An inside look at the patient care experience in the BARLO MS Centre at St. Michael’s

From left to right: Anastasia Korosteliov, Darina Ermakova, Svitlana Yermakova and Rudaba Khan.

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Svitlana Yermakova was diagnosed with multiple sclerosis (MS) in 2014, while living in Ukraine. For years, her symptoms were managed but in 2022, shortly after moving to Canada, she experienced a flare up. Worried about their mother, Yermakova’s family took her to the St. Michael’s Hospital Emergency Department, where she was quickly referred to the hospital’s BARLO MS Centre.

Opened in August 2021, the BARLO MS Centre is one of the largest of its kind in North America and one of only seven adult centres in Ontario focusing on diagnosis and treatment of MS. The centre is staffed by neurology specialists and takes a multidisciplinary approach to MS that includes a variety of health disciplines, including nursing, occupational and physical therapy, pharmacy and social work.

Together, this team provides care for more than 10,000 patients – Yermakova is one of them.                     

During a busy clinic afternoon, Yermakova and her daughter, Darina Ermakova, who often accompanies her mother to St. Michael’s from their home in Innisfil, Ont., arrived for a follow-up appointment. They’re meeting with Anastasia Korosteliov, a Nurse Practitioner (NP) in the BARLO MS Centre, and Rudaba Khan, an NP student at the University of Toronto, to discuss how Yermakova has been feeling.

Speaking to Korosteliov, who also speaks Russian, Yermakova tells her that many of her symptoms have improved in recent months, including the numbness in her fingers that was waking her up a few times throughout night.

Khan asks about Yermakova’s medications and any other neurological symptoms. Yermakova tells her that she’s been experiencing some weakness and numbness in her hands during repetitive tasks in the kitchen.

“But it’s not bad or bothersome so I don’t want to explore it right now,” she says.

“It sounds like you may have a compressed nerve in your wrist,” says Khan.

Khan is a registered nurse, working on her nurse practitioner certification. This is her first placement.

“I worked previously as a trauma and neurosurgery intensive care unit (TNICU) nurse at Sunnybrook so coming into an outpatient clinic has been a cool experience,” she says. “We see such a variety of patients and there’s a lot of collaboration with the interdisciplinary team, which is really rewarding.”

Dr. Alexandra Muccilli, Yermakova’s neurologist at St. Michael’s, arrives at the exam room a short while later. After a quick recap of the appointment, Muccilli agrees that Yermakova’s symptoms are suspicious for carpal tunnel syndrome. She asks Yermakova if she’ll consider wearing wrist splints at night to see if that helps.

“If you’re having problems, even if they feel small, we need to address them right away so that they don’t become more significant problems in the long run,” she says, as she asks Yermakova to move her wrists into different positions to confirm the source of the weakness and numbness.

Yermakova agrees. She also agrees to an upper limb nerve conduction study, which can identify potential nerve damage. Muccilli writes Yermakova a referral for a neurologist in Barrie, Ont., closer to Yermakova’s home in Innisfil, so she doesn’t have to travel down to Toronto again in the coming weeks.

“My mom never wants to bother anyone with these appointments,” says Ermakova.

Before Muccilli leaves for her next patient, Yermakova tells her that she recently had an MRI appointment cancelled. Muccilli re-orders the MRI at St. Michael’s.

“It’s really important that we get these MRIs of your brain so we can monitor your MS and make sure that you’re not developing any new spots,” she says. “We can make adjustments to your medications if you are, but we need to get these images to be able to do that.”

After Muccilli leaves, Korosteliov and Khan ask Yermakova to complete a variety of exercises to see if there are any changes to her mobility, coordination and vision. Everything looks good so Korosteliov lets her know she can book her next follow-up appointment for early 2025.

Korosteliov joined the BARLO MS Centre team right before it opened. She says that it’s been rewarding to see how the centre has improved the lives of patients living with MS over the last 3.5 years.

“I get to see patients on a regular basis, often over years and years, and it’s the most special to see the improvements in their quality of life,” she says. “We used to have limited treatment options but that’s changing. To see people doing better with the right treatments is my favourite part of the job.”

The BARLO MS Centre is committed to providing excellence, not only in patient care but in research and education. Speaking through her daughter, Yermakova says that she’s grateful to be a part of it.

“I cannot say one negative thing about the experience,” she says. “When I wasn’t feeling well, they took me in for an initial evaluation really quickly. The team has been great, the drugs have worked well for me and the clinic looks beautiful. I’m very thankful.”

By Anna Wassermann. Photos by Yuri Markarov.