UCalgary Medicine Magazine Fall 2012 by Cumming School of Medicine

UCalgary

A University of Calgary Faculty of Medicine Publication

MEDICINE

Fall 2012

He a lth sciences ALUMNA in the city What happens when a BHSc alumna gets accepted to medical school in New York City

Well Doc?

Researching the common cold

While physicians are concerned with the wellness of their patients, two UCalgary researchers are concerned with the wellness of physicians

Scientists may be unlikely to find a cure for the common cold but that hasnâ&#x20AC;&#x2122;t stopped them from trying

UCALGARY MEDICINE Fall 2012

CONTENTS

Fall 2012 Issue

F e at ur e s

UCalgary

Volume 4 | Issue 3

MEDICINE UCalgary Medicine is published twice 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: M anagin g Edito r

Kathryn Sloniowski T 403.220.2232 E kjslonio@ucalgary.ca

Alumni

Health sciences alumna in the city 10

Edito ria l T eam

Jordanna Heller, Director, Communications and Media Relations Marta Cyperling, Manager, Media Relations Amy Dowd, Manager, Internal Relations Amanda Fisher, Communications Coordinator Aisling Gamble, Communications Advisor, Events and Recognition

Well Doc? 4

Dean

Dr. Jon Meddings

V ice- Dean

Dr. Glenda MacQueen S eni o r A ss o ciate Deans

Dr. Gerald Zamponi, Research Dr. Jocelyn Lockyer, Education Dr. Ronald Bridges, Clinical Affairs A ss o ciate Deans

Dr. Anthony Schryvers, Undergraduate Science Education Dr. Bruce Wright, Undergraduate Medical Education Dr. Jennifer Hatfield, Global Health and International Partnerships Dr. Doug L. Myhre, Distributed Learning and Rural Initiatives Dr. Maureen Topps, Postgraduate Medical Education Dr. Frans A. van der Hoorn, Graduate Science Education Dr. Lara Cooke, Continuing Medical Education and Professional Development Dr. John Reynolds, Basic Research Dr. Michael Hill, Clinical Research Dr. Janet de Groot, Equity and Teacher-Learner Relations Dr. Kamala Patel, Faculty Development Desi gn

COMBINE Design Ph oto graph y

Jordin Althaus/Disney ABC Television Group/gettyimages, ©iStockphoto.com/Akirastock, ©iStockphoto.com/abidal, Trudie Lee, Janelle Pan, Bruce Perrault, Holly Womba

Research

Message from the Dean

hile physicians are concerned with the wellness W of their patients, two UCalgary researchers are concerned with the wellness of physicians.

Phil anthropy

From patients to donors 3 Research

On the c over

American Dream This local mural is in my largely Dominican community of Washington Heights. While it serves as an excellent guidepost for life in general, its themes seem particularly salient for members of the medical profession. –Holly Womba

D e pa r t m e n t s

Research

Researching the common cold 6

S cientists may be just as unlikely to find a cure for the common cold now as they were a hundred years ago. But that hasn’t stopped them from trying.

What is a concussion? 8 Education

A grey area 13 Residency expansion means more family doctors 17 News

F r e e C o p y / A l u m n i u p dat e

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Awards and recognition 14 In the news 15 Service to Socie t y

In the community 16

Message from t he De an

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have passed since I began my tenure in July, and so far it’s been more fun than I imagined. I credit this in large part to the people who work, train, teach and learn within our Faculty –they are a dynamic group and these experiences bring new joy to my day. The more involved I become in my new role, the more I recognize that there are huge opportunities for the Faculty of Medicine. We are a young and vibrant school with a history of innovative ideas and programs. I would like to see us build upon this foundation. We are currently working to set new and focused strategic research priorities A few months

for the Faculty. We are extremely proud of the diverse and translational research coming out of our seven research institutes and the introduction of these new priorities will help us to better focus the allocation of our resources, and extend and promote the continued collaboration that takes place between them. The loss of AHFMR funding has been a difficult situation that has cast a long shadow over the Faculty for the last few years. I am pleased to say that we have now put this firmly behind us with a plan to move forward. This plan has been endorsed by the University Provost

From patients to donors

Message from the Dean

It is with great pleasure that I write my first Message from the Dean for UCalgary Medicine.

Phil an t hrop y

and presented to the Faculty’s leaders. It will also be the focus of a town hall meeting in the early fall and while it will impact recruitment a bit, it means that within about five years we will have a budget for all currently AHFMR funded positions. I am also very pleased with the progress we have made towards easing the pressure on our health-care system. As a direct result of a $10.3-million grant from the Alberta government, our family residency training program has increased the number of available residency spots and our teaching clinics have expanded both in space and teaching staff to accommodate them. Our goal is to have 40 per cent of our medical students choose family medicine, and while we’re not there just yet, this milestone is a step in the right direction. I would also like to announce that Dr. Don Addington is taking on the role of interim director at the Mathison Centre for Mental Health Research & Education. The centre, which strives to reduce the burden of mental illness in youth, was made possible by a generous $10-million gift from Calgary business leader Ronald P. Mathison earlier this year. I am extremely grateful to Don for taking on this role. Finally, I would like to welcome all of the new students, staff and faculty members who have joined us this fall. This Faculty is home to innovative educators, internationally renowned researchers, a community of talented support and technical staff, and accomplished and diverse undergraduate, graduate and postgraduate students– welcome to the Faculty of Medicine at the University of Calgary, I’m very honoured to be your dean. Jon Meddings, MD Dean, Faculty of Medicine University of Calgary

How one researcher’s work has drawn support from his own patients. By Alison Myers

When Carol Westberg was diagnosed with multiple myeloma in 2004, she was told she had about three years to live− five if she had a stem cell transplant. Eight years and six grandchildren later, Westberg credits medical research taking place at the University of Calgary’s Faculty of Medicine with the fact that she’s still beating the odds. “The drugs I’m on now weren’t even available when I was diagnosed,” she says. “Because of research, I’m still alive and kicking and hoping to be for a long time yet.” The man behind much of that progress is Dr. Nizar Bahlis, a hematologist and oncologist at the Tom Baker Cancer Centre. Bahlis and his research team at the Southern Alberta Cancer Research Institute focus on finding new treatments for patients with this rare and deadly form of bone marrow cancer. Their discoveries have already improved the standard of care for patients, and he sees more changes on the horizon thanks to the support of patients-turned-donors like Westberg. “We’re in a Phase 1 trial testing the combination of two drugs in multiple myeloma patients,” he says. “We’re seeing very promising results.” Bahlis is also in the process of building a tissue bank. Over the past six years, he’s collected samples from nearly 400 patients. Thanks to the generous support of donors, Bahlis will soon have a new machine that will allow him to analyze the entire human genome in each of these samples in about two hours. “Our plan is to sequence all these samples with the goal of uncovering new

genomic abnormalities that we can target for therapeutics,” he says. “This will help us understand what’s causing these patients to have multiple myeloma, why they become resistant to certain drugs and why they are receptive to others.” Bahlis says this machine, combined with his tissue bank, could be the key to finding successful, personalized therapies that target each patient’s unique form of the disease. Purchasing it was made possible through the help and support of patient, Ken Zandee. For more than a decade, Zandee has been involved in a charitable hockey tournament in Calgary called the Oil Olympics. This past year,

counselling for newly diagnosed patients and speaks to student nurses about what it’s like to live with an incurable disease. “This is my mission,” she says, “I’m not happy that I was diagnosed with cancer, but I’ve found a purpose being able to help others and create awareness.” Mary Kennedy says she also sees the need to bring multiple myeloma out of the shadows. She and her husband, Dave Davenport, started supporting Bahlis’ research after Davenport was diagnosed nearly two years ago. “It’s just so rare,” she says. Across Canada fewer than 2,500 people are affected by the disease each year. “Not too many people are familiar with it.”

Dr. Bahlis is, in my mind, second to none. He believes in what he’s doing and genuinely cares about his patients. I thought, it’s up to other people to help him out so he’s not having to concentrate on finances all the time. the organizers told him all the proceeds would go to a charity of his choice. He chose Bahlis. “Dr. Bahlis is, in my mind, second to none,” says Zandee, who was diagnosed in October of last year. “I’ve never met a doctor like him. He believes in what he’s doing and genuinely cares about his patients. I thought, it’s up to other people to help him out so he’s not having to concentrate on finances all the time.” Zandee and his wife also donated a 2011 black Camaro to be raffled off through the Southern Alberta Myeloma Patient Society, run by fellow patient and self-proclaimed myeloma warrior, Carol Westberg. Before her diagnosis, Westberg worked as a professional organizer. Those skills have now become her lifeline. She co-founded the patient society, helps organize its annual fundraising run (this year’s event raised more than $100,000 for Bahlis’ research), does peer

Kennedy says she and Davenport are reaping the rewards of successful research that has made the difference for many multiple myeloma patients in their longevity. Their support is ensuring Bahlis and his research team continue to change the future of this disease for patients here in Canada and around the world.

Message from t he De an

medicine .uca lg a r y.ca / m ag a zine

From patients to donors

Message from the Dean

It is with great pleasure that I write my first Message from the Dean for UCalgary Medicine.

Phil an t hrop y

How one researcher’s work has drawn support from his own patients. By Alison Myers

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Well Doc?

While physicians focus on the wellness of their patients, two UCalgary researchers are focusing on the wellness of physicians. By Kathryn Sloniowski

“There’s this training as a doctor, almost an indoctrination,” says Dr. Jane Lemaire, a clinical professor in the Faculty of Medicine’s Department of Medicine. “‘You will be a physician, you will stay up all night, you will be tough,’ but how do you get doctors to then say, ‘I need to take care of myself.’” Lemaire and sociologist Jean Wallace, PhD, have been studying physician wellness for the past eight years. The term wellness encompasses the notion

of not just surviving in one’s profession, but thriving. While a number of personal considerations for physicians themselves are at stake, such as work-life balance and job satisfaction, the product of these considerations has the potential to impact patient care−driving this body of research to be of particular interest to the medical community. “I always joke that when I get to the point when my inside voice starts saying, ‘I don’t care,’ I know I need to do something or I’m not going to make good decisions,” says Lemaire. “When you work with people, you need to care.” The idea to study the concept grew from preliminary studies in which Wallace shadowed 42 physicians in various specialties to better understand what it is that they do. While she knew they saw patients, she recognized there must be a lot more to the job. “It was really sensory overload,” says Wallace, who is a professor in the Department of Sociology in the Faculty of Arts and an adjunct professor in the Faculty of Medicine’s Department of Medicine. “There was so much noise, there were bright lights, and everything was busy all the time. You’re running from place to place, not eating−after a while, I was dizzy and getting headaches.” Wallace says that when she discussed her observations with Lemaire, who confirmed that what she experienced was quite typical for hospital physicians, it got them thinking about the different aspects of physician wellness they could research. Whereas the literature they reviewed at the onset of the study focused on personal detriments brought on by neglecting wellness, such as burnout and addictions, they wanted to take a more positive approach. To date, the focus of

UCALGARY MEDICINE Fall 2012

their research has been on manageable things that can be done in the workplace to help improve wellness, with a minimal impact on a physician’s work. Through surveys, interviews and job shadowing, they’ve been studying things such as: the benefits of consuming adequate nutrition at regular intervals during work hours, coping skills, gender differences in managing one’s career and family, and biofeedback strategies, such as breathing and calming techniques. Lemaire says self-care isn’t typically in alignment with the average doctor’s standard of professionalism and ethics because as professionals, doctors feel that their patients always come first. And though studies show that most physicians

I always joke that when I get to the point when my inside voice starts saying, ‘I don’t care,’ I know I need to do something or I’m not going to make good decisions. are aware of the link between being well and job performance, they don’t necessarily translate that awareness to themselves. “Some of the physicians we surveyed wouldn’t even go there. They felt, ‘We’re professionals, so that just wouldn’t happen,’” she says. While Lemaire feels that the concept of physician wellness is recognized more so today than it was several years ago, the health-care system is still widely dependent on the traditional health-care model, which can require hospital physicians to work extended hours and work weeks. “If someone was to declare that all doctors can only work a maximum of 50 hours a week, like airline pilots, the whole medical system would collapse− you would need twice the person power, and that wouldn’t materialize overnight.” As such, the team has created the Well Doc? initiative. The initiative relies on education and knowledge translation

to help generate awareness within the medical community about the importance of staying well. They send out newsletters highlighting their findings, and personal feedback to those who have participated in their studies, in hopes of encouraging self-reflection. They have also been involved in several national and international talks, including one at Stanford this past January, and have been involved in helping others to implement wellness awareness programs. “You get to different people in different ways,” says Wallace. “We’re able to show the study participants what we found directly at the local level, because it’s what they themselves have told us,” adds Lemaire. “We believe that’s one of the reasons we have such buy-in.” The team has recently earned a grant from the Canadian Institutes of Health Research (CIHR) to continue and expand their research. For them, the recognition validates the importance of this research for the medical community. While they plan to continue drawing from the research they currently have, they will also explore how physician wellness is impacted by the complexities involved in caring for patients alongside educating medical trainees. Dr. Jane Lemaire and Jean Wallace, PhD, are both members of the Institute for Public Health and are Wellness Leads at the W21C Research and Innovation Centre.

Coping Strategies As part of one of their studies, Lemaire and Wallace examined the association between various coping strategies and overall wellness by surveying physicians on how burned out they felt, how emotionally exhausted they were and how much they liked their job. While the study can’t assign causality, the data was conclusive enough to show that there is an association between certain coping strategies and more/less burnout. For instance, they found that during difficult and stressful times, physicians who kept their stress to themselves, focused on what to do next, or went on as if nothing happened, experienced more emotional distress than those who interacted more heavily with their colleagues. “It’s the little things like deep breathing, taking a break, taking a few minutes to calm down, using humour and talking to colleagues that can be quite beneficial in helping physicians to get through their work day,” says Wallace.

Nutrition Lemaire and Wallace also explored the link between cognitive impairment and workplace nutrition. Through interviews, they discovered that physicians often felt they were too busy to stop and eat, or that it was unprofessional to do so. To build on those findings they implemented a nutrition intervention that involved providing free nutritious meals and snacks to doctors at regular intervals throughout their work day. They compared the data to a similar work day where physicians followed their typical eating habits, and the results did show that during the intervention cognition improved. Upon reflection of the data, some physicians who took part in the study said they would make more of an effort to eat and drink regularly at work, but practical barriers such as a lack of time and inadequate food options would still be challenging to overcome. “Now every time I’m on service, someone talks to me about nutrition,” says Lemaire. “One of my favorite stories is when someone yelled at me, ‘Hey Jane! I have a granola bar in my pocket!’”

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Well Doc?

While physicians focus on the wellness of their patients, two UCalgary researchers are focusing on the wellness of physicians. By Kathryn Sloniowski

UCALGARY MEDICINE Fall 2012

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By Amy Dowd

virus here in Calgary. Subsequently, the University of Calgary is the only place in Canada that can infect cold study volunteers with the virus.

transmission

Depending on how you define a cure for the common cold, scientists may be just as unlikely to find one now as they were a hundred years ago. But that hasn’t stopped them from trying. a cold is the symptomatic response–congestion, runny nose, etc.– to any one of several hundred cold- causing viruses we contract, the most common of which are the rhinoviruses. Since there are about 150 types of rhinovirus, not only is a common cold cure improbable, but it’s doubtful that anyone will ever be immune to catching one. Fortunately, having a cold, despite the general discomfort, isn’t a huge concern for a generally healthy individual–it runs its course in about a week. Unfortunately, rhinovirus is also the most common trigger of acute attacks in those with lower airway diseases such as asthma and chronic obstructive pulmonary disease (COPD). These exacerbations can be life Simply put,

threatening, and are by far the biggest driver of all the health-care costs associated with these diseases.

studying the common cold

A member of the Faculty of Medicine’s Snyder Institute for Chronic Diseases, David Proud, PhD, investigates the cold virus from two angles. First, he looks at human epithelial cells (the cells lining the airways) in the lab in an attempt to understand what’s happening at the molecular and cellular level during an infection and how to regulate it; and second, he infects volunteers with rhinovirus to examine individual responses in vivo–in a living, intact specimen.

Rhinovirus infection models in patients have been used since about the early 1960s, dating back to research at the British Common Cold Unit. Because rhinovirus only really affects humans, in vivo investigation is important to understand the way the virus and the immune system interact. “You’re going to get one to three colds a year anyway, so if I give you one deliberately, as long as you’re healthy, it’s not a risk,” says Proud. It used to take about a year and a half from start to finish to make a cold virus fit for human trials. Prior to 2001, researchers would recruit and extensively screen healthy young volunteers, infect them with a cold virus, and wait to see who got sick. Nasal washes were taken every day for the first five to seven days to work out who had the most symptoms and the highest concentration of virus. The lucky winner’s virus stock would then be purified, batched and stored for future use. Following the introduction of strict FDA regulations in 2001, this process is no longer used. “The FDA decided that anything that induced a physiological response was a drug and therefore they would regulate it. Only viruses made under so-called good manufacturing practices could be used in human trials−that delayed everybody for years,” says Proud. Researchers at the University of Virginia were eventually able to create a virus preparation in accordance with FDA regulations. Owing to Proud’s connection with the principle investigator, Dr. Ronald Turner, he was able to secure Health Canada approval to use the

UCALGARY MEDICINE Fall 2012

Concurrent with the first infection models of the 1960s, researchers were also tackling theories of transmission regulation. “There were two schools of thought: one, I have a cold, I sneeze in your face, you inhale and you get it; two, I have a cold, I touch your cell phone, I put it down, walk away, then you touch the cell phone, maybe rub your eye, and you get it. The two camps disagreed with each other vehemently,” says Proud. “Those arguments have gone on for years and we still think you can probably get the cold both ways.” What you can’t get it from is going outside in the cold with wet hair–like your mother always tells you.

body responds to the common cold virus in two ways: first through an epithelial cell innate immune response, which fights the virus during the symptomatic period and likely regulates the duration and severity of your symptoms; and secondly through an adaptive immune response–or cell-mediated response– where you generate T-cells that attack the virus, and also make antibodies that combat the virus and provide protection against the next infection.

treatment

“The idea that you will ever prevent people from being infected by all 150 strains of rhinovirus–I don’t think is going to happen. The issue is, can we find ways of boosting your defences or reducing inflammation to the extent that you have a relatively symptom-free cold,” says Proud. When it comes to treating the common cold, researchers are investigating the therapeutic qualities of a wide range immune response of potential remedies, while also studying the possibility of new approaches to “When I first got into common cold intervention at the molecular level, such research back in the late 1980s, I was as boosting your immune response. shocked to find out, coming from a Though the cost and potential side-effects background in asthma and immunology, of these experimental therapies often that nobody knew much about the prevent them from making it out of immune response to the virus. It’s still the lab. the case that for the most common According to Proud, since the infectious agent experienced by humans, cold is a self-limiting disease in most we know far less about how you mount generally healthy individuals, the risk an immune response to rhinovirus than you do to many other things,” says Proud. isn’t worth the reward. Where he does see the potential benefit is for those The virus appears to change with compromised lung function in the biology of epithelial cells, inducing which a rhinovirus infection could the production of inflammatory be life-threatening. chemicals that lead to typical common “We know that if you look in cold symptoms. young children, as many as 85 per “We think it’s probably your body’s cent of all acute asthma attacks are response to the virus that is actually triggered by common respiratory triggering your symptoms,” says Proud. viruses, and of those, 60 per cent “You could say that we have a slightly inappropriate or over-exuberant response are due to rhinovirus,” he says. “When you get to adults, to fighting the virus that goes over the the numbers go down a bit, mainly top and makes us a little bit ill.” because adults don’t get as many According to Proud’s research, your

Let’s put it this way, right now you can do nothing and the cold will last seven days or you can treat it vigorously and it will last a week. colds as kids do. Still, as many as 60 per cent of exacerbations are triggered by viruses and again, about 60 per cent of those are caused by rhinovirus.” Anything you can do to improve your general health can’t hurt your body’s response to a cold. Medications such as decongestants and pain relievers may help to relieve symptoms, but they won’t do much else. As far as natural cold remedies such as vitamin C and echinacea are concerned, most clinical studies show that they don’t appear to do anything to prevent infection, treat the cold or reduce the duration of symptoms. Sadly, chicken soup doesn’t help either.

Fast facts  COPD includes conditions such as chronic bronchitis and emphysema  Throughout the 1800s and into the turn of the 20th century, one of the common treatments for asthmatics was asthma cigarettes

 The British Common Cold Unit used to recruit volunteers by advertising their studies as unique holiday experiences  Most of what we think we know about our immune response to the common cold virus is interpreted from other viruses from the same genome family as rhinovirus, such as polio  The average child gets about six to 10 colds per year (as does the average parent of a small child); the average adult gets about one to three  Rhinovirus season peaks in September, but contrary to popular opinion, you can catch a cold year round

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By Amy Dowd

virus here in Calgary. Subsequently, the University of Calgary is the only place in Canada that can infect cold study volunteers with the virus.

transmission

threatening, and are by far the biggest driver of all the health-care costs associated with these diseases.

studying the common cold

UCALGARY MEDICINE Fall 2012

treatment

What is a concussion? A concussion is a complex pathophysiological process affecting the brain induced by traumatic biomechanical forces. There are many different definitions of traumatic brain injury, with upwards of 30 published sport concussion grading scales−none of which have been based on valid scientific evidence.

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Prevention Strictly enforcing rules pertaining to behaviour that may induce concussion

Rules and regulations in sports

Attitudes and behaviour

Emphasizing respect for teammates and opponents

Equipment Wearing certified helmets that fit properly can help prevent focal head trauma such as skull fractures, epidural and subdural hematomas Education Creating awareness around symptoms lets people know when to seek help

Evaluating the composition of equipment and the size of the playing facility, and assessing potential risks can reduce the number of hazards athletes may come in contact with

Environment

Symptoms

Children and concussions

Headache, dizziness, vomiting, nausea, blurred vision, light sensitivity, double vision, ringing in the ears (tinnitus), impaired motor coordination, impaired balance, confusion, disorientation, loss of consciousness, post-traumatic amnesia (cannot remember events leading up to the injury).

Children can experience similar symptoms to adults, but because the brain is still developing until about age 24, there is reason to worry more so for young people receiving concussions. “ C ertainly we don’t want a child sustaining repeat concussions that may not only prevent them from being the best they can be in sport, but can affect their whole livelihood from school and academic performance, to social activities and family/friend dynamics.” — Dr. Brian Benson

Not all concussions present the same–individuals may experience few, or several symptoms.

Risks of receiving multiple concussions Studies have suggested that multiple concussions can be detrimental to brain health, but how many is too many has not yet been defined. There is also increasing evidence to show that after receiving a concussion the risk is higher for repeat concussions.

Causes A direct blow to the head, face, neck or elsewhere on the body, with an impulsive force transmitted to the head. Examples of events which could lead to concussion:

Hits received in collision sports such as hockey, football, soccer, lacrosse, rugby and others; motor vehicle accidents; hitting your head in any other capacity.

Treatment Rest (physical and mental) is the primary treatment for an acute sportrelated concussion. A graded exertional return to normal activity protocol should be based on a physician’s recommendation.

Did you know?

The brain is surrounded by cerebrospinal fluid designed to protect the brain from impact by acting as a type of cushion. A rapid acceleration and deceleration caused by traumatic force can overpower this protective barrier, causing the brain to bounce off of the inside of the skull.

Persistent post-concussive symptoms typically require the expertise of a multi-disciplinary team to manage them. What happens if a concussion goes untreated?

“ An untreated concussion is a big concern. If it’s not assessed in a timely matter and not treated appropriately from the start, it can lead to prolonged symptoms and put the individual at further risk of repeat or other injury.” — Dr. Brian Benson

“ The brain wasn’t designed to do a lot of things people put it through.” — Dr. Sean Dukelow

How long do concussions normally last?

Diagnoses

Most (80 to 90 per cent) concussions resolve in seven to 10 days when managed appropriately. But symptoms may persist for months or even years in a small percentage of individuals and may lead to additional symptoms such as sleeplessness, anxiety, depression and mood disorders.

Dr. Brian Benson is the director of the University of Calgary’s Sport Concussion Clinic, a research assistant professor in the Department of Clinical Neurosciences, and a clinical assistant professor in the Department of Family Medicine. Dr. Sean Dukelow is an assistant professor in the Faculty of Medicine’s Department of Clinical Neurosciences, and in the Faculty of Kinesiology. He is also a member of the Hotchkiss Brain Institute (HBI).

If a patient presents with plausible post-traumatic concussion signs or symptoms, a thorough history, physical examination, and assessment of cognitive status are performed by a physician to confirm an official diagnoses. Traditional imaging technologies such as MRI and CT scans contribute little to concussion evaluation and are not routinely recommended for diagnoses. This is primarily because the technology has not been shown to be sensitive enough to measure changes in the brain caused by a concussion.

For exclusive online content visit us at medicine.ucalgary.ca/magazine

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Prevention Strictly enforcing rules pertaining to behaviour that may induce concussion

Rules and regulations in sports

Attitudes and behaviour

Emphasizing respect for teammates and opponents

Evaluating the composition of equipment and the size of the playing facility, and assessing potential risks can reduce the number of hazards athletes may come in contact with

Environment

Symptoms

Children and concussions

Not all concussions present the same–individuals may experience few, or several symptoms.

Causes A direct blow to the head, face, neck or elsewhere on the body, with an impulsive force transmitted to the head. Examples of events which could lead to concussion:

Hits received in collision sports such as hockey, football, soccer, lacrosse, rugby and others; motor vehicle accidents; hitting your head in any other capacity.

Did you know?

Persistent post-concussive symptoms typically require the expertise of a multi-disciplinary team to manage them. What happens if a concussion goes untreated?

“ The brain wasn’t designed to do a lot of things people put it through.” — Dr. Sean Dukelow

How long do concussions normally last?

Diagnoses

For exclusive online content visit us at medicine.ucalgary.ca/magazine

Alumni

medicine .uca lg a r y.ca / m ag a zine

h t l Hea s e c n scie A N M ALU e h t in y t ci

Photos and commentary by Bachelor of Health Sciences alumna Holly Womba

My first glimpse of New York City was during a family vacation in January 2011. was seeing a Broadway musical called In the Heights, about a lively Dominican community in upper Manhattan called Washington Heights. As life would have it, I was

One of the highlights

Having spent the summer in my PhD lab working on tissue engineering, I have now started my MD program. Although I will be continuing with research and graduate courses throughout, I won’t be a full-time PhD student (in biomedical engineering) until two years from now, when I have completed the first half of medical school. While busy, I am, nevertheless, greatly enjoying my program. I am surrounded by motivated and talented individuals, which I think is more a reflection of moving up in degree programs

accepted by Columbia University’s MD/ PhD program in the 2011/2012 application cycle. The combination of med school, research opportunities and location was impossible to resist, so on June 20, 2012 I stuffed my belongings into four large suitcases and moved close to the medical campus, in the heart of Washington Heights. 1 Rooftop View A glorious rooftop view of the concrete jungle that is Manhattan. While I will miss seeing the Rockies every morning, my dorm at least has an excellent view of the Hudson River. 2 Alberta Pride Most U.S. MD/PhD programs

don’t fund international students. Of those that do, it is usually only one. However, this year my entering class has two international students–myself and Chu Jian (Frank) Ma. While Frank did his undergrad at Cornell, he is originally from…MEDICINE HAT!

UCALGARY MEDICINE Fall 2012

Undoubtedly, there have been many lucky circumstances that led me to be in this position, but I also made some important choices. Looking back, one of the best was joining the Bachelor of Health Sciences program at the University of Calgary. It nourished my interests in both medicine and science, and it helped me to develop the skills I would need to succeed at both. I will always remember my years at UCalgary with fondness and with pride. It is, as the Americans like to put it, my Alma Mater.

of R i g h t s e g Pa s s a

to hear the word Manhattan, I envisioned streets full of honking taxis, and sidewalks consumed by pedestrians,

When I used

What I do appreciate about Columbia, specifically, is the diversity of its medical students. embrace at first. I suppose I felt that I was too young and had worked too hard to end up as some sort of life-size Canadian bumper sticker splayed across the front of a taxi. However, after weeks of being a goody two-shoes, stubbornly obeying the law, I began to convert. You see, I discovered that cars didn’t obey traffic signals either – yielding to pedestrians existed more in theory than in practice. If you’re at risk of

than something unique to Columbia. What I do appreciate about Columbia, specifically, is the diversity of its medical students. They come from all over the United States (and the world) and are just as likely to have backgrounds in the arts as they are in the sciences. I think, too, that my Columbia experience can’t be disconnected from its location, both in Washington Heights and in New York City. If you’re curious, I encourage you to tune into NY Med, a reality show about our hospital that recently aired on ABC (isn’t that awesome?).

determinedly marching forth on their daily missions. In reality, I’m not sure if it is that fast-paced, but I have noticed the pedestrians here exhibit a strange sort of phenotype: they seem to be completely oblivious to traffic signals. In the midst of a clear DO NOT WALK sign they will stride into the street, making meters of progress before stopping abruptly for a car to whiz by, like Neo narrowly dodging bullets in The Matrix. While there is something deliciously rebellious about this behavior, I’ll admit, it wasn’t something I could

being run over regardless, then why wait? As I transition into my new journey as an MD/PhD student in NYC, I have learned that there are, ironically, no rights of passage. One must simply be a defensive walker. And I try to take solace in the fact that I work only two minutes away from a hospital. 3 Taxis

4 Elmo/Mickey Day one of Med School Orientation: a Manhattan-wide scavenger hunt. Our group was quite pleased with ourselves for our

solution to ‘Get a photo with someone unequivocally famous.’ We later found out that another group actually got a picture with Tina Fey in Central Park.

ane an rr e t b u S ony mph Sy with the NYC Metro was on December 2, 2011, the day of my Columbia interviews. Since interviews three and four were with the faculty on the main campus, 56 blocks from the

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No, it wasn’t profanity. It was, well, an accordion. Over the past eight months, I have experienced many other musical interventions while on the metro. I’ve been an audience for Dominican a capella groups, Mexican mariachis and urban jazz players, though, interestingly, playing inside the trains is actually illegal. When I imagine these altogether, it seems like a sort of subterranean symphony, providing a dynamic soundtrack to the ‘city that never sleeps’.

My first experience

Fun/ USEFUL FacTS

New Yorkers are obsessed with straws. You will get one with everything from bottled pop and juice to hot chocolate. One day, I made the mistake of asking the cashier if this was because the pop bottles weren’t clean. Clearly offended, she said, “No hon, New Yorkers just like straws!”

People in Manhattan do not have the stereotypical New York accent (this was disappointing).

med school, the program coordinators armed me with a map and a MetroCard and wished me luck. I managed to get myself onto the correct train and started to count down the stops. Maybe it was because I was used to the diversity on city transit or maybe it was because my mind was oscillating between overanalyzing my previous interviews and worrying about the next, either way, I took little notice when a 20-year-old ‘punk’ stepped onto the train−until I heard an offensive sound coming from his direction.

5 Amazing Things When you receive instruction from and work with internationally renowned physicians, surgeons, and researchers, it’s hard not to believe that amazing things are happening at Columbia. 6 Butler Library The downtown Columbia

campus has some amazing architecture, with many buildings pre-dating the American Revolution. This is an image of Butler Library taken from behind the Alma Mater statue. 7 Fairway Market

For exclusive online content visit us at medicine.ucalgary.ca/magazine

A grey area

In prestigious academic institutions, bow ties are no longer an endangered species.

Educat ion

Get into a taxi before telling the driver where you want to go. As soon as you are seated the driver is legally bound to comply (this doesn’t mean some don’t get frustrated in bad traffic and kick you out). You can line up for cheap Broadway tickets on the day of the performance at TKTS booths. The savings in cash will, of course, come at the cost of unnecessary time in Times Square. The Soup Man (from Seinfeld) actually serves delicious soup.

Grey’s Anatomy is one of television’s leading medical programs, but while some might get caught up in the love triangles and ensuing drama, we wanted to know how the show measures up from a medical perspective. Fifth-year head and neck surgical resident Dr. Monica Hoy, weighs in. There is a lot of medical dialogue in the show. How accurate is it? They do try to be accurate. For example, when they’re running codes they try to use medical jargon appropriate to the scenario; however, their decision making for drastic procedures is very arbitrary. They do certain things that are not evidence-based or that might be considered old medicine−nobody does it anymore because it’s totally old school. Why do you think the show would portray procedures that way? It’s more dramatic to say, ‘Let’s crack open the chest!’ than it is to say, ‘Let’s administer some medication through the IV.’ The doctors seem to bring a lot of personal drama to work. Do real doctors ever bring their personal issues to work this way? I don’t think anybody is drama-less. However, the hospital is a very professional environment and most people don’t bring their personal lives into it to the extent that they do on the show. I’m pretty sure what they have going on on Grey’s Anatomy is unethical and definitely unprofessional. We’ve seen several episodes where the residents are left to do surgical procedures on their own. What are your real limitations as a resident? Procedural autonomy is graded depending on your level. On Grey’s Anatomy, they’ll run into situations where there may be two residents running an operating room with no staff around. That doesn’t happen in our system. But as a first-year resident, if a senior resident is around, they’ll assume the role of teacher and take you through the procedure. As you become more senior, then you

get to do things on your own−especially consults in the emergency room. There is still a staff doctor there though, but they take on more of a helping or assisting role. We see the doctors do everything from start IVs to run CT scans and interpret results. Do most doctors utilize all of those skills on a regular basis? No. I think one of the more blatantly poor examples of this is the show House, where the doctors do everything from drawing blood, to analyzing it in the lab. In the hospital, we’re a huge multidisciplinary team. Doctors do order the exams, but they don’t actually perform them themselves. Surgery of course we do, that’s in our domain, but in terms of scans and other tests−that’s radiology, pathology, etc. There’s a lot of chit-chat that goes on during surgeries on the show. Does that normally happen?

Chatting during surgery happens at appropriate times. Most of the time, people are focused on the surgery so there’s not a lot of conversation–especially if it’s complex or it’s a part of the surgery that’s more difficult−it can be pretty much silent. But it would be boring to watch

a show where they didn’t talk about what’s going on in their lives for however long the surgery lasts. Is there anything you find humorous about the show that a non-medical audience might miss? Oh yeah, the show is actually quite comical. In terms of the operating room– I mean, sterile procedures are completely thrown out the window−they’re touching everything! And one of the most hilarious bits is when they wear headlights. We wear them too; however, the objective of the headlight is to put light into the surgical field. Their headlights are all over the place. And the surgical loups that they wear to magnify the surgical field are mostly hanging off of their noses or hanging off their neck strap–it’s quite funny. For exclusive online content visit us at medicine.ucalgary.ca/magazine

medicine.ucalgary.ca /magazine

My first experience

Fun/ USEFUL FacTS

People in Manhattan do not have the stereotypical New York accent (this was disappointing).

campus has some amazing architecture, with many buildings pre-dating the American Revolution. This is an image of Butler Library taken from behind the Alma Mater statue. 7 Fairway Market

For exclusive online content visit us at medicine.ucalgary.ca/magazine

A grey area

In prestigious academic institutions, bow ties are no longer an endangered species.

Educat ion

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Awards and recognition Faculty of Medicine graduate student Robin Walker was recently awarded the Vanier Canada Graduate Scholarship in recognition of her research and academic achievements. By examining hospital admissions related to common chronic conditions– referred to as ambulatory care sensitive conditions–such as high blood pressure and diabetes, Walker’s research aims to develop new ways of identifying and measuring the number of avoidable hospital admissions in Canada.

Carly Glasner, a family medicine resident, and her faculty advisor, Dr. David Topps, won second prize in the CHEC-CESC Virtual Patient Challenge 2011 for authoring Poppy Gone: A Virtual Prenatal Patient. The primary objective of Glasner’s project was to create a virtual patient that explores problem solving abilities in low-risk obstetrics.

Colin Casault, a third-year medical student, received the Canadian Medical Association (CMA) Award for Young Leaders. Casault is being recognized because of his leadership in advancing medical student issues at various levels of government, and his invaluable contributions to the development of studentrun educational initiatives at the University of Calgary.

This is the second year in a row that a University of Calgary medical student has received the award.

BHSc (honours) graduate Michelle Huie received the President’s Award for Excellence in Student Leadership. In addition to excelling in her academics and carrying out research throughout her degree, Huie has worked to make the university community an engaging experience for other students.

Dr. Morley Hollenberg is the 2012 recipient of the Henry Friesen Award, as chosen jointly by the Canadian Society for Clinical Investigation (CSCI) and the Royal College of Physicians and Surgeons of Canada. The award recognizes a distinguished Canadian scientist who has demonstrated leadership in developing biomedical research at local, national and international levels.

The office of Continuing Medical Education and Professional Development (CME and PD) at the University of Calgary, led by Jocelyn Lockyer, PhD, Claudio Violato, PhD, and their partners at the College of Physicians and Surgeons of Alberta (CPSA),

UCALGARY MEDICINE Fall 2012

In the news Dr. Trevor Theman and Mr. John Swiniarski, was selected to receive one of three 2012 Royal College Accredited CPD Provider Innovation Awards for the development of the Physician Achievement Review Program.

The Canadian Society of Immunology (CSI) awarded Paul Kubes, PhD, the Bernhard (Hardy) Cinader Award. The award is given to an immunologist working in Canada recognized as an exceptional researcher in the field.

The American Society for Surgery of the Hand (ASSH) has named Dr. Kevin Hildebrand as the 2012 recipient of the Andrew J. Weiland Medal for Outstanding Research in Hand Surgery. The medal recognizes and supports outstanding research in hand surgery in order to continue the vision of hand surgeon and researcher, Dr. Andrew Weiland.

The Faculty of Medicine’s Dr. Brenda Hemmelgarn and Dr. Braden Manns, along with the University of Alberta’s Dr. Marcello Tonelli, received the first Alberta Health Services President’s Excellence Award

for Outstanding Achievements in Research. Having lead the Interdisciplinary Chronic Disease Collaboration (ICDC), the group aims to support higher quality, more equitable and efficient care for Albertans with or at risk of common chronic ailments such as kidney disease, diabetes and heart disease.

In recognition of his widespread research accomplishments and extensive contributions to Canadian intellectual life, David Proud, PhD, has been elected as a Fellow of the Royal Society of Canada. The fellowship is considered the highest honour that can be attained by scholars, artists and scientists in Canada.

University of Calgary medical student Stephen Annand received the Tarrant scholarship. The scholarship is awarded to third-year medical students who have demonstrated an interest in, and dedication to, rural medical issues in their undergraduate work.

Dr. Brenda Hemmelgarn, Dr. Todd Anderson and Dr. Subrata Ghosh will be inducted into the Canadian Academy of Health Sciences (CAHS) this fall, for their demonstration of leadership, creativity, distinctive competencies and a commitment to advance academic health science.

Researchers To tackle deadly brain cancer some of the country’s top minds in cancer research recently received an $8.2-million investment to research new treatments for glioblastoma−the most common and deadly form of brain cancer among adults. Dr. Gregory Cairncross, a professor in the Department of Clinical Neurosciences at the University of Calgary, will lead the project. For more than three decades, glioblastoma treatment has remained largely unchanged.

A team of

The research team is focusing on the development of new drugs, the first of which they hope could be ready for clinical trials in two to four years. The investment, one of the largest ever made in Canada for glioblastoma research, came from the Terry Fox Research Institute (TFRI), the Terry Fox Foundation (TFF), Alberta Innovates– Health Solutions, the Alberta Cancer Foundation, Genome Canada, Genome BC and the BC Cancer Foundation.

Researchers discover rare gene A North American study led by Dr. Francois Bernier at the University of Calgary’s Alberta Children’s Hospital Research Institute has identified the gene that causes Nager Syndrome−a condition which causes deformation in a child’s face and limbs, as well as deafness. “Genetic disorders in children are individually rare but collectively common, affecting the lives of hundreds of thousands of children in Canada. And most of

Study investigates virus as potential cancer therapy Researchers at the

Welcome to the Menagerie! Medicine welcomed 170 new and eager faces this summer−the future MD Class of 2015. As part of orientation, students had the option of participating in Med.Zero−a workshop organized by Dr. David Keegan and the Department of Family Medicine. The workshop is designed to generate enthusiasm for family medicine as a career option, and gives students the opportunity to participate in activities such as suturing and casting. Marianna Hofmeister, PhD, acting education manager The Faculty of

for the department, says the event is a chance for students to get to know each other and that the hands-on training is extremely popular. “They get to get their hands wet and dirty before they crack open their books,” she says. “They work with rural and urban preceptors, starting their formal education in a very positive, encouraging environment.” Keeping with tradition, the new class has also been officially inducted into the Medicine Menagerie as the…cows.

University of Calgary and Alberta Health Services’ (AHS) Tom Baker Cancer Centre are examining the potential use of the reovirus as a possible treatment for multiple myeloma−a cancer that affects blood cells. Scientists injected the naturally occurring virus into animal models containing human multiple myeloma cell lines, and found that the virus killed the cancer cells while leaving the normal, healthy cells alone. “The virus appears not to affect healthy cells, unlike radiation and chemotherapy,” says Dr. Don Morris, lead author of the study, AHS medical oncologist and member of the University

the genes that cause these conditions have yet to be found,” says Bernier. The discovery was the result of an international collaboration between FORGE Canada and the University of Washington.

of Calgary’s Southern Alberta Cancer Research Institute. “In the future, this treatment might be used in conjunction with other cancer therapies, as we have recently found that the combination of reovirus and other new therapies currently used in the treatment of myeloma work better together than individually.” Scientists hope this research lays the foundation for an early phase clinical trial using reovirus for the treatment of multiple myeloma. This same group of researchers has already started clinical trials using the reovirus on lung and prostate cancer.

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medicine .uca lg a r y.ca / m ag a zine

This is the second year in a row that a University of Calgary medical student has received the award.

UCALGARY MEDICINE Fall 2012

A team of

Study investigates virus as potential cancer therapy Researchers at the

the genes that cause these conditions have yet to be found,” says Bernier. The discovery was the result of an international collaboration between FORGE Canada and the University of Washington.

Service to Socie t y

medicine .uca lg a r y.ca / m ag a zine

Rick Chin, a statistical associate/data analyst in the Department of Medicine, Division of Nephrology was the winner of the Banff National Park Big Mountain Challenge. As the winner,

By Dr. Brienne McLane and Dr. Anna Kalenchuk

The Department of

McKnight Blvd

B Sunridge

Memo rial Dr

Dr. Dennis Kreptul examines patient Sylvia Pflug.

The idea for Call 4 A Cause was put forth by psychiatry resident, Dr. Anna Kalenchuk. The goals of Call 4 a Cause are to promote a philanthropic spirit, support community programs, and ultimately, to improve the health and well-being of Calgarians. Donations made to date:

Finding a family doctor can be tough, but the University of Calgary’s family medicine residency program’s expansion has made it easier for approximately 12,000 Calgarians.

2009

$4,033

to the Alex Community Health Program 2011

$9,868

to the Alex Community Health Program

Residents interested in participating in Call 4 A Cause this year can contact Kanwal Mohan at kssmohan@ucalgary.ca.

“We are delighted to be able to accept thousands of new patients,” says Dr. Dennis Kreptul, interim head of the Department of Family Medicine at the University of Calgary. “Our teaching sites offer Calgarians access to family doctors who provide as up-to-date and comprehensive primary care as patients receive anywhere else in the city. Along the way, they get the opportunity to help train future doctors by allowing family medicine residents,

$2,857

Faculty of Medicine and Alberta Health Services jointly operate three family medicine teaching centres in Calgary that act as a teaching tool for family medicine residents (recently graduated physicians training in family medicine). While patients are assigned to a primary care physician, they are also often seen by a medical resident who is later joined by a clinical teaching doctor to review diagnosis and treatment options.

C South Health Campus

2010

The University of Calgary’s

Glenmore trail

to the Calgary Homeless Foundation

supervised by fully qualified doctors, to participate in their care.” In addition to family doctors, the clinics also have other health-care workers on site including nutritionists, pharmacists, psychologists and chronic care nurses. The expansion of the residency program was made possible through a $10.3- million grant from the Alberta government. The funding was used to expand training space and add teaching staff in preparation for the additional residents. The long term goal of the expanded program is to produce more family doctors for Calgary and for Alberta. The program hopes to graduate 25 more family doctors annually. An estimated 200,000 people are without a family doctor in Calgary.

Sheldon M. Chumir Health CentRE

In 2011, we expanded the program and recruited several other local resident groups to participate: dermatology, family medicine, internal medicine, neurology, pathology, pediatrics and physiatry. Thanks to the increase in participation, the money we

The teaching centres are located at three sites: Sheldon M. Chumir Health Centre, Sunridge, South Health Campus Hospital Recently, the Sunridge clinic doubled in size and now occupies 18,000 square feet of space to accommodate new patients and staff; the clinic at the South Health Campus location officially opened on September 6 with Premier Alison Redford in attendance. It was the first phase of the South Health Campus to open.

Thanks to the increase in participation, the money we raised more than tripled from the previous year.

raised more than tripled from the previous year. We also issued a friendly challenge to the various resident groups to get the highest proportion of residents involved in the cause. Psychiatry had a head start, having participated for the previous two years, and recruited 58 per cent of residents, but internal medicine residents weren’t far behind with an impressive 57 per cent participation rate. After seeing so many residents participate, several staff physicians decided to donate to the cause as well. Our goal this year is to expand the program further and recruit even more resident groups, as well as to encourage a higher number of residents to participate. We hope to raise $10,000 over the month of December 2012.

diseases get,” he says. “So I just wanted to bring more awareness to it.” The contest called for Chin to hike Mount Temple, Cascade Mountain and Sulphur Mountain− he received $15,000 for the Kidney Foundation of Canada after he completed all three. In addition, Banff Lake Louise Tourism matched an additional $5,000 in pledges that he raised on his own.

M ac

Psychiatry started the Call 4 A Cause initiative three years ago to support local charities within our own community. The idea was born of the notion that despite being very tiring, stressful and hectic, call shifts−a shift over and above a regular work week, often on evenings and/or weekends−could also have a positive impact. Every December, each resident selects one scheduled call shift and donates their stipend from that shift to a pool of funds that goes to a charity voted on by the residents involved. For 2011, the charity of choice was the Alex Community

Health Program−this year, we have chosen to support the Margaret Chisholm Resettlement Centre. Knowing that the money we are earning on a particular call night is supporting a worthy charity makes the reality of what we are capable of doing for others very tangible.

prepare for the challenge. Chin, who submitted a picture of himself ‘singing’ said he’d be preparing for the hikes by singing show tunes to keep the bears away. Chin chose to support The Kidney Foundation of Canada, as his current research position with the Alberta Kidney Disease Network and the Interdisciplinary Chronic Disease Collaboration (Division of Nephrology), has heightened his awareness of the seriousness of the condition. “Kidney disease doesn’t usually get the spotlight like cancer, or some other

By Marta Cyperling

Macleod Trail

Call 4 A Cause

he not only got to do some hiking but he raised $26,762 for The Kidney Foundation of Canada in the process. The contest received 719 entries from across North America. “I don’t usually win contests,” says Chin. “It’s kind of been surreal, to be honest. I’m super excited about the whole thing.” The contest asked for entrants to post a picture on the official contest Facebook page, accompanied by a caption outlining how they would

esidency expansion R means more family doctors

In the community Creative contest entry brings in big bucks for charity

Educat ion

Service to Socie t y

medicine .uca lg a r y.ca / m ag a zine

Rick Chin, a statistical associate/data analyst in the Department of Medicine, Division of Nephrology was the winner of the Banff National Park Big Mountain Challenge. As the winner,

By Dr. Brienne McLane and Dr. Anna Kalenchuk

The Department of

McKnight Blvd

B Sunridge

Memo rial Dr

Dr. Dennis Kreptul examines patient Sylvia Pflug.

Finding a family doctor can be tough, but the University of Calgary’s family medicine residency program’s expansion has made it easier for approximately 12,000 Calgarians.

2009

$4,033

to the Alex Community Health Program 2011

$9,868

to the Alex Community Health Program

Residents interested in participating in Call 4 A Cause this year can contact Kanwal Mohan at kssmohan@ucalgary.ca.

$2,857

C South Health Campus

2010

The University of Calgary’s

Glenmore trail

to the Calgary Homeless Foundation

Sheldon M. Chumir Health CentRE

Thanks to the increase in participation, the money we raised more than tripled from the previous year.

M ac

By Marta Cyperling

Macleod Trail

Call 4 A Cause

esidency expansion R means more family doctors

In the community Creative contest entry brings in big bucks for charity

Educat ion

Alumnus of Distinction Award Winner Community Report 2012

Honouring Dr. Evan Adams, (MDâ&#x20AC;&#x2122;02, a Pangolin) for his outstanding contributions to his community. Dr. Adams was the first Aboriginal Health Physician Advisor in the Office of the Provincial Health Officer, BC Ministry of Health and with the (BC) First Nations Health Council. He is currently the Deputy Provincial Health Officer for the province of BC.

Last year, we introduced a bold new strategy for our university called Eyes High. This year, we delivered the new Academic Plan and the new Strategic Research Plan: the roadmaps to get us there. So whatâ&#x20AC;&#x2122;s next as we head towards our 50th anniversary in 2016?

Learn More At UCalgary.ca/Report

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