Sinai Health Spring/Summer 2018

Sinai Health A P U B L I C A T I O N O F S I NA I H EA L T H F O U N DA T I O N

heart

SPRING/ SUMMER 2018

the

of Sinai Health The MILES NADAL H EART CE NTRE is just one shining example of how we put the needs of our patients and families first.

Kyla, patient.

Contents

Sinai Health S P R I N G / S U M M E R 2018

page 4 ������������SHS News

page 10 ����������Discovery Corner

page 8-9, 42 ����Your Health

page 37 ����������Community Corner

Chief Executive Officer Louis de Melo Editor-in-Chief Lindsey Hodgson

page 12 ���������� T H I S I S S U E : The heart of Sinai Health The needs of our patients and their families are at the very heart of what we do at Sinai Health.

Editor Jane Rimmer Art Director Cecilia Mok

the “strong and silent” stigma 22 Fighting Perinatal depression can strike all parents. Sinai Health is leading the way

Contributors Eden Biggin Janessa Bishop Nancy Carr Marcia Kaye John Packman Heidi Singer Annie Tong Mark Witten

in helping fathers cope.

treatment for 26 Tailoring autoimmune disease

14

A heartfelt gift

With the establishment of the Miles Nadal Heart Centre, the unique and specialized cardiac care programs at Sinai Health are poised to go Mount Sinai Hospital, Joseph & Wolf Lebovic from strength to strength.

ENVIRONMENTAL ATTRIBUTES AND C

Autoimmune conditions affect women disproportionately and often run in families, but new research is providing insights into treatment and even potential prevention.

Health Complex

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story: the 30 Jordy’s challenge of infertility

CHARITABLE REGISTRATION #119048106 RR0001

When problems with conception strike, one in ten cases can be traced to male infertility. At Sinai Health, innovative treatments and novel research are changing the landscape in this area of care.

   

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menopause 33 Managing Sinai Health’s groundbreaking Mature Women’s Health Program is

shattering myths and supporting women who are suffering through this normal, but often trying, life event.

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M E S SAG E F RO M O U R CO - C H A I RS

Sinai Health System is a fully-integrated health-care organization that provides excellent care in a wide range of settings — in hospital, at home and in the community. The people we care for, and their families and caregivers, are the common denominator across our entire system.

Their needs are our main focus and are at the heart of everything we do.

So it’s especially fitting that the cover story in this issue of Sinai Health magazine highlights heart care.

You’ll meet Kyla and Sara, whose lives were changed by the unique clinical expertise available at our Miles Nadal Heart Centre. The visionary gift Miles and the Nadal family provided will bolster the incredible work of our extraordinary clinicians — care that impacts thousands of patients every year.

David G. Cynamon

In this issue you’ll also read about some of the most recent insights into autoimmune diseases, such as the role heredity plays, and the impact these illnesses have on women in particular — like sisters Stephanie and Krystal, and cousins Alex and Kara. Sinai Health is also proud to be at the forefront of important advances in male infertility and paternal perinatal depression, areas of care that Jordy, Ira and Asher can attest to. You’ll also find out about the treatment of menopause symptoms women like Vered and Andrea have received from Dr. Wendy Wolfman, who is the inaugural holder of the just-established Carol Mitchell Chair in Mature Women’s Health.

We’ve had several busy and productive months since our new CEO, Louis de Melo, joined Sinai Health Foundation. Together with new leadership at Sinai Health System, we are forging ahead with a strategic plan and vision for the future that will allow Sinai Health Foundation to thrive and continue to support Sinai Health in delivering exceptional care.

Howard Sokolowski, O. Ont.

Our community of supporters has been busy too — participating in an enormous number of events.

More than 350 guests were in attendance on March 28 at Dream with Scientists, an evening of wonder that illustrated that, while the science that happens at the Lunenfeld-Tanenbaum Research Institute often seems magical, it really is science.

Whether it’s a transformative donation, attending an event, a monthly contribution, or a thank-you gift received from a grateful patient, you allow us to continue to put our patients first and strengthen the heart of Sinai Health.

Sincerely,

David G. Cynamon Co-Chair, Board of Directors Sinai Health Foundation

TO SUPPORT SINAI HEALTH SYSTEM, PLEASE VISIT:

supportsinai.ca/sinaihealth

Howard Sokolowski, O. Ont. Co-Chair, Board of Directors Sinai Health Foundation

C ON N ECT

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@sinaihealthsystemto

@TheLouisdeMelo

facebook.com/supportsinai

MyStory@supportsinai.ca

youtube.com/sinaihealthsystemca

3

SHS News SINAI HEALTH AND SICKKIDS LAUNCH ONTARIO FETAL CENTRE

Premier Kathleen Wynne with patients and staff at an event to launch the Centre.

Provincial funding has been awarded to Sinai Health System, in partnership with The Hospital for Sick Children (SickKids), to launch the Ontario Fetal Centre. The centre will further enhance the successful partnership between these institutions which together perform more than 100 in utero fetal surgeries and procedures each year. In 2017, combined clinical teams from both hospitals performed two groundbreaking surgeries: the first Canadian in utero repair of spina bifida and the repair of a specific congenital heart defect in a fetus a few weeks before birth. Based at Mount Sinai Hospital, the Ontario Fetal Centre will be a specialized provincial centre of excellence for fetal care, research and education and is the first of its kind in Canada.

I NAU G U RAL C HA I R S U P P OR T I N G D IA B E T ES RESEARCH MADE PO SSI BL E BY BOE H R I NGE R I NGE L H E I M

Left to right: Uli Broedl, VP, Medical and Regulatory Affairs, Boehringer Ingelheim (Canada) Ltd.; Dr. Bernie Zinman, C.M.; Dr. Ravi Retnakaran; Howard Sokolowski, Co-Chair, Sinai Health Foundation; John Howse, Sinai Health System diabetes patient; Maximilian von Eynatten, Global Head Medical Affairs, Therapeutic Area Metabolism, Boehringer Ingelheim International GmbH.; David Cynamon, Co-Chair, Board of Directors, Sinai Health Foundation; Brent Belzberg, Chair, Sinai Health System.

Dr. Ravi Retnakaran, Endocrinologist at the Leadership Sinai Centre for Diabetes, based at Mount Sinai Hospital, has been appointed the inaugural Boehringer Ingelheim Chair in Beta-Cell Preservation, Function and Regeneration. Dr. Retnakaran is part of a diabetes research team at the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health System, which ranks among the top in the world in diabetes research. The Chair will support ongoing advancements in research and treatment options. “We are honoured to be supporting Sinai Health System in the area of diabetes and provide researchers the opportunity to pursue innovations in this important area that will improve patient care,” said Richard Mole, President and CEO, Boehringer Ingelheim (Canada) Ltd. 4

SCHWART Z/RE IS MA N E M E RGE NCY CE N TR E : OPE N WH I LE UN DE R CONS TR UC TION !

Construction to expand and redesign the Schwartz/Reisman Emergency Centre — which serves close to 60,000 patients a year — began in March. Even though the scaffolding is up and exciting changes are afoot, it’s still open and providing care to patients and their families as usual. For the time being, the east end of the emergency driveway is closed to vehicles, and the west end is restricted to ambulance and police vehicles only. For pedestrians, there are two passenger drop-off spots on University Avenue just north of the emergency driveway, and dedicated entrances on the University Avenue and Murray Street sides of the hospital provide direct access to the department. There is additional access through the main hospital entrance on University Avenue (6 a.m. to 8:30 p.m.) and, after hours, via the Murray Street entrance. Parking is available on Murray Street, opposite the hospital. Not only will this redesign nearly double the size of the department, but the new space will be more senior friendly, increase safety measures, increase infection control and leverage state-of-the-art technology.

GOL D STAN DARD F O R SMART CO M MUT ES

In December 2017, Sinai Health System received the Smart Commute Gold designation for the first time. It was granted by Smart Commute — a Metrolinx program — based on the Green Sinai Health Committee’s active promotion of sustainable commuting options across our hospitals. Only those organizations achieving outstanding results in this area are granted this designation. This accomplishment underscores the organization’s longstanding commitment to green initiatives.

AP P O I N TM E N T S

Jane Merkley (right) — formerly Executive Vice-President, Patient Services and Quality, and Chief Nurse Executive — has taken on an additional role and portfolio: that of Chief Operating Officer, with responsibility for Information Technology and Sinai Health’s Sustainability Program. Ms. Merkley’s more than three decades of experience span clinical, administrative, executive and professional practice roles. She joined Bridgepoint in 2007 and her leadership helped facilitate the successful amalgamation of Bridgepoint into the wider Sinai Health System.

Dr. Miguel Ramalho-Santos (left) has been appointed the Canada 150 Chair in Developmental Epigenetics — one of four Canada 150 Chairs nationally. He is a Harvard-trained researcher newly recruited to the LunenfeldTanenbaum Research Institute. He studies the influence of environmental cues on fetal development and their long-term impacts on adult health. His research holds enormous promise for improving fertility treatments, pregnancy outcomes and women’s and children’s health. He has also been appointed to the University of Toronto’s renowned Department of Molecular Genetics.

Dr. Ian Witterick (right) has been re-appointed Chief, Otolaryngology – Head & Neck Surgery. He is considered to be a pioneer in minimally invasive skull surgery and has been serving as Chief since 2012. Dr. Witterick is currently the Chair of the Medical Advisory Committee (MAC), holds the Alex & Simona Shnaider Research Chair in Thyroid Oncology, and is a Professor and Chair of the Department of Otolaryngology at the University of Toronto.

Dr. Jay Wunder (left) has been re-appointed Surgeon-in-Chief, a role he has held since 2006.

He is a world-renowned leader in the treatment and research of sarcoma. A surgeon, researcher and educator, he has developed new processes, implemented new clinical pathways and transformed how care is delivered to patients. His leadership of our Renew Sinai redevelopment will result in 19 state-of-the-art operating rooms. He is the inaugural holder of the Rubinoff Gross Chair in Orthopaedic Oncology, and the Leadership Sinai Chair in Surgery.

L TRI RE SEARC H E R S R E C E I V E F U N D I NG F O R I NT E RNAT I O NAL WO RK I N EA RL Y C H I L DH OOD D E V E L OP M E NT

Dr. Stephen Lye (pictured) and Dr. Stephen Matthews, researchers at the Lunenfeld-Tanenbaum Research Institute, have been awarded funding through the Healthy Life Trajectories (HeLTI), an initiative of the Canadian Institutes of Health Research. While most beneficiaries of the funding were national in scope, Drs. Lye and Matthews are focused internationally, in conjunction with the World Health Organization. Dr. Matthews will look at India to understand how environmental exposures in the preconception period and pregnancy, infancy and childhood, impact health and development in children. In South Africa, Dr. Lye — Mount Sinai Auxiliary Chair in Women’s and Infants’ Health Research, and Scotiabank Scientist in Child Adolescent Health Research — will test how to improve women’s health prior to, and during, pregnancy in order to reduce health challenges experienced by their children later in life.

5

IS RAE L I DE L EGA T I ON

Senior political and health-care leaders from Israel visited Sinai Health System in October 2017. They were given a tour of our Newton Glassman Charitable Foundation NICU and then sat down with our leaders, including Drs. Gary Newton, Maureen Shandling, Mathew Sermer, Rachel Spitzer, Howard Ovens, Mark Silverberg and Sharon Unger, to discuss the strengths and weaknesses of our different health-care models. Representatives from the Ministry of Health and Long-Term Care and the University of Toronto’s

Dalla Lana School of Public Health also joined the discussion.

Coordinated by Dr. Chaim Bell, Sinai Health’s Physician-in-Chief, the Israeli delegation included the Director-General of Israel’s Ministry of Health, the Deputy Minister and staff from the Ministry of Finance, and health-care leaders from the Smokler Center for Health Policy Research. “This was a terrific opportunity to exchange ideas and consider what we can learn from each other,” said Dr. Bell.

C ANADIAN S OC I E T Y F OR M OL E C U LA R BI O SCI E NCES

Dr. Jim Woodgett was one of two recipients of an Arthur Wynne Gold medal presented by the Canadian Society for Molecular Biosciences CSMB Scholarly Award. This lifetime achievement award honours an individual who has made a major contribution to biochemistry, molecular and cell biology in Canada over their career, has played a major role in the development and promotion of the discipline in Canada, and has a long-standing record of service to the academic community.

Dr. Woodgett holds the Murray and Marvelle Koffler Directorship for the Lunenfeld-Tanenbaum Research Institute (LTRI), and is Professor of Medical Biophysics at the LTRI.

I M PROV I NG H EALT H O UTC OM E S I N T H E BLACK CO M MUN I T Y

P H O T O C R E D I T: S E T T I K I D A N E

6

In September 2017, Sinai Health’s Human Rights and Health Equity Office (HRHE) released a report issuing recommendations to Ontario’s health-care system that will improve health outcomes for the black community.

The findings were developed during the Black Experiences in Health Care Symposium held in March 2017 that was organized and hosted by Sinai’s HRHE Office and an organizing committee comprising Black Health Alliance, Wellesley Institute and TAIBU Community Health Centre, with support from Toronto Central Local Health Integration Network (LHIN). The recommendations cast a wide net across various health-care providers and included, among other things, mandatory health equity training for all LHINs and a fully-funded Black Health Strategy.

SHS NEWS

BR I DG E P O I N T AC T I V E H EA L T H C A R E

MOBI L E TE C H N OL OGY H E L P S P A T I E N T S STAY CO N N ECT E D

The iPad program at Bridgepoint Active Healthcare has provided patients with the opportunity to learn how to use tablets, smartphones and other devices to find resources and information, and to communicate with loved ones. The program was created by the Patient and Family Resource Centre with the support of two volunteers who also provide hands-on learning. “Technology helps patients stay connected during their stay in the hospital,” says Bozenna Karczewska, coordinator of the Centre and program lead. Paula, a patient who had never used a tablet before, now keeps up to date with her family and friends — and her dogs! — on social media. “This program is wonderful,” says Karczewska.

“It allows patients to be engaged and learn in the company of knowledgeable volunteers.”

ARTS P RO G RA M M I N G F OR P A T I E NT S I N RE HAB

Bridgepoint was one of six Ontario hospitals to participate in a three-year study looking at how engagement in a creative arts program serves the wellness of rehab patients. The Royal Conservatory of Music’s Living Through the Arts Program and Bridgepoint’s Therapeutic Recreation team collaborated on the ARTS-REHAB Project that provided weekly sessions in various media — visual art, music, creative movement, drama and creative writing — to patients. Observed one participant: “Music is relaxing. It lowers my blood pressure. When I go home, I’m going to play more music!” Recreation Therapy Assistant Tanya Greely noted that many of the patients had been in hospitals for long periods of time, with little opportunity to express themselves. “The pieces they created were wonderful and purposeful,” she said.

CI RC L E O F C A R E YOGA CLASSES FOR DEMENTIA CLIENTS AND CAREGIVERS

EASING LONELINESS, WARMING HEARTS

Thanks to a grant on behalf of the Waugh Family Foundation, clients and caregivers of Circle of Care’s Day Centre for Seniors with Alzheimer’s and Dementia are starting to experience the benefits of yoga and meditation as part of the Centre’s regular programming.

Recent research suggests that yoga and meditation can have a positive impact on quality of life for individuals living with Alzheimer’s disease or other dementias, as well as on their caregivers. Touted for stimulating parts of the brain and reducing stress, yoga and meditation are said to be especially helpful for people in the early stages of the disease, as the new realities of memory loss begin to set in. Further, caregivers who take the time to de-stress by participating in yoga are reported to be better able to provide care for their loved ones. The grant will also fund in-home respite care to provide caregivers with the opportunity to attend the program.

For many older adults who live far from family or who struggle with mobility issues, it can be difficult to venture out for social visits and exercise, especially during the winter months. As a result, they become more socially isolated and less likely to participate in meaningful activities and relationships. Circle of Care has always recognized the importance of maintaining independence and offers a variety of supports to help combat social isolation, including transportation, friendly visiting and phone pal programs, monthly social gatherings, Kosher meals on wheels delivery, and more. “Programs like these can be a lifeline to the outside world for many elderly people. More than one-third of the clients we serve don’t have family members, or they live far away from their families,” says Circle of Care CEO, Carey Lucki. Our volunteer-led programs are always looking for help. If you would like to give back to the community and make a difference in the life of a senior, please contact 416-635-2900 x 375 or volunteer@circleofcare.com. (See page 9 for more on this topic.)

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Your Health

Heart tips Heart disease affects approximately 2.4 million Canadian adults and is the second leading cause of death in Canada. While there are some risk factors that we have no control over (family history and our age, for example), there are plenty of healthy lifestyle choices we can make to give ourselves the best chance of staying healthy. Here are six ideas for improving heart health:

1

Talk to your family doctor about your risk factors.

Early detection and treatment of high cholesterol, high blood pressure and diabetes can greatly reduce your risk of developing heart disease.

2

Build physical activity into your daily routine.

Every little bit helps! Try a walk during your lunch break, get to the station on foot rather than by bus, or climb a couple of flights instead of taking the elevator.

6

Find ways to cope with and minimize stress. Physical activity, getting enough sleep, and eating well will all strengthen coping skills, and sharing your feelings with friends and family can help. Try some relaxation techniques, and remember to make time for yourself and to do things you find enjoyable.

5

8

Start with small, manageable steps to achieve and maintain a healthy weight. Drink plenty of water and avoid sugary pop, keep to moderate portion sizes, make mealtimes a social activity, and avoid “unconscious” snacking at your desk or in front of the TV.

3

Be a non-smoker.

Quitting is difficult but you don’t need to rely on willpower alone.

There are many free-ofcharge resources available to help — and remember to let your family and friends know what you need so that they can support you, too.

4

Develop healthy eating habits. Avoid trans fats and sugar, and select fresh, unprocessed foods, a wide range of proteins, fruits, vegetables and whole grains. Variety is the spice of life: why not find some new recipes, add interesting spices to your food, or try a new fruit or vegetable each week.

SOCIAL ISOLATION I N SE N I OR S

Older adults who lack a sense of social belonging, have minimal engagement with others, and without high-quality relationships are considered to be socially isolated. As a result, they are more susceptible to detrimental health conditions. Social isolation is a major health concern among older adults.

30%

An estimated 30% of Canadian seniors are at risk of becoming socially isolated

Seniors without a supportive social network are

60%

more likely to be at risk of developing dementia or cognitive decline.

4 million

Canadians provide care to a family member or relative. Caregivers have higher levels of exhaustion, stress and anxiety, which leads to increased isolation.

Compared to socially active seniors, those who are isolated • • • •

make more visits to their doctor and to emergency rooms use more medication fall more often enter residential care sooner

Lacking social connections can increase one’s chances of early death to a similar degree as smoking

15

1/2

of people over the age of 80 report feeling lonely.

Men over the age of 80 have the highest suicide rate of all age groups.

cigarettes

per day

Sources: Government of Canada, National Seniors Council

9

Discovery Corner USI NG H EALT H-CARE EXPE RI E NCES T O I M PROVE O UR H EALT H-CARE SY ST E M

Dr. Kerry Kuluski, an investigator in the Bridgepoint Collaboratory for Research and Innovation at the Lunenfeld-Tanenbaum Research Institute, led a recent special issue of the journal, Healthcare Papers, along with Collaboratory colleagues. The issue focused on patient and caregiver experience as a core component of health system performance measurement. The publication comprised a main paper written by Dr. Kuluski and her colleagues and responses to it from scientists from across Canada and Europe. Dr. Kuluski was also recently awarded a SPOR (patient-oriented research) grant from the Canadian Institutes of Health Research to design strategies to address delayed hospital discharge (known as Alternate Level of Care or “ALC”). The study will be unique in that Dr. Kuluski will directly engage patients and caregivers in co-designing solutions to the ALC problem. The grant is also supported by the Toronto Central Local Health Integration Network.

AN “ I N TE RNAL S C A L E ” H OL D S C L U E S T O WE I GH T RE G U LA T I ON

Dr. Daniel Drucker of the Lunenfeld-Tanenbaum Research Institute, part of Sinai Health System, was one of the scientists involved in a study published recently in the Proceedings of the National Academy of Sciences that asked: Does your actual body mass affect how much you eat and, ultimately, how much you weigh? To answer the question, researchers implanted into the abdomens of rats and mice capsules that weighed 15 per cent of the body weight of each animal. “Control” animals were implanted with an empty capsule equivalent to only three percent of their body weight. After two weeks, the total body weight was similar in both groups: the artificially-loaded rodents lost about as much weight as had been added and, once the miniature weights were removed, there was a gain in body weight and fat mass.

The scientists think that osteocytes, specialized cells in weightbearing bones, act as an internal body weight sensor that sends signals to the brain to eat less, thereby keeping body weight constant. Today’s typically sedentary lifestyle may play a role in increasing levels of obesity since sitting may make the brain think the body isn’t as heavy as it actually is.

The precise mechanism isn’t clear — nor is the jump from well-regulated weight to obesity. Drucker’s hypothesis is that the signaling system from the bones is defective in obesity. If the research holds up in humans and if scientists discover what kind of “magical factor” the bone cells might be producing, theoretically it could lead to new treatments for obesity, Drucker said.

10

A M O L EC U LAR MA P OF T H E C E L L U LA R RESPO NSE T O E NV I RO N M E NTAL ST RESS

All cells in our bodies need to defend themselves against stressful situations, such as rapid temperature changes or viral infection. As part of this response, cells halt the production of proteins and form a specialized structure called a “stress granule”. Stress granules accumulate various components involved in protein production. Once stress is relieved, the granules dissolve and the accumulated components return to normal protein-production mode.

Stress granules have significance in disease: for example, the faulty formation and prolonged presence of stress granules is associated with Amyotrophic Lateral Sclerosis (ALS), a fatal neuromuscular disease also known as Lou Gehrig’s disease. Therefore, it is important to understand the components of stress granules and how the granules are formed.

This is challenging because these structures are difficult to isolate using traditional methods. A recent study led by postdoctoral fellow Dr. Ji-Young Youn (pictured), in the laboratory of Dr. Anne-Claude Gingras at the Lunenfeld-Tanenbaum Research Institute, used cutting-edge technology to identify the composition of stress granules. This involved marking proteins close to some of the known components of the stress granules in living cells and identifying these proteins using a mass spectrometer. Using this technique, Dr. Youn and colleagues discovered about 40 new stress granule proteins and revealed the function of several of these in the formation of the granules. These findings provide a molecular layout of stress granule organization which will help to better understand the role of stress granules in the response to viral infection and in diseases such as ALS. The study was published in the journal, Molecular Cell.

U N RAV E LI NG RAF : HOW UN DE RSTAN DI NG PRO T E I N I NT E RAC TIONS MAY L EA D T O N EW ANT I -CANCE R DRUGS

Normal cells can become cancerous through a series of accumulated mutations in their DNA — a process that leads to activation of certain key proteins that cause uncontrolled growth.

Mis-regulation of the family of RAF proteins (initially named for causing Rapidly Accelerated Fibrosarcoma) underpins approximately eight percent of all cancers and, while drugs that target RAF are initially effective, the cancer cells rapidly become resistant.

A recent paper in the journal Nature reported on details of the molecular mechanism by which RAF proteins work together to induce the formation of tumors. Dr. Frank Sicheri, Senior Investigator and structural biologist at the Lunenfeld-Tanenbaum Research Institute (LTRI), and Professor in the departments of Biochemistry and Molecular Genetics at the University of Toronto, was a lead author.

Previous work in the Sicheri lab at the LTRI showed that to signal properly, RAF proteins need to interact with themselves in a process called dimerization. How and why RAF proteins dimerize was not well understood. However, the study, performed in collaboration with Dr. Marc Therrien’s lab at the University of Montréal, used advanced atomic imaging to determine which components of the proteins physically interacted. Combined with experiments conducted in cells, the teams were able to identify new components that help the RAF proteins to bind to one another.

This development raises the possibility of new drugs to target these components.

11

heart

the

The needs of our patients and their families are at the very heart of what we do at Sinai Health System.

of Sinai Health page 14

page 22

Sometimes our work at Sinai Health System involves unlocking preventions and treatments that once seemed unimaginable. At other times, it entails caring for patients while also supporting their family and caregivers. It can be about bolstering access and inclusivity. It can mean throwing out long-held assumptions, addressing an underserved health-care need, or enabling an uninterrupted flow of information from researcher to physician and from lab to clinic.

12

But it’s always about health care that is seamless and personalized, measured and innovative — and as rhythmic and coordinated as the heart itself.

In this issue, we celebrate the extraordinary gift given by Miles Nadal to launch the Miles Nadal Heart Centre and hear about the revolutionary cardiac treatments that are game-changers for Kyla, Sara, and countless others. You’ll meet

page 33 page 26

page 30

sisters, Stephanie and Krystal, and cousins, Alex and Kara — all of whom have rheumatoid arthritis — and learn about the significant insights being gained into autoimmune conditions. Jordy shares his surprising but not uncommon story of infertility. We’ll also discuss two often-hidden areas of care. In the realm of perinatal health, fathers can be overlooked.

However, Ira and Asher were two of the lucky ones: recognized as being depressed and

treated successfully. And in the arena of mature women’s health, Andrea and Vered attended our world-leading menopause clinic and gained a new lease on life.

It’s our extraordinary team of professionals and our dedicated community of supporters that allow us to continue to strengthen the heart of Sinai Health System. So read on — because we don’t want to miss a beat.

Miles Nadal

t f i g t l tfe

r a e ah

SI N A I’S WORLD - LEADI NG PRO G RAMS I N H EART DISEASE RECEIVE A MAJOR BOOST W R I T T E N B Y: H E I D I S I N G E R P H O T O S B Y: J O H N PA C K M A N

Kyla Bretney’s heart problems began shortly after a routine hysterectomy. She woke up one morning, took a few steps, and her heart started racing. Soon she began to feel breathless. She was diagnosed with a small pulmonary embolism and put on blood thinners, but those only made her surgical wounds bleed profusely.

What followed was a three-year nightmare of false starts and dead-ends in a quest to help the Whitby mom, just 34 at the time. Nothing worked and she kept getting worse. Taking a few steps would send her heart racing past 125 beats per minute. She had to give up her dream job and could barely care for her three children. “Even if I was sitting, all it took was to start talking to someone and my heart was racing,” Kyla recalls.

Physicians at four hospitals in three cities were out of medications, surgeries and tests when someone thought of Dr. Susanna Mak. “My cardiologist said there was this fantastic doctor at Mount Sinai Hospital who was doing research that he thought could be helpful — maybe pick up something that everyone else had missed,” Kyla says.

Her doctor was right.

Dr. Mak is a pioneer in testing that measures how much blood the heart can pump during exercise.

Through intimate observation of the mechanics of the heart, she finds precise explanations and treatments for breathlessness and heart failure — especially in women, whose hearts are constructed in subtly different ways than men’s. Through sensors inserted into the heart chambers, Dr. Mak detects the system malfunctions that cause breathlessness in patients with heart disease. The process requires specialized equipment and analytical software to conduct studies that involve comprehensive measurements and imaging of heart function.

15

It takes the combined effort and expertize of multiple health-care professionals to keep the Miles Nadal Heart Centre ticking. Left to right: Dianne Locke, Manager, Ambulatory Cardiology; Sheron Green, Echo Receptionist; Victoria Harvey, Cardiology Technician; Rashmi Varshney, Echo Technical Director, Hermione St. Clair, ECG Technician; Teresa Ruggeri, ECG Office Coordinator

Kyla Bretney

Now, she will be able to expand her work, thanks to the establishment of the Miles Nadal Heart Centre and an $11 million gift from philanthropist and business leader Miles Nadal. The gift will allow Dr. Mak to map what goes wrong when heart disease causes breathlessness, leading to better treatments and, hopefully, earlier detection of heart failure.

possible. While the catheter is typically introduced into the body through the leg or neck, Dr. Mak’s team accesses the heart through an artery in the upper arm, making it less invasive and easier to recruit test subjects with healthy hearts. This crucial step shows how hearts should normally pump blood during mild exercise, so Dr. Mak can pinpoint what’s different in sick people.

Kyla’s racing heart was the most glaring issue, but nobody knew whether it was the cause of her problems or the result of some other cardiac defect. And she couldn’t tolerate the beta blockers that would have slowed her heart rate and helped answer the question.

Dr. Mak showed that Kyla’s fast heart rate was indeed the cause of her troubles. The rapid beats were preventing her heart cavity from properly filling with blood. This was forcing her heart to work overtime, using a lot of energy to achieve very little; a condition called inappropriate sinus tachycardia.

“I’ve always prided myself on being an entrepreneur and I see Sinai in that vein: they’re challenging conventional wisdom, doing things in an entrepreneurial way,” says Mr. Nadal. “I believe what we’re going to do at the Miles Nadal Heart Centre will be world leading and will change the health system approach to cardiac care.”

Through her precise observations, Dr. Mak discovered the reason Kyla’s heart was beating too fast — a defect in her ‘pacemaker’ function — and found a very specific drug that would work on the single channel that regulates the heart’s pacemaker cells.

Solving the mystery of Kyla’s heart disease

“The first week I started taking it, I was seeing my heart rate sit around the 80s and then I remember one day looking at my Fitbit and seeing 78,” she recalls. “That was the first time in years I’d seen a normal heart rate. I screen-shot the Fitbit and sent it to my husband.

He was like, ‘no way, that’s impossible!’ I’m like, ‘nope, this is my heart rate right now!’”

In an era when researchers are often focused on the genetics of disease, Dr. Mak looks for mechanical clues to the cause of breathlessness and heart failure that may have been overlooked.

And Kyla, it turned out, had a diagnosis everyone had missed.

Dr. Mak’s test requires catheterization, a normally invasive procedure in which sensors are snaked into the chambers of the heart through a tube. In the past, it has been hard to find healthy volunteers to study, but Dr. Mak — who is the Director of the Mecklinger Posluns Cardiac Catheterization Research Laboratory — and her team of highly-trained nurses make the procedure as painless and easy as 16

For Kyla, the changes were immediate and profound.

Today, Kyla is able to make dinner for her children several times a week and she can attend some of their activities again. She has good and bad days, but now that the under-lying mechanical problem is under control, she’s working to strengthen her heart, weakened by years of inactivity.

Left to right: Kelly Grier with husband Miles Nadal; and Sinai Health System CEO, Dr. Gary Newton at the entrance to the recently named Miles Nadal Heart Centre.

“I’m optimistic,” she says. “We’re just starting the therapy, but we’re seeing signs that it’s successful, although it’s still unpredictable.” For now, Kyla says her ambitions are realistic: “I’d love to do more with my kids, and hopefully even have a part-time career.”

Safe pregnancies for women with heart disease Kyla’s heart problems began after a partial hysterectomy, suggesting that sudden shifts in hormones could have played a role. That would not be surprising to Dr. Candice Silversides, a cardiologist who conducts world-leading research into heart problems and pregnancy through her work at Mount Sinai Hospital as Head of Obstetric Medicine, and in the Medical Disorders of Pregnancy program, and the Pregnancy and Heart Disease program — which is part of the Miles Nadal Heart Centre.

Hormone changes such as those during pregnancy can contribute to heart troubles, says Dr. Silversides.

“Pregnancy puts extra stress on the heart, and for some women with heart problems, this can result in cardiac complications during pregnancy, labour or during those first few sleep-deprived months with a new baby,” she says. “Our job, as doctors, is to help women understand these risks, change medications that might be unsafe for

the baby, and monitor the pregnancy closely for those who chose to become pregnant.

Sinai physicians were the first to develop a risk score to predict those women with the highest chance of complications during pregnancy. Dr. Silversides and her colleagues recently created an even more accurate risk score that can be used by doctors around the world to predict pregnancy complications, based on a study of 2,000 women.

“I think we’ve been able to better understand and treat high-risk pregnant women,” says Dr. Silversides, whose pregnancy and heart disease program will also receive a boost from Mr. Nadal’s gift. “Some of the biggest risks occur in women with heart valve disease, weakened heart muscle or pulmonary hypertension.

Our goal is to identify the women who might develop complications — and try to prevent those complications in both mother and baby.”

Not many years ago, before physicians had a good understanding of pregnancy risks, Sara Jankowski would have been told she should never consider having children. The Woodstock resident was born with a serious heart defect requiring major cardiac surgery during her childhood.

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Dr. Susanna Mak

A B O V E : Cardiologist, Dr. Susanna Mak, is the Director of the Mecklinger Posluns Cardiac Catheterization Research Laboratory at Mount Sinai Hospital. The Centre uses state-of-the-art imaging to look at the mechanics of the heart and is at the international forefront of understanding heart disease.

R I G H T: Members of the catheterization team assist a patient during a procedure.

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T H E H E A R T O F S I N A I H E A LT H

E S TA B L I S H M E N T OF THE

MILES NADAL HEART CENTRE

On April 19, clinicians, patients and members of our philanthropic community gathered at the Hennick Family Wellness Gallery to celebrate Miles Nadal’s landmark $11 million gift.

Left to right: Howard Sokolowski, Co-Chair, Sinai Health Foundation Board of Directors; Senator Linda Frum; Kelly Grier; Miles Nadal; Sinai Health System Chair, Brent Belzberg; Sinai Health System President & CEO, Dr. Gary Newton.

The right precautions But Sara loves children and wants at least two. Luckily, thanks to Sinai Health research, the medical community now has a better understanding of pregnancy risks and many women like Sara are reassured that pregnancy can be managed safely. Dr. Silversides, her cardiologist, always told Sara she could get through pregnancy safely with extra monitoring and some precautions during delivery.

So last year, when she learned she was pregnant, Dr. Silversides was the second person Sara and her husband told.

At first, everything went well. But during her third trimester, the weight gain and increased blood flow started to put stress on Sara’s heart.

“There were a lot of arrhythmias and chest pains,” recalls Sara.

“Before I got pregnant, it was once in a blue moon. This time, the frequency made me nervous. Going up the stairs would be bad — I’d get winded. I would try and go up fast enough that my heart wouldn’t realize what I was doing until I was at the top.”

Dr. Silversides put Sara on a new medication to slow down her racing heart and Sara, who works at another hospital as a cardiac sonographer, monitored herself using a Fitbit. Toward the end of her pregnancy, she and Dr. Silversides decided it was time for her to stop working.

Delivery was “absolutely awesome,” says Sara. The Mount Sinai Hospital pregnancy and heart disease team consists of specialized cardiologists, obstetricians, anesthetists and nurses. Thanks to a

highly coordinated team, approximately 250 babies a year are safely delivered in high-risk women with heart disease.

“I was so excited to push because normally Candice doesn’t want me to lift heavy weights,” laughs Sara. “This was like squatting 300 pounds — it was my moment!” Her son was born after three contractions.

Sinai Health’s Pregnancy and Heart Disease program works closely with the Toronto Congenital Cardiac Centre at Toronto General Hospital (TGH), a nearby cardiac program. The Toronto Congenital Cardiac Centre for Adults — where Dr. Silversides is Director of Research — looks after young women, such as Sara, who are born with heart disease. Many of these women come to Sinai to receive advice before pregnancy and to delivery their babies. These complementary cardiac programs show how patient care improves when hospitals work together.

“We contribute in a very Sinai way,” says Dr. Mak, whose testing helps to identify transplant candidates for TGH. “We do something smaller yet extremely specialized and fairly rare. It’s a can-do culture.”

The other 99 per cent Sinai Health cardiologists are also known for the most general of skills — taking care of the 99 per cent of patients with heart failure who will never receive a heart transplant.

“For the overwhelming majority of people, heart disease is a chronic issue where we need to help them find ways to manage and 19

T H E H E A R T O F S I N A I H E A LT H

Sara Jankowski and baby Kasper

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live well with it,” says Dr. Alan Barolet, Site Director for Cardiology at Mount Sinai Hospital. “I think we do a very good job of helping people, particularly once they get back home, to have as high a quality of life as possible.”

A major advantage is that all of the hospital-based cardiologists at Sinai also run outpatient clinics, allowing them to follow patients for many years and to coordinate care between daily life and any hospitalizations they may need.

Caring for the whole patient “One thing we do very well is that we take ownership of the patient.” That continuity of care, says Dr. Barolet, “is a better way to treat patients, and I think it translates to better outcomes.”

Dr. Barolet recently treated a patient who had been flagged by orthopaedic surgeons because her vital signs were off during surgery. It

turned out she had some serious signs of heart disease that she was unaware of.

“Now, the lady with the broken elbow is delighted that we are finally going to work out why she keeps fainting all her life,” he says. “Providing that sort of care, taking care of the whole patient, is gratifying, and it’s a big part of what we do.”

It’s also a big part of the future of medicine.

It’s what Miles Nadal envisions for the future of heart care in Canada, and why he chose to support this important work.

Dr. Alan Barolet

“Because of the hospital’s end-to-end capability of serving the patient, and the extraordinary dedication of the physicians and researchers I’ve met, I thought this was the perfect opportunity for my family to make this commitment of time, talent and treasure to this wonderful institution,” he says. “I think the Miles Nadal Heart Centre is going to be the future of cardiac care in Canada.”

Where hearts and minds connect Dr. John Floras

Dr. John Floras studies the complex interplay between the heart and the brain. A cardiologist by training, he has always shown a remarkable ability to cross disciplinary boundaries in pursuit of a scientific question — often posed by a patient, for which there is no existing answer.

A Senior Clinician-Scientist at the Lunenfeld-Tanenbaum Research Institute (part of Sinai Health System), Dr. Floras has shown how the heart works together with the circulatory system in both time and space — adding circadian biological rhythms to cardiac research. In the course of his experiments, he has made some of the most important discoveries in understanding the role of the nervous system and hormones in determining how heart function is regulated. He was among the world’s first cardiologists to show that sleep apnea is common in heart disease, and that sleep apnea leads to heart problems not helped with

drugs alone. He is now studying whether treating apnea in people with heart failure can lead to recovery of heart function. At the same time he is exploring why patients with heart failure have high blood concentrations of noradrenaline — an important nervous system transmitter that causes harm in excess.

Dr. Floras’ discoveries have been reported in over 200 original publications and synthesized in numerous book chapters and reviews. He has served two full terms as Tier 1 Canada Research Chair in the emerging field of Integrative Cardiovascular Biology. With the federal government’s decision to cap the number of years a scientist can hold this chair, Sinai aims to raise $3 million to establish its own chair in this field.

The funds will allow Dr. Floras to expand his research into the ways that the heart interacts with the rest of our bodies: using cutting-edge brain imaging to map the nervous system’s interaction with the heart, kidneys and blood pressure system; studying the impact of sleep apnea treatment on the heart and circulation; and discovering new ways of prolonging life in patients with heart failure.

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Fighting the ‘strong and silent´ stigma

Asher Lenz

Dads can experience perinatal depression, too — and Sinai Health is caring for them W R I T T E N B Y: N A N C Y C A R R P H O T O S B Y: J O H N PA C K M A N

Ira Weisman

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T H E H E A R T O F S I N A I H E A LT H

When Asher Lenz learned that his wife was pregnant with their second child, the 39-year-old composer couldn’t muster the feelings of joy and excitement that he thought he should.

“I was having trouble working, concentrating and focusing, and just having really vicious, cyclical thoughts,” said Lenz, who had been experiencing mild anxiety since his early thirties. “It was all very scary.”

Then, at a prenatal obstetrical visit with his wife, the obstetrician suggested Lenz speak to a psychiatrist who helps fathers deal with mental health issues. He immediately agreed. And while not many people would want to be in his shoes, the fact that his condition was recognized makes him one of the lucky ones.

According to Dr. Ben Rosen, paternal perinatal depression (PPD), a mental health condition that can happen during a man’s partner’s pregnancy and in the first year of their child’s life, affects one in 10 men. But too often it goes undiagnosed.

Depression can affect all parents, regardless of their gender, sexual orientation or family situation. And many people find it hard to confront depression. But men tend to be especially reluctant when it comes to seeking help for health issues, especially mental health.

Dr. Rosen notes that the number one risk factor for PPD is depression suffered by one’s partner. Other risk factors include a mood disorder history, relationship dissatisfaction, poor social supports, previous miscarriage or pregnancy loss, and unexpected or negative experiences related to childbirth or the baby’s health.

“In my view, the number one reason [the condition is often undiagnosed] is that there is a stigma associated with traditional gender roles. Men kind of have the expectation that they should be the caregiver for their partner and that it would show weakness to acknowledge distress and mental health symptoms,” said Dr. Rosen, a Sinai Health System psychiatrist specializing in fathers’ and men’s mental health. “It’s supposed to be a time of immense joy when people become new parents, and if people are feeling miserable, society has trouble acknowledging that, which contributes to shame and avoidance, and delays in treatment.”

Health care has made great strides in recognizing and treating postpartum depression in women over the past few decades, and Mount Sinai has treated female same-sex partners for years, but men’s mental health related to a partner’s pregnancy and childbirth is just now coming into focus. Dr. Rosen, who has a medical degree from McMaster University and an MSc in health policy from the London School of Economics, joined Mount Sinai Hospital in 2017 to work specifically with fathers and men. He’s also the co-founder of the Fathers’ Mental Health Network, a network of clinicians, researchers, educators and fathers that aims to generate knowledge, research and solutions for men in their role as fathers.

“I think the biggest issue is under-recognition that paternal perinatal depression exists, how to diagnose it and how to treat it,” Dr. Rosen said. “And that’s among anybody who is going to come into contact with new and expectant parents: family doctors, nurses, public health nurses, obstetricians and paediatricians.”

If perinatal depression isn’t recognized, the effects can be felt by the whole family. According to Dr. Rosen, children of a parent with untreated depression can have developmental and behavioural problems from the toddler stage right up to adolescence. The rate of substance abuse is also higher in kids who have a parent with untreated mental illness or depression.

The recognition of the impact of his condition on his family, and the desire to be a better parent, was the main catalyst behind Lenz’s willingness to connect with Dr. Rosen.

“It’s hard not to feel like you’re failing your children if you can’t be there to set a good example for them,” Lenz said.

Ira Weisman also sought help because of how his mental health was affecting his family. Weisman was still processing his feelings about his wife’s earlier miscarriage when the couple found out another baby was on the way.

Anxiety, not joy, took over at that point.

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“There were probably a couple months of me just not doing anything about it, and it progressively getting worse,” said Weisman, who was also dealing with workplace challenges at the time. “It really was starting to have an impact within our home. Deep down I knew I should have done something about it before I did.”

With the support of his wife, Weisman got a referral to see Dr. Andrew Howlett, a psychiatrist at Mount Sinai Hospital and St. Joseph’s Health Centre, and Rosen’s co-founder at the Fathers’ Mental Health Network. Weisman’s condition worsened before it got better, partly because he was diagnosed with breast cancer during his wife’s pregnancy, and thoughts of mortality set in. Fortunately, he had surgery to remove the cancerous tumour and didn’t require chemotherapy or radiation therapy. He still takes daily medication to help prevent a recurrence, but he’s been cancer-free since before his daughter’s birth, almost 18 months ago.

“ It’s supposed to be a time of immense joy when people become new parents, and if people are feeling miserable, society has trouble acknowledging that, which contributes to shame and avoidance, and delays in treatment.”

— DR. BE N ROS E N

“Becoming a parent is quite a change,” said Weisman, who used to enjoy travelling and going out to try new restaurants before his daughter was born. “Your life becomes dramatically different and I think it’s natural to have questions or concerns or fears, and there’s nothing wrong with that.

I, personally, found that having an outlet, in my case it was Dr. Howlett, on a regular basis was very helpful and beneficial. I know that it’s a cliché but it does feel like a weight is lifted off you.”

While Dr. Rosen is pleased that more practitioners are learning about PPD, and more men are getting help, he’d like more parents and parents-to-be to find ways to avoid perinatal depression before it even occurs.

“It’s very hard to prepare for being a parent,” Dr. Rosen said.

“And when you become a parent, you are exposed to a number of stressors that, if you don’t anticipate them, can be overwhelming.”

One of the best ways to avoid mental health issues, he said, is for partners to communicate clearly and talk openly with each other.

Tackling topics about the future, such as how they’d like to make parenting decisions, how much the in-laws will be involved, and how they’ll deal with finances in their new, expanded family unit, can help smooth the way. But remaining flexible and changing tactics when needed is important, too.

Both Weisman and Lenz agree that their lives changed for the better after working with a medical professional to better understand their feelings around becoming a parent. Following his cancer diagnosis and parenting anxieties, Weisman re-evaluated his priorities in life and focuses more now on what brings him joy: his wife and daughter. Lenz still meets with Dr. Rosen regularly and feels grateful or his support.

“I didn’t get better right away,” Lenz said. “We had to try a bunch of things with Dr. Rosen. But I’m able to do my work and joke around and annoy my business partner, and then go home and actually play with the kids and enjoy myself,” Lenz said. “I’m thrilled to be feeling as well as I am.”

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Tailoring treatment for autoimmune disease

Alex Bennett, left, with cousin, Kara McIntosh.

W R I T T E N B Y: H E I D I S I N G E R P H O T O S B Y: J O H N PA C K M A N

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T H E H E A R T O F S I N A I H E A LT H

Alex Bennett remembers the fear she felt as a young child when she visited her arthritis-stricken great-grandmother who was seated in a wheelchair, her hands bent into claws from stiffness and pain. Alex and her cousin Kara held hands on the way home and comforted each other.

Today, they are still supporting each other through rheumatoid arthritis (RA) — their own. Each woman developed the debilitating autoimmune condition after delivering her third child, and each within a year of one another.

noticed huge improvements in his patients. Today, “very few patients ever get into a wheelchair and there are half as many joint replacements for rheumatoid arthritis,” he says. Instead of 40 beds in one hospital, there are now only half a dozen beds in all of Toronto for people with RA alone.

On her first visit to Dr. Ed Keystone, a rheumatologist at Mount Sinai Hospital, part of Sinai Health System, Alex could barely hold her three-month-old twins. Her symptoms had progressed quickly from aching palms to crippling exhaustion just days after giving birth. She was terrified and could only look at her babies and weep.

Alex remembers Dr. Keystone telling her: if you were wheeled into my office ten years ago, I would tell you that you wouldn’t be walking out ever. But today I can promise you hope.

Like other autoimmune conditions, RA runs in families: a quarter of patients have a relative with the disease. In the beginning, the cousins thought of their great-grandmother’s suffering with a great deal of anxiety. But their own experience has proven much different, thanks to dramatic advances in treatment in the past 15 years that allow patients to live fuller, more mobile lives. And with greater understanding of the role of genetics, including key contributions from Sinai Health System scientists, many expect that one day most autoimmune diseases like RA will be managed as effectively as diabetes.

“Very few patients ever get in a wheelchair” When Dr. Keystone started treating people with autoimmune disease in the early 1980s, there wasn’t much doctors could do.

He remembers arriving as a medical resident at the old Wellesley Hospital in downtown Toronto and seeing 40 beds filled with people in pain who would stay for weeks on end. He thought of his own mother, who suffered from autoimmune disease.

“We had one or two therapies, and if they failed, then we had nothing,” recalls Dr. Keystone, Director of the Rebecca MacDonald Centre for Arthritis and Autoimmune Disease at Mount Sinai Hospital. “We just watched people suffering. I swore that I would work diligently to find a better way.”

Around the turn of the century, highly effective new medications called “biologics” began to emerge in the fight against RA and other autoimmune disease. Biologics target specific parts of the immune system that attack phantom foreign invaders and cause many of the painful, debilitating symptoms associated with swelling in this group of diseases. Dr. Keystone began using them right away and

But Dr. Keystone has observed that biologics don’t work at all for 10 to 15 per cent of Dr. Ed Keystone his patients and eventually they stop working for almost every patient. And there is no way of knowing which of the eight biologics to try first.

Sisters Stephanie Gutcher and Krystal DiFrancesco are very familiar with the medication rollercoaster. Stephanie was diagnosed with RA as a toddler but is currently in medical remission. Krystal didn’t develop symptoms until she was 18 but has more active disease.

Both sisters have moved from drug to drug, with most lasting a year or two. For Krystal, being on the right drug is life changing.

She can dance all night at a wedding or go zip-lining, as she and Stephanie did for her bachelorette party. But when a drug stops working or she’s having a bad day, she worries about the future.

“On a day that I’m having a lot of pain, I’ll think: by the time I’m 65 I’m going to be in a wheelchair,” says the former competitive gymnast and cheerleader. “But then other times I think: no, I’m going to be one of those 90-year-old people doing a deadlift from the ground!”

Customizing treatments Many patients follow Krystal and Stephanie’s pattern of moving through drugs every year or two. But for some, biologics work for a decade or more. To understand why, Dr. Keystone teamed up with Dr. Kathy Siminovitch, a genetics expert and Senior Investigator in the Lunenfeld-Tanenbaum Research Institute (part of Sinai Health System), whose work has helped identify 100 genes associated with risk for rheumatoid arthritis. They hope to apply this genetic information to guide treatment decisions in the clinic.

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“We have many treatment options for rheumatoid arthritis and that’s why we have an opportunity to personalize care — not just for RA but for all autoimmune disease, because many of these conditions share genetic roots,” says Dr. Siminovitch. “But there’s a lot of work to do: most patients respond to treatment, but only half respond fully and go into clinical remission.”

Genetic analyses can help doctors select the best treatment for each patient. This is a relatively new field, called “pharmacogenetics”.

Already, it’s helping the Sinai team to distinguish patients with extremely different outcomes of disease — those who do well for many years on the same drug versus those who failed to respond to any medication. The hope is to learn from the first group to find new “druggable targets” for the second one. Alex and Kara have both contributed their blood samples to this project, along with dozens of other Sinai Health patients.

Dr. Siminovitch has also identified genes involved in primary biliary cirrhosis as well as vasculitis — a rare but very severe autoimmune disease. She is now complementing this approach with a cutting-edge technology, immunophenotyping, that allows for very detailed characterization of a patient’s immune responses over time. This information can be analyzed in relation to the patient’s symptoms at the time the sample was drawn: Was the person experiencing a disease flare-up or feeling entirely well? If, for example, the test reveals that certain immune cells are unusually active before a disease flare occurs, doctors could detect these “activated” cells and treat them with a drug that suppresses their activity, preventing a flare-up.

Predicting and preventing The other frontier for Drs. Siminovitch and Keystone is in the area of disease prevention.

“Because our information and understanding of autoimmune diseases is so much better now, we have an unprecedented opportunity to begin treatment before disease is clinically apparent,” says Dr. Siminovitch.

Recently, scientists have started to appreciate the importance of a “pre-disease” period, in which immune changes can be seen in apparently healthy people that suggest RA may develop. By monitoring those at unusually high risk for RA for selected immune markers in the blood, Dr. Siminovitch says it is possible to identify those who will develop the disease. As these people get closer to developing RA, levels of these markers increase, allowing scientists to predict who will develop overt disease within the next few years.

Efforts to prevent disease onset by pre-disease treatment are now being actively explored, says Dr. Keystone. And with Dr. Siminovitch’s genetic expertise, he hopes to identify new markers and treatment approaches to make disease prevention a reality.

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“We’ll rethink the equation: the patients, the type of medications they used previously,” says Dr. Keystone.

“Just bashing the immune system may not be good enough. You might have to more selectively target the areas that are causing the problem.”

Drs. Keystone and Siminovitch have also started a unique study that takes advantage of Sinai’s expertise in pregnancy Dr. Kathy Siminovitch and delivery. At the suggestion of his daughter, Dr. Keystone is studying the genes and immune profiles of women whose RA remits during pregnancy, 80 per cent of who will have a flare-up within two months of delivery.

“We’re looking at the genetic development of RA from zero to 100,” says Dr. Keystone. “With these patients, we’re not just looking at a static snapshot of the disease. We’re seeing how it moves in time.”

Perhaps it’s not surprising that autoimmune flare-ups are influenced by the hormonal shifts of pregnancy, since three-quarters of patients suffering from an autoimmune disease are women. That the disease can first strike when a woman has a new baby, as it did with both Alex and Kara, underscores its cruel timing.

Krystal, now 34, was struggling with the first RA symptoms 16 years ago when she learned that her cheerleading team would travel overseas for the first time to compete in Hong Kong. “They had to tell me I couldn’t go,” she recalls. “I don’t remember if I cried right there or if I just tried to hold it in. But I had to stop coaching gymnastics and cheerleading. I thought, there goes my world.”

These days, Krystal is still active, doing Crossfit and hiking.

But like Stephanie, Alex and Kara, she has learned to adjust to the rhythms of RA. She must constantly decide when it’s worth paying the price by pushing her body a little too far. For her, it’s dancing at a wedding — even though she’ll spend the entire next day in pain. For Alex, it’s acting like everything’s ok during an unexpected downturn for the sake of her three kids. Despite amazing advances in treatment, everyone — physician, researcher and patient alike — struggles against the unpredictability of autoimmune disease.

“ On a day that I’m having a lot of pain, I’ll think: by the time I’m 65 I’m going to be in a wheelchair.

But then other times I think: no, I’m going to be one of those 90-year-old people doing a deadlift from the ground!”

— K RYS TA L D I F RA NC ESCO

Sisters Krystal DiFrancesco (left) and Stephanie Gutcher

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Jordys’ story:

THE CHALLENGE OF INFERTILITY

For Canadians hoping to become parents, starting a family can often be challenging. Infertility affects 15 per cent of couples in this country and male infertility contributes to about half of all cases.

While the obstruction due to an absence of the vas deferens meant that Jordy had no sperm in his semen, tests showed he was, in fact, able to produce healthy sperm. Dr. Jarvi assured Jordy that by using a procedure called testicular sperm aspiration — in which sperm is retrieved directly via a needle — in vitro fertilization (IVF) would be an option. So in early 2014, in preparation for IVF, Jordy underwent the procedure which, he notes, “was fairly easy; like freezing a tooth”. One sperm was injected into each one of 11 eggs that had been harvested from Pam’s ovaries.

Jordy Mecklinger and his wife, Pam Mecklinger, understood those frustrations only too well. By the summer of 2013, excited to start a family but having no luck conceiving, they began the process of medical testing to figure out what was going on. Pam checked out fine but Jordy’s semen provided a surprise. “There were no sperm in the sample,” says Jordy.

Happily, Jordy and Pam became the proud parents of healthy twins, Hayley and Brandon, on September 17, 2014. “Now that our kids are more than three-and-a-half years old, it’s like nothing extraordinary happened — except it did,” says Jordy.

Unbeknownst to him, Jordy was a carrier of Cystic Fibrosis (CF), a chronic and often fatal disease of the lungs and digestive system. His version was mild enough not to cause serious symptoms. However, males who carry a CF mutation are born without vas deferens, the tubes that carry sperm from the epididymis, behind the testicles, to the ejaculatory ducts — effectively rendering them infertile.

Dr. Jarvi and scientist Dr. Eleftherios Diamandis, an associate member at Sinai Health’s Lunenfield-Tanenbaum Research Institute (LTRI), have developed a new diagnostic test that promises to help avoid invasive testicular biopsies. It’s been licensed by LabCorp, a leading health-care diagnostics company. “The test shows whether there’s a good chance of finding sperm or not. You would operate if there is and avoid an unnecessary biopsy if not,” explains Dr. Jarvi.

The discovery surprised and alarmed Jordy, and gave rise to all kinds of questions: “How could I be so healthy and have such a serious problem? Would I be able to have kids, and would I be healthy in the future?”

In addition, David Sinton, a professor and microfluidics researcher in the Department of Mechanical and Industrial Engineering at the University of Toronto, is collaborating with Dr. Jarvi in the development of a device that would select the strongest-swimming, most viable sperm for use in reproductive technologies. In research dubbed the “Sperm Olympics”, sperm raced down tiny, fluid-filled channels to the selection chamber. Sinton’s team discovered that sperm that slither, snake-like, move faster and may be more viable.

They will clinically test and commercialize the sorting device, which can select the most viable single sperm from 100,000 for intracytoplasmic sperm injection (in which sperm are injected directly into eggs in a petri dish) —– a technique that Jordy and Pam benefited from.

He was in good hands: the MKUWC is the largest clinic of its kind in the country and is at the forefront of spearheading techniques to combat infertility related to sperm production, quality, and/or quantity. More than 12,000 patients walk through its doors each year, from all over Canada and around the world. Dr. Jarvi — who also directs the Male Infertility Program at the University of Toronto — is a pioneer in the field, developing the use of minimally invasive techniques and a sperm mapping procedure to retrieve sperm.

Jordy and Pam conceived after their first IVF cycle, but many others aren’t so fortunate. “The success rate for assisted reproductive technologies has plateaued at about 33 per cent, partially due to the use of suboptimal sperm,” explains Sinton who, himself, is a father of two thanks to fertility treatment. “If our device can do a better job of selecting the sperm which is most likely to fertilize an egg, this has the potential to boost success rates and improve the health of offspring for patients in Canada and globally.”

Jordy was referred to Mount Sinai Hospital, part of Sinai Health System, for genetic counselling and testing. At a rate of one in five with male fertility, “cystic fibrosis is the most common genetic abnormality,” explains Dr. Keith Jarvi, Head of Urology and Director of Mount Sinai’s Murray Koffler Urologic Wellness Centre (MKUWC).

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Due to advances in diagnosis and treatment, Sinai Health can now offer potentially successful treatments to many people — and new research breakthroughs are also underway.

P H O T O C O U R T E S Y O F : M E C K L I N G E R FA M I LY

Infertility issues that involve not producing any or enough healthy sperm, and obstruction — where sperm is blocked from getting out — are experienced by one million Canadians. This, it turns out, was Jordy’s problem.

W R I T T E N B Y: M A R K W I T T E N

Jordy and Pam Mecklinger with twins Hayley and Brandon.

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T H E H E A R T O F S I N A I H E A LT H

Preserving the opportunity

Jordy Mecklinger (pictured above with wife, Pam) is passionate about combating the stigma around male infertility. He also feels a great debt of gratitude, and is committed to raising funds in support of Sinai Health System. He founded and is Co-Chair of the annual Leadership Sinai Porsche Rally — which is sponsored by DFC Auto Group and Peerage Capital, and is now in it’s third year.

He and Dr. Jarvi are also collaborating to develop a low-cost, easyto-use home fertility test that could be bought in the drugstore.

It would indicate whether there are any or enough healthy, motile sperm in the semen to conceive. “Guys don’t generally want to go to a lab for fertility testing, so it can take months or years to find out they have a problem. If they know sooner, this can make a big difference in timing and pregnancy success rates,” says Dr. Jarvi. He also notes that this aspect of fertility often can be improved with lifestyle changes, such as eating healthy, exercising, and avoiding smoking, alcohol and recreational drugs.

Fighting stigma and raising awareness about the prevalence of these kinds of infertility problems are goals shared by Dr. Jarvi and Jordy.

“No one talks about it because it’s socially unacceptable. When patients come to our clinic, they feel alone. We tell them how frequent it is, which normalizes it for them,” explains Dr. Jarvi.

Jordy wants to build public awareness and acceptance by sharing the challenges and ultimate rewards of his own journey. “My personal mission is to highlight and end the stigma around this issue. It’s still very much taboo. Men suffer in silence because they’re embarrassed. They often become depressed and relationships fail as a result,” he says. “By talking about what I went through, though it’s difficult, I believe more men will go and get help.”

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An exciting and growing area of fertility treatment is fertility preservation, an important service offered through Mount Sinai Fertility (MSF) at Sinai Health System.

There are many individuals who have not yet started or completed Dr. Keith their families and who Jarvi require treatment or medication that may cause impairment or loss of fertility. These may be gender diverse individuals who are starting gender affirming treatment; or adolescents or adults with cancers who may experience infertility as a side effect of chemotherapy or radiation. In anticipation of these consequences, many people are encouraged to consider the option of freezing sperm, eggs or embryos before starting treatment.

“It is so important that people are informed of fertility preservation options before potentially fertilitycompromising treatment,” says Eileen McMahon, a Nurse Practitioner at MSF and an Adjunct Lecturer in the Bloomberg Faculty of Nursing at the University of Toronto. She notes that, in Ontario, there is government funding for one round of IVF per lifetime for eligible patients, which helps to remove some of the financial barriers to this mode of treatment. Sinai Health is also one of the few places in Canada that offers — in partnership with the Hospital for Sick Children — fertility preservation for young boys undergoing cancer therapy.

Sinai Health scientists are using emerging technologies to further this area of health care. For example, urologist and surgeon investigator, Dr. Kirk Lo, is carrying out innovative research to encourage human testes cells to grow and mature to a stage where the tissue itself could produce sperm. This could mean that even young children, those not old enough to be producing sperm, could have immature sperm forms stored for development into mature sperm, “in a dish”, at a later date.

Dr. Keith Jarvi, Head of Urology and Director of Mount Sinai’s Murray Koffler Urologic Wellness Centre, is excited by how this field of medicine is expanding. “We are offering state-of-the-art clinical care and novel research in an area which has a tremendous impact on the lives of young adults, adolescents and even children,” he says. “In my experience, even if these patients are not thinking about it, they would like to know that the door to having children is not closed.”

menopause

MANAG I N G The Mature Women’s Health Program at Sinai Health

W R I T T E N B Y: M A R C I A K AY E P H O T O S B Y: J O H N PA C K M A N

“ As women, we’re used to dealing with some discomfort with our bodies and we suck it up and live with that.”

— VE R E D EYA L

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T H E H E A R T O F S I N A I H E A LT H

In her late 40s, Vered Eyal had every intention of going through menopause without any medical intervention. The Toronto organizational consultant had always lived a healthy lifestyle, which included a plant-based Mediterranean diet, organic fruits and vegetables, regular exercise, yoga and meditation.

But while her habits were excellent for her overall health, Vered had no idea that they wouldn’t be enough to see her through a difficult menopause that was just on the horizon.

Within a couple of years, once her cycle began to change and then eventually stop, Vered was experiencing disturbing symptoms: hot flashes, sleep problems and mood changes that included inappropriate bursts of rage and bouts of extreme sadness. She dragged herself out of bed every morning exhausted and lethargic.

For a long time, the busy mother of two children and stepmother of three downplayed her symptoms. “As women, we’re used to dealing with some discomfort with our bodies and we suck it up and live with that,” she says. She took a year off work. She consulted a naturopath and tried various herbal formulations, with little success.

Vered’s family doctor referred her to the Mature Women’s Health Clinic, part of the Frances Bloomberg Centre for Women’s and Infants’ Health in Mount Sinai Hospital. She met with director Dr. Wendy Wolfman. Since Vered didn’t have a disease, she halfexpected the physician to dismiss her symptoms. On the contrary, Dr. Wolfman took them very seriously. “What I like about Dr. Wolfman is she is really all about quality of life,” Vered says.

“We had a long conversation, and I was impressed by how open and knowledgeable she was. She gave me tons of information.”

“ The biggest public misconception is that these are trivial, short-lived symptoms that women have to endure, almost like a woman’s burden.”

— D R. WE N DY WOLFMAN

Like many women, Vered remembered the hormone therapy (HT) scare of 2002. Widely-published results of the United States’ Women’s Health Study Initiative (WHI) linked HT (a term including either estrogen alone or an estrogen-progesterone combination) to an increased risk of a number of health conditions, including breast cancer and heart disease. That caused women to run in fear of HT, and many physicians to pull their patients off it. (Menopause is defined as the point at which there have been no menstrual periods for one year. That occurs in North American

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women, on average, around age 51.) However, subsequent reanalyses of some of the data, as well as follow-up studies, showed that there was no increase in breast cancer at all in women who took HT for three years, and only a tiny increase after five years.

And while HT may not help protect women over 60 from heart disease, as was once thought, it could do exactly that for younger women who experience a very early menopause before age 40. Both the Society of Obstetricians and Gynaecologists of Canada and the North American Menopause Society recognize HT as an option for managing troubling menopausal symptoms.

Last October, Vered began a low level of hormone therapy. Within three days she felt dramatically better. The hot flashes vanished, her sleep improved, her energy returned and her mood lifted. Now 52, Vered plans to stay on the medication for four years and undergo regular monitoring for heart disease and breast cancer, both of which run in her family. “I’m not promoting hormone replacement therapy,” she emphasizes, “because every woman is different. Dr. Wolfman makes sure you get what’s right for your circumstances. And right now I’m feeling really, really good.”

About 1,600 women come to the menopause clinic every year. But Dr. Wolfman says thousands more suffer in silence. “The biggest public misconception is that these are trivial, short-lived symptoms that women have to endure, almost like a woman’s burden,” she says.

About 70 to 80 per cent of all women will experience unpleasant menopausal symptoms. For 20 per cent of them, their symptoms will be severe and life-altering. Ten to 15 per cent of women will continue to have hot flashes into their 70s. Within three years of menopause, half of all women will experience bladder, urethral or vaginal problems because of the lack of estrogen in genito-urinary tissues.

“It’s something that no one talks about. And since these are complaints of aging, there’s been a stigma of shame talking about them.”

But Dr. Wolfman is talking about them. Her new position as inaugural holder of The Carol Mitchell Chair in Mature Women’s Health means she’ll be able to reach more people to increase awareness and educate the medical community. She runs an annual course for up to 400 physicians and other health professionals, in conjunction with Dr. Harold Drutz, former head of Mount Sinai’s Division of Urogynaecology. She lectures throughout the community to family practitioners, allied health professionals and medical students. Mount Sinai has a unique fellowship in Mature Women’s Health for obstetricians and gynaecologists from across Canada and around the world.

Andrea Marcus

There are two clinics a week for menopausal patients. There is also a clinic for women with premature ovarian insufficiency, a condition affecting one per cent of women under 40 and bringing on premature menopause. Causes are mostly unknown but may include certain surgeries, cancer treatments such as chemotherapy, autoimmune diseases and genetics. Dr. Wolfman says many studies now show that women who have a very early menopause and who don’t receive replacement hormones up to age 50 may have a higher risk not only of heart disease but also of Parkinson’s and dementia.

“So that’s one very important group of women who I don’t think have been adequately served by the medical community,” she says.

The interdisciplinary clinic, run jointly with endocrinologists from Toronto’s Women’s College Hospital, is one of the only clinics in North America for women with premature ovarian insufficiency.

Women with this issue are encouraged to come to the clinic, both to seek treatment and to contribute to a growing body of information for future research about this condition.

Andrea Marcus of Thornhill, Ontario, experienced an earlier than average menopause around age 44 and started taking HT for severe hot flashes, night sweats, headaches, muscle pain and fatigue. It worked well, but about 15 years later, after hearing the frightening news about HT, she went off it cold-turkey. All her symptoms returned, plus a new one — frequent urinary tract infections. With a longstanding connection to Mount Sinai Hospital (she was born there and had her two children there), Andrea asked for a referral to the Mature Women’s Health Clinic.

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“ There’s been a stigma of shame…

It’s something that no one talks about.”

Celebrating a milestone

— D R. WE N DY WO LFMAN

Andrea is now on a low-dose HT regimen that has resolved her symptoms. “It’s been unbelievably successful,” she says. Now 70, under Dr. Wolfman’s guidance she is gradually cutting back the dosage. “I have the utmost respect for Dr. Wolfman. The way she talks to me — and I’m sure other patients — is just so professional and straightforward and honest. She gives you information about this study or that study so you can make informed decisions. I feel totally in control.”

There’s a whole array of body-identical HT therapies available, such as pills, gels, patches and local vaginal treatments. But HT is not for every woman, says Dr. Wolfman. Some women will not want to take it, some won’t benefit from it, and some shouldn’t take it, including those with unexplained bleeding, new cardiovascular disease or a history of certain cancers or stroke, as well as women initiating treatment over age 70, because of an increase in cardiovascular disease in that age group.

There are also many effective non-hormonal options, including gabapentin (an anti-seizure drug) and SSRI antidepressants. For mild to moderate symptoms the clinic may also recommend acupuncture, cognitive behavioural therapy or simple lifestyle changes such as dressing in layers, lowering room temperatures and avoiding triggers such as alcohol, spicy foods and stress. Andrea says she was impressed that the clinic also coordinated her care with other specialists, such as a urologist.

It’s crucial to tailor therapies to every individual patient, says Dr. Wolfman. Her overarching goal is to ensure that women who are at the peak of their lives in terms of their knowledge, skills and experience can continue to function well without being sidelined by bothersome symptoms. “It’s so rewarding to hear patients say, ‘Thank you for giving me my life back.’”

The establishment of Dr. Wolfman as inaugural holder of The Chair in Mature Women’s Health was the brainchild of Carol Mitchell (nicknamed “Mitch”), CEO and Portfolio Manager of iMaGiNe Wealth Management, a small hedge fund. As a professional woman on Toronto’s Bay Street for 30 years, Mitch had met a vast number of midlife women, and she began to see a pattern in some of their stories and their lives. “I could see the physiological strain and the toll it took on women, on their relationships, their loved ones, their kids,” she says. “It was heartbreaking.”

Mitch, who holds a phys ed degree as well as an MBA, has always been interested in women’s health issues. She heard about Dr. Wolfman, who is also a Professor in the Department of Obstetrics and Gynaecology at the University of Toronto. The two women met and talked, and Mitch decided to create a Chair to help destigmatize menopause.

The Chair would consist of an endowment, with an initial target of $2 million. The funds would be invested in perpetuity, with the return on investment available for the chair-holder’s work. Today, after two years, with Mitch as lead donor and fundraiser, $2 million has been raised and the goal has now been set at $3 million. At fundraising 36

Left to right: Dr. Gary Newton, President & CEO, Sinai Health System; Carol Mitchell; Dr. Wendy Wolfman; Louis de Melo, CEO, Sinai Health Foundation.

On April 12, guests and donors gathered in the Hennick Family Wellness Gallery to celebrate a $2 million funding milestone for the Carol Mitchell Chair in Mature Women’s Health. Dr. Wendy Wolfman is the inaugural chair holder. Carol Mitchell and her family have made a commitment to match every new donation to meet the new goal of $3 million for this Chair.

events where Dr. Wolfman speaks, Mitch says it’s telling to see how misinformed, uninformed and desperate many women are for help.

Mitch emphasizes that she wouldn’t have founded, sponsored and marketed this Chair for anyone but Dr. Wolfman. “She’s a trailblazer. She works tirelessly towards tailoring the treatment for every individual. It’s her MO to make quality of life better for people who are suffering.” Another primary goal of the program is to have young doctors, female and male, become menopause specialists as the next generation of Dr. Wendy Wolfmans. As Mitch says, “It’s like you want to clone her!”

Dr. Wolfman says, “I’m so grateful to Mitch and to all the people who have donated. It means that, hopefully, all the work I’ve done to establish these internationally recognized clinics and build the fellowships — really, my life’s work — will stay forever at Mount Sinai.”

T O DO NAT E T O T H E CHAI R I N MAT U R E WO M E N´S H EA LT H , PL EASE VISIT:

supportsinai.ca/maturewomenshealth

Community Corner 10

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HELP MOUNT SINAI HOSPITAL BUILD FOR THE FUTURE 30

COM M U N ITY BU I L D E R S

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S C H WA R T Z / R E I S M A N E M E R G E N C Y C E N T R E

A Sinai Health Community Builders Campaign event on April 9 was hosted at the home of Howard Sokolowski, Co-Chair of Sinai Health Foundation Board of Directors. Leaders in Canada’s building development community came together to support Sinai Health System and its plan to physically transform Mount Sinai Hospital, including the hospital’s Schwartz/Reisman Emergency Centre, to meet the changing needs of the community. The Honourable John Tory, Mayor of Toronto, was also a guest. More than $11 million was pledged collectively and the figure is still growing.

E N T RA NC E

New Space

Ambulatory Entrance

2018201F

Current Space

Dr. Mathew Sermer, Chair of Obstetrics and Gynaecology

AM ISRAE L CHAI

Four years ago, a group from the Jewish community came together and raised $2.45 million to establish the Am Israel Chai Antenatal Unit. At a gathering in April, these efforts were extended with the objective of securing funds to sustain this vital component of our Women’s and Infants’ program. Guests at the event enjoyed a reception and had an opportunity to tour the antenatal unit.

SU N L I FE G I FT H E L P S T RA NS F OR M P OST-PREGNANCY DIABET ES CARE

Sun Life Financial has made a $750,000 commitment to Sinai Health System to launch the Sun Life Financial Program to Prevent Diabetes in Women. This innovative program will help Sinai Health’s efforts to transform women’s health in Canada by developing risk assessment tools that will screen, monitor for, and prevent the onset of Type 2 diabetes post-pregnancy for women affected by gestational diabetes.

Left to right: Linda Dougherty, Executive Vice-President, Corporate Strategy and Global Marketing, Sun Life Financial; Dr. Gary Newton, President and CEO, Sinai Health System; Louis de Melo, CEO, Sinai Health Foundation; Dr. Ravi Retnakaran, Endocrinologist, Leadership Centre for Diabetes, Mount Sinai Hospital; Dr. Denice Feig, Head of the Diabetes in Pregnancy Program, Mount Sinai Hospital; Victoria Cho; former gestational diabetes patient.

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DREAM WITH SCIENTISTS LEAVES GUESTS IN AWE As Dream with Scientists — Sinai Health’s marquee benefit for the Lunenfeld-Tanenbaum Research Institute (LTRI) — made clear: the important research that goes on at the LTRI is science and not magic. But sometimes the discoveries made there certainly seem magical!

Presented by PearTree Financial and held on March 28, 2018 at Rebel nightclub in Toronto, the evening brought together more than 350 guests from the city’s business, philanthropic and scientific communities for an evening of awe and wonder that raised critical funds in support of LTRI research.

Guests had the opportunity to learn about the important work of four scientists — Dr. Rayjean Hung, Dr. Kerry Kuluski, Dr. Bruce Perkins and Dr. Frank Sicheri. “Scientific discovery is the single most powerful force for unravelling the mysteries of disease and improving our health,” said Dr. Jim Woodgett, Director of the LTRI in the opening video. “Our researchers pursue bold ideas and take leaps of imagination that push the boundaries of medical science.”

Entertainment included 15-year-old operatic singing sensation Laura Bretan, a cirque performance from A2D2 and an exclusive performance from illusionist Darcy Oake who dazzled guests by making doves appear out of thin air and performing several logic-defying illusions. The event co-chairs were Judy Tanenbaum and Stacey Cynamon.

Since its inception, Dream with Scientists has raised close to $3 million to fuel life-saving research that impacts patients around the world.

Judy Tanenbaum, Darcy Oake, Stacey Cynamon

Howard Sokolowski, Co-Chair, Board of Directors, Sinai Health Foundation; Brent Belzberg, Chair, Board of Directors, Sinai Health System; Dr. Howard Ovens, Chief Medical Strategy Officer, Sinai Health System; Dr. Gary Newton, President and CEO, Sinai Health System; David Cynamon, Co-Chair, Board of Directors, Sinai Health Foundation; and Louis de Melo, CEO, Sinai Health Foundation

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P H O T O C R E D I T: R YA N E M B E R L E Y

Illusionist Darcy Oake performs for the crowd

Soprano Laura Bretan with A2D2 cirque performers

T H E 7 T H AN N UA L G R EA T JEWE LLE RY H E IS T W H E N : October 27, 2017 W H A T: A diverse and influential

group of men and women from Bay Street and Toronto’s fashion circles came together in support of Bridgepoint Active Healthcare at The Great Jewellery Heist, presented

by CIBC. Attendees participated in exclusive silent and live auctions featuring fine jewels, vintage estate jewellery and one-of-a-kind designer pieces, and were treated to a gourmet luncheon at the RitzCarlton hotel. The event was hosted

by Jeanne Beker and has raised over $1.8 million since its inception.

W H O : 1. Event Chair Amber P H O T O C R E D I T: G E O R G E P I M E N T E L

Choudhry with emcee Jeanne Beker 2. Guests enjoying the luncheon at the Ritz-Carlton

RAC E F OR RESEARCH Errol Tenenbaum started running six years ago and it wasn’t long before he was ready for his first race. “In addition to being great exercise, running gives me a chance to disconnect from everything for a little while,” he says. Errol enjoys giving back and showing his gratitude for the care his family has received at Mount Sinai Hospital over the years through Race for Research (R4R). R4R allows participants to fundraise for Sinai Health Foundation while participating in local Toronto runs — such as the Scotiabank Toronto Waterfront Marathon, or by creating a personal, individual challenge.

M I LES F O R M I RACLES W H E N : November 4, 2017 W H A T: The eighth annual Miles for Miracles Cole

Tummers Memorial Fundraiser in support of the Fetal Therapy Program at Mount Sinai Hospital.

W H O : Tummers Family with Dr. Greg Ryan

TH E 4 TH AN N UA L GA LA I N S U P P OR T OF T H E PAN OV P RO G RA M A T M OU N T S I NA I H OSPI TAL W H E N : January 20, 2018 W H A T: An annual fundraiser which brings more than 500

young professionals together to enjoy a night of food, drinks, dancing and live entertainment to raise funds and awareness for cancer research at Mount Sinai Hospital.

W H O : Adam Panov, along with his mother Dr. Rochelle

Schwartz and brother Elan Panov

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2 0 1 7 ASSET MANAGE M E NT I N DUSTRY HO LD’ E M F O R LI F E CHARI T Y CHALLE N G E W H E N : November 29, 2017 W H A T: The event is a unique evening of fun and friendly

competition attended by top executives from Canada’s leading asset management and finance firms to support cancer research.

W H O : Guests are seated for the first round of the poker tournament

BEYO N D BO RDE RS: AM BI T I O N

PHOTO COURTESY OF:TH E ROBI NS N EST

P H O T O R E D I T: M A N G O S T U D I O S

VA LE NT I N E’ S DAY M U SI C & LUNCH PART Y W H E N : February 14, 2018 W H A T: Marissa Kassam, Lauren

Granatstein and Ashley Steinhauer hosted a music and lunch event for moms and their babies to support the Rogers Hixon Ontario Human Milk Bank. Proceeds will be used to help fund marketing tools for the Milk Bank.

W H O : Marissa Kassam, Lauren Granatstein,

Ashley Steinhauer

W H E N : January 13, 2018 W H A T: An elegant evening

filled with great food, music and motivational speakers, in support of Twin-to-Twin Transfusion Syndrome.

W H O : Beyond Borders group on

stage at the event

SE RV I N G F O R S I NA I W H E N : March 25, 2018 W H A T: Serving for Sinai returned to Beach

P H O T O C R E D I T: J O S H F E E P H O T O G R A P H Y

Blast, an indoor beach facility, for its second year. Thirty teams competed in a “battleof-the-business” volleyball tournament. The event has now raised more than $400,000 for the Lunenfeld-Tanenbaum Research Institute.

W H O : 1. Front row: Carly Bardikoff, Demi Sacks; Back row: Louis de Melo,

Zack Belzberg, Dr. Jim Woodgett, Jesse Abrams, David Cynamon 2. Teams competing at Beach Blast

Your Health

WHY HEART HEALTH MATTERS

5%

of Canadians live with heart disease, and every seven minutes it kills one of them

Cardiac complications are the leading pregnancy-related cause of death in women

HOW SINAI IS HELPING

• Our cardiac research team is exploring the heart factors that cause breathlessness in both women and men

• Global leader in defining standards of care for pregnant women with heart disease

• Research aimed at tailoring treatment to gender will save the lives of about 35,000 women admitted to hospital for heart attacks in Canada each year

• The Heartfull Collaborative is a “shared-care” model that integrates specialized cardiology and homebased palliative care teams

• The Harold & Esther Mecklinger Family/The Posluns Family Cardiac Catheterization Research Laboratory was the first catheterization laboratory in North America focused exclusively on research

31,000/yr heart patients consult with our cardiac physicians

pregnant women receive care for their heart conditions

100/yr pacemakers implanted

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He a #1 rt fai ov rea lure is the so er 65 n people are hospitalized

THE SEARCH FOR ANSWERS

• National leader in care and research for advanced heart failure

600/yr

Heart disease is the leading cause of death among Canadians

HEART CARE FOR THE 99% Only a tiny percentage of patients with heart failure will ever need or receive a heart transplant. The vast majority will be cared for medically, often over many years.

These are the patients we focus on at Mount Sinai Hospital.

• Using the cath lab’s rare imaging infrastructure we can measure cardiovascular and pulmonary performance in people with heart disease, healthy people and endurance athletes to study the impact of exercise on the heart • Researchers are laying the groundwork for safer pregnancies by studying pregnant women who have congenital heart defects or structural problems with their heart valves, arteries or veins

Thank you Miles and the Nadal family for strengthening the heart of Sinai Health An $11 million gift from philanthropist Miles Nadal will transform cardiac care at Mount Sinai Hospital.

The Miles Nadal Heart Centre brings together the hospital’s expertise in different patient populations and is at the international forefront of understanding heart disease. The Centre will propel research to better understand heart function to help address one of the most pressing health issues facing Canadians.

We are truly grateful for this visionary gift and extend our heartfelt thanks to Miles and his family. supportsinai.ca43

Hospital + Rehabilitation + Home Care + Research Sinai Health System is Canada’s leading integrated health system and comprises Bridgepoint Active Healthcare; Circle of Care; Lunenfeld-Tanenbaum Research Institute; and Mount Sinai Hospital, Joseph & Wolf Lebovic Health Complex. Sinai Health Foundation, with its partners Arthritis Research Foundation and Bridgepoint Foundation, raises and stewards funds to support Sinai Health System.

The generous support of our community fuels everything we do, from seamless care to scientific discovery.

TO SU P P O R T SI NAI H EA L T H S Y S T E M , P L EASE V IS I T:

supportsinai.ca/ sinaihealth