SUMMER 2011
SUMMER 2010
A UNIVERSITY OF CALGARY Faculty of Medicine Publication
Dean’s Edition
life starts now See what it’s like to experience Your new
convocation as a med student – a photo essay
06 Poetry in motion Bringing hope to pediatric cancer patients medicine.ucalgary.ca
11 Shaping a discipline A look at the evolution of the GI Division as recalled by the gentlemen who helped shape it
14 Do no harm
Investigating a controversial MS treatment on multiple fronts ucalgary medicine | Page 1
uCalgary
Medicine Vol 3 Issue 2 | Summer 2011
UCalgary Medicine is published three times a year by the University of Calgary Faculty of Medicine, providing news and information for and about our faculty, staff, alumni, students, friends and community. For more information contact:
Managing Editor Kyle Glennie T 403.210.6577 E kglennie@ucalgary.ca
Dean Dr. Thomas E. Feasby
Vice Dean Dr. Jon Meddings
Senior Associate Deans Dr. Richard Hawkes, Research Dr. Benedikt Hallgrímsson, Education Dr. Ronald Bridges, Clinical Affairs
Associate Deans Dr. Anthony Schryvers, Undergraduate Science Education Dr. Bruce Wright, Undergraduate Medical Education Dr. Jennifer Hatfield, Global Health & International Partnerships Dr. Doug L. Myhre, Distributed Learning & Rural Initiatives Dr. Joanne M. Todesco, Postgraduate Medical Education Dr. Frans A. van der Hoorn, Graduate Science Education Dr. Jocelyn Lockyer, Continuing Medical Education Dr. John Reynolds, Basic Research Dr. Michael Hill, Clinical Research Dr. Janet de Groot, Equity & Teacher-Learner Relations Dr. Kamala Patel, Faculty Development
Design and Production Kelly Budd, Radius Creative
Photography Carlos Amat, Dan Bannister, Trudie Lee, James May, Bruce Perrault, Kathryn Sloniowski
Free Copy/Alumni Update
To receive a free copy of UCalgary Medicine please call 403.220.2819 or e-mail medcomm@ucalgary.ca The Faculty of Medicine is committed to staying in touch with our alumni. Please update your contact information at our website www.alumni.ucalgary.ca (click on “update your info”)
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PM AGREEMENT NO. 41095528 RETURN UNDELIVERABLE CANADIAN ADRESSES TO: University of Calgary Faculty of Medicine Communications & Fund Development Health Sciences Centre 3330 Hospital Drive NW Calgary, Alberta T2N 4N1
Summer 2011
Volume 3 Issue 2 | SUMMER 2011
pg4 Adding to the ranks, and fulfilling our duty | Message from the Dean Sharing our accomplishments as a Faculty.
pg5 Helping kids & teens cope...one donation at a time | Philanthropy A family from Medicine Hat shares their daughter’s legacy by donating to a special cause.
pg6 Poetry in motion | Research
‘There are no other options’ is a phrase that Dr. Aru Narendran is trying to eradicate from the vocabulary of families dealing with pediatric cancer.
pg8 Your new life starts now | education
Cover Story
For the hundreds of prospective medical students who apply to our Faculty each year convocation is a day they dream of. It is when one chapter of our students’ lives end and another begins.
pg11 Shaping a discipline | Service to Society
At around 50 doctors, the Faculty of Medicine’s Division of Gastroenterology (GI) is one of the largest GI divisions in the world. We look at some historic moments of the Division of Gastroenterology, as recalled by five gentlemen who helped shape it.
pg14 Do no harm | Service to Society
Ensuring the safety of our community is the duty of the Faculty of Medicine. That’s why our researchers are investigating chronic cerebrospinal venous insufficiency (CCSVI) and its relation to multiple sclerosis on three fronts.
pg16 Play through the pain? | research
Athletes are taught to persevere and push through illness, keeping their eye on the prize. However, new research suggests that extreme physical activity while sick may be detrimental to one’s heart, causing more long term harm than good.
pg18 ‘Working out’ the symptoms of osteoarthritis | research
Taking a walk may be the last thing on the minds of those suffering from osteoarthritis, but new research has shown that it should be one of the first.
On the cover Following a med student through convocation.
pg19 Heart of glass | Terminus
Cardiologist and researcher Dr. Henry Duff has found a unique way to give back to the Heart and Stroke Foundation—the organization that has funded research through his whole career.
medicine.ucalgary.ca/magazine
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SUMMER 2011
contents
message from the dean
Adding to the ranks, and fulfilling our duty Here at the Faculty of Medicine we know our students are central to our success. We train our doctors and researchers to be critical thinkers, rational and compassionate, all so they may become the leaders of tomorrow. Some may specialize in areas such as surgery, family medicine or oncology, some may help fill the demand for rural doctors, and some may develop new treatments for diseases that currently have few. As we move into summer we saw 147 medical students graduate from the Faculty of Medicine. For the first time, I am pleased to give you a glimpse into convocation day as experienced by recent grad Dr. Jori Hardin. In this special Dean’s Edition, we follow her as she celebrates her graduation with friends, classmates, instructors and family (photo essay pages 8, 9 and 10). As we take a look at the beginning of Jori’s journey as a medical professional, we also share with you the journey other members of the Faculty have taken. Dr. Aru Narendran has recently joined forces with the POETIC project, aiming to bring new treatment options to pediatric cancer patients (pages 6 and 7). Located at the Alberta Children’s Hospital, the project’s only Canadian site, Dr. Narendran and his colleagues have already made available several new treatment trials for pediatric patients.
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In this issue you will also learn how our Faculty is investigating chronic cerebrospinal venous insufficiency (CCSVI) as it relates to multiple sclerosis, a topic of much controversy in recent years. Our research is being conducted on three distinct fronts, all with the intention of ensuring the safety of our community (pages 14 and 15). We also highlight research that has found athletes who exercise too heavily while sick may be putting their health at risk (pages 16 and 17), and that exercise may reduce the symptoms of osteoarthritis (page 18). While these are just a few of the interesting stories we’ve included in this issue, I’m sure you will agree the Faculty of Medicine is comprised of great people doing great things. I thoroughly enjoy hearing about the accomplishments our students, faculty and alumni achieve, and in turn, sharing those accomplishments with you in our community. I hope you enjoy reading these stories and I encourage you to stay in touch.
Dr. Tom Feasby Dean Faculty of Medicine
Summer 2011
Philanthropy
Helping kids & teens cope… one donation at a time
From left to right: Cheryl Tilleman; Tallulah; Archie and Madeline Fischer.
When it comes to philanthropy efforts, every contribution counts. When Drew was five years old, his mom was diagnosed with cancer. His parents were not sure how much they should tell him about the cancer and how to communicate to their son about the disease. That’s when his father Allan Ingelson discovered the Kids & Teens Can Cope Program, an after-school education and support group designed for kids aged nine to 19 who are affected by a parent with cancer. “At first my wife had reservations. She was not sure what to expect but we’re very pleased with the outcome of the program and strongly recommend it,” says Ingelson. “After visiting the chemo and radiation departments last fall, our son (now age 11) has a much better idea as to what his mom has been doing at the medical center, and he appears to be more comfortable now as he has met other kids with parents who have cancer.” The Kids & Teens Can Cope program began in 1990 and holds two sessions each year. Children in the program learn about cancer and they tour the different areas of the Tom Baker Cancer Centre, seeing first-hand how their parent is being treated for the disease. Most importantly the program gives children a chance to interact with others who are going through the same experience and to talk about their fears and anything else that may be on their mind. Most recently, the program has incorporated the use of a pet therapy dog−Tallulah the labradoodle.
medicine.ucalgary.ca/magazine
By Marta Cyperling
This past year, a $500 donation from a Medicine Hat couple has helped with one of the program’s sessions. Archie and Madeline Fischer donated the money, through the Alberta Cancer Foundation, in honor of their daughter Cheryl Tilleman who passed away from breast cancer in 2006. “Our daughter Cheryl participated in some cancer programs and we saw the difference it made to her and our family. She worried about others and how they were handling their journey. She was so thankful for all she had and all those who cared for her in any way,” says Madeline. The program has another unique donor−the Foothills Medical Centre Volunteer Resources (FMCVR). Through the Alberta Cancer Foundation, they have been donating healthy snacks and drinks for program participants over the past few years. Dr. John Robinson, a University of Calgary psychosocial oncologist who coordinates the program has seen many children benefit from attending the workshops. “When I ask kids about their participation in the program, they tell me how much they are affected by their parents’ cancer. At home though, they try their best not to let on that are worried because they don’t want to further burden their parents. They find the group is a safe place for them to talk and get their questions about cancer answered.” For more information on the program please phone (403) 355-3207. D
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RESEARCH
Poetry in motion
‘There are no other options’ is a phrase that Dr. Aru Narendran is trying to eradicate from the vocabulary of families dealing with pediatric cancer. He, along with the collaborative efforts of the POETIC group, is taking great strides in doing just that. By Maria Turner It started, like so many things do for Dr. Aru Narendran, with a child. Narendran, who is a clinician scientist in pediatric oncology at the Faculty of Medicine, was approached by the father of a child who was suffering from cancer. Standard therapies had failed and there seemed to be nothing left to do. “The father asked me ‘Can’t you give him something so he will live long enough for someone to find a cure?’” remembers the pediatric oncologist.
Working with other centres is particularly important for those in the field of pediatric oncology. “Cancer is rarer in children than in adults,” says Narendran. “To do a clinical trial properly, you have to do it across a number of different centres in order to get the numbers you need for meaningful statistics.” Narendran and his colleagues at the Alberta Children’s Hospital are currently the only Canadian members of the consortium.
Narendran, who hates nothing more than having to tell parents that there isn’t anything to be done, set out to see if there wasn’t a better answer to this heart-breaking question. Information available in the pediatric oncology literature confirmed the scarcity of proven therapies for this particular kind of cancer, but suggested a number of possible new medications. Among these was a family of drugs known as heat shock protein (HSP) inhibitors, initially developed at the U.S. National Institutes of Health (NIH). A call to the developmental therapeutics branch provided the names of two young pediatric oncologists who were in the process of forming a new clinical trials group to explore promising new agents, including an HSP inhibitor, for the treatment of children with incurable cancer. As someone with a research background, Dr. Narendran also wanted to study the compound, known as 17-AAG, in his own laboratory to evaluate its effect on cancer cells that have developed resistance to current chemotherapeutics.
Looking for new treatments The search for new cancer treatments usually starts with in vitro studies in a laboratory and one of the strengths of POETIC is that most members, like Narendran, are both research scientists as well as clinicians. “We are constantly trying to study the drug as well as the biology of cancer,” explains Narendran. “The way a cancer cell responds to a drug often gives you a clue about the processes and pathways that sustain their growth and survival in the patient.” Once a promising drug has been identified in the lab, it is tested for safety and toxicity in a phase I trial. “These trials are not designed with the intention to cure,” he says. “We are looking for the doses and conditions that are critical to ultimately determine the suitability of a new medication as a future treatment.” These trials are a critical step in the development of future treatment protocols.
The initial data looked promising and Narendran presented his findings at an international conference. Following his presentation, he was approached by the very two oncologists he had heard about from the NIH: Dr. Lia Gore, from the Denver Children’s Hospital, and Dr. Tanya Trippett, from the Memorial Sloan-Kettering Cancer Center in New York. This informal meeting was the beginning of Narendran’s involvement in what was to become the Pediatric Oncology Experimental Therapeutics Investigators’ Consortium (POETIC), a consortium of 11 large academic centres across North America. POETIC’s mission is to promote the early clinical development of promising therapies for the treatment of children, adolescents, and young adults with cancer and related disorders. The establishment of the consortium has opened up new possibilities in the field of pediatric oncology. Traditionally, only a small number of large institutions in North America were sanctioned to do phase I clinical trials and the trials took a very long time to complete. Now, POETIC members can work together to provide the collaborative and research strength needed to complete intensive phase I and II studies of novel treatment agents.
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Since joining POETIC, the Alberta Children’s Hospital group has already conducted a phase I study of 17-AAG. “It’s quite an interesting drug,” says Narendran. Unlike traditional chemotherapy which targets cancer cells directly, 17-AAG binds with and disrupts the function of ‘chaperone proteins’, proteins that cancer cells generate to help them stay alive. This leaves pro-malignant client proteins unprotected by the chaperones, which makes it harder for the cancer cells to survive. The drug is now being tested in phase II trials. The researchers are also busy studying other potential agents. “We have a large pipeline of drugs lined up and have six or seven trials open to treat all forms of pediatric cancer,” says Narendran. Despite the extraordinary dedication of the clinicians and researchers involved, the story did not have a happy ending for the child who started the search for compound 17-AAG. Sadly, he passed away before any new treatment options were available for him. It is stories like this that POETIC wants to change. It is hard to predict the future, but Narendran is optimistic. “We are ultimately aiming at finding cures,” he says. “I really don’t see any reason why we can’t completely cure cancer in children. We just have to get there.” D
Summer 2011
RESEARCH
Dr. Aru Narendran is an assistant professor in the Departments of Pediatrics and Oncology, and is a member of the Southern Alberta Cancer Research Institute and the Alberta Children’s Hospital Research Institute for Child and Maternal Health.
medicine.ucalgary.ca/magazine
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EDUCATION
Your new life starts now For the hundreds of prospective medical students who apply to our Faculty each year, it is a day they dream of. Convocation; when one chapter of our students’ lives end and another chapter begins. But what does this special day mean to the bright young minds who have earned this honour? Dr. Jori Hardin, a graduate of the Class of 2011, was kind enough to let us join her on this occasion, and from that we are able to present this photo essay.
“I definitely enjoyed my experience at UCalgary. It goes by like a whirlwind! Working with physicians in the community who advocate for their patients and who take time to build relationships is inspiring. I had so many exceptional role models in the last three years and I hope to live up to the example I was shown.”
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Summer 2011
EDUCATION
“It’s so exciting to see my hard work come to fruition and to feel just as passionate about my career as I did on the first day.”
“My dad is a general practitioner in the city so I think he especially is happy to have someone to talk shop with at home.”
Elizabeth Cannon, PhD, President and Vice-Chancellor of the University of Calgary.
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EDUCATION
“During the convocation my dad was touched when Dr. Feasby had all physicians present (not just the graduating class) recite the Hippocratic Oath. I looked over at him in the stands and felt quite emotional that we could share that moment together. It was something very special and I will remember it forever.”
“I am very close with my family and my parents couldn’t be more proud.”
“You can learn something valuable from every person you encounter on your journey.”
“I matched to the dermatology program here in Calgary and could not be more thrilled and honoured. The program is quite young so I feel humbled to be a part of it and I am excited to make it something special.”
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Summer 2011
Service to Society
From left to right: Dr. Subrata Ghosh; Dr. Eldon Shaffer; Dr. Lloyd Sutherland; Dr. Jon Meddings; Dr. Ron Bridges.
Shaping a
discipline At around 50 doctors, the Faculty of Medicine’s Division of Gastroenterology (GI) is one of the largest GI divisions in the world. Comprised of clinicians that see patients daily, and of clinician scientists that see patients and also research various GI diseases, the Division produces translational research that begins in the lab and progresses to a patient’s bedside; it is healthcare from its earliest point to its application.
Highlighted by its Inflammatory Bowel Disease (IBD) Program, recently ranked fifth in the world behind institutions like Harvard University and the Mayo Clinic for number and quality of IBD research publications, the Division is well known and respected internationally in the field of gastroenterology. But what is now a powerhouse began with just three doctors and the desire to succeed. Here now is a look at some historic moments of the Division of Gastroenterology, as recalled by five gentlemen who helped shape it.
The Early Days and the Kahanoff Foundation “It was 1977 and I was recruited to set up an academic gastroenterology (GI) division at the University of Calgary. I was at McGill University, but at the time the attraction in Calgary was twofold: one was the building, they had facilities and empty lab space at the Faculty of Medicine, and the second was the advent of Heritage monies (the Alberta Heritage Foundation for Medical Research) coming forward to support research. When I got here we needed three full time people on site, so I got one position and I got Grant Gall (former dean of the Faculty of Medicine) cross appointed in medicine for the second, and I forget how we had set up the third. It must have been a scientist or something because it was called desperation at that time! So pretty soon after that I negotiated with Lloyd Sutherland because he was interested in moving out of private practice and he came over as the other GI full time person to develop inflammatory bowel disease epidemiology.” - Dr. Eldon Shaffer, head of Division of Gastroenterology, 1981-1991
“Syd Kahanoff (a well known Calgary oil and gas businessman) had a major problem in his liver and I was the GI doc looking after him, and Roy Preshaw was the surgeon looking after him. Syd was very grateful to us for extending his life several years, and through Syd, after he passed away, the Kahanoff Foundation was set up and we were awarded a generous grant through them. That really got us up and going. We had this seed money and we had Heritage funding as backup and we could use this to really start recruiting basic science people.”
“When I came to Calgary I started at the General Hospital for the first two years, then I switched over to the Foothills Hospital. Eldon Shaffer needed someone to organize the educational programs for the division, and I had some interest in that. He asked me to take part in some clinical trials which had just started to appear on the horizon. Eldon was a bench researcher and wasn’t interested in clinical trials so he said ‘why don’t you do the clinical trials and we’ll get others to pay for them, and then you can do the trials that you yourself want to do?’ It sounded good to me.” - Dr. Lloyd Sutherland, head of Division of Gastroenterology, 1991-1995
- Dr. Eldon Shaffer
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Service to Society
“The Intestinal Disease Research Unit (IDRU) was set up within the Division after we received a grant of $3.5 million from the Kahanoff Foundation, and that was in 1986 so you can imagine how much money that was. They were a very unique organization to work with. They insisted we had an international board of review every two years to review the function of the grant, and the grant was to be used over seven years.” - Dr. Lloyd Sutherland
“When the review board came around to do their first review, I actually wasn’t receiving any funding myself from the Kahanoff grant. I was a minor part-time appointment which was basically a thank you handshake for doing some bedside teaching. But Grant Gall nonetheless asked me to make a presentation to them. I told him no because I wasn’t receiving any funding and I thought it might give the wrong impression as to the direction of the unit. Well the next day Eldon came into my office, put his arm around me and said ‘Lloyd, you’ve made your point. Please give the talk.’ Well I gave the talk and when the review board came back they said you needed to hire someone to do bench to bedside correlations and you should hire Lloyd Sutherland to do the epidemiology.” - Dr. Lloyd Sutherland
“The fact that Calgary was ranked number five in the world for inflammatory disease research by the Crohn’s and Colitis Foundation of Canada I think is a result of the Kahanoff Foundation and their philanthropic gift to the IDRU. It took 30 years to become number five in the world, and that’s the long view of what philanthropy does in my opinion. It takes time but here you had a little dusty two bit university on the western prairies with no real strength in anything and now with one significant investment here we are. The difference was the Kahanoff Foundation and IDRU.” - Dr. Jon Meddings, head of the Division of Gastroenterology, 1999-2003
Creation of the Colon Cancer Screening Centre “One of the biggest hurdles when I became Division head (in 1999) was lack of endoscopy space at the Foothills Hospital. That was a huge fight with the Calgary Regional Health Authority (the former governing body of healthcare for the Calgary region) and getting new space that was functional. Gary May, who is probably Canada’s number one invasive endoscopist out of Toronto, was here at the time, and Gary and I fought the good fight and we got more endoscopy space. The other part was recognizing the oncoming train for GI was going to be colon cancer screening, and that’s when Ron Bridges and I developed this gift from (Calgary businessman) John Forzani to create a colon cancer screening centre that is now at the Faculty of Medicine.” - Dr. Jon Meddings
“The review board was headed by two of my mentors from when I went to Boston and did three years of research there. When they did the review their prime agenda was to have an inflammatory disease clinical research unit headed up by someone who did epidemiology and saw IBD patients. That wasn’t my job description and it wasn’t really Grant Gall’s either as he was in pediatrics, and there was a crying need to have someone that did epidemiology. Lloyd was out in private practice, we were good friends and he wanted to be back in academics, but he had to earn his own way. He was what they called a minor part-time person, and it was basically, ‘Hey you want to do some research? Great go do some research on your spare time, meanwhile earn your living by seeing patients.’” - Dr. Eldon Shaffer
“One of the reasons we got the Kahanoff award was they knew Lloyd was in the background and interested in doing the epidemiology and clinical trials. So credit to Lloyd; here’s a guy who is fully trained, comes back in and finally gets supported, does a master’s in epidemiology and becomes a world class epidemiologist scientist in a short period of time. To come back and do that I give Lloyd so much credit.” - Dr. Eldon Shaffer
“I was recruited by Grant and Eldon as part of the Kahanoff grant for the IDRU, and so were Jon Reynolds (currently associate dean, Basic Research at the Faculty of Medicine), Brent Scott (former vice dean of the Faculty of Medicine) and others. If you look at that, those are people who are doing significant things for the Faculty of Medicine and the University so it was a strong group of people that the IDRU recruited.” -Dr. Jon Meddings
“The interaction with John Forzani actually started when I was ‘scoping’ (performing endoscopies). There was a golf tourney sponsored by the Peter Lougheed Centre (PLC) and Sunridge Mall and John designated the funds from that tournament towards novel equipment for the PLC. At the time there was a new piece of equipment called an argon plasma coagulator that was used in endoscopy procedures. I forget the price tag but it was around $150,000 to $200,000. One of the nurses brought this to my attention so literally while I was doing a scope I dictated a draft note and we sent it in and John Forzani selected it as the piece of equipment he wanted to purchase. The relationship really built from there.” - Dr. Ron Bridges, head of Division of Gastroenterology, 2003-2007
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Summer 2011
“We talked about the Colon Cancer Screening Centre conceptually for a number of years, and then the Calgary Health Region (previously known as the Calgary Regional Health Authority) identified they didn’t have enough endoscopy capacity in the city and they couldn’t add to any of the existing units in the city because of space limitations. So they put out a request for proposals for a freestanding endoscopy facility in the community. Jon Meddings was head of GI at that time and we talked and decided to jointly put in a proposal on behalf of the division and Faculty. We wanted to link in not only the clinical care but the educational and research aspects as well, and to focus all of the activity on colon cancer screening because that was a major driver of the need for additional endoscopy resources in the city. We were selected as the preferred option by the Calgary Health Region. John Forzani made the commitment to fund the equipment for the Centre and that was a significant donation, and he brought on (Calgary businessman) Keith MacPhail whose mother had colon cancer and Keith has been a very strong supporter of the Centre along with John.”
- Dr. Jon Meddings
“We have some pockets of excellence especially with the Colon Cancer Screening Centre, but when I came here even just a few years ago we had started to fall behind in modern endoscopy equipment. Now we have managed to upgrade all of those very significantly including at the Alberta Children’s Hospital, so we are absolutely cutting edge as far as the tools doctors have now, which is good for the patients and good for the doctors.” - Dr. Subrata Ghosh, Head of Division of Gastroenterology, 2009-2010
- Dr. Ron Bridges
“The Centre has been open two and a half years now and it has had a significant impact on the community. Certainly it has increased awareness regarding colon cancer screening, and the educational and quality assurance programs related to colonoscopy and endoscopy is something that is now used as a standard across the country.” - Dr. Ron Bridges
It’s all about good people “When I was head of the Division I wanted it to grow and I wanted to recruit great clinician scientists. Paul Beck was one of our great recruits and we had many others and that was our goal, to have the most outstanding clinician scientists and clinician educators.” - Dr. Jon Meddings
“I must say my spell as Division head lasted much shorter than I meant it to be, and moving to lead the Department of Medicine came after much soul searching, but I felt at that stage that we had set a map for the future of the Division. You have to give equal importance to clinical care, research and education and I think we have set a culture that in a large GI Division all of these three will be given equal importance. We had to be successful in recruiting people from around the world and the Division itself has to be balanced, but that only came via strategic recruitment.” - Dr. Subrata Ghosh
medicine.ucalgary.ca/magazine
“I felt bad leaving early (to become senior associate dean, Clinical Affairs for the Faculty of Medicine) from the head of the Division, but I also felt comfortable doing it because we had recruited almost 20 people in that time and we had set other people in place to come back after training in other areas. I felt we had really moved things forward and we had dealt with the man power crisis.” - Dr. Ron Bridges
“I think for this group to continue doing well we need to recruit strong clinician scientists as that’s where the future is. We need to corrupt young minds of trainees and bring them into GI and into being clinician scientists because that’s where all the advances are going to be made. The problems have changed but the answers have always been good people.” - Dr. Jon Meddings D
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Service to Society
“It used to be that 80 per cent of all endoscopies were upper endoscopies, we didn’t do a lot of colonoscopies. But there was all this information coming out that we could actually prevent colon cancer from happening if we could screen people, so we saw the trend and starting working towards that. Nowadays almost 90 per cent of what we do is colonoscopies and we’re screening for colon cancer.”
Service to Society
Do no harm
By Kyle Glennie
It’s a key principle of the Hippocratic Oath and also the duty of the Faculty of Medicine; do no harm. That’s why three separate research teams at UCalgary are investigating the chronic cerebrospinal venous insufficiency (CCSVI) theory–and how it relates to multiple sclerosis–from three separate angles. It’s been called the “miracle cure” and has names like the “liberation treatment”. To many it represents hope, and has been said to have multiple sclerosis (MS) patients up and moving freely, walking without assistance and even planning for marathons. But is it really what so many have been waiting for, the bona fide solution for a disease that affects one in every 350 people in Alberta alone? Or is it an unproven theory that can lead to patients undergoing potentially deadly treatments?
at the University of Calgary that was one of four Canadian groups funded by the MS Society of Canada to study the CCSVI theory in 2010.
At the Faculty of Medicine, analyzing chronic cerebrospinal venous insufficiency (CCSVI)—an abnormality in the veins that drain blood from the brain and spinal cord—is being done on three fronts.
While this theory sounds promising, many in the medical community have questioned Zamboni’s research and the results he’s achieved, including the fact that in his study Zamboni reported 100 per cent of the MS patients he saw had abnormalities in veins in their neck, versus zero reported abnormalities in patients not suffering from MS.
Imaging multiple sclerosis patients “We are conducting a cross-sectional study that will determine whether venous outflow from the brain is different between MS patients and healthy control subjects,” says Dr. Fiona Costello, clinical associate professor in the Department of Clinical Neurosciences and a member of the Hotchkiss Brain Institute. Together with her colleagues from the Diagnostic Imaging and Stroke services, Costello is part of a research team
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The controversy surrounding CCSVI comes from research conducted by Italian scientist Dr. Paulo Zamboni, who hypothesized MS is caused by CCSVI and that treating the abnormalities through the use of a stent or a procedure similar to balloon angioplasty will improve the symptoms of MS.
“There have been several comments on the research, stating that steps were taken which could have led to a bias toward good results. But that’s part of the process of medical publishing; you put something out there and people look at it and they say ‘this is interesting, we better test it and see if it can be replicated,’” explains Dr. Michael Hill, a professor in the Department of Clinical Neurosciences and also a
Summer 2011
Service to Society
From left to right: Dr. Michael Hill; Dr. Jodie Burton; Dr. Fiona Costello; Dr. Luanne Metz.
member of the Hotchkiss Brain Institute. “We’re in that process right now; something has been put out there and it is interesting but we are unsure about it so we better figure out if it’s right or not.” The study has received funding for two years, and the researchers will provide regular six-month progress reports to be posted on the MS Society’s website. Analyzing various treatments Imaging the veins of patients with MS will help answer some of the questions surrounding CCSVI, but what about patients who have already undergone CCSVI treatment? That’s something Dr. Luanne Metz is hoping to shed some light on. Metz, a professor in the Department of Clinical Neurosciences and a member of the Hotchkiss Brain Institute, was tasked by Dr. Tom Feasby, dean of the Faculty of Medicine, to lead an Alberta government funded initiative to improve the understanding of treatment for CCSVI. The project, dubbed The Alberta Multiple Sclerosis Initiative (TAMSI), aims to gather information from as many MS patients in Alberta as possible to assess the safety of CCSVI treatments patients are undergoing outside of Canada. “The main thing is to describe what people are experiencing after they have had some form of CCSVI treatment compared to those that have not. We want to know who is going for it, how many are going for it and what are they having done,” says Metz. The study will be conducted entirely online, and patients will be asked to complete a series of questionnaires over a two year period. “It’s not simply a matter of looking at what’s wrong or right with CCSVI treatments, it’s about comparing people that have had an angioplasty to people that have had stents put in; or comparing people that are taking Aspirin or anti-coagulants afterward compared to people that don’t,” says Metz. “We need to look at all of those factors and see what role they play in the safety issues.”
medicine.ucalgary.ca/magazine
Evaluating the research Because of the controversy surrounding CCSVI treatments, a number of research papers have been published—both for and against Zamboni’s original work. For an MS patient trying to decipher the truth and decide what might be best for them, it can be an extremely confusing process. “Our goal is to evaluate the data that exists and the data that is still coming in on CCSVI to assess its validity,” says Dr. Jodie Burton, an assistant clinical professor in the Department of Clinical Neurosciences and a member of the Hotchkiss Brain Institute. Supported through a grant from the Canadian Institutes of Health Research, Burton is part of a Canada-wide team conducting a systematic review of the evidence that tests for CCSVI are valid and reproducible and that CCSVI is associated with MS. The team also includes Dr. Tom Feasby. “We have statisticians, we have vascular experts, imaging experts, MS experts, and we all have certain roles in how we interpret the research that is coming into us for analysis,” explains Burton. “Right now we are at the stage where we’ve determined how we are going to get info from all these studies and we’re starting to take the data so we can assess it ourselves with very standard, rigorous methods.” The group plans on delivering their findings every three months for a full year beginning in the summer of 2011, and will produce descriptions of their results for those suffering from MS and for public and health care decision makers following that. In all, the Faculty of Medicine has dedicated a vast quantity of resources, personnel, equipment, time and facility space to help answer the CCSVI question. It’s a task, however, that falls perfectly in line with the responsibility the Faculty has to the health of the community. D
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RESEARCH
Play through the
Athletes are taught to persevere and push through illness, keeping their eye on the prize. However, new research suggests that extreme physical activity while sick may be detrimental to one’s heart, causing more long term harm than good. By Colleen Biondi Elite athletes have a lot going for them. They are determined and ferociously hard-working; they don’t let a simple thing like the common cold with a slight fever stop them from working out. After all, who can afford to forego critical training time right before a competitive event? If Dr. Matthias Friedrich, director of the Stephenson Cardiovascular MR Centre at the Libin Cardiovascular Institute of Alberta had his way, that thinking would be turned on its head. In fact, as a result of a recent study examining heart function in high-performance endurance athletes, Friedrich is now asking the question “who can afford not to forego training when ill?” Prior to this research, Friedrich and colleague/PhD student Myra Cocker knew that non-athlete patients coming to hospital with chest pain (on the heels of having a cold) were frequently found to have inflammation of the heart. Combine that with the fact that athletes, as a rule, have enlarged hearts due in part to extreme training, and a question needed to be asked: If non-athlete patients were found to have slightly weakened hearts after a cold, would high-level athletes—whose hearts were regularly under extreme stress and were already enlarged—be at higher risk when they had a cold? In 2007, the two researchers recruited 80 participant athletes from a variety of disciplines of competitive endurance sport (50 under age 40 and 30 over age 40) through the Faculty of Kinesiology’s Human Performance Laboratory, where Canadian national athletes train. There was also a 10-member nonathlete control group from the community. Friedrich and Cocker studied participant hearts via cardiac magnetic resonance imaging—known as CMRI the “gold standard” for heart function, says Friedrich—on four occasions over a short period: during low-intensity training, during high-intensity training, with an acute cold with fever (72 hours after the onset of symptoms) and four weeks afterwards. It was a snapshot in time, says Friedrich. Initial findings were that athletes had evidence of cardiac injury at rest. In fact, approximately 78 per cent of the young athletes and 68 per cent of the master athletes had evidence of scar patches on the heart. From 20 participants who managed to complete the entire trial, the common cold
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had resulted in minor heart enlargement that appeared to return to a normal state at follow-up. But evidence of inflammation (found in 38 per cent of athletes with a cold) escalated to 48 per cent after four weeks. “Our data indicated that athletes may suffer more than non-athletes from the common cold,” says Friedrich, likely as a result of the coincidence with extreme physical training. “Physical stress causes some damage but in combination with the cold it may have persistent effects.” And despite the fact that athletes have ‘super hearts,’ such persistent effects could ultimately mean compromised performance. The high percentage of scar tissue (also referred to as fibrosis) was also concerning. Scar tissue is related to arrhythmia, which is associated with sudden cardiac death. In addition Friedrich and Cocker found that athletes who had scarring in their hearts had larger hearts than those athletes who did not have scar tissue. These results are associative, says Friedrich, not causal. It is clear that colds and the physical stress of performing are related to inflammation, enlargement and scarring of the heart of a high-performing athlete. But larger studies of a longitudinal nature are now needed to differentiate between what impact high-level performance has and what impact colds have in these areas, as well as how and when these markers connect to irreversible injuries. Drilled-down results from additional research would allow physicians and coaches to direct their athlete patients more effectively and efficiently. For now, results suggest exercising caution. “If you do not combine highlevel training with a cold, you are safer,” says Friedrich. “But when you have a cold, go to bed like grandma says and wait until it’s over to resume training.” This is also good advice for couch potatoes or weekend warriors whose hearts are not as strong and not as resilient as elite athletes. People with heart disease should be particularly careful regarding activity when they get a viral disease. “Overdoing it, just as with anything else in your life, is probably not a good thing,” says Friedrich. “Do everything in moderation and don’t over-exert when you’re feeling unwell.” D
Summer 2011
RESEARCH
pain?
A patient enters the cardiac magnetic resonance imaging machine.
A nurse prepares a patient.
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Dr. Matthias Friedrich.
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RESEARCH
‘Working out’
the symptoms of osteoarthritis Taking a walk may be the last thing on the minds of those suffering from osteoarthritis, By Kathryn Sloniowski but new research has shown that it should be one of the first. For the hundreds of thousands of Canadians who suffer from osteoarthritis, pain, swelling and stiffness are only a few of the words a part of their often daily vocabulary. Another word however, is hope, and it may even be ‘a walk in the park’. Dr. John Esdaile recently joined the McCaig Institute for Bone and Joint Health in the Faculty of Medicine. His passion for helping those who suffer from the disease has led him to build a partnership between Alberta and B.C. called the Arthritis Research Centre of Canada. Focused on patient and results-based research, Esdaille hopes to alleviate some of the pressures for those who suffer from osteoarthritis (OA), the most common type of arthritis, by giving them new ways to manage their symptoms. “After a patient is diagnosed with osteoarthritis, they wonder what they can do. Chronic disease management is a really important issue to address,” says Esdaille, who holds the Arthur J.E. Child Chair in Rheumatology Research at the Faculty of Medicine, the first dedicated rheumatology chair in Canada. To do this, Esdaile conducted a research study aimed at discovering new ways health practitioners can slow the progression of osteoarthritis, or more specifically, osteoarthritis of the knee. Because OA often affects weight bearing joints, knees are often affected by the disease. The study, published in Arthritis Care & Research in April 2010, followed 190 newly diagnosed patients over a six-month period. Esdaile’s findings concluded those who participated in physical exercise and thus remained active significantly lowered their OA related symptoms. While physical activity levels did need to be tailored to the needs of each individual, results were conclusive that physical activity levels played an important role in disease management.
Dr. John Esdaille and OA sufferer Eric Gould.
Calgarian Eric Gould can attest to the research findings. After having experienced Calgary’s unpredictable and often chilly winters, the 54-year-old noted his inactivity levels during such times. “During the winter months I’m not as active and I absolutely feel a difference in my knee,” he says. After having chronic knee pain for three years due to osteoarthritis, he says he does occasionally take over-the-counter medications to ease the pain, but acknowledges that pain management is most achievable through physical activity. By remaining active year round, Gould is able to add another word to his daily vocabulary—relief. D
Arthritis Facts: • Osteoarthritis is the deterioration of cartilage. It is often referred to as “wear and tear” of the joints. This can be caused from previous injuries and excess weight gain.
• Arthritis is the leading cause of pain and disability in North America.
• The two most common forms of arthritis are osteoarthritis and rheumatoid arthritis.
• Osteoarthritis affects more than 10 per cent of Canadians.
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• Arthritis affects more than 4.2 million (16 per cent) of Canadians 15 years and older.
• More than 411,000 (15 per cent) of Albertans have arthritis.
• Arthritis is a broad term that encompasses over one hundred conditions that affect the joints. • Rheumatoid Arthritis (RA) is an autoimmune disease that causes inflammation and even deformity. RA affects 1 per cent of Canadians.
Summer 2011
Terminus
Heart of glass
By Kathryn Sloniowski
Cardiologist and researcher Dr. Henry Duff has found a unique way to give back to the Heart and Stroke Foundation—the organization that has funded research through his whole career. Every Tuesday night from 5 p.m. until 10 p.m., Dr. Henry Duff takes a step back from the stresses involved with being a medical scientist and steps into a realm of creativity: glass blowing. His interest in the art form was sparked as a student in a chemistry lab, when his class used glass blowing techniques to fabricate chemistry equipment—a process Duff says is “still cool”. As his interest lingered, his wife bought him a weekend of art classes as a birthday gift one year. In the 12 years since, he has taken classes at the Alberta College of Art and Design, summer courses in Red Dr. Henry Duff. Deer and proudly showcases and sells his work online, at local craft shows and at the Museum Shop at the Glenbow Museum.
While the hobby is soul-satisfying, Duff has chosen to share his passion in a unique way. Since he began selling his pieces, he has donated all proceeds to the Heart and Stroke Foundation. His current donation amount sits at approximately $1500. “The Heart and Stroke Foundation are everything to me. They’ve funded research throughout my whole career.” The Heart and Stroke Foundation funds research, educates patients and implements preventative programs, all of which Duff equates with what he refers to as a “fabulous organization, pivotal to cardiovascular research and fundamental to many careers.” Duff says the Heart and Stroke Foundation also targets young investigators and puts an emphasis on the careers of young people—something he considers very important. So important in fact that this year the money he donates to the organization will be for ‘Young Mavericks’ which strives to reach young investigators and to get corporate citizens to see the value in young mavericks starting a new research direction. D
“It’s mainly a diversion in my life, it’s a creative outlet,” Duff admits. “I’m a cardiologist and a researcher so it gets stressful. When you’re three feet away from a 2500 degree flame, you’re in the moment and not thinking of anything else. If you are not focused, you might get burned.” While the intense colors and unique shapes of the pieces are striking and would undoubtedly be rewarding in itself, Duff says it’s the process of creating them that keeps him hooked. The entire process of blowing a piece of glass takes approximately 45 minutes to an hour, so it’s quick to satisfy. They are then put into a kiln to build strength and durability, after which time they are ready to serve their ornamental purpose—that is if they turn out. “Sometimes you think it will be gorgeous and it comes out (of the kiln) a mess and vice versa,” he says, laughing as he described the end result, often a mysterious and obscure discovery.
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