Stroke patient John Kranjc is pictured with the outpatient speech therapy team that’s been helping with his recovery since being discharged home.
From left to right: Shannon Stanners, Tricia McMurtry, John Kranjc, Anna Alexandrova
In February, Hamilton resident John Kranjc took a skiing vacation in France with friends. On their second last day on the slopes, John had a bad fall. Despite a cracked helmet and initial concerns about breaking the hip he landed on, he walked away with only a concussion and a nasty bruise.
After heading home, the 66-year-old lawyer went back to work and his usual routine. Three days later, during a family breakfast before work, John fell to the ground. He tried to speak, but nothing came out and he couldn’t move the right side of his body properly.
“I knew right away he was having a stroke and I called 9-1-1,” says Michelle Kranjc, John’s wife.
Removing the clot
Thanks to Michelle’s fast action, John was in an ambulance heading to Hamilton Health Sciences’ Hamilton General Hospital (HGH) within minutes and the stroke team was ready for his arrival. HGH is the designated Regional Stroke Centre for the Central South Ontario region.
“My head felt fine when I got home, so I didn’t expect anything like this to happen.”
The stroke team found not only a blood clot blocking the flow of blood to the brain, but also a subacute subdural hematoma – a brain bleed that doesn’t cause symptoms until hours, days or even weeks after a head injury.
“My head felt fine when I got home, so I didn’t expect anything like this to happen,” says John. “It was my hip that was bothering me. It was black and blue all the way to my knee.”
John was quickly sent to have the clot removed, but when he woke up from the procedure he still couldn’t speak, write or hold a pen properly.
“After the procedure, I noticed a huge positive difference in John’s ability to use his right side,” says Michelle. “But it was his speech that was going to take some work to get back.”
Stroke damage causes language challenges
The stroke caused damage to John’s brain that resulted in both aphasia and apraxia of speech that would require rehabilitation to re-learn how to speak, read and write. He was transferred from the stroke unit at HGH to the stroke rehabilitation unit in the neighbouring Hamilton Health Sciences’ Regional Rehabilitation Centre (RRC).
“it requires a significant amount of work to regain the skills that used to be second nature.”
Aphasia is a condition that affects a person’s comprehension and expression of language. Apraxia of speech affects a person’s physical ability to coordinate the speech movements associated with specific sounds.
For example, when John first woke up from surgery, his care team asked him a series of questions, but when he tried to answer, his speech was jumbled, and some of his answers were even in French. This is aphasia. But, if he was asked to say a single word, he wasn’t able to coordinate his mouth to make the correct sounds needed to say that word. This is apraxia of speech.
Shannon Stanners, Speech Language Pathologist.
While on the stroke rehabilitation unit, John worked with a speech language pathologist and communicative disorder assistant multiple times a day. He went from speaking a few single words to saying full sentences.
“John’s progress as an inpatient was impressive,” says Shannon Stanners, speech language pathologist with RRC’s outpatient services. “By the time he was discharged home, the impact of his aphasia on his speech was minimal. It was the apraxia that we still needed to work on.”
Rehab program leads to communication improvements
John was discharged home in March and began working with Stanners and the outpatient speech team in April. While his language comprehension had returned at that point, his speech was still choppy and missing natural rhythm and flow.
“We know how frustrating not being able to communicate properly is for our patients, and it requires a significant amount of work to regain the skills that used to be second nature,” says Stanners. “John’s main goals are to work on his flow of speech, using natural pitch and emphasis, and when stuck on a word to use other words he knows. I remind him often to slow down, take a breath and plan how to place his lips and tongue to say the sound. Slowing down is a key strategy for many of our patients.”
John works to improve his speaking, reading and writing not only at his appointments but also throughout his everyday life.
John has also been working with the outpatient speech team on his reading and writing skills. At discharge he was reading single paragraphs and is now reading short stories and magazine articles. His writing has progressed from single words to short paragraphs.
“Everyone I’ve worked with at the Rehab Centre has been wonderful,” says John. “They take the extra time to personalize the exercises and really set you up for success.”
John is extremely determined and dedicated to his stroke recovery rehabilitation program. He’s been taking every opportunity he can to practice language skills, including cooking meals with Michelle, reading his favourite magazine, The Economist, and having social conversations with family and friends.
A recent success for John was attending a social gathering for a few hours without anyone noticing that he has had difficulties with his speech.
“John’s significant progress is a reflection of his hard work and wonderful support from Michelle,” says Stanners. “Soon he’ll be discharged from outpatient speech therapy, as he’s learned all the skills he needs to continue on his own.”
For now, John plans to work in his garden, cook with Michelle and spend time with his grandkids. And, eventually, he looks forward to returning to work.
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
