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HPV & ME WHAT MEN NEED TO KNOW

23 1/2 HOURS SAVE YOUR LIFE IN 30 MINUTES

SURVIVORSHIP: LIVING AFTER CANCER


t er-free movemen into Albertas canc
SPRING 2012

Ezekiel Weis sets his sights on new ocular cancer treatments

LITTLE CANCERS
Should we really use the C-word?

LESS PAIN, MORE GAIN

A top nurse helps patients deal with discomfort

LICKS & WAGS: Pets help your health p. 42

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EPIC RIDE. EPIC IMPACT.


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CONTENTS
ON THE COVER: Ezekiel Weis PHOTO: Aaron Pederson, 3TEN

SPRING 2012 VOL 2 No. 4

SPRING SPOTLIGHT
SURVIVORSHIP: Living After Cancer

24 SURVIVORS: THE ROAD AHEAD


Life after cancer can be a beautiful burden

20

28 A LITTLE CANCER DEPARTMENTS 4 OUR LEAP 6


FOREFRONT
Top 10 foods you should eat; Women in Action walk the Kitikmeot; Hair for care; The musical fruit; Prairie boy remembered; + Much more!

Is surviving pre-cancerous cells the same as surviving cancer?

30 32 36

BEYOND CHILDHOOD CANCER


Find out how long-ago disease impacts health today

A message from the Alberta Cancer Foundation

DOWN SYNDROME AND CANCER


Having cancer adds a new layer of complexity for some patients and their families

THE PERSONAL TAKE


A cancer foundation trustee finds the cause of his life

16

12 13 14

BODYMIND
Find out more about integrative oncology

SMART EATS
Go green for springtime

FEATURES 16 HOUSE OF PAIN (MANAGEMENT)


A nurse practitioner soothes patients savage discomfort

ASK THE EXPERTS


Does a larger waist circumference put women at risk for endometrial cancer? Should my elderly mother do exercise classes? What are the top five heart-protection tips?

20 EYES FRONT 38

Dr. Ezekiel Weis keeps his focus on saving patients vision

38 42

19

CORPORATE GIVING
Imperial Oil funds a gym especially for cancer survivors

THE ABCS OF HPV


Should boys get the Garadasil vaccine, too?

42 PAGING DR. SLOPPY KISS 44 23 47


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50 MY LEAP

Newsflash: our creatures improve our health

Scott Todd runs for his life

HOURS

Limit your sleeping, lollygagging and sitting to this much time per day

WHY I DONATE
Katie McLean brought her enthusiasm for Joes Team to Calgary

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ALBERTA CANCER FOUNDATION

Starting at the End


Our ability to detect cancer earlier, diagnose it more accurately and treat it more effectively means there are an estimated 100,000 Albertans alive with a personal cancer story to tell. While it is important to celebrate that progress, it is just as important to ensure those survivors receive the support they need to lead as healthy and active a life as possible, for as long as possible. In this issue, you will learn Experts in the eld that surviving cancer is a conargue that survivorship tinual and evolving process. should even come with Living with cancer begins at a prescription of its own the moment of diagnosis. Yet, so patients and caregivers the transition from active treatknow what to expect ment to post-cancer care is critical to long-term health. after treatment. You will hear from Kali Cousins, diagnosed with leukemia seven years ago, and how, for her, the end of treatment signalled more anxiety than relief. When her safety net of frequent contact with a personal care team came to an end, it was difcult to adjust to life lled with uncertainty. You will hear from Dr. Janine Giese-Davis, who leads provincial research and evidence-based care on survivorship, and how cancer care has shifted to focus on this previously ignored area of study. You will also learn how surviving childhood cancer can present its own set of challenges and how researchers are trying to address those needs. As research in the eld of cancer survivorship continues to advance, we learn more about the appropriate delivery of care to this population. We are learning how to address the effects a cancer journey may have on the physical, psychological and social well being of cancer survivors and their caregivers. The amount and quality of research related to cancer survivorship continues to grow. This rapid increase of new knowledge that helps us understand and promote the health of adults and children affected by cancer has allowed us to do a better job at mapping out and changing the landscape of cancer survivorship. Experts in the eld argue that survivorship should even come with a prescription of its own so patients and caregivers know what to expect after treatment. That is how important the transition is. As you will see by the stories inside, we tend to agree.

Myka Osinchuk, CEO Alberta Cancer Foundation TRUSTEES Leslie Beard, Edmonton Angela Boehm, Calgary Heather Culbert, Calgary Steven Dyck, Lethbridge Dianne Kipnes, Edmonton Katie McLean, Calgary John J. McDonald, Edmonton John Osler, Calgary Brent Saik, Sherwood Park Prem Singhmar, Sherwood Park Heather Watt, Edmonton Vern Yu, Calgary John Osler, Chair of the Board of Trustees Alberta Cancer Foundation

spring 2012

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SPRING VOL 2 No. 4

ALBERTA CANCER FOUNDATION ASSOCIATE EDITOR: PHOEBE DEY EDITORIAL ADVISORY COMMITTEE DR. PAUL GRUNDY, Senior Medical Director, Cancer Care Alberta Health Services DR. HEATHER BRYANT Vice-President, Cancer Control Canadian Partnership Against Cancer DR. STEVE ROBBINS Director, Southern Alberta Cancer Research Institute Associate Director, Research, Alberta Health Services, Cancer Care CHRISTINE MCIVER CEO, Kids Cancer Care Foundation of Alberta VENTURE PUBLISHING INC. PUBLISHER: RUTH KELLY ASSOCIATE PUBLISHER: JOYCE BYRNE EDITOR: MIFI PURVIS ASSISTANT EDITORS: CAILYNN KLINGBEIL & MICHELLE LINDSTROM ART DIRECTOR: CHARLES BURKE ASSISTANT ART DIRECTOR: COLIN SPENCE ASSOCIATE ART DIRECTOR: ANDREA DEBOER PRODUCTION MANAGER: VANLEE ROBBLEE PRODUCTION COORDINATOR: BETTY-LOU SMITH DISTRIBUTION: HEATHER MORRISON CONTRIBUTING WRITERS: Collen Biondi, Linda Carlson, Mike Evans, Lewis Kelly, Cailynn Klingbeil, Michelle Lindstrom, Nomi LoPinto, Steve McLeod, Omar Mouallem, John Osler, Lisa Ricciotti, Karol Sekulic, Debby Waldman CONTRIBUTING PHOTOGRAPHERS AND ILLUSTRATORS: 3TEN, Brian Buchsdruecker, Christy Dean, Caroline Hamel, Joey Podlubney, Lisa Rebnord, Liisa Sorsa ABOUT THE ALBERTA CANCER FOUNDATION The Alberta Cancer Foundation is Albertas own, established to advance cancer research, prevention and care and serve as the charitable foundation for the Cross Cancer Institute, Tom Baker Cancer Centre and Albertas 15 other cancer centres. At the Alberta Cancer Foundation, we act on the knowledge that a cancer-free future is achievable. When we get there depends on the focus and energy we put to it today.

The Alberta Cancer Foundation is more than a charityits a movement for cancer-free lives, today, tomorrow and forever.
Its a movement of those who know a cancer-free future is possible and who wont settle for some day. Its a movement of Albertans who stand with those who have no choice but to stand up to cancer. Its a movement of those who know something can be done and are willing to do it. For those facing cancer today, in honour of those lost to cancer, and for generations to come, we promise progress.

Leap is published for the Alberta Cancer Foundation by Venture Publishing Inc., 10259-105 Street, Edmonton, AB T5J 1E3 Tel: 780-990-0839, Fax: 780-425-4921, Toll-free: 1-866-227-4276 circulation@venturepublishing.ca
The information in this publication is not meant to be a substitute for professional medical advice. Always seek advice from your physician or other qualied health provider regarding any medical condition or treatment.
Printed in Canada by Transcontinental LGM. Leap is printed on Forest Stewardship Council certied paper Publications Agreement #40020055 ISSN #1923-6131 Content may not be reprinted or reproduced without permission from Alberta Cancer Foundation.

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PREVENT, TREAT, CURE

BY MIFI PURVIS

Prairie Boy

Rock the Fight!


It was a case of creativity vs. limitations.

Lorne Howes was a tall, skinny guy with big brown eyes. The girls

always liked him, says brother Randy Howes. Their mom and dad raised the boys and sister Sandy in Carstairs in the 1960s and 70s. Lorne lived in Calgary for a year but, an avid hunter and sherman, city life never took. After a hunting trip in his early 20s, Lorne was skinning some pelts and got the usual spate of little nicks. This time they didnt heal properly, and he was bruising easily, too. Tests revealed acute myeloid leukemia (AML). Doctors said that treatment would be aggressive and harsh and, if it knocked the AML into remission, might allow him six to 24 months of relative good health. Randy spent a lot of time at his brothers bedside at Calgarys Holy Cross Hospital in the weeks that followed and, happily, Lornes cancer went into remission for ve years. But it came back in 1988. No one in the family was a match to donate bone marrow, a procedure that might have saved him, and the bone marrow donor registry was years away from being a viable tool. At the time, Randy was a university student when 30-year-old Lorne, by this time nished with chemo, called to invite him to his home in Cremona for a meal with him and a group of friends. Deep into a group project with a deadline, Randy told him hed see him on the weekend instead. But the next day Lorne collapsed and friends rushed him to the hospital in Calgary, starting CPR on the way they knew Randy and the rest of the family would want to say goodbye. Randy and his parents made it to the hospital quickly, but Sandy, living in High River, was harder to reach. There was this young nurse, and she stayed with Lorne, Randy says. The nurse squeezed a manual bag valve mask to breathe for Lorne until Sandy made it to say her goodbyes. That nurse must have stood there squeezing that bag for three hours. Years later, Randy became a spokesperson for bone marrow donation, and a bone marrow donor for another Southern Alberta man. SURE SHOT: Randy and friends Donald and Gwen Day, who own Silver Willow Golf and Sporting Club in Carstairs, host the annual Lorne Howes Clay Shoot for Cancer, held this year on April 21, benetting the Alberta Cancer Foundation. Find out more at silverwillow.ca. 6

Creativity won in Vermilion. Anthony Martin and three-time cancer survivor Bernie Webb knew that in a small town you cant rely on sheer numbers of people to raise money for a charitable cause. Anthony and I started talking about a way to give back and hit on a hockey game, says Webb. They adapted the plan as they went along, and the ensuing event, Rock the Fight, is a little like a town carnival for cancer. The pair arrived at the idea of outtting the players in pink hockey jerseys and then auctioning them off at a silent auction later. There was a bidding war and some of them were sold for $500, Webb says. Other items were a little pink ride-on tractor for kids, a 50/50 draw, and we added a tailgate party in the third year. The four-year total is more than $100,000 benetting the Alberta Cancer Foundation, with proceeds earmarked for various things at the Cross Cancer Institute, including an airbed, wheelchairs, research into kids cancer and, last year, a perometer. The device measures the limbs of patients who might be at risk of developing lymphodema, a dangerous and uncomfortable swelling of one or more limbs. This condition is a common side effect of breast cancer treatment. Last year we had Olympian Becky Scott come to Vermilion as a speaker, Webb says. Next we want Rick Mercer. I dont know he knows that yet. Vermilionites are hoping hell turn up to Rock the Fight.

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Hooray for Hinton


Little Hinton is home to a host of events that raise money to benet

the Alberta Cancer Foundation in support of the Hinton Community Cancer Centre. Check it out: THE FIRST ANNUAL STEVE DANIELS MEMORIAL HORSESHOE TOURNEY: August 13, 2012. PINK QUILTS: The Rocky Mountain Quilters Guild and the Solomon Creek Quilters Guild have made more than 30 pink quilts in support of the local breast cancer unit, raising $28,145. INSPIRE BRACELET FUNDRAISER: Terri Bainbridge writes on her Facebook fundraiser page: I have a future vision of our Hinton Community Cancer Centre that has been expanded in size and is visually and physically comforting for the patients receiving treatment and for those who also come to encourage and support their loved ones. Last year Bainbridge raised $4,025. COURTNEYS PHOTOS: This vibrant photographer has created a calendar and is donating the prots from its sale ($7,000 to date) to the local cancer centre. THE BOOB TOUR: A stand-up comedy show, this event came to Hinton in 2010 and 2011, benetting the Hinton Community Cancer Centre. THE BLIZZARD BBQ: This get-together was well-received in Hinton. Glen Szegi, general manager at Sears, organized the event that was kick-started by a donation from Sears, helping raise more than $1,100.

Keep Walking

There was a time when the Inuit were arguably

ANDREW MICHAELS

the ttest people on earth. A great diet of country food from the land and sea, and a lifestyle that entailed lots LOTS of walking contributed to their well-being. In the Kitikmeot (central Arctic area) modern convenience has eroded traditional healthy habits. As in the south, its taking a toll on peoples health. It seems like so many people are getting cancer, says Cambridge Bay resident Jeannie Ehaloak. In her mid-40s, she had already lost two sisters to cancer and she wanted to take action. I believe that living a healthy lifestyle and eating right will help Nunavummiut live longer, she says. She wasnt the only one thinking that way. In Iqaluit, her sister Edna Elias, commissioner of Nunavut, had been making her own strides to better tness she had lost more than 60 pounds. To reach the goals of a higher level of health and tness, becoming an example for others and raising money for the Alberta Cancer Foundation (cancer patients from the Kitikmeot typically get treatment at the Cross Cancer Institute), the two sisters, along with three other women from Nunavut and one from Calgary, plan to take a walk. Their walk will take place in May and extends from Umingmaktuuq to Cambridge Bay, a journey of seven or eight days, walking about a marathons distance (42 kilometres) per day. Theyll have a resupply team on snowmobiles and theyll camp along the way. As if the walk werent enough, Elahoak adds: If theres a storm, well wait it out and somebody will bring a gun in case of bears. The group, Women in Action, is raising funds at albertacancer.ca/womeninaction

Alber tas cancer-free movement

spring 2012

Red Beans and Rice


This is one of the recipes you can nd in the latest cookbook by Calgarys Julie Van Rosendaal and Sue Duncan, Spilling the Beans (Whitecap, $29.95). The book offers great tips on preparing and cooking all kinds of beans, and tting them seamlessly into every course and any meal. Even breakfast.

Ingredients (serves 4 to 6)
Vegetable or olive oil 1 onion, chopped 2 stalks celery, chopped 1 red or yellow bell pepper, seeded, chopped 3 to 4 garlic cloves, crushed or chopped 4 cups cooked red kidney beans, or 2 cans (540 mL size), drained 4 to 5 plum tomatoes, chopped, or 1 can (398 mL) diced or stewed tomatoes cup (60 mL) Pickapeppa sauce* Hot, cooked rice * Jamaican condiment available on most supermarket shelves.

Directions Heat a drizzle of oil in a large saucepan set over medium heat. Add the onion, celery, red pepper, and garlic and saut for about 10 minutes, until the onion starts to turn golden. Add the beans, tomatoes, and Pickapeppa sauce and bring to a simmer. Turn the heat down, cover, and cook for about 1 hour, until nice and thick. (Add a little water, stock, or tomato juice if its too thick.) If you like, let the mixture cool down and refrigerate, then reheat it after a day or two. Serve hot, over rice.

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Learning Through Love


Its the unknown that scares us and, as the

saying goes, forewarned is forearmed. Sure, adults need to know whats going on with their cancer treatment but so do their family members, right down to the little guys. Thats why Karen Saban and team members at Edmontons Cross Cancer Institute started the Learning Through Love program. Its aimed at the children of cancer patients to demystify the cancer treatment experience and help them gain a better understanding of what to expect. We take children through the areas that a patient would see, says Saban, co-ordinator of the program. Tour groups start at psychosocial services and move to the volunteer information

centre. Next they visit the day care unit, learning all the reasons why their family member might visit, such as to receive hydration or other therapy. They get to see what an intravenous needle looks like, for example, Saban says. Its very hands-on. Volunteers from various parts of the cancer hospital come and speak to the kids to explain what they do. The kids get to look through microscopes, and we take them to the wig salon to try on wigs they all like that. Saban says groups of anywhere from four to 12 kids go through every six weeks during the school year. The tour is catered to the childrens ages and they have toured kids from about six to 17. The tour culminates in the sunroom with a surprise visit from a balloon twister. To register your child for Learning Through Love or to nd out more, call 780-643-4304.

Pick up your free copy of My journey, now available at centres throughout the province. Tom Baker Cancer Centre:

New patient information sessions A  lbertaCancerFoundationoffice

Cross Cancer Institute:

New patient clinicis A  lbertaCancerFoundationoffice Cancer Information Centre

For those facing cancer today


Manage your cancer-care and navigate the health care system with a patient journal from the Alberta Cancer Foundation.
The more information you can track and communicate with your care team, the more they can ease your cancer journey.

Associate cancer centres:


Grande Prairie Cancer Centre Central Alberta Cancer Centre (Red Deer) Medicine Hat Cancer Centre Jack Ady Cancer Centre (Lethbridge)

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Long on Love
Neil Makokis started

growing his hair, thinking he could donate it to make a wig for his sister Darlene, who was facing cancer treatments. Unfortunately, she died before his hair was long enough. But in a tribute to her, he kept growing it for several more years, and prayed when he braided it every morning. In November 2011, 48-year-old Makokis had the braids cut in a ceremony at City Hall in Edmonton that remembered his sister and raised money to benet the Alberta Cancer Foundation. The whole experience was enlightening and ful lling, Makokis says. The oering of my hair was meaningful, but doing so in a ceremony and honouring my culture made it that much more meaningful.

Still Time to Bust Out


All across Edmonton, men and women are

donning runners and tutus and joining friends as they enter the nal prep for Bust a Move BaM a six-hour exercise extravaganza to raise money for the Alberta Cancer Foundation, benetting breast health. BaM happens at Edmontons Northlands Expo Centre on March 24. Participants do six, 45-minute exercise sessions think yoga, 10

zumba, old-fashioned aerobics taught by Richard Simmons himself. Event organizers supply food and water and massage therapists are on hand to work out the kinks. Head down that day to check out the festivities and start planning your entry for next year. And head to bustamove-edmonton.ca to donate in honour of your favourite team or solo participant. Consider yourself a mover and shaker!

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Top 10 Ways to Boost Your Diet


Theres lots of information out there about foods that are great

boosters against cancer. Here are some of our favourites, along with easy ways to incorporate them into your daily meals and snacks.

TURMERIC This yellow spice has a mild earthy avour. A couple of teaspoons in a pot of chicken soup gives depth to broth, in terms of colour and avour. Also add it to tomato sauce.

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GARLIC No meal has ever suffered from the addition of minced garlic, which contains selenium, tryptophan and sulphur these discourage the development of cancer. Mince it up a clove or two and add to almost any dish, cooked or fresh. TOMATOES Lycopene in tomatoes may have discouraging effects on the growth of cancer in the prostate, lung and colon. Use cooked or jarred tomatoes to maximize the lycopene. SEEDS & NUTS Sunower and pumpkin seeds have lots of plant protein and oils as wells as vitamin E, zinc and vitamin C. Walnuts are rich in healthy oils and help make you feel full. Throw a handful on your salad, into your mufns or cereal.

Drug Holds Off-label Promise


Researchers in Scotland uncovered an

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5. CHOCOLATE Ditch the candy in favour of some rich dark chocolate, the higher the cocoa content the better. Its also rich in avinoids, antioxidants that convince your body to send out clean-up crews. The trick? Stop eating it after a couple of squares. 6.
CITRUS All citrus fruits may boost the cancer-buster properties of the phytochemicals we gain from other foods. Use lemon or lime in your salad dressing and curries, and toss a whole orange into the blender with some frozen berries and ice water for a sweet drink. Squeeze lemon in your soup right before you serve it it spikes the taste, too. FLAX Flaxseed oil or ground axseeds are great in salad, soups or smoothies. Flax has omega-3, which, with its anti-inammatory properties, could help prevent tumour growth. (Olive oil, oily sh and bison also have omega-3.) FRUIT & VEG More, more, more! Strive for seven to 10 servings (about a half-cup each) per day. Boost it with fruit smoothies, a fruit bowl kept on the desk in the ofce and serve a salad with every meal. Keep frozen veggies on hand for when you are time-strapped.

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SPUDS These should neither come in a crinkly package nor be cut into shoestrings and deep-fried. Leave the skins on for extra nutrients.

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BE LIKE MIKE Michael Pollan, author of the Omnivores Dilemma, writes: Eat food. Not too much. Mostly plants.

interesting surprise in 2005: people with type II diabetes who were taking a common, well-tolerated drug called metformin had lower incidences of cancer. There have been several other studies since looking at the relationship between metformin and cancer that support the Scottish ndings. That much established, it was time to look at how metformin was inuencing cancer development. Researchers from McGill University and the University of Montreal published a paper in January in the journal Cancer Prevention Research, documenting their ndings. They found that metformin reduces the rate at which cells mutate. Mutation accumulates cellular damage in the DNA, a process at work in the development of cancer. It is remarkable that metformin, an inexpensive, o-patent, safe and widely used drug, has several biological actions that may result in reduced cancer risk, said study director Dr. Michael Pollak, professor in McGills Departments of Medicine and Oncology, in a press release. These latest ndings suggest that it reduces mutation rate in somatic cells, providing an additional mechanism, by which it could prevent cancer. The study shows that metformin reduces reactive oxygen species (ROS). ROS are known to be DNAdamaging agents produced as by-products when mitochondria in cells generate energy from burning nutrients. But before you go to the drug store looking to buy a bottle of metformin, the study authors are quick to say that the mechanisms are still not understood well enough to use the drug in the general population as a means to prevent cancer. But the ndings open a new area of cancer research, Pollak says.

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bodymind /

MAKING POSITIVE CONNECTIONS

Integrative Oncology: What is it?


BY LINDA E. CARLSON
You may have heard the term integrative oncology bandied about quite a bit lately. According to Dr. Steven M. Sager, (in the Journal of the Society for Integrative Oncology, winter 2006) integrative oncology combines the discipline of modern science with the wisdom of traditional healing. It is an evolving evidence-based specialty that uses complementary therapies in concert with medical treatment to enhance its efcacy, improve symptom control, alleviate patient distress and reduce suffering. You would be forgiven for thinking this sounds very similar to what people usually refer to as complementary and alternative medicine (CAM). Integrative oncology, as a subspecialty of integrative medicine in general, stems from a philosophy of treating the whole person: body, mind and spirit. It uses many CAM approaches such as natural health uses complementary approaches, as distinguished from alternative medicine products (botanicals, vitamins and minerals), nutrition, approaches, which usually eschew standard treatments while promising cure. acupuncture, meditation and other mind/body Alternative approaches are typically lacking evidence for their efcacy and often rely approaches, music therapy, touch therapies (such as on anecdotal reports alone. A hallmark of integrative medicine is that interventions are evidence-based massage) and physical activity, to name a few. and, where evidence doesnt exist, research is The key element that distinguishes integrative A hallmark of integrative medicine conducted with promising treatments. Currently oncology from CAM is that it is that interventions are evidence- there is a lack of evidence for many integrative is a system of interdisciplinary based. Its an evolving specialty. oncology interventions as this field of research is still quite young. Ive already reviewed some care, blended throughout cancer care as necessary for each person. This system of those with good evidence for this column, including meditation, yoga, exercise, employs a collaborative team approach that is patient- support groups and creative therapies. At the Tom Baker Cancer Centre, as part of my research chair in psychosocial centred, so that the patients needs and views dictate the course of care, not those of the practitioners. The oncology, one focus area is integrative oncology. Over the next ve years we plan idea is to avoid medical paternalism and instead to to step up this research program and expand from our expertise in mind-body provide evidence-based advice that is consistent with approaches into better understanding of natural health products, such as vitamins each patients values. It is meant to treat the whole and botanicals. Hopefully we will be able to provide better information for patients person through a partnership between patient and and begin clinical trials to investigate the utility of some of the more promising practitioner, and to promote health and wellness, integrative interventions. prevention of disease and to bring out the innate healing capacity in each person. Dr. Linda Carlson (lindacarlson.ca) is the Enbridge Chair in Psychosocial Oncology at One overall goal of integrative oncology is to increase the University of Calgary and a clinical psychologist at the Tom Baker Cancer Centre. the efcacy of conventional cancer treatment programs such as chemotherapy and radiation by reducing side-effects and improving tolerance, reducing READ: Dr. Sagerss article, The State of the Art and Science symptoms and improving quality of life. Some of the Integrative Oncology, www.sunshineih.com/Health/ approaches may also have potential to extend life, but wp-content/uploads/2010/11/integrative-oncology.pdf this is a controversial topic that is currently the focus VISIT: myleapmagazine.ca and search bodymind. of much investigation. Integrative oncology typically 12

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cookingsmart /

FOOD FOR LIFE

Coming Up Greens
BY KAROL SEKULIC
The green of spring is a good reminder that most of us need to green up our plates with vegetables and fruit. Eating the daily recommended amount of vegetables and fruit reduces the risk of heart disease, stroke and certain types of cancer. Vegetables and fruit are lower in energy density, meaning they have a low amount of energy (calories) per unit of food. For example, 20 stalks of celery have the same amount of calories as half a chocolate bar. Not only are vegetables and fruits packed with nutrients, they also help us to feel fuller. Green vegetables are recommended to improve your intake of folate, important for women who are pregnant or are considering pregnancy, and in children and adults for avoiding anemia. Your bones love green leafy vegetables for the vitamin K, which may improve bone density in people with osteoporosis. Leafy greens can also benet your eyesight because they have two plant chemicals, lutein and zeaxanthin, which may protect your peepers from age-related macular degeneration. Really, its difcult to nd a reason not to eat more green vegetables. Most adults need seven to 10 servings of vegetables and fruit per day. Canadas Food Guide makes specic recommendations about choosing one dark green and dark orange vegetable daily. So, in the spirit of the season, here are the ABCs (arugula, broccoli, chard) of adding more green to your plate. A is for Arugula Arugula is a green leafy vegetable that has a distinct, spicy flavour. Use it raw in mixed garden salads or cooked tossed with pasta or risotto. Other leafy greens that pack a lot of nutrients include spinach, kale and mustard greens. But use delicate arugula and spinach quickly because they spoil sooner than kale or mustard greens. A serving of the leafy greens is half a cup (125 mL) cooked or one cup (250 mL) raw. If you are adjusting to the taste of a new leafy green, add arugula, kale or spinach to whatever lettuce you are already using for a salad. You can also chop these greens nely and add to soups, stews or sauces. Try a green smoothie with some raw spinach, fresh or frozen blueberries and cold water. It can be a refreshing and nutritious drink.

B is for Broccoli and Brussels sprouts Broccoli and Brussels sprouts belong to a powerful family of good greens called cruciferous vegetables. Cruciferous vegetables have high concentrations of chemicals called glucosinolates. (These affect the way your body processes blood thinners check with your doctor.) They also are among the lowest-calorie vegetables. The unfortunate thing is that many people report that these are not their favourite vegetables. Try broccoli chopped in smaller pieces as a pizza topping, to pasta sauce, in stir fries with a drizzle of sesame oil or as a lling for omelets. Grate Brussels sprouts and add to soups and stews. Or combine cooked Brussels sprouts with walnut halves and goat cheese as a side dish. C is for Cabbage and Chard These are nutritious, inexpensive green vegetables. Cabbage, also a cruciferous vegetable, keeps for a long time in your refrigerator. Beyond using it for coleslaw you could also saut it with onions and serve over brown rice. Use cabbage leaves to wrap your next taco or burrito or add shredded cabbage to sandwiches as a change from lettuce. Chard, or Swiss chard, is commonly found in Albertas backyard gardens. It is a tall leafy green vegetable that has a thick, crunchy, white, red or yellow stalk. Both the stalks and the leaves are edible. Trim the bottom end of the stalk. Sometimes the stalks are brous; if so, discard the tough parts. Separate the leaves from the stalks and chop the stalks. To add it to your meals, stir fry Swiss chard with oil, garlic and seasoning you enjoy, substitute Swiss chard where you would normally use spinach and add to omelets or frittatas.
Karol Sekulic is a registered dietitian with expertise and interest in the areas of weight management, nutrition and communications.

TOP TIP: Are you getting enough? Half your plate should be covered by veggies and/or fruit, a quarter with whole grain products and a quarter with meat or meat substitutes. Pour a glass of milk and youre set! www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php

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asktheexpert /

A RESOURCE FOR YOU

ASK AND ANSWER


We trolled our experts and came up with some thoughtful responses to tough questions about heart health, senior yoga and endometrial health
BY MICHELLE LINDSTROM AND CAILYNN KLINGBEIL

What are the top ve ways that I can keep my heart healthy?

There are multiple factors at play that lead to coronary artery disease and sometimes heart attack. Some are xable and some arent, says Dr. Todd Anderson, director of the Libin Cardiovascular Institute of Alberta and head of the department of cardiac sciences at the University of Calgary. His list of the major risk factors includes high blood pressure, high levels of blood sugar or cholesterol, smoking, physical inactivity, family history (a rst-degree relative who had heart troubles before age 60) and obesity (particularly fat that accumulates around the middle). To reduce the risks of heart disease, Dr. Anderson gives ve tips for keeping your heart healthy because cardiovascular disease is the leading cause of death and disability, particularly for women. About 30 per cent of Canadians will die from heart disease and stroke. 1. Know your numbers. Be aware of your blood pressure, cholesterol, blood sugar and waist circumference. Also know what the ideal values are and work toward them. 2. Talk to your doc. If your numbers are out of line, seek consultation with a medical provider to help you plan how to improve those numbers. 3. Another number: 150. Engage in a healthy lifestyle with an ideal body weight and regular physical activity. Get a minimum of 150 minutes of exercise per week. We used to think that you had to do 30 minutes at a time full-out, but we now know those chunks can be 10 minutes long. A 10-minute walk in the morning and another in the afternoon would both count. 4. Dont smoke. Seek help quitting if you cant do it on your own. 5. Know the signs. Look for symptoms that might be indicative of a developing heart problem: unexplained chest or upper body discomfort when exercising, shortness of breath or a decrease in exercise tolerance. M.L.

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I heard that there is a relationship between endometrial cancer and waist circumference. Can you explain it?

Waist circumference is a marker for obesity, says Dr. Gregg Nelson, an assistant professor, tumour group leader and oncologist in Calgarys Tom Baker Cancer Centre, department of gynecologic oncology. Obesity matters because as a womans body mass index (BMI) increases, so does her risk of endometrial cancer. As waist circumference increases, so does a womans BMI and level of estrogen within her body. Dr. Nelson explains that risk factors are increased with higher amounts of estrogen in the body. The hormone stimulates growth of the uterine lining, which can then lead to cancer developing in that area. He says women can decrease their risk factors by decreasing their BMIs. They wont forever be considered at higher risk for endometrial cancer if, at one time in their lives, they were overweight. He notes that obesity is linked to other medical conditions, such as diabetes, which increases endometrial cancer risk. A lot of it is tied together, Dr. Nelson says. The one silver lining in all of this is: in obese women who develop endometrial cancer, their cancers are often found to be earlier-stage and also lower grade likely treatable with a higher cure rate. M.L.

Should my senior mother take up yoga, or are there better low-impact activities for her to consider?

As we age we can lose exibility and balance, says Nicole McLeod, a personal trainer and PhD student in exercise psychology at the University of Alberta. That makes yoga, which teaches poses that help improve balance and exibility, a great option for seniors, McLeod says. The exibility that seems to be lost by aging is actually caused by inactivity or lack of movement, so exercise is important for seniors. The Public Health Agency of Canada recommends that adults age 65 and older who do not have a suspected or diagnosed medical condition take part in at least 2.5 hours of moderate to vigorous intensity aerobic activity each week. McLeod has worked in the tness industry for more than 10 years and recommends that seniors entering a yoga class check an instructors qualications and also make the instructor aware of any limitations they may have, just like they should in any tness class. Another popular activity for seniors is water tness classes. They are no-impact or very minimal impact, McLeod says. The other nice thing about water-t is its quite social as well. A lot of seniors like it because theyre being active but they can chat with their friends. The Public Health Agency of Canada recommends seniors spread out their tness activities into sessions of 10 minutes or more and add muscle and bone strengthening activities like lifting weights or yoga that use major muscle groups twice a week to help improve posture and balance. If you are unsure about the types and amounts of physical activity most appropriate for you, consult a health professional. C.K.

Ask our experts questions about general health, cancer prevention and treatment. Please submit them via email to letters@myleapmagazine.ca. Remember, this advice is never a substitute for talking directly to your family doctor.

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Top Job

HOUSE of PAI

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IN Management
A Calgary nurse finds the best medicine for symptom control lies in a mix of compassion, resourcefulness and a healthy dose of experience
BY COLLEEN BIONDI / PHOTOS BY BRIAN BUCHSDRUECKER

lmost 25 years ago, Rene Lee graduated And the pain varies as well. There is the pain of a new from nursing school. Since then she has had a cancer, when a growing tumor presses on a nerve, for rewarding career for 18 years she assisted example. A person who lives with chronic pain from another inpatients on the surgical oncology ward at the Foothills condition may have trouble managing the treatment Hospital and, for another three, helped patients with associated with a new cancer diagnosis; perhaps he or she wound and ostomy care. She felt honoured to work with cannot comfortably lie down for radiation therapy and people dealing with acute issues that needed immediate may require sedation. Someone taking radiation therapy for a head-and-neck cancer may need advice dealing with and time-limited attention. But two years ago, while looking for more hours the pain of eating or swallowing. Chemotherapy often and wanting to contribute more to the welfare of results in debilitating nerve pain that needs attention, or there might be pain patients beyond their stemming from a surgical experiences, Lees best review came from a patient, just previous cancer and she took on a threedays before he died. I am so glad to be associated treatments. days-per-week job at home and not in pain, he told her colleague. Occasionally, the pain a facility next door might not even be to the hospital. She is a nurse of the Supportive Oncology Clinic, commonly associated with the cancer; the hand pain of a recent referred to as the Pain Clinic, but we do more than patient was found to be carpal tunnel versus cancer-related pain, says Lee. She also helps cancer patients deal with neuropathy. Night-time splints oered relief. Solutions for pain range from medication to symptoms such as fatigue and nausea. At the clinic in the Tom Baker Cancer Centre, she is part clinician, part adjustments in treatment protocol. For example, the person with lower back pain may be able to manage navigator and part innovator. The Supportive Oncology Clinic comprising Lee, shorter periods of radiation therapy. After they visit two physicians and two pharmacists conducts two, the clinic, Lee follows up with patients by phone to three-to-four hour sessions a week for people dealing track their progress or to tweak their plan. There are up with pain associated with cancer. During these sessions, to 15 patients attending each clinic and up to ve new patients are assessed and given a treatment regimen. Lee referrals each week, says Lee. Our clinics are busy. But Lee and her team members are a resourceful takes referral calls from patients, from family members, doctors or hospital colleagues. The clinic sees patients bunch. They will squeeze in patients or if patients are within two weeks of referral, and they are redirected if unable to make the clinic hours see them when they the pain issue does not have an accompanying cancer are at the Tom Baker for other consults or treatments. During the telephone intake process, Lee asks a diagnosis. We try to work patients in so they can be seen in a timely manner, says Lee. These patients have variety of questions related to pain and other aspects so many things on their plates already. We need to deal of the cancer experience. She checks for eating habits, sleeping patterns, nausea and fatigue, social support with them quickly. Presenting cancers run the gamut from breast to and depression. She will refer patients for home care lung, from brain to blood. Lee has had to become a support or to social workers or dieticians, as necessary. generalist, in learning the basic etiology and treatments This is all about team-based care to better meet patients comprehensive needs. of many cancers.

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Often getting to the root of the discomfort is a complex process. If a patient is feeling nauseated, is that from chemotherapy drugs or the ongoing prescription medication or both? We try to gure out which is which and deal with symptoms, says Lee. Pain, she says, is manageable; its just a matter of nding the right combination of treatment, medications and timing. Lees colleagues and patients admire her optimistic and dedicated approach to managing the pain and discomfort. Sonya Caruth, transition services co-ordinator at the Tom Baker, describes Lee as a calm, concerned professional who has a good sense of humour. Shes a team player who puts the needs of the patients rst. But maybe the best review came from a patient, just days before he died. I am so glad to be home and not in pain, he told Caruth.

There are challenges with the work. It is frustrating when referrals come in later than they should, resulting in some clinic attendees being severely debilitated. And the emotional toll of seeing people in protracted pain is dicult. But Lee deals with stress by keeping to a part-time work schedule, hiking in the mountains, running, spending time with her husband a math teacher her two young adult sons and her mother-in-law, with whom shes particularly close. She also takes breaks at a family cabin in Kananaskis. And her late mothers experience dying four years ago from uterine cancer with her pain not managed well spurs her on to make a dierence for others. Advances in pain management continue. There is a trial currently taking place at the Tom Baker involving tetrodotoxin, the neurotoxin in puer sh, that holds promise as a painkiller. But in the meantime, its the people like Lee at places like the Supportive Oncology Clinic in Calgary who are making a dierence. We are here for the patients from the time of diagnosis, through treatment and, if necessary, recurrence, Lee says. Were here to support their changing needs through their cancer journey, help them live longer and have a better quality of life.

We are here for the patients from the time of diagnosis, through treatment and, if necessary, recurrence, Lee says. Were here to support their changing needs though their cancer journey, help them live longer and have a better quality of life.

CAREFUL LISTENER
During the telephone intake process, Rene Lee, manager of Supportive Oncology Clinic at the Tom Baker Cancer Centre asks patients questions about pain and other aspects of the cancer experience. She uses the result to arrive at a personalized plan to help patients cope and thrive. She might ask: How long have you had the pain? Has it gotten worse and, if so, when? Can you rate it on a scale from one to 10 (one being mild and 10 being severe)? What medications are you currently on? What other treatments have you tried? What other symptoms are you experiencing, i.e. fatigue, nausea? What is a typical day like? Do you get out of the house? Are you sleeping at night? How and what are you eating? Do you have support at home? Do you sometimes feel depressed?

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A PLACE TO
Imperial Oil and the U of C teamed up to establish a tness centre for cancer patients and survivors
BY STEVE MACLEOD

THRIVE
TEAM UP: Thrives staff and volunteers make the gym work. (L-R) Amanda Wurz, Carolina Chamorro-Vina, Nicole Culos-Reed, Lauren Capozzi, Michael Mackenzie.

Donna Kohle has always led an active life.

The 45-year-old hit the gym regularly and took up running ve years ago. Shes competed in half-marathons, as well as 10-kilometre and ve-kilometre runs, and was going to run her rst marathon when a breast cancer diagnosis in January 2011 put plans on hold. Kohle tried to stay active despite feeling weak and nauseated from treatment but she hadnt been back to her gym since the diagnosis. In March 2011, she saw a poster for the Thrive Centre a gym at the University of Calgary for cancer patients and survivors. The Thrive Centre opened in January 2011 and the former multi-purpose room is located in the universitys kinesiology complex. Transforming the space into a tness centre was no small task. The purchase of exercise machines, exercise balls, bands and weights, was largely due to a $250,000 donation from the Imperial Oil Foundation to the Alberta Cancer Foundation. Though Imperial Oil has been bettering the communities in which it lives and operates for the better part of 100 years, it revamped processes and minted its Imperial Oil Foundation 10 years ago. In just the last decade, that foundation has invested $15 million annually into communities across Canada. Marilyn Kandt, vice-president of the Imperial Oil Foundation, says that this particular donation funding for the Thrive Centre t a number of criteria and Imperial was keen to support this project. Theres great research at the Thrive Centre, Kandt says, and its a great spot for people currently under treatment. Dr. Nicole Culos-Reed, associate professor of health and exercise psychology at the University of Calgary, spearheaded the initiative. Shes been
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researching the correlation between physical activity and quality of life in patients and survivors since 2001. The biggest stumbling block, if you can get money, is nding space, Culos-Reed says. The Thrive Centre is home for her research and to the many survivors and supporters who use the gym for personalized workouts after a tness test in the lab. Workouts cater to the energy level a patient feels on a given day. Its a big change for cancer patients who want to stay active but for whom regular public gym programming just isnt working. Culos-Reed says most personal trainers dont know how to create programs for cancer patients. Our goal is to change that, she says. We dont want to be the only people doing this. The Thrive Centre is monitored at all times by volunteers, the majority of whom are kinesiology students trained in exercises appropriate for specic cancer treatments. The Thrive Centre has 90 volunteers and a big part of their training involves how to provide emotional support. Somebody will come in and exercise for 10 minutes, but talk to you for an hour, says Kevin Boldt, the Thrive Centres volunteer coordinator and third-year student at the University of Calgary. They dont always want to exercise; sometimes they just want somebody to be with them. Kohle says that being surrounded by people going through the same issues is comforting. It means being able to go to the gym without facing uncomfortable stares from people because of her bandana, lack of hair or surgical scars. It also meant she was able to carry on an annual tradition. Every September, a girlfriend and I do a half-marathon in Canmore. I was kind of mad I wouldnt be able to do it last year, but my friend encouraged me to register anyway and if I was up to it, wed go out there and just do what I could, even if I just walked some of it, Kohle says, then a smile spreads across her face. I ran the 10K. It wasnt my best time, but I ran it.

Get on Your Bike: Whether you are interested in getting back to the gym or volunteering, find out more about the Thrive Centre. Visit www.kin.ucalgary.ca/healthandwellnesslab/Site/ Free_Fitness_Centre.html or call 403-210-8482.

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Research Rockstar

EYES FRONT: Ezekiel Weis took an opthamology elective on a whim. The rst eye surgery he saw had him hooked.

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An Alberta researcher brings an eye-saving technique back home


BY LEWIS KELLY

/ PHOTOS BY AARON PEDERSEN

f he hadnt become a medical researcher and eye surgeon, Dr. Ezekiel Weis says he would have been a professional mountainclimbing guide, shepherding less experienced climbers through dangerous, dicult climbs and making sure they lived to tell the tale. But for Carol Balcerzak, cancer patient, he did just that, metaphorically anyway. Before the distortions and arcs of light across her vision, before the ocular angiograms and blood work and ultrasounds and anxiety, before Ezekiel Weis sutured a radioactive gold disc to the back of her eyeball, Balcerzak had 20/20 eyesight. Clear as crystal. There was a time, long past, she used to wear glasses, but laser eye surgery xed that. To look at Balcerzak today, you wouldnt know that she doesnt still enjoy perfect vision not in one eye, anyway. The young mother of two appears totally healthy, with none of the stereotypical appearance associated with cancer treatment. Her lustrous blue eyes move and look like a perfectly normal set of peepers.

But Balcerzak developed intraocular melanoma in her right eye in March 2011, and can only see peripherally out of that eye as a result. A treatment new to Alberta, brought to the Cross Cancer Institute by Weis and a large team of ophthalmologists, medical physicists, nurses and others, let Balcerzak keep her eye and her life. Ocular brachytherapy debuted in the Canadian Prairies late last year, thanks in part to funding from the Alberta Cancer Foundation. Now it will help around 30 Canadians a year. The idea of handling other peoples eyeballs for a living might strike some as grotesque, but Weis, who grew up in Calgary, says determination, training and experience trump squeamishness. Once you sit in the drivers seat, you have a job to do, he says. That takes over most of your emotions. In the fth year of his residency at the Royal Alexandra Hospital, he repaired the eye of an Edmonton man suering from a machete wound. Weis recalls it as a moment of memorable triumph. Ocular melanoma, by far the most common type of cancer found in the eye, has a survival rate of about 50 per cent. That might seem strangely low. The cancers deadly character stems from its access to the bloodstream. Many cancers move through the body via the lymphatic system

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but, since that network doesnt extend inside the eye, ocular melanoma travels through the bloodstream, which does reach the eye. For yet-unknown reasons, it often metastasizes in the liver, at which point mortality is all but certain. For much of the 20th century, modern medicines technique for preventing this was as primitive as it was eective: removal of the eye, called enucleation. While the idea might seem crude in the age of modern technology, enucleation produced the best survival rate for ocular melanoma. Plus, articial eyes can provide a surprisingly good facsimile for the empty socket postsurgery. And then in the 1990s, medical research revealed the power of ocular brachytherapy. Radiation kills tumours, but it also destroys other tissue. The problem of applying its power precisely to a malignant tumour and not to adjacent healthy cells prevented conventional beam-radiation therapy from replacing enucleation as the dominant treatment for ocular melanoma. But enucleation means the total removal of the eyeball, which most people feel a gurative and literal attachment to. The ideal solution is the precise application of radiation to tumours and not to surrounding tissue, and this is what ocular brachytherapy allows. Radiation hits the tumour and almost nothing else. Plus, 60 per cent of patients retain some kind of vision in the treated eye. Because its super-precise radiation and not chemotherapy, patients dont even 22

Radiation hits the tumour and almost nothing else. Plus, 60 per cent of patients retain some vision in the treated eye.

lose eyelashes from the treatment, never mind whole heads of hair. The therapy achieves this by placing the source of radiation on the eyeball itself. Medical physicists prepare radioactive seeds of iodine, covered in plastic and silicon and embedded in a gold disc. A surgeon hand-sutures the disc onto the white of the patients eye at the precise location where the radiation will damage the tumour. The optic nerve has between ve and eight millimetres of slack in it, which allows the eye to be rotated for this suturing. Fine control limits radiation damage to the healthy parts of the eye, and the dense gold prevents it from leaking into the delicate and squishy circuitry of the brain. The procedure requires a second surgery to remove the disc after around a week. For Balcerzak, that might have meant another expensive and dicult trip to Toronto. She was willing to head east for the surgery, of course an eyeball is worth more than a few plane tickets. But that didnt make it easy. She had to take time o work, as did her boyfriend, Ryan Peterson. These things run into money. Their two young children, Jacob and Jade, stayed with their grandparents. Fortunately for Balcerzak, at the time of her trip Weis and a large team of medical sta in the province, including Dr. John McWhae, another ocular oncologist trained in brachytherapy and working in Calgary, were reaching the closing phases of setting up an ocular brachytherapy program at the Cross Cancer Institute. (Other key members include medical physicist Dr. Matthew Larocque and radiation oncologist Dr. Kurian Joseph.) Weis, who went to medical school in Calgary and trained in Vancouver, Ottawa, Amsterdam and Philadelphia, wanted to establish a brachytherapy program in Alberta right after he nished school and came to work in Edmonton. The recent recession was rolling up its sleeves and getting down to business, so funding took a hit and the programs start up was delayed. This was a letdown for Weis, who decided to become an ocular surgeon while in medical school. He initially took an elective in ophthalmology on a lark, but on the rst day of the class he met a man who urgently needed eye surgery. After Weis witnessed his instructor, Dr. Tom Chang, perform the delicate surgery and saw what improved vision meant for the patient, he decided to become an eye surgeon.
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Enter the Alberta Cancer Foundation. It supplied nances to set up the program and operate it for one year, letting the team get the program o the ground. Now, the Cross Cancer Institute will provide ocular brachytherapy for western Canadians who need it, around 30 patients a year. That number will maintain the surgical teams expertise through practice, meaning ocular brachytherapy programs wont spring up elsewhere in the prairies. The benets of the location are more signicant than you might think. In addition to multiple surgeries, ocular brachytherapy requires an unusual number of post-surgery checkups. Patients see their oncologist roughly every three months for the rst two years after surgery, and less frequently beyond that. The procedures availability in Alberta means, for Balcerzak, the dierence between a three-hour drive and a quarterly cross-country plane ight. Balcerzak had actually booked the procedure in Toronto, but was able to cancel her appointment while en route to Edmonton for an appointment with Weis. He performed the rst of Balcerzaks two surgeries on Halloween of 2011. Balcerzak was able to recuperate at home instead of a hospital bed as a result, and she had the disc removed after eight days. She was surprised at how little post-surgery pain she felt and at how unobtrusive the disc seemed in her eye. Balcerzak appreciated Weiss demeanour and decisiveness when describing the status of her eye disease and treatment options for it. He displayed a condence and air of knowledge that she found very reassuring. Hes amazing, she says. Hes knowledgeable, hes caring. He just knocked all the fear out of me. I was a
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mess up until we met him. And then after it was like, OK, its not going to be that bad. Its going to be a small blip in my life. Weis says it has more to do with the combination of a surgeons natural disposition and the world-class training he received. Ive had amazing teachers along the way, and from the way they interact with patients and seeing the comfort they can give patients with their bedside manner I learned a lot from that, he says. You come out of there realizing that you really have a lot to oer your patients. Balcerzak cherishes her health and vision her left eye remains perfect. She still enjoys playing ping-pong with Jacob and Jade, though the surgery interfered with her depth perception, giving her kids a small competitive advantage. She also likes colouring with them, where her experience with ocular brachytherapy helped her move towards an innovative and daring approach to art. Im really good at art. she says. But I cant colour inside the lines anymore.

AN EYE FOR THE OPERATIC


Ezekiel Weis, on top of hands steady enough to sew gold discs onto eyeballs, has a host of other interests including: Twenty years of mountain-climbing experience, including recent summits of Mt. Athabasca, Mt. Andromeda and Mt. Temple in the Canadian Rockies Season tickets to the Edmonton Opera and a fondness for attending the operas preview brunches at the Westin Hotel An inordinate fondness for sushi, along with the food of Vietnam and Italy Fluency in Hebrew and growing familiarity with French Participation in the famed Eye Care team in the Alberta Cancer Foundation Ride to Conquer Cancer A child on the way with his wife Chantal, who is due in May. They met when Ezekiel was doing a fellowship in Ottawa

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Survivorship: LIVING AFTER CANCER

CUTANEOUS T-CELL LYMPHOMA

Little Bitof CELL CARCINOMA

KAP

SEBACEOUS
I
was six months pregnant when I got a message from my doctor saying he needed to see me right away. I soon found myself in his oce, tapping my foot. Finally, the nurse ushered me in. My doctor asked politely about the family and then got to the point: I had cancer. Well, a little bit of cancer. My annual pap smear had revealed pre-cancerous cells on my cervix, probably caused by HPV (human papilloma virus), a common virus that in most people causes no symptoms, but in some can lead to my predicament. I was scared without medical intervention I might be looking at cervical cancer down the road. My doctor assured me I would be ne; but I had to have a colposcopy (see Know the Facts, opposite) and then a cauterization procedure called a LEEP, or Loop Electrosurgical Excision Procedure. I remember wondering if I should be upset, since it was a relatively small procedure and the abnormal cells had been caught early. Since I was six months pregnant, I went with upset. When I called my common-law partner, I was in tears.

MICROCYSTIC A
BY NOMI LOPINTO

ATYPIC

The cells in my cervix were called pre-cancerous. Would they grow up into a deadly disease or stay small? I wasnt waiting to nd out

SQUAMOUS C
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MICROCYSTIC ADNEXAL CARC


Cancer is a word that terries; even just a little bit of it. But the truth is, there are hundreds of forms of cancer and not all of them are lethal. Some of us will die of unrelated causes in old age carrying cancer somewhere in our bodies without ever knowing it. In this sense, cancer refers more to the behaviour of certain cells than it does to the bigger picture of disease. Its important to make these distinctions, says Dr. Jay Easaw, an oncologist with Calgarys Tom Baker Cancer Centre, not just for doctors but patients. Dr. Easaw treats people with potentially lethal brain and gastrointestinal cancers. The distinction is important, he says, Because once it becomes invasive it can kill people. These are the things we want to get on top of and treat, because down the road they are much more aggressive. Oncologists now talk of in situ cancers, which people are more likely to die with, than die of. Doctors are more often calling some types of prostate, thyroid and breast cancers high-grade dysplasia. Ductal carcinoma in situ, or DCIS, for example, accounts for one fth of breast cancer cases. But it has been removed from the ocial list of cancers by the medical establishment, because it is an accumulation of abnormal-looking cells in the milk ducts. It does not appear as a lump, but as a collection of weird cells in an xray. DCIS can be treated with surgery and radiation therapy, but some experts say that these treatments may be unnecessary. When they hear the dreaded C-word many people want to get rid of the deadly passenger. Another name for what I had is cervical dysplasia, which to me sounds a lot nicer than pre-cancerous cells. The latter sounds like it was time to start writing a bucket list. Dysplasia, on the other hand, sounds like my cervix went for a stroll without a map all it needed was a nice old lady to bring it back home. I sometimes wonder: should my doctor have told a pregnant woman with a collection of abnormal-looking cells that she cancer? Yes, says Dr. Easaw. The terminology is treat some types of prostate cancer. Some agencies that monitor cancer now exclude 74,100 non-melanoma skin cancers because theyre localized, non-life-threatening abnormalities. I wouldnt say Im a cancer survivor. That would be disrespectful to people whove had to quit work and suer months of painful treatment in order to save their lives. There was some courage involved in my own experience I had to wait until my baby was born before I could undergo treatment and the LEEP procedure was, personally, a very emotional experience. But ultimately I spent one morning in the hospital, and then I was cancer-free, with no expectations of a recurrence, by that afternoon. Its good you got the LEEP procedure, says Dr. Easaw. My own belief is that the more people who are aware of these possibilities, the better o we are. In your case you had a chance at a cure a great thing. The best way to cope with cancer is to never have it.

POSIS SARCOMA

S CARCINOMA
KNOW THE FACTS
DCIS, or ductal carcinoma in situ is cancer that starts inside the milk ducts of the breast. In situ means in its original place.

ADNEXAL CARCIN
Cancer terrifies; even just a little bit of it. But the truth is, some of us will die in old age carrying a cancer somewhere in our bodies without knowing it.
important because its more accurate, he says. We need to know these things because they tell us what the risk is. High-grade dysplasia, if untreated, has an increased risk of becoming an invasive disease. Its necessary for the patient to know that treating it is important. And its important to remember how we can make these distinctions at all because of innovations and advances in cancer diagnosis and treatment. Dr. Easaw says he personally has witnessed an explosion of new treatments in recent years. The eld is pushing forward so fast, he says. We have surgeons who are able to give previously deemed incurable patients a chance. Rules about who could and could not be saved arent rules anymore. There have been advances in treatments, too, such as drugs that work in conjunction with chemotherapy to thwart the growth of the blood vessels that supply the tumour with nutrients and allow it to grow. A physician may be more likely to follow than A colposcopy is a procedure that a gynecologist can do in her ofce. She puts acetic acid (vinegar) on the cervix and looks at the cervix through a machine called a colposcope. The acetic acid makes the abnormal cells on the cervix look white and the doctor takes samples of the whitest areas to send them to the lab. Cervical dysplasia is abnormal growth of cells on the surface of the cervix. Doctors classify it as low-grade or high-grade. Low-grade cervical dysplasia progresses slowly, often resolving by itself. Without treatment, between 30 and 50 per cent of cases of high-grade cervical dysplasia progress to invasive cancer. HPV and cervical cancer: Many people have a common infection called HPV. For unknown reasons, a few women infected with HPV will develop cervical dysplasia. See page 38 for more information about HPV.

CAL FIBROXANTHOMA

CELL
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Survivorship: LIVING WITH CANCER Sharing: FACE CANCER AFTERSTORIES

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Surviving cancer can be a beautiful burden. The good news is life goes on but the road ahead can be uncertain
BY LISA RICCIOTTI / ILLUSTRATIONS BY CAROLINE HAMEL

ali Cousins still remembers the fear. It hit hard, on a day when everyone expected her to be happy. Shed just heard from her doctors that, after four long months at Calgarys Tom Baker Cancer Centre, she was well enough to go home. She was terried. Id had close medical attention for so long, I was afraid to be without it, Cousins explains. After she returned to her home in Elk Point, northwest of Edmonton, she couldnt sleep for a month. Even though Id moved back in with my parents, I was scared something would happen at night and no one would notice or be able to help. That was seven years ago, when Cousins was 21. After nishing her third year of university, a month of tests revealed that her lack of energy and the re in her leg was due to acute myelogenous leukemia. By noon the day after her diagnosis, shed begun aggressive chemotherapy. I had a rapidly growing mass of cancer cells on my spine. Another day, and the doctors think Id probably have died. Next came radiation and, when she was strong enough, a high-risk hematopoietic stem-cell transplant, her only hope for a long-term future. Hard as her treatment was, Cousins says the most dicult part was when it stopped. When youre going through it, you keep going because you have to, she says. Afterwards, things werent the way they were before. Im happier than ever now, but it took time to start feeling like me again.

Cousins is a cancer survivor, one of an ever-growing number. The majority of people survive beyond cancers acute treatment phase, a welcome upward trend that started in the mid-1970s. The total number of survivors has tripled over the past four decades according to the U.S. National Cancer Institute. In Canada, 65 per cent of those diagnosed with cancer now live beyond the ve-year post-cancer mark. Patti Morris knows those stats well. Shes the executive director of Wellspring Calgary, a non-prot organization oering supportive care to people living with cancer. More than 120 trained volunteers partner with leading oncology health professionals to deliver its wide-ranging programs and resources at Carma House, a 4,000-squarefoot building on the banks of the Bow River. Carma was co-founded in 2006 by three Alberta cancer survivors, referrals arent required and theres no fee for services. Wellspring doesnt draw lines to dene who receives cancer support or for how long. They can come at any phase and we welcome families and caregivers too, Morris says. Some walk in the day theyre diagnosed, some are still in active care, others have completed treatment. Many describe themselves as survivors, although they use the term dierently. They embrace the word, nding it a source of strength. Others prefer to say theyre thriving, not surviving. The biggest lesson Morris has taken from her experiences with cancer survivors however they dene themselves is that cancer is highly personal. Its very

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Survivorship: LIVING AFTER CANCER


By 1985, an American physician and cancer survivor named Fitzhugh Mullan drew attention to a neglected area in cancer care. The challenge in overcoming cancer is not only to nd therapies that will prevent or arrest the disease quickly, but also to map the middle ground of survivorship and minimize its medical and social hazards, Mullan wrote. Janine Giese-Davis, PhD, wholeheartedly agrees. That statement really shifted the ground in cancer research, she says. Initially researchers focused on nding a cure while doctors were busy treating patients. But funding is also needed for a previously neglected phase of research what happens after active treatment. So many issues arise that aect an individuals physical and emotional health once the immediate life threat of cancer has passed. Theres a clear need to address this. The opportunity to concentrate on the lifebeyond-treatment phase of survivorship is what drew Giese-Davis to Alberta in 2008 from a stellar 15-year career in psychosocial oncology in the U.S. In addition to her work at the University of Calgary and with psychosocial resources at the Tom Baker Cancer Centre, she now leads provincial research and evidence-based care focused on survivorship. This multidisciplinary team is called CancerBridges. The group has important research and programs underway (see More Pieces on page 29), and is already drawing national attention to the needs of post-treatment cancer survivors. Mike Lang, a cancer survivor whose own story was featured in Leaps spring 2011 dierent for everyone and people need to follow their own path. Cancers impact goes far beyond the physical, issue, is CancerBridges rst survivor network coordinator. His personal goal is to so we oer support from diagnosis onward, as much as ensure CancerBridges focuses on the practical needs of survivors and translates it quickly into new programs and services. While immersing himself in existing research needed, for as long as needed. Although the denition of cancer survivorship is literature on survivorship, Lang found something that jumped o the pages for him a moving target, the most accepted one was adopted because it resonated with his experience: the two times when cancer survivors reported in 2004 by the U.S. National Cancer Centers Oce of their highest levels of distress. The worst moment is when they rst hear they have cancer, says Lang. But after Cancer Survivorship: An individual is considered a cancer survivor from the time of diagnosis through the that, the second-most stressful period is one to three months post-treatment, when balance of life. Family members, friends and caregivers survivors think Im done with this cancer thing, now Ill get back to my life. But it takes time and eort, two years on average. are also impacted by the Morris nds many of Wellsprings survivorship experience and The second-most stressful period is from cancer survivors call this dicult phase are therefore included in this one to three months post-treatment, when trying to pick up the pieces. (Its also denition. survivors are trying to move on. They think the title of a helpful book, Picking Up the Thats quite a change from Im done with this cancer thing. But it Pieces: Moving Forward After Surviving the dark days when cancer Cancer, by Sherri Magee and Kathy was considered incurable, takes time, two years on average. Scalzo.) Survivors recount that during when the word survivor was saved for the family left behind after the loss of a treatment their main focus is their disease. Friends and family rally round with support loved one. As outcomes improved in the 1960s, doctors and patients draw comfort from them and the close attention of their medical team. began referring to those who lived ve years post- Then treatment ends, caregivers are exhausted, and everything changes. Suddenly they treatment as cancer survivors. By the mid-1970s, feel alone. People got frustrated with what they considered my slow progress, Kali Cousins survivorship hit a tipping point; for the rst time in medical history, more than half of people diagnosed with remembers. They just wanted me to be better once I was home. Her circle of friends cancer were expected to be around to celebrate what shrank to a small, understanding handful. She could no longer play sports; walking to Kali Cousins and many other cancer survivors call their and from the bathroom was a workout. It took a year for her hair to grow back, she had second birthday the ve-year anniversary of diagnosis. to isolate herself while her immune system rebuilt and, even when she felt physically The meaning of survivorship evolved as advanced strong enough to return to university, she was afraid she couldnt handle it mentally. treatments and earlier detection shifted toward success. We joke about chemo brain but its real. It took a long time to regain her memory. 28

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her that her children wanted their old mommy back. Shes seen high-performers asked to step down from management positions because of memory issues related to chemotherapy. And shes also seen survivors who, nearing retirement at diagnosis, were forced to return to work because their savings vanished during active treatment. Id never have chosen cancer, says Kali Cousins. But if I could go back now, I also wouldnt change anything thats happened. I never realized before how amazing life is. Surviving cancer has given my life more meaning. We also see these beautiful responses to cancer in survivors, Railton says. That could be the realization that its time to embrace a healthier lifestyle, a shifting of priorities or a total change in life direction. Others just want to put cancer behind them. Their feeling is, Well, I didnt need cancer, thanks for the experience but now Im closing that door. And thats OK too. Survivorship can be empowering. You lose control of your life during treatment, says Mike Lang. Afterwards, you can choose how to live. Its about making the rest of your life the best of your life. Just as theres no one meaning for the term cancer survivor, theres no right or wrong way to be a survivor. As Railton puts it: The new message is that the posttreatment cancer care is a unique phase. And nally, its receiving attention. Its not just cancer treatment and youre done. Theres another step and its important. And every time I got a cold, or felt minor pain, I worried it could mean the cancer was coming back. At the same time, Cousins wanted no pity party. I hated the how-are-you? concerned head tilt, and being treated like a child. I tried to keep my survivorship as quiet as possible because, in my small town, so many people now knew me as the cancer girl. I wanted an identity beyond that. At the Tom Baker Cancer Centre Cindy Railton, a nurse practitioner involved in clinical trials for breast cancer survivors at high-risk of recurrence, sees survivors who share similar experiences. As well, many breast cancer survivors need to continue endocrine therapy for ve years after active treatment, which brings its own set of physical and emotional side eects. These women are coping with mood disturbances and residual eects from chemotherapy like fatigue and memory loss, says Railton. They may have new physical limitations or issues around sexuality and selfesteem related to body changes. Their visible scars are a constant reminder and can reinforce fears of recurrence. And theres a 25 per cent higher risk of long-term clinical depression. The list of possible problems after active treatment has multiple categories: physical, emotional, nancial, legal, sexual and/or spiritual. Railton says cancer survivors need time to nd their new normal. But while they struggle to adjust, theres huge pressure for them to bounce back to their old life. One survivor told
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MORE PIECES
There are an estimated 100,000 surviving cancer patients in Alberta, says Janine Giese-Davis, PhD. A certain percentage are well-supported, but many others need more community support. As director of CancerBridges, the new provincial survivorship research and care organization, Giese-Davis outlines initiatives and programs underway. cancerbridges.ca is an evolving source of information. Look for its Myths of Survivorship video series, weekly blogs, a summary of CancerBridges survivorship research (results or in progress) and other resources. From Cancer Patient to Cancer Survivor: Lost in Transition (2005) is a powerful report from the Institute of Medicine and National Research Councils Committee on Cancer Survivorship. (Read it online at www.nap. edu/catalog.php?record_id=11468.) One of its key recommendations was that all patients receive a survivorship care plan at the end of active treatment that includes a summary of treatment, a detailed plan for long-term care, a list of survivor support services and tips on preventing recurrence. The rst major project of CancerBridges tested the use of similar care plan packages for breast cancer and head-and-neck cancer survivors. Survivorship support and resources in rural communities are more difcult to access. A CancerBridges Rural Survivorship program is planned that will connect post-treatment rural survivors with nurse navigators and survivor peers for ongoing support. The use of a virtual clinic is underway. Cindy Railton, a nurse practitioner at the Tom Baker Cancer Centre, is testing it to see if online support will encourage breast cancer survivors to continue their recommended postactive treatment.

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Survivorship: LIVING AFTER CANCER

BY CAILYNN KLINGBEIL

Many people survive childhood cancers. Researchers are finding more about how the past disease impacts health later in life

Early Memories: Paula Jones (top) in 1995 before her thyroid cancer diagnosis and (bottom) at age one, during treatment for neuroblastoma. I never felt like that kid who had cancer, Jones says.

aula Jones doesnt remember the rst time she had cancer. She knows from her family that at age one she was diagnosed with neuroblastoma. My brother and sister are 11 and 13 years older than me, so rst they got this little sister that no one expected and then they had to deal with going to the hospital every day, Jones says. The tumour, located around her spine, was successfully treated with chemotherapy, radiation and surgery. Jones does remember her second diagnosis, as a teenager, of thyroid cancer and isnt certain if it was the result of treatment for her rst cancer. In my mind it couldnt happen again, Jones says, crediting the combination of a teenagers attitude of invincibility with knowing she had overcome the disease once before. To treat her second cancer, in Grade 10 Jones had a thyroidectomy, followed by radioactive iodine treatments. Now 32 and working as a project co-ordinator for Alberta Health Services and a provisionally registered psychologist, she remains cancer-free. Cancer did shape my family and who we are, but my family also normalized it for me, Jones says. I never felt like that kid who had cancer. Today, long-term eects of her childhood cancers remain, along with the lingering possibility of recurrance. The multiple surgeries left Jones without the proper amount of supporting back tissue, which causes her spine to curve and gives her back pain. There are other eects, too, though Jones says its hard to know whats biologically who you are and whats an after-eect of treatment. When she recently researched eects of cancer treatment, Jones was shocked to read about foggy memory and fatigue. Everyone always jokes with me because if I stay up late three nights in a row, Im just wiped, she says. She hadnt attributed her tiredness to cancer treatment. Its a similar story for other adult survivors of childhood cancer, many of whom have later health issues as a result of the cancer or the treatment. Late eects are varied and include infertility, physical damage to organs, secondary cancers, delayed puberty and learning disabilities.

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IN IT TOGETHER: Paula Jones, in the hospital (left) receiving treatment, is thankful for her familys support throughout her cancer journey. Shes pictured above (second from left) with her siblings Andrea and Dean and parents Sheila and Trevor.

The most common late eects include complications with hormone levels and metabolic function, according to information released in 2008 by Statistics Canada, the Public Health Agency of Canada and other partners. The same report estimated the ve-year survival rate for all childhood cancers to be 82 per cent, which is an 11-per-cent increase compared to 15 years ago. While more children surviving cancer is welcome news, theres little research on the long-term eects of treatments. In addition to health problems, theres also a challenge in approach. Depending on their age at diagnosis, childhood cancer survivors are accustomed to a parent keeping track of details of their diagnosis and treatment. It can be dicult for them to take charge and know where to go for more information or who to go to for medical problems related to their childhood cancer. Dr. Janine Giese-Davis, director of CancerBridges, says that adult survivors of childhood cancer can fall into a gap, as theyre no longer treated at childrens hospitals but by oncologists more familiar with adult cancers. We are interested in understanding the needs of adult survivors of childhood cancers and what kind of situation might be better for them, Giese-Davis says. To that end, a team at CancerBridges, an organization that researches and delivers evidence-based survivorship care, is assessing the unmet needs of survivors of childhood cancer, using a survey that can be lled out online or on paper. Giese-Davis, along with research co-ordinator Jennifer McCormick and psychology honours student Joanne Park, are conducting the survey that will wrap up this summer. Weve already had responses from all over the province,

including small towns where people may have even fewer opportunities to get the type of care that they need, McCormick says. The group is also surveying caregivers, and wants to hear from people who may have no unmet needs. We need that information as much as we need to know that there are particular needs, Giese-Davis says. Once all the data have been collected, the team will look at how the health system can handle the identied issues. We communicate with survivors in Alberta and listen to them and help facilitate in whatever way we can, Giese-Davis says, to allow better lives for them. The results of the survey may also lead to collaboration with childrens hospitals where the cancer diagnosis rst occurs, to make a dierence to survivorship later. For Jones, cancer was part of her childhood and its eects still impact her life, but shes not about to let that limit her. I think my family didnt give in to their fears and anxieties, so that it wouldnt change my development or who I was growing up, she says. If anything, it really gave me a sense of I can do what I want and be who I want. Experiences dont necessarily dene you, but they shape you.

If youre an adult survivor of childhood cancer, we are trying to reach you, says Dr. Janine Giese-Davis, director of CancerBridges. While a letter of invitation has been sent to all survivors listed on the cancer registry, if you havent received one, you are still asked to participate. Contact Jennifer McCormick, research co-ordinator, at 403-698-8148 or Jennifer.McCormick@albertahealthservices.ca or learn more at www.cancerbridges.ca/unmetneeds. CancerBridges is also surveying the unmet needs of all survivors of lymphoma cancer (whether they were diagnosed in childhood or adulthood) and adult survivors of cancer who are more than ve years post diagnosis.

ALL GROWN UP

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Survivorship: LIVING AFTER CANCER

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Cancer is tough for all young patients and their parents. When the patient has Down syndrome, it adds another layer of complexity
BY DEBBY WALDMAN / ILLUSTRATION BY LISA REBNORD

hen Paula Holman of Sherwood Park was diagnosed with respond to leukemia treatment better than children in Down syndrome 23 years ago, her general practitioner gave her mother the general population. The bad news is, like many people and father the same advice he gave all new parents: She just needs being treated for any form of cancer (including people your love. She needs to be fed. She needs to be played with. Shes just who do not have Down syndrome), complications are not unusual. like any other child. The Holmans learned about complications within That was true with a few important exceptions, which Jane and Ken discovered when they did some research. In addition to developmental and cognitive delays, children with minutes of Paulas rst chemotherapy treatment at the Down syndrome have slightly higher incidences of heart defects, leukemia, diabetes, Stollery Childrens Hospital in Edmonton, early in the summer of 2007, when her thyroid dysfunction, and problems with hearing and vision. Paula, who is studying at MacEwan throat began to close. Nurses crash cart and By the time Paula was two and a half, she was a University to become a special needs wheeled in a with Benadryl, pumped her veteran of the operating room, having undergone educational assistant, also received which made it possible for major surgeries to x two large holes in her heart, her to handle the treatment and numerous day surgeries for less serious the all-clear at her checkups. when they restarted it a ailments. But for the next dozen years she was relatively healthy. The only time Jane and Ken thought about cancer was when Janes few hours later. In the four months during which she underwent mother died of leukemia and their older daughter was successfully treated for a benign chemotherapy, Paula lost her hair, suered kidney brain tumor. When Paula, then 15, developed a stomachache that wouldnt go away, Jane and damage, developed marks on her arms, gained weight, and Ken thought it may have been stress related, caused by problems at school. Paula experienced nausea, vomiting, heartburn, constipation assured them school was ne. They began sending her to sleep with a heating pad, and extreme fatigue. She also encountered signicant setbacks in her intellectual development, which is which seemed to help. After a few weeks of doctors visits and worry, spots appeared under one of Paulas typical for cancer patients; studies have shown that the arms. Jane brought her to the family doctor, who treated her for a staph infection. Three chemotherapy they receive via their spinal uid can cause days later, when Paula developed another stomachache, Jane brought her back to the problems with learning, Dr. Wilson says. But dealing with doctor. When Paula lay on the exam table, it was clear that her abdomen was larger than any kind of cancer and Down syndrome poses unique normal. An ultrasound, blood tests, and CT scan revealed that she had a dysgerminoma, problems both for the medical team and the patient. Children with Down syndrome often have pre-existing a fast-growing tumor. A biopsy led to a diagnosis of stage-III ovarian cancer. Dysgerminomas are most common to people in their teens and 20s, but not to people health conditions that require alterations to their with Down syndrome, says Dr. Beverly Wilson, a pediatric oncologist and director of the treatment, Dr. Wilson says. They also have problems Northern Alberta Childrens Cancer Program. But leukemia aects children with Down with their immune systems, which puts them at an increased risk for infection and death from infection. syndrome at 10 to 20 times the rate of children in the general population. The good news is that studies show that children with Down syndrome generally Developmental delays mean they often have trouble
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Survivorship: LIVING AFTER CANCER


communicating. That, especially, was a problem for the Holmans. Instead of addressing Paula, sometimes sta would look to us to interpret for her, Jane says. It aected Paulas self esteem negatively and she became very quiet and introverted, and at times unsure of herself and her situation. Paula became profoundly depressed. Even though her prognosis was good, we were all waiting for the second shoe to drop, her mother recalls. Most signicantly, Paula didnt believe she was going to get better, which was devastating to a previously outgoing and gregarious 15year-old. Jane credits the team at the Stollery with helping the family get through the experience, particularly the neuropsychologist who worked one-on-one with Paula. She gave her a platform to express herself completely free of her parents, Jane says. It really helped her to open up and talk about her fears with someone who understood, but who wasnt a family member. It helped her deal with her cancer experience and learn how to look forward to the future and to put her cancer diagnosis behind her. Ayden Gamble had a harder time explaining his fears. The Sherwood Park pre-schooler was four years old when he was diagnosed with acute lymphoblastic leukemia ve years ago. Like many children with Down syndrome, his speech was delayed. He and his family communicated

NEW TIMES: Paula Holman has learned to embrace the possibilities of a future after cancer.

with sign language and picture cues. To soothe himself at home, he would often lay on his stomach and bang his chin on his hands. Three weeks into a three-month stay at the Stollery for chemotherapy, Ayden had a neurotoxic reaction to one of the drugs. His vocal chords were paralyzed open. His breathing turned hoarse, his oxygen saturation dropped, his heart rate soared, and a tube was inserted up his nose to feed him. The tube made it harder for him to breathe.

Give the gift of a lifetime.


Mary I. Johnston knew melanoma would take her life. But that didnt stop her fighting the disease. She set a plan in action. After Mary died in 2004, according to her direction, family and friends established the Mary Johnston Chair in Melanoma Research at the Cross Cancer Institute. Today, Dr. Alan Underhill keeps Marys resolve by investigating the inner workings of melanoma, knowledge critical to driving development of more effective therapies.

To learn more about leaving a legacy to a cancer-free future, please contact: Derek Michael 780 643 4662, 1 866 412 4222 derek.michael @ albertacancerfoundation.ca

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Unable to articulate his frustrations, Ayden yelled and banged his head. Hospital staff padded his crib so he wouldnt hurt himself. The pediatric psychiatrist gave him antipsychotic medications. He seemed even more agitated with the drugs, recalls his mother, Angela Samis. There was no calming him at all. Ayden spent five nights in the pediatric intensive care unit at the Stollery Childrens Hospital. Back on the cancer unit, his home for three and a half months, Ayden continued with the chemotherapy and the side effects. In addition to hair loss and vomiting, he developed ulcers in his mouth and through to his digestive tract. His skin chapped and peeled off and became easily infected. Yet once he recovered from the initial unpleasantness that led to his stay in the PICU, Ayden remained cheerful. Nurses would poke him, prod him, do everything to him, and he would hug them afterwards, his mother recalls. He is very forgiving. Ayden was on chemotherapy for three and a half years and, while he went back and forth to the hospital, he took most of his treatment at home. His post-treatment tests have shown that he is cancer-free. Paula, who is studying at MacEwan University to become a special needs educational assistant, also received the all-clear at her post-treatment checkups. However, she continued suffering from exhaustion and stomach pain even as post-treatment blood tests showed she no longer had cancer. Three years ago Paula was tested for celiac disease and found she had an advanced case. Its another complication common to people with Down syndrome. And while Jane wonders whether it was triggered by the cancer or the treatment, shes mostly relieved that Paula has been able to treat it with a change in diet. Paula is also dealing with the early onset of menopause that is the result of her surgery and chemotherapy. But in typical fashion, she remains optimistic and enthusiastic, not letting anything stop her from achieving her goals. She wants to get a job when she

graduates and move into her own apartment when she is 25 years old. I want to find a good man to marry, she says. Still, the cancer diagnosis isnt ever far from Ken and Janes thoughts. Youd think wed have accepted her developmental disabilities by the time she was 15, but a cancer diagnosis really put it into perspective for us, that life is here to cherish, Jane says. Every day we have together and each accomplishment Paula has is truly a blessing.

Ups & Downs: The Calgary Down Syndrome Association, aims to enrich the lives of individuals with Down syndrome and their families by providing a network of resources, sharing common experiences, learning together and creating awareness. upsdowns.org, (403) 289-4394 Edmonton Down Syndrome Society aims to benefit persons with Down syndrome and their families by providing information and support, facilitating services and promoting inclusion through public awareness and advocacy. edss.ca, (780) 944-4224

Give the gift of a lifetime.


In September of 2005, Elma Spady and 30 friends celebrated a tugboat launch in Pigeon Lake Alberta. The day celebrated friendship and the vibrancy of 63-year-old Elma, a lawyer, who had built the replica of New York Harbour tugs by hand in her garage. Elmas friends gathered with her again just three months later as she died of pancreatic cancer. But her ability to push through challenges continues. Elma funds cancer research with her legacy. She knew that if one small woman can build a boat, together, we can build a future without cancer.

To learn more about leaving a legacy to a cancer-free future, please contact: Derek Michael 780 643 4662, 1 866 412 4222 derek.michael @ albertacancerfoundation.ca

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Survivorship: LIVING AFTER CANCER

I believe that Alberta can and must be a world leader in cancer research, prevention and care. However, we will have to take bold steps.
TAKING WORK SERIOUSLY: John Osler, on the board of the Alberta Cancer Foundation, found out the hard way about cancer care.

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Personal Take
Its really not about my resum any more. Im a cancer foundation trustee who became a cancer patient, survivor and advocate
BY JOHN OSLER / WITH MIFI PURVIS PHOTO BY BRIAN BUCHSDRUECKER
was invited to join the Board of Trustees of the Alberta Cancer Foundation in 2006. Like all of us, I had had friends and family whove experienced cancer. Some of them lost their lives to it. At the time, I saw joining the Alberta Cancer Foundation as a new opportunity to give back to my community. I had no idea how involved I would become. In February 2007, I was skiing at Lake Louise and I took a fall. In the days after, I began to experience dizzy spells and a loss of balance. After a particularly bad dizzy spell in my oce, an ambulance took me to Foothills Hospital. The dizziness was a consequence of vertigo triggered by the fall. But some blood work the doctors ordered at the time found something else. I had abnormally high levels of white blood cells and lymphocytes. I was told that I had a form of leukemia called Chronic Lymphocytic Leukemia (CLL). And I suppose it made for an interesting story Alberta Cancer Foundation trustee diagnosed with cancer. The irony wasnt lost on me then and it still isnt. CLL is a cancer of the blood and bone marrow. Doctors call it chronic because CLL typically progresses more slowly than other forms of leukemia. The name comes from the cells aected by the disease a group of white blood cells, called lymphocytes, that help your body ght infection. Theres a feeling of helplessness that comes with a cancer diagnosis, but perhaps especially so in my case. I had two questions for my medical team right away: How long do I have? and What are we going to do about it? The answers I received were, not sure, and nothing for now. Instead, the plan was watch and wait. Patients with early stage CLL typically dont receive treatment because early treatment doesnt extend their lives. Instead, doctors reserve treatment for when the leukemia progresses, calling this watchful waiting. And thats where I found myself. For a control freak like me, it was challenging. The watch-and-wait strategy exacerbated my feeling of helplessness. Every ache, pain and bump seemed ominous. I visited the Tom Baker Cancer Centre for blood tests every two or three months, each time wondering if Id need treatment. In September 2009, blood tests revealed low platelets, indicating that my disease had entered a more aggressive phase. I should have guessed. I had started experiencing symptoms of advancing CLL, including fatigue, night sweats and swollen lymph nodes. I was almost glad that my cancer was advancing. Starting active treatment meant I was doing something, it was game on. But treatment came with drama. In my rst session of chemo, I had an allergic reaction to a drug called Rituximab. The sta administering the chemo called a code 66 triggering the hospitals rapid response team, who worked quickly to stabilize my condition. I didnt realize how serious the situation had been until a chaplain appeared at my bedside later that day; he asked me if I wanted to talk. But, by adjusting the infusion rate of the drug, Ive since received it without incident. Initially, I had six rounds of chemotherapy on a three-week cycle. This was followed by a maintenance infusion of Rituximab on a quarterly basis. Its been a hassle, but so far its keeping the cancer at bay and Im in complete remission.

The

For me, having cancer has been a strangely positive experience. My approach to life has changed. I focus on the positive things around me. While I cant change my diagnosis, I can control what I think about and how I approach life. My professional life as a lawyer hasnt changed and I have tremendously supportive partners and clients. Despite some initial diculty, my wife and kids coped too. So did my parents and siblings, even though my sister was diagnosed with colon cancer shortly after my diagnosis. (Shes healthy now, too.) As a parent, I hope I never understand what my mother and father went through. I owe my life to my family and my wonderful network of friends. I never forget Im a cancer patient. I dont think that anyone in my shoes does. Leaving the nest of the Tom Baker was hard, as having treatment gave me a sense of control. I cant say enough about the nurses who treated me. Their support, professionalism and gentleness meant so much. And I have unconditional faith in my hematologist/oncologist, Dr. Andrew Daly. But I dont want you to think that our experience was all rosy. One doctors bedside manner wasnt as compassionate as the rest of the care teams he actually left my wife in tears. In spite of that, my experience with the Tom Baker has been overwhelmingly positive. At rst, joining the Alberta Cancer Foundation was just another way to give back and maybe add a line to my resum. Now the Alberta Cancer Foundations goal of a cancer-free future is the cause of my life. Ill never pass up an opportunity to advocate for our board or for cancer patients. Call me an active stakeholder. We live in a great province and Im lucky to live in one of the best cities in the world. But Calgary is the only city in Canada that doesnt have a stand-alone cancer centre. Alberta can and must be a world leader in cancer research, prevention and care. However, we have to take bold steps now to achieve that vision. This year, 16,000 Albertans will hear the words you have cancer. Alberta is the can-do province with vast resources, wealth, talent and a desire to lead. Its time to rise to our highest ideals and build a cutting-edge, cancer-free future in Alberta. I know well meet the challenge. I am John Osler, cancer patient and Chairman of the Alberta Cancer Foundation. This is what I am doing in my cancer survivorship. Join the conversation! What should Alberta and Albertans do to become the best jurisdiction on the planet to deal with cancer? Leave your comments at myleapmagazine.ca

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THE ABCs OF
SWEET LIFE: Omar and Janae have armed themselves with knowledge to cope with HPV.

BY OMAR MOUALLEM / PHOTO BY AARON PEDERSEN

HPV

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Like most guys, I had only a peripheral awareness of human papilloma virus, one thats harmless to most but can cause cancer in some. It was time to get schooled

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efore leaving the room, the nurse turned to Janae and said, Just exponentially, Teknos says. We used to see 60-yeara small warning, the video is very comprehensive. After the door shut, Janae old smokers of lower socioeconomic status, he says. got into her saggy hospital gown and I pressed play. It could have been called, Now were seeing young, higher-educated people of So Youve Had an Irregular Pap Smear or So Youre Getting a Colposcopy. I dont higher socioeconomic status whove never smoked. The OSU study received an unrestricted grant from remember, but comprehensive it was. I sat squinting at what looked like a wet, Merck, makers of Gardasil, one of two HPV vaccines on outward belly button. What is that? A cervix, said Janae, who has taken enough sexual health courses in university to the market. But Teknos points to an independent 2009 recognize a cervix, or a genital wart, when she sees one. Which is how we ended up Swedish study from Karolinska Institute showing that at the Misericordia Hospital in Edmonton last June: a tiny, insidious pebble-shaped 93 per cent of recent tonsil tumours tested positive mark that she discovered on herself 15 months prior. Again, Janae was knowledgeable for HPV, up from 20 per cent in the 1970s. And men, it seems, are three-to-one more likely to develop these enough about it to say, You better not have given me HPV! I likely had, because my fiance hadnt had any sexual partners before me. Although illnesses, perhaps because they have more sexual the human papilloma virus (HPV) requires sexual contact and can pass with or partners and are infected at rates three times higher. Teknos says HPV without intercourse or a condom, it was pretty much has already surpassed an open-and-shut case. Teknos says HPV has already smoking as the leading But hold on. When I got tested for sexually surpassed smoking as the leading cause of throat cancer transmitted infections early into our relationship Id heard the clinician correctly, all negative. cause of throat cancer and, in men, and, in men, this disease will soon outnumber What gives? this disease will soon outnumber cervical cancer cases HPV is not part of the standard screening tests womens cervical cancer cases. in women. Its an for sexually transmitted infections because its so epidemic, Teknos says. common. If you looked at a group of individuals, Thats a pretty big claim and Romanowski is more people under 30, youd find a lot of HPV, says Dr. Barbara Romanowski, an infectious diseases expert at the University of Alberta and former director of Albertas Sexually guarded in her predictions. She cautions that its just Transmitted Disease program. No one in the world is recommending routine one study, in a field of research still in its infancy. But, closer to home, Dr. Nigel Brockton is also screening for HPV. In fact, most of us will be exposed to one of the 200-plus strains in our lifetime studying changes in the occurrences of HPV-related and, if youre sexually active and under 30, a quarter to a half of you have one right head-and-neck cancers in Alberta since 1998. There now. The majority will never develop symptoms and virtually all of them will clear is substantial literature on the increasing incidence of oropharyngeal cancer, says Brockton, a research the virus, Romanowski says. In fact, most people will never know HPV was there. In other words, Janae and I actually, just Janae was the exception. Her first scientist with Alberta Health Services. He estimates appointment for a colposcopy was preceded by two irregular pap smears showing that half to two-thirds of oropharyngeal tumours low-grade cervical dysplasia, basically abnormal cells. From the sexual health experts (including the tonsils and base of tongue, in which to her general physician to the Misercordias OBGYN, they all assured her that this HPV-related tumours most commonly occur) are was common and there probably wouldnt be a next step. And yet, there always was. caused by HPV, and men account for the vast majority So far, her two colposcopies, the last in January, have been the only bearers of good of those cases. If the projections of Brockton and Teknos are news because they were followed by no news at all. That doesnt mean her cervix cells true, and HPV becomes as much of a mens health have returned to normal; they just havent displayed any further changes. Though I should have felt relieved that I was unaffected, I felt guilty for clearing the issue as prostate cancer, whats behind the upsurge? virus like the vast majority of people who have contracted it without ever knowing. Teknos guesses that, just as smoking has gone from I wanted to play a bigger role in helping Janae, but all there was for me was to be commonplace to taboo, oral sex has gone from fetish to Chief of Emotional Support, and driver. It was perverse even sexist! that I could routine. And he says that HPV acts mysteriously in the unknowingly transmit this commonplace virus without personal consequences, throat. Whereas genital tissue reacts quickly, if at all, to while my partner is left to bear them all, and possibly for the rest of her life. That, the viral infection, the related throat cancers Teknos is and the general knowledge I had about its relationship to cervical cancer and a seeing occur possibly decades after infection. Fortunately, head-and-neck cancers respond well contentious vaccination programs for girls, only validated my misconception that to treatment unless the patient smokes, in which case HPV is a womans disease. outcomes are not as good. The answer to this epidemic, In men, HPV has been linked to some cancers of the penis, anus and Teknos says, is to start vaccinating boys. Though Health head-and-neck region, but the proportion of incidences pales in comparison to abnormal Canada stopped short of recommending the vaccine cervical cells and cervical cancer, the vast majority of which is caused by the virus. for males, it approved the use of Gardasil for boys and However, a landmark study from Ohio State University contradicts many experts young men. So far only PEI has considered offering it freely to boys. opinions, that it either attacks quickly or not at all, and that it generally afflicts women. Brocktons research supports Teknoss claims. The Dr. Ted Teknoss colleagues at OSU examined more than 250 samples of throat tumours collected between 1984 and 2004 and found an upsurge in HPV-positivity numbers of Albertan males developing cancer due to in the more recent the samples. Not only that, but in the division of head and neck HPV infection are significant, Brockton says. At the surgery at the Arthur James Cancer Hospital, where he is the leading otolaryngologist, current rate of vaccination, a cohort of Albertan males will continue to be at risk for a long time. incidences have more than tripled. Yet even with evidence that HPV doesnt discriminate, What the data are showing is the numbers of these patients has gone up

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that men carry the virus and are increasingly carrying the related diseases, HPV immunization programs currently only give girls the pinch. The way its been sold, says Teknos, is as a way to prevent cancer of the cervix and warts in women. To then turn around and talk about oral sex and cancer in men is a big leap. Its like trying to sell bras to boys. Romanowski, however, doesnt see the need for a school-wide male vaccination program like those offered to girls in every province and territory. She says that herd immunity the immunization of one part of the population to protect everyone else will protect the bulk of the population. She says a vaccination rate of 80 per cent, meaning four out of five women, would achieve herd immunity. Youre not going to gain anything by also vaccinating boys, she says. Its not cost-effective. Romanowski would rather see focus on increasing female immunization. But herd immunity can be fragile. Large populations are not amorphous, but comprise a series of smaller networks. There are a variety of reasons people in certain networks opt out of immunization, weakening parents will have their 10-year-old boy injected on the off chance he might grow up gay or bisexual. the case for herd immunity. I am of the mind that young men should be included in government-funded vaccine Only 10 per cent of women age 18 to 25 received the three-step vaccine, the rest citing cost as the primary programs, not just for their safety, but because it shouldnt just be up to women to reason against it. For school-aged girls in Alberta with clear the proverbial table. Current health measures all but validate HPV as a womens access to free vaccines, the rate is three in five publicly health issue and leave sexually active men unaccountable and about as educated on the educated girls and one in five girls attending Catholic topic as they are about menstruation. Boys and men should be likewise empowered to schools, Romanowski says. She says that Catholic care for their own their health and sexuality. schools wont let the vaccine through their doors because they fear its a tacit approval of premarital sex, In June, Janae and I will exchange vows, promising fidelity in good times, so the Alberta government offers to vaccinate these girls bad times, sickness and health, before we fly across the Atlantic for our honeymoon. After that, well return for her third colposcopy. If elsewhere for free. her cells are still low-grade, or have worsened, shell Religious beliefs are Romanowski doesnt see the need get a more invasive electro-surgical treatment called not the only obstacle for a school-wide male vaccination LEEP (loop electrical excision procedure). If they to herd immunity. After return to normal, shell need two more good-news a televised debate in program. She says that herd colposcopies over the next year before she can return September, would-be immunity will protect the bulk to regular pap smear screening, recommended for presidential candidate of the population. all women in Alberta. So, even if her body clears the Michele Bachmann HPV, it will be years before her mind does. told NBC news about And me have Ive cleared the virus? Teknos tells me to be vigilant, look for changes a woman whose daughter suffered from mental in my neck and face, look for lumps, sore throat, ear pains. And, of course, not to retardation after being administered Gardasil. Her claims, that it can have very dangerous side- smoke. Janae and I look now toward the next step in our relationship, having children. effects, went unchallenged on live TV and were quickly adopted by tepid parents and conspiracy theorists. Whether theyre girls or boys, we can only protect them through immunization its When you have people like Michele Bachmann the least we can do. Actually, its the best we can do. standing up and saying, Thou shall not vaccinate the child for HPV because its dangerous people listen to Vaccine Facts for Women: that nonsense, says Romanowski. About 20 million women have received the vaccine safely. Romanowskis view, that immunizing boys is not The vaccine has also been approved for use in boys but theres no cost-effective, is widely supported by research including province-wide vaccination program. a study in the British Medical Journal. But it ignores men The HPV vaccine is effective in preventing two types of HPV, which who have sex with men. They carry HPV at rates 17 times cause 70 per cent of cervical cancers. higher than heterosexuals and more frequently get its Vaccinating school-age girls against HPV will dramatically reduce associated illnesses. She says, I think they should be cervical cancer for future generations of women. vaccinated for HPV, because theyre not going to benefit Girls whove been vaccinated still need to have regular pap smears from the herd immunity. But its crucial that people starting in their teens. Source: www.health.alberta.ca/health-info/imm-HPV.html are vaccinated before theyre sexually active and few

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Good Dog!
BY LISA RICCIOTTI / PHOTO BY CHRISTY DEAN

Such a

Youll never convince a pet-hater to snuggle a furry friend for healths sake. But dont kibble with the evidence: animals may really improve human health
f your dog could read and write, you might come home to nd a note attached to the latest scene of destruction: Human: Sorry I scratched the leather couch, chewed your Jimmy Choos, and made a mess on the rug. But I just read the latest research and it says Im good for you. Stop kvetching and give me a hug! You can nd research to back what every pet owner intuitively knows dogs and cats are good for your physical and emotional health. Not just the obvious fourlegged heroes, like Roselle the Labrador retriever, who guided her blind owner, Michael Supported by the calm presence of the pet therapy animals, participants dont think about Hingson, down 78 ights to emerge their limitations, as the dogs move among them unscathed from without prompts from their owners. the north tower of the World Trade Center following the 9/11 terrorist attacks, or the many animals trained to support people with health challenges. The average owner reaps rewards too. In July 2011, the American Psychological Association published a paper, called Friends with Benets: On the Positive Consequences of Pet Ownership in the Journal of Personality and Social Psychology, that said: There are many positive consequences for everyday people who own pets .... Pets benet the lives of owners, psychologically and physically, by serving as an important source of social support. The report summed up the ndings of three studies to compare dierent samplings of pet owners against the pet-less. In all cases, those with Fluy or Fido were happier, healthier and better adjusted than non-owners. Pet owners had greater self-esteem, were more physically t, tended to be less lonely, were more extroverted, tended to be less fearful and tended to be less preoccupied than non-owners. The paper also put to rest the myth that says, they love their pets because they dont get along with people. The studies showed that owners were very close to key persons 42

in their lives, indicating that loving a dog doesnt preclude loving your own species. Im not one who needs convincing. I give thanks daily for the therapeutic benets of my three silly, snorting French bulldogs. And I know that volunteers at pet therapy associations throughout Alberta see the dierence visiting animals make at hospitals, rehabilitation centres, seniors residences, mental-health day programs and hospices. If I needed proof, seeing is believing so Edmontons Janice Rowley, president of the Pet Therapy Society of Northern Alberta, invited me to observe their PAWSabilities program. I watch Cotton, a Husky-retriever mass of u, Bandit, a serene border collie cross, and Daisy, the one-eyed rescue pug, connect with an appreciative group of mentally and physically challenged adults from a Winnifred Stewart Association day program. All three dogs sport the green scarves worn by PTSNAs ocial therapy dogs. An art session is underway. Cotton quickly positions himself beside a wheelchair where a woman with spina bida struggles to glue sequins onto a picture frame. She repeatedly reaches down to Cotton for reassurance. Cotton knows he needs to stay where he is, so Bandit makes the rounds, nudging participants for pats, while compact Daisy seeks welcoming laps. Daisy kissed me! one previously silent man squeals. But the star is Merlynn, a black twitchy-nosed loppedeared rabbit. Solemnly sitting on his pink plush bed, Merlynn stays still as hes passed around, accepting the stroking hands of strangers and stoically enduring tugs on his ears. He knows hes working when hes on that bed, says proud owner Wendy Watson. He wont jump o. Supported by the calm presence of the animals, the group focuses on their projects. The dogs move among participants without prompts from their owners. People dont think about their limitations; theyre just enjoying the simple pleasure of time spent with accepting, aectionate animals. Its quiet testimony to pet therapy power. Research shows measurable benets of pet therapy,
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FURRY FRIENDS: Pet therapy dogs Bandit and Cotton take ve with Janice Rowley, president of the Pet Therapy Society of Alberta.

agrees Sandra Johnston, executive director of the Pet Access League Society (PALS) in Calgary. We see it rsthand. There are many little miracles depressed seniors who talk to a dog after not having spoken for months, a patient considered immobile after a stroke turns to touch a pet, a dogs visit lightens the mood of a sorrow-lled family in a hospice for a few moments. Jill Rhyson coordinates St. John Ambulances provincial therapy dog services program for Fort McMurray, Grande Prairie, Lethbridge, Medicine Hat and Red Deer. Shes seen people light up around a tiny Chihuahua or a 100pound Great Pyrenees. Theres a dierent emotional connection beyond than we get from humans. People relax, let down their guard and forget their problems. Sta at various facilities see a dierence after our visits. At the Chimo Project, pets work with certied health professionals in programs known as animal assisted therapy (AAT). Interaction with animals can reduce anxiety, lower blood pressure, build trust, put people at ease and act as a social lubricant, says program coordinator Danielle Clark. Chimo uses those benets from psychiatric to rehabilitation hospitals and from school settings to eldercare. Our research shows clients are also more motivated to attend and participate in therapy where animals are present. But back to you and your four-legged friends. In spite of his occasionally exasperating antics, your family pet does his part to keep you healthy. A 2011 study led by a Michigan
Alber tas cancer-free movement

State University researcher found people who own and walk dogs are 34 per cent more likely to meet U.S. physical activity benchmarks. Youre a cat-owner? They dont need to be walked, but a 10-year study by researchers at the Stroke Institute in Minneapolis found owning a cat could reduce the risk of a heart attack by nearly one-third. And American journalist Ben Williams once said: Theres no psychiatrist in the world like a puppy licking your face. Now if youll excuse me, I have three French bulldogs waiting for their walk.

MORE LICKS AND WAGS


Old thinking: allergy-prone families should pass on pets. New thinking: kids who grow up with furry friends are at less risk of allergies and asthma, according to Dr. James E. Gern, at the University of Wisconsin-Madison (Journal of Allergy and Clinical Immunology, 2004). The Australian People and Pets Survey, documenting benets of pet ownership in 1994. Among its ndings: pet owners had fewer visits to doctors and were less likely to take medication for heart problems or high-blood pressure. The survey didnt nd that benets increased for multiple-pet owners. Pet owners are eight times more likely to be alive a year after suffering a heart attack according to a study by Dr. Erika Friedmann, published in The American Journal of Cardiology in 2003. Shake a paw and nd out more: Pet Therapy Association of Northern Alberta 780-413-4682, pettherapysociety.com

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BY MIKE EVANS / ILLUSTRATIONS BY LIISA SORSA

A powerful medical intervention reduces your risk for a huge swath of diseases. Its free and has no side eects

m Dr. Mike Evans and I have a big interest in preventative medicine. This could mean a lot of things from cancer screening, to eating more ber, to having a good social network (and I mean that in the old sense of the word), weighing less, drinking less, smoking less, controlling your blood pressure, cholesterol and so on. All these are incredibly important and I wouldnt want you to minimize your eorts in any category. But what health intervention comes rst? What has the biggest impact and return on investment? What one thing can you do that will make the biggest dierence to your health? I did my research and I found an answer. I picked out this one intervention because of its breadth. This intervention, in patients with knee arthritis who received one hour of treatment three times a week, reduced their rates of pain and disability by 47 per cent. In older patients, it reduced progression to dementia by around 50 per cent. For patients at high risk of diabetes and coupled with other lifestyle interventions it reduced progression to frank diabetes by 58 per cent. Postmenopausal women who had four hours a week of the treatment had a 41-per-cent reduction in the risk of hip fracture. It reduced anxiety by 48 per cent and in a metaanalysis in patients suering from depression 30 per cent were relieved with low dose of this intervention that jumps to 47 per cent as we increase the dose. Following more than 10,000 Harvard alumni for over 12 years, those that had the intervention had a 23 per cent lower risk of death than those who didnt get the treatment.

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Its the number one treatment for fatigue and, my favourite outcome, it improves quality of life. Its about making your life better and this treatment has been shown over and over again to improve quality of life. So the question is, whats this intervention whats the medicine and what is 23 1/2 hours? The medicine was exercise, mostly walking. There are 24 hours in a day. You might spend most of your day couch surng, sitting at work and sleeping. The evidence that Im going to show indicates that the best thing you can do for your health is to spend half an hour being active, maybe an hour, but if you can do that you will realize all the benets I described above. Lets just take a quick walk through some of the medical literature. Steven Blair, a professor at the Arnold School of Public Health at the University of South Carolina, created the Aerobic Centre Longitudinal study that followed more than 50,000 men and women over time. He looked at something called attributable fractions, the estimated number of deaths in a population that would have been avoided if the risk factor had been erased. An example of an attributable fraction is turning a smoker into a non-smoker. Blair looked at a number of risk factors, but the one that applied the most risk was low cardio-respiratory tness (CRF). It means really low tness and it was the strongest predictor of death. Most of the trials that we see are funded by pharmaceutical companies testing a drug for, say, hypertension or high cholesterol or diabetes. We rarely see tness thrown into the mix. Blairs work is interesting; he also undertook another trial looking at obesity. He found two things. First, obesity plus no exercise is a very bad combination. Thats where we see many of the negative consequences of obesity, from a health point of view. But, second, he found that if obese people were active even if they didnt lose the weight their health was much better. The exercise ameliorated many of the negative consequences of obesity. So, if exercise is the medicine, what is the dose how long, how often and how intense? Im going to give you a slightly mixed message: the rate of return seems to decline after

20 or 30 minutes a day but, essentially, more activity is better. If you are being active less than 150 minutes a week (kids need an hour a day) my ag goes up in the clinic. The literature draws a broad stroke and we see big dierences when someone goes from not doing anything to doing something. After that, the return is more granular. The Nurses Health Study shows that women who went from zero activity to just one hour a week reduced their heart disease rate by almost half. And you still see the health gains even if you break it down to three, 10-minute increments to achieve your 30 minutes. But the clinical pearl lies in thinking about your style and habits and your personal cues. Some might only exercise if its pre-booked with friends. Or some couples might take a half-hour walk every evening to organize their lives. A dog is a great walking coach; the data show 67 per cent of dog walkers achieved 150 minutes of exercise a week just with the dog walking. And your commute is a great opportunity to work in exercise getting o a stop or two early or taking the stairs. I can walk you through some quick slices of the literature. The rst exhibit comes from Japan. In the 1990s, Japan required all employers to conduct annual health screens for employees, and that included a large gas company. They asked: if peoples walk to work was longer, did that reduce their chance of serious health problems,

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for example high blood pressure? At the Japanese gas company, they found that an under-10-minute walk made no dierence to blood pressure. An 11-to-20-minute walk reduced high blood pressure or hypertension by 12 per cent. For walks of more than 21 minutes, high blood pressure rates dropped by 29 per cent. The authors of that study calculated that for every increase of 10 minutes to your daily walk to work, there was a 12 per cent reduction in your likelihood of getting high blood pressure. The second exhibit is from Germany and it involves stents, which are pretty common in medicine. If an artery starts to get blocked, a vascular surgeon puts in a balloon to open it up and inserts a stent to keep it open. A German researcher named Rainer Hambrecht looked at this with about 100 cardiac patients. He got half the group to exercise 20 minutes day on an exercise bicycle, plus once a week for 60 minutes in an aerobics class. And the other half got the high-tech stent and kept with their normal activity. After one year, 88 per cent of the exercisers were cardiac-event free, compared to 70 per cent of the people who got a stent. So both worked, but I nd it amazing that the low-tech intervention, exercise, made a bigger dierence. And a stent just xes just that one part of the heart. The third exhibit is from Australia and its about what I call sitting disease. We know that being sedentary is bad for your health. A researcher named Lennert Veerman wanted to quantify it with a big study. He found that, compared to people who watched no TV, those who spend a lifetime average of six hours a day watching TV can expect to live about ve years less, and the average adult in the United States watches for about ve hours a day. TV is as powerful as many other risk factors for chronic disease. Im going to leave you with two quotes. One is Jerry Garcia, the lead singer for the Grateful Dead. And he

said, Somebody has to do something, it is just incredibly pathetic that it has to be us. And I think thats true: it has to be us. And Hippocrates said Walking is a mans best medicine. Im going to nish by asking you a question. This may have some personal challenges for you; you might be very busy at work, or with kids, or you may be in pain, or you may have other priorities. But my question is this: Can you limit your sitting and sleeping to just 23 1/2 hours a day?

GET GOING! Dr. Mike Evans video, 23 1/2 Hours, went viral after its release earlier this year. Watch it here: www.youtube.com/watch?v=aUaInS6HIGo Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michaels Hospital.

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why I donate /

STORIES OF GIVING

Inspiration MEETS Perspiration

MOTIVATOR: Katie McLean helps everyday Joes complete triathlons.

BY MICHELLE LINDSTROM

PHOTOS BY JOEY PODLUBNY

For Katie McLean, it made sense to connect her three passions: triathlons, giving back and helping people cross finish lines

he says she had no choice. She was drawn to Joe Finleys magnetic personality and found herself asking, How can I help? Thats how Katie McLean recalls becoming a champion of Joes Team of Calgary, which hosted its rst sprint triathlon last summer. Finley is known as Joe to hundreds of his closest friends friends he made during a personal challenge to help others feel the sense of accomplishment he felt after completing a lifelong goal in 2006: a triathlon.

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why I donate /

STORIES OF GIVING

IRON WOMAN: Training hard is not new to Katie McLean. She competes in Ironman races and major marathons.

McLean met Joe through a mutual friend and neighJoe and McLean were part of Joes leadership team. They advertised mainly by bour, Norm Lamarche. Well, sort of. McLean trains peo- word-of-mouth. Joe inspired me. I inspire others. And thats really how it works, ple for marathons and triathlons not as a paying job, just McLean says. The event has become a repeat sell-out event in Muskoka, Ontario. a fun pastime. Lamarche completed the New York City McLean moved to Calgary with her husband and four kids two years ago. She cares marathon about a decade ago with McLeans help. She for their children and does some writing, but was uncertain how she wanted to ll her assumed theyd start training for it again the following time, with the kids in school. Get a part-time job? Spend more time volunteering in the year. Instead, Lamarche told her he wanted to help a kids schools? Or, bring Joes Team to Calgary? Joe knew he only had a short time and friend who had throat cancer, Joe, raise money for he spent his time giving, McLean says. She took it as a message and the decision made Torontos Princess Margaret Hospital and inspire others itself. The rst Calgary Joes Team sprint triathlon took place on June 19, 2011. to try their rst triathlon. Joe was quite ill by the time McLean got the Joes The idea aligned with The big obstacle was how few people Team Calgary idea rolling, but he was supportive. what McLean did help McLean knew in her new city, since the He even helped pick the triathlon venue. There are people cross finish success of Joes Team weighed on wordnot a lot of lakes in this province! McLean says with lines and she called a powerful, two-beat laugh. The bigger obstacle was Joe directly. When I of-mouth. Luckily, Joes Team makes it how few people she knew in her new city, especially met Joe, it unlocked this into most of her conversations. since the success of Joes Team weighed heavily on desire, she says. The word-of-mouth. Luckily, Joes Team makes its way whole thing just hit me so hard that I had to help. Her into most of her conversations, like at her youngest sons hockey game. She spoke desire to help was fuelled by a long-simmering sense of with a hockey dad who turned out to be an advertising executive and he wound up frustration she had harboured since her mother had died oering some free advertising space. Calgarians are entrepreneurial, McLean says. of cancer at age 46. It was this frustration that my mom Once I gured that out, I started talking to everybody about it, and those people didnt get to live her whole life. started talking to other people. She recruited a formidable local leadership team to Joe had Stage IV throat cancer that had spread to his make it happen. lungs. He did his rst triathlon after going through Calgarys Joes Team triathlon held a launch party in March 2011 which connected incredibly invasive chemotherapy and radiation, Cara McLean with a key guest, John Osler, Chair of Alberta Cancer Foundations Board of Finley, Joes wife, says. He was five-foot-11 and he Trustees. He followed up with McLean a few months later requesting she join the weighed about 120 pounds when he did this. Joe, Foundations board. She became a board trustee in September 2011. his wife, McLean and about 230 of their friends Joe died in October 2010, leaving grieving friends and uncertainty. The leadership all shapes and sizes with little or no triathlon experience teams, even Joes wife Cara, wondered how they could spread Joes message without participated in a triathlon as Joes Team. The idea him. I mean, Joe is the reason people do the triathlon, she says. Finley and grew and, with a strong leadership team in place, McLean had become friends and worked together on Joes Team from the beginning. Joes Team triathlon became its own event in 2008. She learned about McLeans high-energy and ability to get a group together and 48

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I couldnt have done this work without an amazing group of people who are as committed as I am: Joes friends and his wife Cara, as well as my new friends in Calgary whove formed a strong leadership team. Theyve made Joes Team a success.

truly motivate them. I think when people hear what Joes message is all about, combined with Katie, its just a winning combination. I wouldnt have met all of these wonderful people if I hadnt done this, Joe once told McLean. I didnt know that all of this would happen. Recalling his positivity keeps McLean inspired, as does the increasing evidence that obesity is a factor in some cancers. Her familys actions also prove how the message is reaching people. Her husband participates in the triathlon every year even though hes not the competitor in the family. Its cool for kids to see their parents cross the nish line, McLean says. We spend a lot of time taking our kids to sports and asking them to try new things, but we dont take chances ourselves. Its valuable for them to see us put ourselves out there and try something that scares us. Her kids have volunteered and raised money for Joes Team since its inception. Im pretty sure my daughter thinks she started Joes Team because shes been volunteering since she was 11 or 12, McLean says, recalling the many lemonade stands on their front lawn. McLean takes pride in the celebratory feel of Joes Team events something she says sets it apart. Theres endless encouragement for the teams to meet a common goal and for rst-timers to achieve the unachievable. I hate you, one friend told McLean from the shore before swimming in 2011s Calgary event. Apparently the swim portion is the scariest part for most competitors. At the nish line, McLean met up with this friend again and was told with a huge smile, I dont hate you anymore Katie. Message received.
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KNOW JOE
Joes Team ran its rst sprint triathlon on July 5, 2008 at the CNIB camp on Lake Joseph in Muskoka, Ontario. Roughly 300 competitors raised over $670,000. Joes Team Calgary ran its rst sprint triathlon on June 19, 2011 at Elbow Valley, in Calgary, Alberta. There were approximately 170 participants and the event raised more than $160,000 benetting the Alberta Cancer Foundation. A sprint triathlon consists of a 750-metre swim, 20-kilometre bike ride and a ve-kilometre run. An Ironman triathlon consists of a 3.86-kilometre swim, 180-kilometre bike ride and a 42.2-kilometre (full marathon) run. Both locations of Joes Team events offer a duathlon ve-kilometre run, 20-kilomtre bike ride and a 2.5-kilomtre run. Joes Team Muskoka triathlon sells out each year and must cap its participants around 660 total entries. It raised over $1.4 million in 2011. Calgarys Elbow Valley venue can accommodate 500 participants, so join up! Muskokas triathlon raises money for Torontos Princess Margaret Hospital for head-and-neck cancer research. Calgarys triathlon raises money for the Alberta Cancer Foundation in support of Calgarys Tom Baker Cancer Centre for head-and-neck research. See www.albertacancer.ca/joesteam for information about Calgarys triathlon. See www.joesteam.ca for information about Muskokas triathlon. Email Katie McLean at kamclean@rogers.com for more information about Joes Team.

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INSPIRING INDIVIDUAL

Run Away
In May 2011, Scott Todd was a busy service coordinator for construction giant PCL. Shuttling between the Nisku and Edmonton ofces and hurrying home to Sherwood Park where his wife Kristy and then-18-month-old daughter Zoey were waiting left him little time for personal goals. That said, he was keen to get back to running hed already bagged a half marathon the year before. Then he started to get itchy skin. Doctors treated him for allergies but it didnt help. Fatigue set in and the tests ramped up. Was it pneumonia? A chest x-ray found a tumour: Todd had Hodgkins lymphoma, a diagnosis no young dad wants to hear. A few days later, Todd was sitting in his chair in Edmontons Cross Cancer Institute, receiving his rst dose of chemotherapy. I needed to set a goal for myself, he says. Using his iPad, he registered for a half-marathon in Disneyworld, date: January 7, 2012. Todd spent the next months, when other runners would be training, getting his chemo. Once the chemo was done and I was on radiation, I started taking long walks in the evenings. When he completed radiation, he resumed running two or three 50 nights a week. His goal was completion, not speed. I had some scans on January 4th and, when I went to my follow-up appointment on the 16th and told my doctor Id run a half marathon in between, he said maybe that wasnt the best idea, says Todd, who promised to scale back and rest. What started as a personal goal turned into a fundraiser run, benefitting the Alberta Cancer Foundation by more than $6,000. Todd has registered for another half in September, this time in California, and hes not sure if this one will be a fundraiser. Last time I was blown away by peoples generosity, he says. I dont think I could ask my friends and family to do it again. Mi Purvis
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