Q&A with Dr. Paul Winston

Researcher and Medical Director of Rehabilitation and Transitions at Victoria General Hospital

VHF: Tell us about your research project

Dr. Winston: We treat a condition called spasticity. It is a neurologic disorder that, for the purposes of this project, can happen after a stroke. Pain in the shoulder is the fourth most common disability after stroke, and the most common cause of pain. It’s so disabling that some people can’t participate in rehab. Many of these patients are paralyzed or have a high resistance to movement, which is what we call spasticity. People can’t use the limb that is affected by spasticity.

INNOVATION PHASE: $3 MILLION

INNOVATIVE RESEARCH PROJECTS now it’s spreading around the world quickly. We’re presenting it everywhere, and I really do think it’s going to become a global practice. And the innovation is that we can go right to the patient’s bedside to offer this treatment, thanks to the portable ultrasound that donors funded through the Victoria Hospitals Foundation. We do the procedure and it has an instant effect. The patient can suddenly start moving their limb, or they tell us they no longer have pain.

Your giving can be the catalyst that a clinician needs to transform their novel idea into reality. Help develop new care methods today by supporting research projects in our hospitals.

NEW & ADVANCED EQUIPMENT

You can help fund new and replacement equipment in our Victoria hospitals. New equipment has the power to significantly improve care for both physicians and Island patients.

SURGICAL SERVICES

Arthroscopy Instruments and Operating Room AV Equipment

$313,600 - Victoria General Hospital

Our project aims to treat these people within the first weeks to months after their stroke so that we can eliminate their pain as much as possible, and stop their spasticity from getting worse. Otherwise, people get permanently deformed limbs that they can’t move. We’re trying to alter the course of that progression and offer immediate treatment so that they can participate in rehab and stop taking their medications—including opioids.

DIAGNOSTICS

Automated Chemistry Line Core Lab at Royal Jubilee Hospital

$2,175,000

$209,000 - Royal Jubilee Hospital

NEUROSCIENCES

INNOVATION PHASE: $3 MILLION RESEARCH

Conducts tests on patient samples such as blood

Enables orthopedic surgeons to perform procedures using tiny instruments which do not require large incisions

PROJECTS

The second part is treating the pain in hips and knees from arthritis that prevents patients from getting out of bed or getting to their chair, walking or participating in exercise. We freeze the nerves that carry pain to the hip and knee.

• Smaller incisions mean quicker recovery time and less scarring in society. It might be too painful for someone to walk, or they might not be able to even dress or feed themselves. After treatment, we see many of these patients transform. Even if they don’t gain more movement, the pain goes away. They’re sleeping through the night. They’re not taking opioids or painkillers. It’s been really exciting for us to see that. For some people, the results are dramatic. We’ll often treat an inpatient at the end of the day. Each patient is different, but the excitement is the look on a therapist’s face when they come back in the morning and they say, “What did you do to my patient? They’re a new person!”

We’ve had cases where there’s a patient upstairs who needs an overhead lift just to get up and down, and after this treatment, all of a sudden all the nurses are clapping because this 90-year-old patient is walking. Or there might be a patient who can’t use their arm, and they’re crying and they’re on opioids. They have their treatment and the next time we see them, we ask them how they are and they can say they’re fine.

Physiatry Ultrasound Victoria General Hospital

$44 000

Produces real-time high-quality diagnostic images images was a big part of what made that possible.

VHF: Donors currently have an opportunity to help fund a $44,000 physiatry ultrasound. How does this equipment enable your work?

VHF: What is the most meaningful part of this project for you?

Dr. Winston: What’s so meaningful for me is that it’s a really human project. It’s taking suffering and something that robs people of their independence and mobility, and giving them back as much as possible. We’re giving people back their freedom, their autonomy, and it has been very rewarding.

VHF: How does support from our giving community fuel your work?

NEW & ADVANCED EQUIPMENT

VHF: How does this improve someone’s quality of life?

Provides clearer and more precise imaging than current tools

• Will replace current 20-year-old Chemistry Line (most-used equipment in Island Health) Can run over 1,200 tests per hour (current system can run about 1,000 tests per day)

VHF: What do you think is the most innovative part of your project?

• Helps physicians accurately identify joints, muscles, and nerves that need to be targeted during procedures Will benefit patients with neurologic disorders such as stroke, MS, cerebral palsy, and spinal cord/brain injuries

• Can complete an electrolyte panel 15 minutes faster than current system

Dr. Winston: This novel use of the technology was designed in Victoria, and

• Benefits patients with musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumours, and congenital disorders can be the catalyst that needs to transform their into reality. Help care methods today research projects in

• Equipped with an emergent test track to fast-track samples needing urgent results

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Diagnostics

$2,175,000

You can help fund new and replacement equipment in our Victoria hospitals. New equipment has the power to significantly improve care for both physicians and Island patients.

Dr. Winston: Spasticity can prevent someone from participating to their capacity

• Will be used by Dr. Winston and his team in the Physiatry Rehabilitation Clinic

Dr. Winston: We cannot do this procedure without the ultrasound, which helps us locate the correct nerves to freeze. We have also just published the world’s first atlas on how to do ultrasound procedures for spasticity, and having really beautiful, high-tech ultrasound

Dr. Winston: Support from the community means we can create projects that meet the needs of our community. The community supports us by funding equipment through the Foundation. Ongoing supports means we can continue to build on projects they have already supported. We can keep building until we get even better.

To be supported by the people of Vancouver Island, and to be able to give back to the Island, is just amazing. Support from the community allows us total freedom to do this work.

Eleven-year-old regains movement after traumatic brain injury thanks to ground-breaking research

serious.

Automated Chemistry Line Core Lab at Royal Jubilee Hospital victoriahf.ca/give-today 250-519-1750

Neurosciences

On December 7, 2020, Katie was already at work, and Niki was still asleep when Autumn came into their bedroom to tell him she had a headache.

Physiatry Ultrasound

Victoria General Hospital

$44,000

• Conducts tests on patient samples such as blood atie has lived on Vancouver Island all her life. She has a husband, Niki, and two daughters. Their family loves spending time outdoors, whether it’s kayaking, hiking, or spending the day at the beach.

K• Will replace current 20-year-old Chemistry Line (most-used equipment in Island Health)

• Can run over 1,200 tests per hour (current system can run about 1,000 tests per day)

Then, she experienced what looked like a seizure, and began vomiting. Niki rushed Autumn to Nanaimo Regional General Hospital, where he learned his daughter had an arteriovenous malformation (AVM), an abnormal tangle of blood vessels connecting arteries and veins in her brain, which had ruptured.

• Produces real-time high-quality diagnostic images

As a result of her traumatic brain injury, Autumn suffers from spasticity—a neurological disorder that creates a high resistance to movement—in her left arm, which was curled up to the point where she could no longer extend it. It also affected her left leg and caused some difficulty walking.

• Helps physicians accurately identify joints, muscles, and nerves that need to be targeted during procedures

Autumn was then airlifted to BC Children’s Hospital.

• Can complete an electrolyte panel 15 minutes faster than current system

A genetic blood disorder called hereditary hemorrhagic telangiectasia (HHT) runs on Niki’s side of the family. Part of the disorder is characterized by the malformation of blood vessels—including vessels in the brain. For Niki, his mother, and his grandmother, the condition only ever manifested in more frequent nosebleeds than experienced by the average person. Katie never thought the condition would put her then nine-year-old daughter Autumn at risk for something far more

• Will benefit patients with neurologic disorders such as stroke, MS, cerebral palsy, and spinal cord/brain injuries

“We didn’t know if she would walk or talk again,” says Katie.

• Equipped with an emergent test track to fast-track samples needing urgent results

“With brains, you just don’t know. There was the thought that her life might be over.”

• Will be used by Dr. Winston and his team in the Physiatry Rehabilitation Clinic

“Autumn was receiving Botox treatments every three months at Sunny Hill for her spasticity. The Botox was not fun, and all of those needles were really painful,” says Katie. “It would deaden the muscle so that her arm could stretch out again, but she still couldn’t use it. It wasn’t helping her arm work again.” victoriahf.ca/give-today

Autumn stayed in the hospital for nearly a month. At the end of December, she was moved to Sunny Hill Health Centre, a rehabilitation facility. There, she spent the next four months learning how to walk, talk, and eat again before she was finally able to return to her home in Nanaimo and go back to school with the support of an Education Assistant.

Autumn’s physician at Sunny Hill thought she might be a good candidate for a ground-breaking treatment for those living with spasticity, and referred her to see Dr. Paul Winston, Island Health’s Medical Director of Rehabilitation and Transitions at Victoria General Hospital.

250-519-1750

“When we first went to see Dr. Winston, we were in the waiting room and Autumn kept saying she was scared,” says

Katie. “But there was an older woman in the waiting room with us, and she told us that she couldn’t walk two months ago, and thanks to Dr. Winston she was now walking with the help of a walker.”

When Autumn first met Dr. Winston, she was the youngest patient in the world to ever receive his nerve-blocking treatment for spasticity. The novel use of this technology was designed by Dr. Winston and his team in Victoria, and, as far as they know, it is the only treatment of its kind in the world. The team is now working to present the procedure across North America, Europe, and beyond, with the hope that it will become a global practice.

Dr. Winston treated Autumn’s left arm and a few spots in her leg by inserting a tiny probe with nitrogen gas to deepfreeze the nerves that were causing her muscles to contract and tense up. He used a physiatry ultrasound to help locate which nerves to freeze.

Immediately, Autumn was able to begin to stretch out her arm and move her fingers for the first time since her stroke in December 2020.

Today, Autumn is able to use her hand, and can grasp and let go of objects. Her walking has also improved, and she’s limping less. She still does speech therapy to help with her short-term memory problems, but Katie says she continues to get better.

“She has come so far. We’re pretty hopeful that she will have full use of her arm again through the nerve-freezing treatments,” says Katie. “Autumn is really happy about being able to use her arm and hand again, and she loves going to see Dr. Winston.”

“This is going to be life-changing for Autumn. It will be the difference between whether or not she can drive one day,” says Katie. “She’ll still have some social issues and things like that—but she’s here, and that’s what’s important.”

VHF: Tell us about your research project.

Dr. Chen: I’m interested in advancing clinical diagnostics, which means making diagnosis faster, easier, more affordable, and better quality. Currently, diagnosing a patient with pneumonia— especially a very sick patient who is intubated—requires a procedure to “wash” their lung and then culture the fluid that comes off of the lung. The culture is very time-consuming, and it can take 72 hours to get a result. This isn’t ideal because 72 hours is a long time to wait to start the right therapy for that patient, and it can sometimes result in negative health outcomes.

Through this research project, our goal is to identify the bacteria or other pathogens directly from the lung wash fluid and bypass that lengthy culture step completely. We could then identify the pathogens within an hour of receiving the fluid in the lab, so the patient could start receiving the appropriate treatment the same day, rather than three days later. Ultimately, this will improve care, and it helps both the clinicians and the patients.

VHF: What do you think is the most innovative part of your project?

Dr. Chen: Globally, no one is doing what’s called “direct-from-specimen” analysis, which means you don’t have to culture it to grow and amplify the number of pathogens. Globally, everyone follows routine clinical care, which is to culture the specimen for up to 72 hours, find out what pathogens are growing, and then determine the treatment from there. So, the innovative part of our project is the rapid diagnosis—and it’s also more affordable for our healthcare system, and better quality. This is immediately relevant for the Vancouver Island population. From there, we can offer it provincially, and grow organically from there.

VHF: What does this research mean for a future patient with pneumonia?

Dr. Chen: In principle, whenever you have early diagnosis and treatment, patients are able to receive the right treatment in less time. We call this precision medicine, and it’s about treating the patient individually rather than the entire population. If you and I are both sick with pneumonia and we don’t know what pathogen is causing it, we get the same treatment—maybe the same antibiotic. But the faster we know what bacteria is causing you and I to be sick—because it could be a different bacteria for each of us—the sooner the right antibiotics can be given. This decreases the chance of disease progression, and can be lifesaving for a patient in the ICU who has chronic or complex infections.

VHF: Why did you choose Vancouver Island to live and work?

Dr. Chen: I trained at McGill University, and I did a fellowship here. I stayed for four months while I was doing my research, and I just fell in love with the place. Who doesn’t? I have two little kids, and it’s a great place to raise a family. Island Health has been very supportive in providing the space and some of the infrastructure for my research. Overall, I think this is the right place for my career, and for my family too. I have to say that I was interviewed at Vancouver, but I chose Victoria, and I say that proudly.

VHF: What’s your “why?” What drives your work?

Dr. Chen: I am a clinical pathologist, so my daily work is trying to provide the right diagnosis to clinicians and patients. But I am always looking for areas of improvement. We can always do better, and I see this every day in my work. I ask questions like, “Why does this take so long? Can it be faster?” or “Why is this so expensive and inaccessible to the patient?” You really need to gather and develop that expertise to translate it into a better outcome for the patient. All of my work centers around what can immediately impact healthcare and the patients.

VHF: How do community donations help fund local innovation?

Dr. Chen: I think we are in a unique position on the Island. There are a lot of very dedicated and knowledgeable people here who are keen to find ways to improve healthcare. We also have support from Island Health, academic institutions, and foundations like VHF who want to help us. I didn’t reach out the Victoria Hospitals Foundation—I was introduced to the Foundation because they wanted to support us. This has set me up for success.

VHF: What does the word “innovation” mean to you?

Dr. Chen: It’s something that requires you to think outside of the box and challenge the status quo. It’s also about not being afraid to look for the answers that are out there.

VHF: What gives you hope for the future?

Dr. Chen: I’m very optimistic, partly because I have very good support and good collaborators both on the Island and in the province. I have wonderful students from the University of Victoria who are well-trained and very keen to learn new things. But I think most importantly, the relationships I have with scientists, the hospital system, the patients, and the Foundation continue to grow. So, I think the future is very bright. With the right support, we can tackle anything. And it’s continuous support from donors that allows us to carry on.

To support innovative research projects that help advance care for patients like Autumn through the Emerge Stronger campaign, visit victoriahf.ca/give-today or call 250-519-1750.

About The Victoria Hospitals Foundation

For over 30 years, donors to the Victoria Hospitals Foundation (VHF) have been making a difference in the health and care of patients across Vancouver Island. The Victoria Hospitals Foundation works to enable donations to every area of care at Royal Jubilee, Victoria General, and Gorge Road hospitals.

The Foundation runs fundraising campaigns to inspire community giving in order to replace and fund new equip- ment and technology, build new hospital units, accelerate ground-breaking research, train staff, and ultimately improve the health of the community. When the community unites together for Victoria hospitals, local care teams can use state-of-the-art equipment much sooner than if we relied on government funding alone. It also gives patients a better chance at staying on the Island while they receive care. Having the best equipment means attracting the best and brightest from around the world to work in Victoria.

VHF is proud that Vancouver Island hospitals can provide world-class care to the community, thanks to donors. This truly embodies VHF’s vision that “giving makes us all better.” Thanks to the generosity of community donors, the Victoria Hospitals Foundation has raised more than $181 million to benefit our hospitals since 1989. To learn more about the Victoria Hospitals Foundation visit: victoriahf.ca.