress and

scroll down to find the quiz.

Hair Holds SecretsYour hair can say a lot about your

personality, but did you know it

can also reveal how much stress

youve been under? Dr. Stan Van

Uum, an endocrinologist at St.

Josephs Hospital in London,

and colleague Dr. Gideon Koren

developed a method to measure

cortisol levels in hair to provide an

accurate assessment of stress lev-

els in the months prior to an acute

event such as a heart attack.

Cortisol is a hormone released

into the blood by the adrenal

glands during moments of high

stress, explains Dr. Van Uum. Hair

follicles are exposed to whatever

circulates in the bloodstream, so

more cortisol in the blood means

more ends up in the hair.

Stress has long been linked to

an increased risk of heart attack.

By analyzing a strand of hair, we

can look back in time before the

heart attack to determine stress

levels, says Dr. Van Uum. One

strand of hair five inches long can

give us a year of information.

The findings are important in

seeing how preventive programs

for stress can help decrease the

risk for heart attack.


GreensThe

Wonderful World of

By Colleen RinGeR

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GreensGobble up these 6 good-for-you veggies BY COLLEEN RINGER

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What if you could fi ll your plate to overfl owingeven go back for secondsand be healthier? Well, you can! Grab the nearest green vegetable and start noshing.Leafy greens in particular are exceptionally nutritious and offer a number of health benefi ts, says Leslie Beck, a registered dietitian based in Toronto and the author of The Plant-Based Power Diet.

That means that when it comes to your greens, theres

no such thing as too much. These six superstars can do everything from reduce your risk of cancer to boost your bone health. And, to misquote Lucy Ricardos immortal Vitameatavegamin commercial, Theyre so tasty, too!

KaleWhy its good for you: Kale is the king of superfoods. When it comes to vitamin K, kale beats out all other leafy greens, Beck says. In fact, one serving of raw kale gives you 525 per cent of your daily dose of vitamin K, which is great for bone health. Its also a good source of calcium, folate and potassium.

What it tastes like: Expect it to be deep, earthy and slightly bitter, although the smaller leaves can be milder.

How to eat it: Use it in place of your usual go-to leafy green (such as romaine or spinach). Put it in salads, on burgers or in an omelet. Feeling adventurous? Bake it to make kale chips.

Why theyre good for you: The long maligned martyr of the produce aisle, Brussels sprouts offer all the benefi ts a good cruciferous veggie should: anti-oxidants, vitamin C, folate and more. Theyll last up to one week when stored in the refrigerator.

What they taste like: Think of them as mini cabbages.

How to eat them: If you think you know Brussels sprouts, think again: Drizzle with olive oil and rice vinegar, then sprinkle with Parmesan cheese. Roast in the oven at 400 F (205 C) for 30 minutes. Youll discover a whole new delicious side of these small green globes.

Brussels Sprouts

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Why its good for you: Swiss chard gives you a lot of bang for your calorie buckjust 15 calories in two cups. Plus, it provides a boost of fi bre, magnesium, and vitamins A and K. Like all greens, it is a heart-healthy addition to your diet.

What it tastes like: Do you like beets? Then youll like Swiss chard. But remem-ber, the taste is all about how you pre-pare the veggie and what you combine it with, Beck says.

How to eat it: After sauting it, add apples or dried cherries for a sweet and sour mixture. And, as with other leafy greens, you can add it to salads or sand-wiches, or even mix it into a smoothie or a soup.

Swiss Chard


Nutrition Know-how

Visit EatRight Ontario and browse a list of nutrition topics,

menu plan or track nutritional goals. You can also call or email

to contact a dietitian at no cost. 1 877 510-5102 ;

eatright ontario.ca .

CALL

St. Josephs Serves Up GreensSpinach with its dark green leaves is often considered the worlds healthi-

est vegetable. It contains significant amounts of vitamins C and K, fibre,

folate and carotenoids, explains dietitian Susan Greig, professional practice

leader at St. Josephs Health Care London.

Raw spinach has a mild flavour that is delicious on its own or blended

with other leaf vegetables to create a salad. When cooked, spinach often

has a bitter taste that can be easily overcome with seasonings such as

lemon juice or garlic, by incorporating it into soups and pasta dishes, or

marrying it with cheese, Greig suggests.

Patients and residents at St. Josephs enjoy a large variety of veg-

etables, she says. Green vegetables, including brussels sprouts, broccoli,

asparagus and spinach, are on the regular menu every day.


AsparagusWhy its good for you: Is your diet high in sodium? The potas-sium in asparagus can counteract sodiums negative effect on your blood pressure. Hoping to get pregnant? Asparaguss folic acid can prevent birth defects.

What it tastes like: It has a mellow fl avour, and is a bit earthy, Beck says.

How to eat it: Serve steamed, sauted, roasted or grilled as a side dish. I like to roast them because it changes the taste profi le, and you dont lose any nutrients to water as with boil-ing, Beck says. To keep asparagus fresh for as long as possible, store standing up in the fridge in a small dish of water.

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CollardsWhy theyre good for you: Collards offer similar vitamins and nutrients as kale, mak-ing them good for your bones (calcium) and your skin and eyes (vitamin A).

What they taste like: Think about biting into a strong cabbage leaf.

How to eat them: Trim the ribs and use the wide, sturdy leaves in place of tortillas or bread for a healthy wrap. If the taste is too biting for you, cook them to mellow the fl a-vour. Saut the leaves with olive oil and gar-lic, and then sprinkle with Parmesan cheese.

BroccoliWhy its good for you: A cousin to cabbage, broccoli is a cruciferous vegetable that is packed with vitamin C, calcium, fi bre and phytochemicals, which may reduce the risk of cancer.

What it tastes like: You may pick up on a hint of cabbage, but its fairly mild and there are many ways to prepare it.

How to eat it: Raw is best since cooking damages some of its cancer-fi ghting com-pounds. Not a fan of raw broccoli? Toss it into stir-fries and omelets, or top your pizza or baked potato with it.


BY ELLEN OLSON

Knee-B A S I C S

BY ELLEN OLSONBY ELLEN OLSON

W I N T E R 2 0 1 3 25

Your overall mobility

hinges on this joint. Heres

how to keep it well oiled

We run. We jump. We cli

mb stairs. Sometimes we (

well,

some of us) compete in m

arathons or climb mounta

ins.

Throughout our lives, ou

r knees take a beating. S

o its

no wonder that a good bit

of pain is associated with

this

important joint. But just h

ow important is it?

to-Know

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Coupe recommends following the RICE steps to ease the pain: rest, ice, compression, elevation.

People are often tempted to put heat on pain, but that could actually make it worse. Ice will reduce the swelling and numb the pain, Coupe says. And most importantly, rest! Get off your feet for a bit.

Arthritis Most common in older people, arthritis of the knee is a result of damaged cartilage. The cartilage is there to protect the kneelike a cushiony layer of insula-tion, DiNubile says. When its healthy, the bone can slide across the cushion like ice on ice.

But when that cartilage becomes damaged, problems ensuenamely, arthritis. In the early stages, arthritis is treated with non-sur-gical methods, like lifestyle changes, medica-tion and supportive devices. If the arthritis progresses, your doctor may recommend a bit of excavating through arthroscopic sur-gery or a partial or total knee replacement.

Ligament tears If youre a sports fan, youve probably heard the term torn ACL. Its a common injury in athletes, especially among women. ACL stands for anterior cru-ciate ligament, and actions like twisting your knee with the foot planted, getting hit on the knee and stopping suddenly when run-ning can tear it. The ACL is the best-known ligament, but it isnt alone in being at risk. Your knee is made up of four ligaments, all of which can be torn. Depending on the sever-ity of the tear, surgery may be needed.

What Lies BeneathUnderstanding the construction of the knee can be tricky. Most of us are only aware of the visible kneecap, but theres much more to this joint, says Dr. Nicholas DiNubile, an ortho-pedic surgeon and the author of FrameWork for the Knee: A 6-Step Plan for Preventing Injury and Ending Pain.

The main structural elements are bones, tendons and ligaments. Think of those like the walls, floor and roof of your house, he says.

Heres how its laid out: The knee joins the thighbone (femur) to the shinbone (tibia). The smaller bone (fibula) that runs alongside the tibia and the kneecap (patella) round out the bone structure of the knee. Tendons con-nect the knee bones to the leg muscles that move the joint, and ligaments join the knee bones and provide stability to the knee. All these elements work together to help you twist, turn, walk, run and jump.

CraCks in the FoundationEven the best feats of engineering are sus-ceptible to a few structural weaknesses, and the knee is no exception. The three main structural weaknesses that eventually may call for repair:

Overuse and inflammatory injuries These are the types of problems we see in runners, gardeners and other people who simply use their knees a lot, Coupe says. Overuse can result in tendinitis or swollen ligaments, which is painful, but not overly detrimental.

The knee is a hinge joint that essentially allows us to move. Without it, we would be immobile, says Dr. Kevin J. Coupe, an orthopedic surgeon in sports medicine.Makes you want to sit down for a minute, doesnt it? Heres how to prevent or treat knee pain and injury, and keep

this marvel of design healthy and hinged for years to come.

W i n t e r 2 0 1 326


Fixer-UppersMuch like your house, your body will hold up a bit better if you perform basic upkeep.

Its always better to prevent injury than treat it, DiNubile says. He offers these tips:

1Keep a healthy weight.Have you ever loaded your car with heavy objects or multiple people and noticed that the ride wasnt quite as smooth? The same holds true for your knees. When you are overweight, youre putting an extra burden on the knees cartilage, which can cause it to wear down more quickly.

2 perform a balanced, regular exercise routine. If you only work out the first week of January, youre not doing yourselfor your kneesany favours.

The knees are meant to be moved, DiNubile says. Plus, strong leg muscles help take the strain off of the knee.

3experiencing knee pain? Get it checked. By ignoring it, youre almost asking for it to worsen. If you notice persistent pain, dont brush it offtalk to your doctor.

With all the treatment options available today, theres no reason why you should have to suffer, DiNubile says.

W i n t e r 2 0 1 3 27


ON

LIN

E

Learn MoreEach year, the Rheumatology Centre of St. Josephs

Health Care London sees more than 10,000 patients requiring diagnosis and specialized treatment for

a multitude of rheumatologic disorders. For infor-mation on the centres leading-edge care, visit

sjhc.london.on.ca/rheumatology.

WHAT YOU KNEE TO KNOW

With no easy answers when it comes to osteoarthritis of the knee, St. Josephs Hospital in

London has undertaken innovative

studies to determine the best treat-

ment approach.

Osteoarthritis, the most com-

mon form of knee arthritis, causes

the joint cartilage to gradually

wear away. Proven treatments,

says St. Josephs rheumatologist

Dr. Janet Pope, include nonsteroidal

anti-inflammatory drugs (NSAIDS),

physiotherapy for strengthen-

ing the quadriceps, taping of

the knee, weight loss, exercise,

orthotics, and injections with intra-

articular steroids.

Glucosamine, thought to pro-

mote formation of cartilage, and

chondroitin, thought to prevent

cartilage breakdown, have been

widely promoted as treatment

but that verdict is still out, says

Dr. Pope. Herbal treatments are

also unproven.

Studies done at St. Josephs

compared the benefits of a NSAID

to a placebo and glucosamine to a

placebo. These studies are novel

in design to determine who really

needs their current medication

so that, long term, only those still

benefitting are receiving it, explains

Dr. Pope.


When Matt Damon went smoke-free, his motivation came from the heart. See how you can discover your inner quitter and breathe free

Bourneto

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Quitting: a Team SportNo question, cigarettes are poison. But even when you know how deadly they are, it takes practical strategies and support to turn the desire to quit into a smoke-free life.

The physical dependence on nicotine is one of the most diffi cult things for people to overcome, says Tracy Fehr, tobacco issues spokesperson for the Canadian Lung Association. Its also the behavioural, psychological conditioning thats happened over time.

Since the majority of smokers are both physically and psychologically addicted to cigarettes, the best chance of success comes through a combination of medication and counselling. These address both physical cravings and psychological urges to smoke.

Smoking cessation counselling can prepare you with a personalized strategy. You can talk to your doctor, attend a hospital support group, or get online or phone support.

To help with physical cravings, nicotine replace-ment is available in patches, gum, lozenges, inhalers or nasal sprays. Prescription medication to ease with-drawal symptoms can be used instead of or in addition to nicotine replacement.

Get O to a Good StartTo get started, fi rst set a quit date; then tell your friends and family that youre quitting. Theyll be important sources of support as you embark on your journey to being smoke-free. Be sure you trash all of your cigarettesand

Blame It on LoveAug. 5, 2004, was a life-changing day for Damonthe day he became a non-smoker and put 17 years of pack-and-a-half days behind him.

Rewind a year or so: This story begins, as many good stories do, with a boy-meets-girl epiphany. When Damon met his wife, Luciana Barroso, in Miami in 2003, there was a halo of light around her, and I absolutely knew that moment had changed my life before I even spoke to her, he told Macleans in a 2011 interview.

The desire to have children with Barroso became part of his motivation to quit smoking.

I remember my brother gave up [smoking] before he had kids, Damon told The Observer in April 2013. He said, Im going to give myself six months or a year to clear out my system. I remember thinking, Yeah, Ill do that, too.

Damons motivation was sound: In addition to the better-known health risks of smoking, men who smoke cigarettes have a lower sperm count and increased abnor-malities in sperm shape and function, according to the American Society for Reproductive Medicine.

In a July 2004 interview with the Washington Post, just a month before he quit, Damon was already refl ecting on the toxins in cigarettes. He had switched to a more natu-ral brand, he said. Its amazing. You know, its about 350 additives your average cigarette has, from arsenic, from cyanide to ammonia.

Theres a down-to-earth charm about Matt Damon.Maybe its his earnest gaze when he talks about clean water

issues or the fl ash of dimples as he blazes forth with that daz-zling grin. He just comes o as a likeable guy.

Whether playing things bald and bionic in Elysium, bad to the bone in the Bourne trilogy or scrappy and brilliant in his breakout role in Good Will Hunting, the actor himself seems like someone youd enjoy hanging out with over a beer.

But not a cigarette. Those days are behind him.


Up in Smoke: Whats Really in a Burning Cigarette?A lit cigarette produces more than

4,000 chemicals. Many are poison-

ous, and at least 50 are known

to cause cancer. Here are some

examples of the chemicals in ciga-

rette smoke:

Carbon monoxide (found in car exhaust)

Arsenic (used in rat poison) Ammonia (found in

window cleaner)

Acetone (found in nail polish remover)

Hydrogen cyanide (gas chamber poison)

Naphthalene (found in mothballs)

Sulfur compounds (found in matches)

Lead Volatile alcohol Formaldehyde (used as

embalming fluid)

Butane (lighter fluid)These chemicals mix together

when you smoke, forming a sticky

tar that clings to clothing, skin and

the hair-like cilia that line the lungs

and act as filter for dirt and germs.

When tar impairs the function of

the cilia, the lungs are more vulner-

able to infection.

Source: Canadian Lung Association

Source: American Lung AssociationW i n t e r 2 0 1 3 31


Source: smokefree.gov

W i n t e r 2 0 1 332


Achieving a Smoke-free HospitalTo promote a healthy community,

St. Josephs Health Care London is

taking the next steps in becoming a

smoke-free hospital organizationone

site at a time. The Southwest Centre

for Forensic Mental Health Care was

the first site to go smoke-free and

St. Josephs Hospital will follow by

year-end. A smoke-free policy has

been developed and staff and patients

alike are being encouraged, and

helped, to quit the habit.

As health care providers, we

know the toll smoking and second-

hand smoke have on people and

the cost to our health system, says

St. Josephs president and CEO

Dr. Gillian Kernaghan. Its now time

to go further in our commitment

to a smoke-free environment for

patients, staff, volunteers and visitors

using various strategies to address

this important issue.

At St. Josephs, a smoke-free

hospital task team is at work using

approaches that have been successful

at other organizations.

CA

LL

Access HelpYou may wish to speak with your health care

team, or call the Smokers Helpline to start or maintain a plan for stopping smoking for

good. Quitting smoking is the best thing you can do for your healthit is never too late to

quit. Smokers Helpline: 1 877 513-5333 ; smokershelpline.ca/.


For a successful START to your new smoke-free life:

Anticipate and plan for the challenges youll face.

Remove cigarettes from your home, car and work.

Talk to your doctor about getting help to quit.S T A RSet a quit date. T Tell family, friends and colleaguesyoure quitting.

dont forget the packs you have stashed in your drawer at work or in your glove compartment.

The insomnia, irritability and anxiety that can strike as nicotine dependence wanes tend to be most intense in the fi rst couple of weeks. Where most people fl ounder is once theyre past that and trying to get through day-to-day coping, Fehr says.

When you think about situations that might trigger the urge to smoke, remember that both a diffi cult or a happy situation can be a trigger, Fehr says. One fellow I talked to recently had quit smoking for six months and then he won $1,000 and asked the woman next to him for a smoke.

Claim a New IdentityThe majority of smokers want to quit, and many have tried before. Only a third of ex-smokers were successful on their fi rst quit attempt, according to a report by the Canadian Lung Association.

We really stress visualizing yourself as a non-smoker, says Marianne Popovacki, a tobacco cessation specialist with the Canadian Cancer Society Smokers Helpline. Instead of labelling a past attempt a failure, its truly a learning experience that can strengthen you for the next time youre attempting to quit. You can identify what worked for you in the past and build on that.

When asked by The Observer earlier this year how his life had changed since Good Will Hunting made him famous 15 years ago, Damon came up with one big dif-ference: He doesnt smoke anymore. Quitting is a whole new lifestyle change, Popovacki agrees.

In transforming from eager aspiring actor to satisfi ed family man, his priorities and identity changed. Ben [Affl eck] and I started [smoking] when we were in high school, Damon said. Wed see the great actorsBrando, James Dean, Mickey Rourke, who we loved back thensmoking, and we just thought it was cool.

A healthy lifestyle became a priority for Damon as he got older, got married and became a father. (He and Barroso now have four daughters.) When asked in 2011 how turning 40 had felt, Damon said, Actually, it felt really good. I felt lucky to have the family that I have and the wife that I have, and the job that I have, and I just kind of found myself wanting health and more of the same.

Finding Your Motivation As with any big change, motivation is key. Its very good to build a strong case for yourself about why you want to quit, Popovacki says. You can bring those reasons back to the forefront of your mind and thats what can keep you from giving in to that cigarette.

Beyond better health for you and your family, the money you save by not buying cigarettes can be another motivat-ing factor. You can put the money toward a weekly mas-sage, add it to your college or retirement savings, or donate it to a cause you care about. In fact, while saving your own life you could contribute to saving another persons.

Damon became passionate about public health issues while travelling in Africa. I co-founded water.org, which focuses on water and sanitation. I was in Ethiopia, and I watched children taking fi lthy water out of a hand-dug well and putting it in bottles to take to school. The water was so dirty, it looked like chocolate milk, he told Parade magazine in 2009. Parents in these impoverished areas lose children every year to diseases that could be com-pletely prevented if they had access to clean water.

Just $25 will give someone clean water for life, Damon said.

In the 2011 movie We Bought a Zoo, Damons character is giving his son advice on talking to a girl. He tells him, Sometimes all you need is 20 seconds of insane courage. And I promise you, something great will come of it.

To quit smoking, all you have to do is get through the next 20 seconds without a cigarette. Then do it again.

33W I N T E R 2 0 1 3


for Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Yourfor Your

W I N T E R 2 0 1 334

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FdVVWI1300CND_34-37_Cancer_v3.indd 34 10/4/13 3:52 PM

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W I N T E R 2 0 1 3 35

When 34-year-old Monika Carlson got the news that an inoperable tumour was growing in her brain, she asked her doctor an unusual question.

Can I run a marathon?She successfully had run 18 marathons, including two that

year, even as her cancer grew, and she was training for another.He looked at me like I was crazy, she says with a laugh.Carlson had surgery and wasnt allowed to run for 30 days. Six

months later, 11 days after a potent dose of chemotherapy, Carlson crossed the fi nish line at the LA Marathon in a Wonder Woman costume and T-shirt that read Powered by Chemo. A friend ran beside her in a Supergirl costume with the message Impossible Things Happen Every Day.

Carlson has learned what studies now show: Exercise is safe for most cancer patients, and more than that, it fi ghts fatigue, nausea, depression and possibly the disease itself.

Its safe to say the evidence is growing, says John M. Saxton, a clinical exercise scientist and the author of Exercise and Cancer Survivorship. Theres a large volume of research now to show that exercise is benefi cial not only for cancer patients but for helping to prevent certain cancers.

Even better news is that you dont have to be Wonder Woman or run marathons. Just 150 minutes of moderate exerciseor 75 minutes of vigorous activityand two days of strength training per week will do. If you or someone you love has cancer, consider these fi ve powerful reasons to get moving. >

It may be the last thing on your mind after a cancer diagnosis, but exercise can ease treatment side e ects, boost strength and even fi ght the disease itself

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Working Out SafelyIf you have cancer, chances are your health has risen to the top of your priority

list. In some ways, its the perfect time to start a workout regimen, says Nancy S.

Brennan, author of Active Against Cancer: A Guide to Improving Your Cancer Recovery

with Exercise.

But first, consider these five precautions.

1. Dont push it. If you werent active in the past, start slowly. And if you

were very active, scale back. Even marathon runner Monika Carlson, who is bat-

tling a brain tumour, takes a walk break every mile.

2. Listen to your body. When youre in cancer treatment, your goal is to

recover your health, not to train for an event and stay super fit, Brennan says.

If you need a day to rest, take it.

3. Prevent injuries. Some treatments cause numbness in the hands and

feet, or alter your sense of balance. Holding the rails of a treadmill or using a

stationary bike might be safer than running on uneven streets.

4. Avoid risks. If your red blood cell count is low, your doctor might ask

you to delay activity. Also, people with compromised immune systems should

wear masks outdoors, and those with catheters should avoid pools and lakes.

Radiation patients should stay away from chlorine, and those with ports should

avoid upper-arm strength training.

5. Talk to your doctor. No one knows your health status better than your

oncologist. Be sure to discuss an exercise plan before you begin.

W I N T E R 2 0 1 336

your life. Thats what happened to Carlson when she learned her head-aches werent the result of work stress or a neck injury, as doctors initially thought.

They were signs that cancer had grown like a tangled weed in her brainstem.

Carlson is a passionate market-ing professional, runner and board member of the Girls on the Run charity in San Diego. After her diag-nosis in September 2012, life became a funnel cloud of surgery, radiation and chemotherapy.

Carlson took her dog for long walks after surgery, and when she felt well enough a month later, she started running again. It makes me feel that Im taking charge.

Running was part of my routine, and being able to get back to that routine helps me feel more normal, she adds. I ran marathons every year, my friends are all runners, and being able to maintain that helped me feel like myself.

Exercise is a powerful way to gain control over your body, self-image and daily routine, says

Nancy S. Brennan, a survivor and the author of Active Against Cancer: A Guide to Improving Your Cancer Recovery with Exercise. The cross-country skier took 20-minute

walks and swims during treat-ment for ovarian cancer in 2007.All my best memories from

treatment are when I was exercis-ing, taking a walk or a short swim. It felt like the most normal thing I did compared to putting chemi-cals in my chest and [experi-

encing] the ridiculous side effects, says Brennan, who has been in good health since treatment. Having

your identity taken away as a healthy person is rugged, and for a few minutes you can feel

like a healthy person again.

once sent patients to bed to pre-serve their strength, but now Saxton reports they are urging people to throw off the covers and work out.

The message is getting out, he says. Its slow moving, but more and more modern medics are becoming aware of the potential benefi ts. The medics I work with are all keen on promoting exercise with patients.

Your type of cancer, treatment and level of activity before diagnosis will decide how much you can do, so talk with your oncologist about a safe plan. It might range from stretching in bed and walking around the block to yoga and competing in a race.

Show em Whos BossCancer has a way of taking over

Fight That Bad BoyThe number-one goal for anyone with cancer is to beat it. In the battle for your life, exercise is your ally.

First, physical activity keeps off unnecessary weight, builds muscle, improves bone density, boosts cardio health and acts as an anti-infl amma-tory. This creates the ideal environ-ment for cells to fi ght disease.

Second, mounting research sug-gests that exercise helps fi ght breast, prostate, colorectal and ovarian can-cers. Some studies have found that people who exercise are more likely to complete treatment and survive and less likely to see their cancer return, Saxton says.

This marks a major shift in con-ventional cancer wisdom. Doctors

FdVVWI1300CND_34-37_Cancer_v3.indd 36 8/6/13 8:35 AM

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W I N T E R 2 0 1 3 37

Beat the BlahsFatigue is a major problem for peo-ple going through radiation and chemotherapy. The solution is coun-terintuitive but true: Activity can help with fatigue.

Staying active was Carlsons secret weapon against radiation fatigue. She says it gave her the energy to keep up her daily activities.

Some people feel fi ne, some sleep for 18 hours a day, some people end up going on disability, Carlson says of radiation effects. I started walk-ing three times a week, and never got tired enough to miss work.

Her experience isnt unique. A study of breast cancer patients found that women who stayed active dur-ing treatment not only had more energy to fi ght the disease, but they also had more energy one and two years later, Brennan says.

The author experienced the bounce back effect fi rst-hand.

I bounced back after chemo pretty fast. I personally think a daily menu of light exercise has a lot to do with helping the body heal, she says. A little bit goes a long way.

Tame Your TummyAnother unpleasant side effect of treatment is nausea, and managing it will help keep your strengthand spiritsup. Exercise can help with this, too.

Brennan had a queasy stomach after every round of chemo. The only

thing that helped was taking a walk.That alone can be an enormous

benefi t for people in treatment, she adds.

While researching her book, she found that exercise also aids in digestion and helps you make better choices about what to eat. That adds up to a more settled stomach.

Seize the DayCarlson is the most positive person with an incurable brain tumour you will meet. Her hope is to keep the tumour from growing so that she can live as long as possiblespend time with her new husband, enjoy friends and family, and yes, run another marathon or 20.

I kind of feel like its a choice you have to make, she explains. You can choose to think about the what ifs, or you can focus on today. Focusing on today is what has helped me. I feel mostly fi ne. Im more fi t than the average person. Im not in a hospital bed yet. Why worry about that happening?

Thanks to endorphinsthose brain chemicals that trigger pleasant feelingsexercise is a natural mood booster and stress reliever. When youre fi ghting for your health, you need both.

Youre ruining today by worry-ing about tomorrow. I feel like Im living the reverse of that, Carlson says. I think continuing to run has been a huge help emotionally for me as Ive gone through all of this.

Monika Carlson (right) and her glam-runner.com partner Taramae Baize finishing the LA Marathon.

FdVVWI1300CND_34-37_Cancer_v3.indd 37 8/13/13 9:08 AM

Fun Fitness for Breast HealthImprove your health and the health of

others by taking part in Bust a Move for

Breast HealthTM , a national fundraising ini-

tiative returning to London this spring.

For a second year, hundreds of women

and men will gather at the London

Convention Centre on March 29, 2014,

for six hours of fun group fitness led by

industry experts. With dance-worthy

beats, healthy snacks, crazy costumes and

a special celebrity guest, this is one event

you wont want to miss.

Proceeds from the event will support

the Breast Care Centre at St. Josephs

Hospital in London, which brings together

breast imaging, assessment, surgery ser-

vices and an interdisciplinary care team in

one specially designed location.

Join the movement today and support

those in the community facing medical

challenges like breast cancer.

online

Register for 2014Bust a Move for Breast Health is hosted by St. Josephs Health Care

Foundation. Last year, the event raised more than $1 million for St. Josephs Breast Care Centre. Visit bustamove.ca for details

on how to register for 2014, support a friend or make a donation.


CircleCircle BY STEPHANIE R. CONNER

Meet the fi ve people most likely to infl uence your healthand learn how you can make these relationships the healthiest they can be

FdVVWI1300CND_38-41_FivePeople.indd 38 8/6/13 8:35 AM

CircleCircleYOUR SPOUSE Dr. Linda Waite, author of The Case for Marriage: Why Married People Are Happier,

Healthier, and Better Off Financially, has studied the effect of marriage on health and found that married people tend to be healthier than unmarried people.

Research suggests that both women and men see improvements in their health when they get marri

vim & vigour winter 2013

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