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Bancroft This Week article published August 3, 2017. Article in full pasted below. Sarah Sobanski, Bancroft This Week North Hastings Hospital is celebrating the first graduating class of its pulmonary rehabilitation program — and the program’s continuation. The class of under 10 participants — referred to the program from area health professionals — all improved their quality of life and physical abilities. Physical test scores from a six minute walk test improved 15.4 per cent, with participants walking an extra two to 90 meters further than when they started. More than two thirds of participants reported an improvement in their general health and anxiety/depression. The same amount saw a 20 per cent improvement to their COPD. “We wanted to get this going because there’s a big need for people with [Chronic Obstructive Pulmonary Disease] and pulmonary issues,” said physiotherapist with the program Melanie Dalley. “There’s a lot of incidences of COPD in the area and it’s a big concern with the emergency because it’s a lot of what they see in the emergency — so definitely something that’s being needed.” Quinte Health Care North Hastings and the Bancroft Family Health Team first worked together to bring the  program to the area in May. Respiratory therapist Lysanne Burnett, kinesiologist Alex Boyle, registered nurse Tammy Ives and Dalley monitor the program’s participants. It’s in the same room as the cardiac rehabilitation program, which began in 2015. Funding for it has now been extended, following the successful pilot. It will run four times a year with patients attending the physiotherapy room in the hospital twice a week for eight weeks. Dalley said having a pulmonary rehabilitation program in addition to the cardiac rehabilitation program is important because it’s in high demand. “About four per cent of people have access to pulmonary rehab when it should be accessible to everybody,” said Dalley. “This is a pretty big deal because people don’t have access to it and we’ve got it in Bancroft.” One of the main focuses of the program is exercise. Participants do weight training, cardiovascular exercise and resistance training. “When you get short of breath you don’t want to exercise because you just can’t breathe and so you end up getting in this really bad cycle of can’t breathe, stop moving. Now that I’m stopping moving I really can’t breathe,” said Dalley. “It just keeps getting worse and worse. The whole point of this is to stop the cycle.” Dalley explained maintaining a regular workout routine and staying physically fit helps the body use oxygen more efficiently. The program also focuses on breathing techniques, energy conservation — such as knowing your body’s schedule and when you get tired to plan accordingly — and education about the disease and the medications used to treat it. She said the better people understand what’s happening to them, the easier it is to slow the progression of pulmonary illnesses and CODP. “A lot of people think, ‘I can’t breathe I better run to the hospital,’ and often times you can learn some techniques that you can do at home that can actually help to control your shortness of breath and you may not need to get to the hospital.” Bancroft This Week attended the last class in the program July 27 to see how the participants were fairing. Each said they had improved. “I just think it’s a really good thing,” said participant Gail Robinson. “There are lots of people who need it and haven’t had it. There are lots of people who have health issues, probably lots of them have breathing issues.” Tony Youdale also found the program “very helpful” and said it was good for him to keep moving. He said he’s 81 and he wants to combat “things starting to slow down.” The next program will begin in September. Dalley said anyone wanting to attend the program should talk to his or her family doctor to be referred. Anyone looking for more information or to be referred can also call Tammy Ives at the Bancroft Family Health Team: 613-332-1565 ex. 242. “I think it’s been needed for a long time. It’s one of those things its really hard to get funding for any of these types of programs even though the literature is there to say they’re just as effective or more effective than just basically giving medication and treating it as a primary prevention. This is treating people before it happens,” said Dalley. “It’s one of those things that’s been proven over and over and over.” Click here to access the Bancroft This Week article.

St. Catharines Standard article published July 28, 2017. Article in full pasted below. Cheryl Clock, St. Catharines Standard It was some 30 years ago that Dr. Brian Kerley, then a new family doctor in St. Catharines, started working shifts in the emergency department at the old Hotel Dieu Hospital on Ontario Street. At that time, 1985, the hospital had just opened a new oncology clinic. Before that, the closest treatment centre for people living with cancer was Henderson General Hospital in Hamilton, now the Juravinski. The clinic was a welcome relief for people, an advancement in care that allowed them to receive chemotherapy in their own community, closer to home. It wasn’t long before Kerley and the late Dr. Heime Geffen were troubled by the growing number of cancer patients showing up in the ER with uncontrolled pain. He had received some instruction in medical school about palliative care but he largely felt ill-equipped to give people the comfort they were needing. They were in immense physical pain, constipated, nauseated and vomiting, and also enduring a deep emotional and spiritual agony. “People were dying with unrelieved pain,” he says. “There was suffering. You’d see people suffering.” At the time, palliative care wasn’t well integrated into cancer care, he says. When active treatment was no longer an option, when a cure was no longer possible, there were no palliative care physicians to tend to a person’s physical, emotional and spiritual needs. No one to offer quality palliative end-of-life care. It wasn’t until 1993 when three St. Catharines nurses, distressed by the circumstances under which people were dying in the community, gave life to Hospice Niagara by establishing a visiting volunteer program to provide care, support and dignity to people who were at the end of their lives. Three years later, in 1996, a specialized 11-bed palliative care ward opened at the Dieu — under Kerley’s leadership. The goal was to manage a person’s pain and other symptoms and get them back home. Then in 2007, Hospice Niagara opened its 10-bed residential hospice, The Stabler Centre in St. Catharines. Kerley has been its medical director since the start. A year later, McNally House Hospice opened in Grimsby to provide six beds for people living with a terminal illness in Grimsby, Lincoln and West Lincoln. But back when Kerley was in the ER, there was none of that. And oncology patients were showing up on his doorstep, in unmanageable pain. As a doctor, indeed as a human being, he needed to do something more. As a medical resident, he had met Dr. Elizabeth Latimer at Hamilton General. She was a year ahead of him. Latimer became passionate about palliative care and Kerley passionate about learning from her. Latimer, who died in 2012, is now considered a Canadian pioneer in the field of palliative care medicine. She was the first palliative care physician at Henderson General. What he learned from her and others to follow was “simple stuff” that had a huge impact on people’s lives. How to resolve bowel problems. Relieve vomiting. And the biggest revelation, albeit not without controversy, that at or near the end of someone’s life there really is no maximum dose of morphine and other opioids. It all came as a welcome realization: “People don’t need to suffer with pain.” These days, Kerley is the teacher. As a physician with the Niagara North Family Health Team in St. Catharines and medical director at The Stabler Centre, he divides his practice between family medicine and palliative care. He sees residents at the centre who are in their last days of life. And he sees people as outpatients, offering consultations. A good death is a journey made with dignity, he says. One where people are comfortable, cared for and safe. In many cases, surrounded by people who love them. It begins with pain and symptom management — physical pain is eased, people can breathe, their bowels work, and nausea and vomiting is controlled. People hold many misconceptions about death, he says. That it will be painful, a struggle to breathe, that they will choke or suffocate. Open conversations are encouraged. “If asked, most people who are dying want to talk about it,” he says. They want to talk about their fears. About details such as their care, place of death, funeral, will. All that. “But many physicians are notoriously, historically reluctant to have those conversations,” he says. “People need to be listened to. They need to be able to tell their story.” When Kerley meets a person, he often prompts them: “Tell me about yourself.” It’s about understanding the person, beyond the illness. “What’s your journey been like? Not just your illness journey, but your life journey. “What do I need to know about you, to maximize the quality of your last days. “It’s whole-person care.” He is guided by many palliative role models. One of them is Dr. Harvey Chochinov, who pioneered Dignity Therapy to address the reason’s behind a dying patient’s emotional distress. Patients can record meaningful aspects of their lives to leave something behind with their loved ones. Often people will find solace in reviewing their life. “How will the planet be a different place because you were in it?” says Kerley. “People need to know their life had meaning.” Even at the end of life, there is still time to live. At the centre, residents have been able to have their thoughts and memories written or recorded by video or audio. Their legacy story told. There has been a wedding, a hospice resident was married at the centre. A couple was able to celebrate their wedding anniversary in a therapy tub with a glass of champagne. Another family hosted a barbecue on Mother’s Day in honour of their wife and mother, and invited families of other residents to attend. Musicians have listened to their favourite music. An accomplished artist wanted to be surrounded by his artwork when he died. Indeed, whenever Kerley instructs a group of final-year medical students about palliative care, he begins with the video, Dying for Care, produced in partnership with Quality End-of-Life Care Coalition of Canada. It explores the attitudes about death and dying in the health care system and how it can impact a person’s end-of-life experience. One doctor shares a story of feeling less-than-adequate, many years ago, when faced with a man suffering from immense pain due to metastatic colon cancer. He refused to increase the man’s dose of morphine because he didn’t want him to become addicted. The man stood up and began to cry. He told the doctor: “I hope one day, as physicians, you can better look after us.” And he walked out of the office. https://www.youtube.com/watch?v=KU4_DKTMfUQ Video source: Pallium Canada For Kerley, palliative care is a calling. It’s not about death, but about helping people to live until they die. It’s about relieving pain and suffering. About human interactions, however short. “It’s the essence of being a physician,” he says. “It’s the job I feel I was called to do,” he says. “To help people to be as comfortable and alert as they can be to complete the work they need to complete at the end of their life.” It’s often a time when he sees people at their best. Their strength of character. The relationships with family. The focus they bring to life. “It’s a privilege to be invited in to be a part of that.” cclock@postmedia.com Click here to access the St. Catharines Standard article.