Category: Cancer

Published: November 2024

The pace at which medical advancements are taking place in the field of immunotherapy is staggering. Immunotherapy harnesses a patient’s own immune system to attack their cancer, and The Ottawa Hospital is at the forefront of research in this area — from the development of new therapies to clinicals trials. In fact, our hospital hosts BioCanRx, a national network for immunotherapy research and has pioneered a number of unique immunotherapies made directly of cells and viruses. These groundbreaking immunotherapies, developed right here, are pushing the boundaries of medicine and transforming patient care.

“The field of oncology is like a hurricane of clinical trials. Every six months now, we are trying to implement practice-changing data or chase promising data.”

— Dr. Michael Ong

Unlike traditional treatments like chemotherapy, immunotherapy can adapt to a patient’s cancer, which can lead to improvements that can last years — even after the patient has stopped treatment.

For Dr. Michael Ong, a medical oncologist and clinical investigator at The Ottawa Hospital, it’s reassuring to see the combination of incredible progress and long-term success for patients during his career. “The field of oncology is like a hurricane of clinical trials. Every six months now, we are trying to implement practice-changing data or chase promising data.”

The survival rates for metastatic melanoma, for example, have gone from only 20% surviving one year to 50% not only surviving 10 years, but also being both cancer-free and treatment-free. This is thanks to immunotherapy.

Immunotherapy shows promise for bladder cancers

Now, experts like Dr. Ong are asking what other cancers can be treated with immunotherapy and how to harness its full potential. “Over the years, we’ve been doing melanoma surgery for those who are high risk, and then treating with immunotherapy after surgery. But it turns out immunotherapy works better before surgery happens, because the immune system can be better trained against the cancer when there’s more cancer present,” explains Dr. Ong. 

That means treating with immunotherapy first, and envisioning a future where surgery could one day be unnecessary. This would be a huge improvement for patients’ quality of life. 

Recently, the results of a clinical trial led by Dr. Ong at The Ottawa Hospital as part of a multinational effort were presented at a conference in Barcelona, Spain. In this trial, chemotherapy and immunotherapy were prescribed before surgery in patients with bladder cancer. The group that had immunotherapy prior to surgery had a lower rate of cancer recurrence and higher cure rate, and it is now considered standard of care to offer pre-operative immunotherapy.

“It’s so exciting to have recruited patients to this trial and contributed to this global effort that ultimately improved how we treat our patients with bladder cancer,” explains Dr. Ong. 

The next generation of trials may look at whether there is a need to remove a patient’s bladder if they are super responders. “Not everyone will get away without surgery, but even if some patients can avoid it, then it’s a huge advancement. We are talking about complete response rates from pre-operative treatment that are now exceeding 50% in bladder cancer,” says Dr. Ong. “So, by the time of surgery, we’re not even seeing any more cancer cells. That begs the question, ‘Do we need to take out the bladder’.” 

The fact that each person’s cancer is unique adds to the complexity of the disease and treatment. But the potential impact of immunotherapy is reaching even farther.  

What is prostate cancer?

Prostate cancer is a type of cancer that can develop in the prostate — a small, walnut-shaped gland in the male reproductive system that produces seminal fluid.
Learn More

How some prostate cancer patients may benefit

There have previously been significant efforts to evaluate if immunotherapy works in patients with prostate cancer. Multiple phase-three prostate cancer clinical trials have had largely disappointing results. However, within every one of these trials, there were a small proportion of patients who benefitted, and it shows that 3 out of 100 patients can actually benefit significantly from immunotherapy.

It has taken time and more data to understand who these patients were, but it has come down to something called mismatch repair deficiency, which seems to be the most promising way to identify patients that will respond to immunotherapy. “Normally when cancer cells copy their DNA, mistakes (or mismatches) in copying happen. The mismatch repair system will normally catch and fix those errors. But if this repair system is deficient or faulty, these mistakes are tolerated and DNA mutations accumulate rapidly,” says Dr. Ong.

Cancers generally become more aggressive when more mutations accumulate. “It turns out, however, that these ‘ugly’ mutated cancers are actually very sensitive to immunotherapy,” according to Dr. Ong.

That’s incredible news for a small but specific group of patients with prostate cancer, like Larry Trickey.

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Stage 4 prostate cancer diagnosis

Larry Trickey, a retired computer specialist, was diagnosed with a highly aggressive prostate cancer in 2022. His scans showed the cancer had spread to the bladder and pelvis. It was the height of the pandemic, adding to the stress, and surgery was not possible. Initially, he began standard hormone treatment, then his oncologist, Dr. Dominick Bossé, suggested he enroll in a study that involved genomic testing of his tumour and access to a new treatment called a PARP inhibitor.

“When Mr. Trickey and his wife walked into my office with determination and hope, they were deeply supportive of one another and committed to finding the best path forward,” explains Dr. Bossé. “As always with research, the addition of a new form of care on top of standard treatment could make it more challenging to tolerate, but may also uncover new ways to treat cancer efficiently. Mr. Trickey was willing to take that risk.”

While initially Larry had benefit from the treatment, the effect was relatively short-lived, with the cancer worsening in 2023. He then received some radiation treatment and in a surprising turn of events, the radiation triggered an abscopal effect — a very rare phenomenon where the immune system kicks in to fight cancer after radiation releases.

Dr. Dominick Bossé

“It was a remarkable moment. Mr. Trickey put his trust in me to hold off on further treatments while he benefited from this abscopal effect and until the cancer showed signs of progression, with the hope of enrolling him in an immunotherapy trial as our next option,” says Dr. Bossé.

“The entire team rallied together — the research team, radiology, oncology — to get him promptly into that trial."

— Dr. Dominick Bossé

Clinical trial led by Dr. Ong

Within months, Larry’s condition started to deteriorate and that’s when Dr. Bossé said it was time to see if he could enroll in a clinical trial that Dr. Ong was running. “The entire team rallied together — the research team, radiology, oncology — to get him promptly into that trial. Despite the alarming news of progression, Mr. Trickey agreed to multiple tests for the trial eligibility, which he met just in time, hours only before the trial closed.”

Larry Trickey

Larry remembers the call vividly. “It was around suppertime when Dr. Bossé called, and he seemed to be very ecstatic about one of the mutations I had,” remembers Larry. “There was a study looking for patients with that mutation. He was so excited when he saw the results and what it could mean for me.”

Hundreds of patients in Canada have been enrolled in this study over the last five years, but Larry was the last one accepted before the trial completed.

“It was kind of like winning the lottery to have that mutation. I was very lucky that it allowed me to get into this more aggressive study. If it was successful, it would really make a huge difference,” says Larry.

And Larry needed a win because by this time he had multiple metastases, including one in his left shoulder that was progressively weakening his arm. His stomach was bloated, and he was in pain because of the size of the tumour on his prostate and the difficulty of having bowel movements.

“Things were getting desperate for me. My son and his wife were expecting their first child around Christmas, and I didn’t know if I would ever get to meet my first grandchild.”

Astonishing results from immunotherapy clinical trial

By mid-February 2024, Larry started on the PC-BETS study, with the Canadian Cancer Trials Group, for which Dr. Ong is a national co-chair. The results were astounding, and his condition improved very quickly after receiving two types of immunotherapies in combination.

"The cancer just melted away."

— Dr. Michael Ong

“The cancer just melted away. His PSA (prostate-specific antigen) in February 2024 before we started the trial was high. By April, his PSA was undetectable, and it’s stayed undetectable. The scans in July 2024 showed only a small residual nodule on the left adrenal gland. All the other sites of cancer have disappeared on his scans, and by the next scan, it’ll hopefully all be gone,” explains Dr. Ong.

To put this in perspective, a few cycles of chemotherapy would have maintained his life, but would not have improved it in the end. This clinical trial truly changed Larry’s life.

Read our Q&A with
Dr. Michael Ong

"If it wasn't for the trial, for sure, I don't think I'd be here now."

— Larry Trickey

Larry will continue with monthly immunotherapy treatment, but Dr. Ong says for how long is something that is also still being studied. “There’s an open question with immunotherapy right now to understand how long we need to deliver these treatments even when the scans normalize. That doesn’t mean every last cancer cell is gone. There are currently studies trying to address that.”

Today, the 69-year-old is enjoying every moment as a grandfather, and now he’s optimistic he’ll be able to celebrate that special milestone of his grandson’s first birthday. He’s also gaining his strength back, little by little, and he’s got movement back in his left arm. “If it wasn’t for the trial, for sure, I don’t think I’d be here now.”

He and his wife are deeply grateful to the cancer care team who have been with them every step of the way. “The nursing team honestly feels like family, especially Rayelle Richard, she’s really terrific. She gives me my infusions and is my contact to Dr. Bossé and Dr. Ong. It is such a supportive team at the Cancer Centre.”

What’s next in the field of immunotherapy?

For Dr. Ong, the goal is to find the right fit of treatment for each patient — it’s about individual analysis for each prostate cancer patient.

He also points to the importance of having access to things like The Ottawa Hospital’s molecular lab, funded by donors, which allows our scientists to do this kind of specialized testing and to provide much more personalization of care to patients. “We need to be at the forefront and test our patients for those mismatch repair alterations and get them immunotherapy when indicated,” says Dr. Ong. “That will be a significant advancement and will benefit more patients like Larry.”

Admittedly, the field is complex and moving at a rapid pace. Since he entered the medical oncology field 15 years ago, the change has been remarkable. 

“I was a little bit concerned at that time that I would only ever be just delivering chemotherapy and never having a big impact. I was clearly wrong. Today, we’re seeing this totally new technology called antibody-drug conjugates that is revolutionizing bladder cancer treatment. They target the cancer specifically and then deliver high potency chemotherapy inside the cancer cells and that’s the huge advance of bladder cancer right now when combined with immunotherapy.”

Next is to bring this success to other patients with different types of cancers. The way to that will be through more cutting-edge research and clinical trials.

Dr. Michael Ong and Larry Trickey

The Ottawa Hospital is also leading the way in research to develop and manufacture new cancer immunotherapies. For example, laboratory scientists like Drs. John Bell and Carolina Ilkow are developing biotherapies that use cells, genes and viruses to unleash an immune attack against cancer cells. They worked with clinician scientist Dr. Natasha Kekre and others to develop the first made-in-Canada CAR-T cell therapy. Other clinician researchers, like Dr. Alissa Visram and Dr. Rebecca Auer, are also developing new cancer immunotherapies and working to bring these to patients. This kind of research is fuelled by core facilities and platforms like The Ottawa Hospital’s Biotherapeutics Manufacturing Centre as well as networks like BioCanRx.

Categories: Clinical Trials, Immunotherapy, World-Leading Research

Published: August 2024

Like many university students, Erin Brown, a kinesiology undergrad at uOttawa, was burning the candle at both ends. When she started to complain about headaches, nausea, and seeing stars, those close to her believed she was pushing herself too hard. Even her doctor initially said, ‘You need to take a break’. But as symptoms worsened, Erin soon learned it wasn’t stress or exhaustion; she had a brain tumour — and it was a type the world hadn’t seen before.

The 21-year-old was in her fifth year of her undergrad in human kinetics studies in 2018 when the symptoms started. When they worsened, she paid another visit to her family doctor who did some neurological tests, but couldn’t pinpoint the cause. “He said if the symptoms continued, I should go to the nearest emergency room and get some imaging done,” explains Erin.

It wasn’t long before her dad took her to an area hospital, and after initial tests, Erin was sent to the Civic Campus of The Ottawa Hospital. Dr. Safraz Mohammed, a neurosurgeon specializing in brain and spine, was on call when Erin arrived at the Emergency Department.

“After reviewing her CT scan, we immediately ordered an MRI scan, and that unfortunately revealed a brain tumour in her right frontal lobe,” says Dr. Mohammed.

Erin with Dr. Mohammed

He remembers those early interactions with Erin quite well. “She had such an uplifting spirit, even at the time of diagnosis. I could see that she was an amazing person and she was going to be a great patient.”

For Erin, the feeling is quite mutual. This young doctor, just two years into his career, brought her much ease. She was admitted to F7 (the neurosciences inpatient floor) and had another MRI the next morning. When Dr. Mohammed came to meet with Erin and her family — he sat down.

“When I meet patients, I sit down at the eye level. I sit on the bed sometimes or sit on a chair close to them, because I think it’s important to be at eye level to have good patient interaction rather than having a height difference.”

He also jokes that it’s a good opportunity to sit down after operating all day or being on rounds.

MRI of Erin’s tumour
MRI of Erin’s tumour
MRI of Erin’s tumour
MRI of Erin’s tumour
MRI of Erin’s tumour
MRI of Erin’s tumour
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A type of tumour never seen before

Erin’s tumour was quite large — the size of a small apple — and all signs indicated it was a meningioma, which is a type of tumour that develops from the membrane that covers the brain and spinal cord. In Erin’s case, it was invading the middle vein in the brain known as the superior sagittal sinus, which is a major vein and damage to it can result in devastating consequences, according to Dr. Mohammed.

“Those devastating consequences include a massive stroke, massive bleed into the brain, and unfortunately, even death. It’s a big vessel, but it has a thin wall. It would take a lot of planning for the surgery.”

After careful planning, Erin was prepped for surgery with Dr. Mohammed and his team. A continuous trans-esophageal echocardiogram was used to ensure that no air was sucked in through the main vein, as this could result in death. Dr Mohammed wanted to remove the entire tumour, given that Erin was so young. During the six-hour procedure, the tumour was completely extracted and sent for analysis.

"That’s when we discovered this tumour had elements to it that were never seen or discovered before."
— Dr. Safraz Mohammed
Q&A with Dr. Safraz Mohammed

The testing yielded the most unusual results. Dr. Mohammed learned it was a grade 3 tumour, which meant it was cancerous. “It wasn’t benign, as we suspected. It also didn’t follow the criteria for meningioma. As a result, we sent it for further testing in Toronto, and that’s when we discovered this tumour had elements to it that were never seen or discovered before,” explains Dr. Mohammed.

This new type of tumour is called a dural-based spindle cell neoplasm, characterized by a novel MN1-KMT2A fusion gene, based on the type of cells and genetics discovered within it.  This tumor was unlike anything ever seen or described before. With the neuropathologist’s help, the team was able to publish this new tumour in the medical journals.

It was difficult news for Erin to grasp. “I remember becoming so overwhelmed with emotions that I just started crying. This is a lot more serious than I thought, but Dr. Mohammed calmed me down. The nurse in the room, Nancy Mongeon, was so sweet and nice,” explains Erin.

“My parents gathered themselves too, and then we just talked about next steps. I was never scared after that because of all the reassurance I got — I just knew I was in good hands, and I just had to trust my team,” adds Erin.

Ready for treatment

Because the team was working with a new type of tumour, there was no precedent for treatment. But since they knew they were dealing with a grade 3 tumour, they recognized radiation was required.

That’s when Dr. Vimoj Nair, a radiation oncologist who specializes in the treatment of children and young adults, stepped into the picture. He brings a particular skill and knowledge in high-precision radiation therapy, including his work with the CyberKnife — a radiosurgery robot that can destroy inoperable brain tumours, as well tumours in other parts of the body. This important piece of equipment was acquired thanks to donors of The Ottawa Hospital.

“We are proud to have access to cutting-edge technology here at The Ottawa Hospital and of our decades of experience when it comes to radiation treatment.”
— Dr. Vimoj Nair

It was Dr. Nair and his research collaborators who first published the made-in-Ottawa platinum seeds used to improve an already incredibly powerful and precise radiosurgery treatment system for tumours in the liver, pancreas, and kidneys. “We are proud to have access to cutting-edge technology here at The Ottawa Hospital and of our decades of experience when it comes to radiation treatment,” explains Dr. Nair.

As Erin was so young, Dr. Nair wanted to give her the best chance at a full life, without recurrence. “It’s not just giving radiation, but there’s ensuring the patient can have good survivorship and maintain all their capacities. She’s young, and we wanted a plan to spare her memory centre, so she has full use of her brain.”

That meant targeting the tumour, but also covering the area around the tumour to treat any potential microscopic disease that human eyes or scans cannot detect. “It’s like a tree on the lawn. You can cut it down, but you still must go after the roots of the tree,” he explains. “This meant using the linear accelerator machine, which could give a lower dose per day to a wider area and allow normal irradiated brain tissue recover, instead of using the CyberKnife, where an intense radiation treatment is given to only any visible tumour.”

By late 2018, after 30 rounds of radiation, the team was hopeful.

Erin recovering

Becoming a part of TOH family

It was during those weeks of radiation treatment that a switch flipped for Erin. It had nothing to do with her health, but rather her career aspirations. Dr. Mohammed remembers when Erin shared this part of her journey. “She talked to me about how she was so much younger than the other patients around her and how much compassion she had for the older people who were also having radiation. She started helping them up, helping them move across the room, and getting paperwork or whatever it was they needed.”

This proved to be a defining experience in her life — a spark in her journey towards healthcare.

Dr. Mohammed could see what an exceptional nurse she would make, and he was there to support her. “I wrote her a reference letter for nursing school and then her training led her to Sunnybrook Hospital in Toronto — that’s where I trained during my residency. When her program was wrapping up, I encouraged her to come to work at the Civic because it’s simply the best place to work.”

In 2021, Erin became a nurse in neurology on F7 — the same floor where she was first admitted to when her care journey began three years earlier. The neurosurgical patient became the neurosurgical nurse.

Erin is a nurse on F7 of the Civic Campus

New lesion appears in a different location

As Erin’s career blossomed, she continued regular MRI scans every six months. Then in May 2022, a tiny dot on the right temporal lobe appeared in a scan.

“I discussed it at the tumour board. This is a group of neurosurgeons, radiation oncologists, and neuropathologists from our hospital who discuss complex cases. I wasn’t ready to put her through another operation just yet, so we watched this new lesion closely,” says Dr. Mohammed.

Then two months later, the lesion grew quite a bit, to the size of a grape. By October 2022, Dr. Mohammed and his team returned to the operating room with Erin to perform a right-sided craniotomy in the temporal region, along the side of her head. “This is a new, small tumour in a different location. The original tumour was gone and all the images that we’ve had so far show that nothing grew back there. So, we removed the lesion and as much dura layer or the covering of the brain as I could.”

Erin with Dr. Mohammed and the surgical team before her first operation

The way it was described to Erin is this new lesion was the result of a drop metastasis — where a small cell from the original tumour dropped down the side and developed into a new tumour.

Unfortunately, just over a year later, the lesion was back, and in January 2024, Erin faced a third surgery to fully resect it, followed by more radiation. Consensus from the tumour board was radiation helped long term with the first tumour, so they should proceed with radiation on the second one.

This time, the challenge was to treat the brain in a different location but minimize overlap with the previous radiation plan, ensuring a good balance between tumour control and any short-term and long-term toxicity risks in a young patient.

“At TOH we are proud to have access to cutting-edge technology and an experienced radiation planning and therapy team. We’re able to spare the brain and it shows our expertise in treating younger brains,” explains Dr. Nair.

Focused on a career of caring

Today, Erin continues to be monitored closely and more treatments lie ahead but she also takes what she’s learned as a patient to the bedside when caring for her patients — knowing firsthand what they are going through.

“It’s such a privilege to take care of patients when they’re in their most vulnerable state, knowing the degree of what they’re going through even though each experience is different.”

— Erin Brown

She has a special connection to those younger neuro patients with whom Erin can relate. “I’ve had a couple of younger patients who were in their 30s and 40s. They just look so scared. They’re going home to their family. They have young kids. They don’t know how to navigate it, and I feel for them because I’ve kind of been in their situation. Maybe not 100%, but I know to a degree what they’re going through, so I’m able to give them that support.”

As for the unprecedented tumour that put her in the history books, she jokingly wishes they had called it an “Erinoma”. Regardless of what her future holds, she’s grateful for the highly skilled team who brought not only their expertise, but also a sense of calm during the most challenging time in her life — a team she is proud to now be a part of.

Categories:

Published: July 2024

Imagine a constant whooshing sound, like a washing machine, in your ear day in and day out — 24 hours a day; never a peaceful moment — even when you’re trying to sleep. For millions of people worldwide, the cause is something known as pulsatile tinnitus. Now, in a world first, The Ottawa Hospital has discovered a potential cure for the majority who live with this debilitating condition.

Chris Scharff-Cole had lived with pulsatile tinnitus for years, but like many, she didn’t know what was wrong and was constantly searching for help. The now-retired psychotherapist from Deep River, two hours west of Ottawa, spent 30 years helping others using her horses as a part of her therapy practice. As a long-time horse person, Chris has seen her share of injuries over the years — including multiple joint replacements. While she’s learned to live with chronic pain, it was that constant sound coming from her right ear that left her wondering how she would ever find peace again.

It wasn’t until she met Dr. Robert Fahed, Interventional Neuroradiologist and Stroke Neurologist at The Ottawa Hospital, that she finally found relief.

Chris with one of her horses
Chris with one of her horses
Chris and her husband together at their horse ranch
Chris and her husband together at their horse ranch
Chris and Messiah's Majesty
Chris and Messiah's Majesty
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Read our Q&A with Dr. Robert Fahed

Brain aneurysm brings patient to the Civic’s Emergency Department

In 2021, Chris was suffering significant pain, so her doctor sent her to Pembroke for an MRI. That scan showed a brain aneurysm, and she was transported by ambulance to the Civic Campus’s Emergency Department. “I had extreme head pain. When I was asked to describe it between 1-10, I said it was 13,” explains Chris.

While waiting with paramedics in the Emergency Department, a top surgeon came down to see her. That was her first introduction to Dr. Fahed. “He listened to the side of my head, and he knew what to do. He said, ‘It’s ok, we’re getting things ready for you.’ It was so busy, but he was truly compassionate.”

“There was a throbbing in my head 24 hours a day that sounded like a washing machine. The pumping in my right ear was constant. It distorted my ability to hear, but mostly, I couldn’t sleep."

— Chris Scharff-Cole

Dr. Fahed and his team performed surgery on the aneurysm, and it was a success, but during regular follow-up, Dr. Fahed uncovered an underlying problem impacting Chris’ quality of life.

Chris had pulsatile tinnitus. “There was a throbbing in my head 24 hours a day that sounded like a washing machine. The pumping in my right ear was constant. It distorted my ability to hear, but mostly, I couldn’t sleep. Even when I fell into a sleep from exhaustion it would wake me up.”

“She had been suffering for years, but when Christine complained to her doctors, she had been told there’s nothing wrong with her ears — multiple scans said everything is normal,” says Dr. Fahed.

He adds it was actually an underlying vessel condition that was the real culprit, one that not many ENT specialists or radiologists know to look for on scans. “This vessel is close to your ear. It’s disrupting blood flow and that’s generating waves. It’s because your ears are fine that you’re able to hear that abnormal flow disruption.”

“No one else in Canada is caring for those patients.”

— Dr. Robert Fahed

What is pulsatile tinnitus?

It’s estimated that 750 million people around the world are affected by some form of tinnitus, and Dr. Fahed says 10 to 20% of those patients have pulsatile tinnitus. Unlike the more common forms, they don’t usually hear a ringing sound, but rather they hear a whooshing sound, like a heartbeat sound constantly in their ear. “Ninety percent of these patients with a pulsatile tinnitus have an underlying curable vascular cause. Among the possible techniques/devices that can be used is the technique we have pioneered with Christine,” explains Dr. Fahed.

The challenge is most people live with this problem because they’re not able to find a solution — much like Chris. But a team at The Ottawa Hospital is giving hope to those suffering. “What’s tough with this is there are vey few people around the world who know how to manage those patients, do the proper work, find a cause, and treat them,” explains Dr. Fahed.

That is why in late 2023, The Ottawa Hospital’s Pulsatile Tinnitus Clinic was launched. The only other clinic is in Toronto. “No one else in Canada is caring for those patients,” says Dr. Fahed.

It was Chris’s case that inspired this leading interventional neuroradiologist, one of only four in Canada, to focus more of his time on this area of medicine.

Pioneering a new treatment for pulsatile tinnitus

In March 2023, Chris was the first patient to undergo a new technique pioneered at The Ottawa Hospital. There are various reasons for pulsatile tinnitus, and the cause for Chris’ was a venous diverticulum, which is a rare defect that consists of an outpouching in the wall of a venous sinus, a vein that carries blood from the brain.

This new technique is called Intrasaccular Flow Disruption. According to Dr. Fahed, it consists of putting a small sphere of metal inside the vein pouch. The sphere traps the blood inside the diverticulum, then creates a clot and the blood will no longer enter that vein. “It’s the blood flow inside that outpouching that is creating waves that are heard by the ear, because of its proximity to the ear.”

"It’s minimally invasive surgery, we go through the groin, we fix whatever anomaly we find, and we cure your pulsatile tinnitus."

— Dr. Robert Fahed

Unlike other techniques used, this one doesn’t require a stent. There are no blood thinners required and the patient requires no medication afterwards.

“The patient comes in for a day procedure. It’s minimally invasive surgery, we go through the groin, we fix whatever anomaly we find, and we cure your pulsatile tinnitus. When you wake up from the procedure the sound is gone. You’re home the same day. It’s incredible,” says Dr. Fahed.

That day when Chris woke up from the procedure, her life changed completely. “When I opened my eyes I said, ‘It’s gone.’ I had total trust in Dr. Fahed. He is gifted. Life is peaceful. I appreciate each day that I’m not haunted by that sound. Every day I wake up is a blessing.”

Not settling for the status quo

She was glad to go first and now hopes it will help others in the future. “We’re absolutely blessed to have access to this type of care. I’m glad to be a recipient, and I hope more people will have this procedure. I’m so grateful and we do what we can to support the hospital – I’m so glad we have Dr. Fahed at The Ottawa Hospital,” shares Chris.

“The Ottawa Hospital pioneered this new technique — we thought outside the box to make it happen.”

– Dr. Robert Fahed

Referrals can be faxed to
613-761-5360
Dr. Robert Fahed
- Ottawa Pulsatile Tinnitus Clinic.

As of July 2024, Dr. Fahed and his team have treated 17 patients for this form of pulsatile tinnitus. It’s important to know that the technique can be used to treat other cerebrovascular conditions and patients are welcome to reach out to the Pulsatile Tinnitus Clinic to learn more.

“It’s another example of how TOH is at the forefront of innovative care,” says Dr. Fahed. “The Ottawa Hospital pioneered this new technique — we thought outside the box to make it happen.”

Dr. Fahed adds this is just the beginning. It’s the launch of a new area of care.

To learn about Dr. Robert Fahed’s “disruptive innovations” in stroke care, listen to episode 73 of Pulse Podcast.

Listen Now:

Categories: Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Cancer, Innovation and Technology, Technology

Published: April 2024

Picture hundreds of medical images mapped out into a concise report so a surgical team can plan a complicated surgery to remove a rare cancerous tumour. Then, picture a virtual reality (VR) system taking all that imaging and giving the surgeon a 3D view that allows them to move within the patient’s body — just like a video game — before surgery. It’s a whole new way of surgical planning, and this new technology was used for the first time in Canada right here at The Ottawa Hospital (TOH).  

When Emeric Leblanc was 13, he started to have pain in his left leg. It was initially believed to be growing pains, but as months went by, the pain worsened. “I used to play basketball, and then I couldn’t anymore because it hurt so much. It would keep me awake at night. Then it got to the point where I had trouble walking,” explains Emeric.  

Eventually, he would undergo a series of tests. On December 8, 2021, now 14 years old, Emeric sat with his mom and dad at CHEO and learned he had Ewing sarcoma. This type of cancer forms in the bones — most often in children between age 10 and 20. The teen’s growing tumour was in his pelvis and about 12 cm in diameter — the size of a grapefruit.  

Fishing is something Emeric is happy to be back doing.
During treatment in hospital

Grasping the complexity of a Ewing sarcoma tumour

While it was a shock to hear the word cancer, deep down Emeric says he already expected further tests would reveal it was cancerous. What was especially hard to digest was the news that he wasn’t going back to school.  

“Everything changed in that moment,” explains Emeric’s mom, Hélène Lachance. “There was a lot of information to digest about the treatment plan and how we could prepare him for that.” 

He returned to school to retrieve all his belongings because chemotherapy treatment started right away. He needed to have his braces removed, and was referred to a fertility clinic, because chemotherapy could make him infertile. It was a great deal for this teen to absorb. No longer as active as he wanted to be, he became much more invested in video games — a sign of what was to come, since VR would be used to help save his life. 

A collaborative team effort

“It was a collaboration of top-notch medical oncology, radiation oncology, and surgical teams between TOH and CHEO. A lot of great people came together to help Emeric.”

— Dr. Joel Werier

For more than a year, Emeric spent most of his time in the hospital. A team from The Ottawa Hospital and CHEO came together to give him the best possible chance at a healthy, active life. “It was a collaboration of top-notch medical oncology, radiation oncology, and surgical teams between TOH and CHEO. A lot of great people came together to help Emeric,” explains Dr. Joel Werier, Head of The Ottawa Hospital Sarcoma Program and orthopaedic oncologist. 

Also, an integral part of the team effort was Dr. Kawan Rakhra, a senior musculoskeletal radiologist at our hospital. Both doctors are also working with Realize Medical, the company behind the new VR technology used for Emeric’s surgery.  

They each played a pivotal role in tackling Emeric’s challenging case. The tumour was on the pelvis and coming quite close to the left hip joint. The goal was to remove part of the pelvis but save the hip joint, because without it, he wouldn’t have the same function of his leg. However, removing a pelvis is probably one of the more complex surgeries in medicine, according to Dr. Werier. 

Dr. Joel Werier is an orthopaedic oncologist and Head of The Ottawa Hospital Sarcoma Program

Stepping inside the patient through VR

That’s where the unique use of technology comes into play. The first step was chemotherapy to try to shrink the tumour, followed by radiation. With the tumour located on Emeric’s pelvis, a plan was needed to save his hip joint.  

“This is where the VR system was really critical. It allowed us to clearly understand the exact anatomy of the tumour and its relation to important structures, including the hip joint,” explains Dr. Werier. 

To best prepare a team to care for a patient, Dr. Rakhra must examine a litany of scans. In his area of expertise, whether it’s an X-ray, ultrasound, CT scan, MRI, or more, there can sometimes be 1,000+ images to scroll through, review, and create a detailed report to help with staging a cancer or planning a surgery. It takes an extensive amount of time and can be overwhelming.  

“If as the saying goes, ‘A picture is worth 1,000 words,' well then a 3D virtual reality model is worth a million, and it's going to transform how we use radiology in surgical planning.”
— Dr. Kawan Rakhra
Q&A with Dr. Rawan Rakhra

“Tumours tend to be complex and challenging for radiologists, surgeons, and oncologists to really understand the intricate anatomy, the location, and relationship to other critical tissues in the organs,” explains Dr. Rakhra. 

The VR system is a game-changer on many levels. Using technology previously used by the video gaming industry, surgical teams can view a customized 3D image of the tumour, then VR headsets help them step inside the patient’s virtual space and make a much more concise surgical plan. “It’s a paradigm shift in radiology where, traditionally, we look at these raw CT or MRI images and generate independent, descriptive reports that are sent to surgeons. But now, we found a way to further process them, integrate them, and convert them into a 3D model, which is a far more informative and powerful tool,” says Dr. Rakhra. “If as the saying goes, ‘A picture is worth 1,000 words,’ well then a 3D virtual reality model is worth a million, and it’s going to transform how we use radiology in surgical planning.” 

VR at The Ottawa Hospital

There is virtually nothing as disruptive in healthcare right now as VR — or virtual reality, if you’ll excuse the pun. This technology is being used across disciplines to improve patient safety, outcomes, and efficiency, while reducing costs and recovery times. It is transforming training and education today, with lifesaving implications tomorrow. 

VR in action

A whole new perspective for the surgical team

For Dr. Werier, it gives a whole new perspective for him and his surgical team. “It allows me to see things the way they’re meant to be seen — in three dimensions, the way our eyes would see them,” explains Dr. Werier. “It allows us to better understand the intricate anatomy and manipulate the images — for example, move nerves out of the way. We can share this with other members of the team and with the patient.” 

And there lies another key benefit to this technology — the patient gets a much better understanding of their diagnosis and care plan. “When you show a tumour on an MRI scan, it’s not quite as appreciated as it is in a VR system,” adds Dr. Werier.  

As for Emeric, he experienced VR by playing video games in the past, but this took him inside his own body to view what his surgical team had to do and to better understand the process.

Emeric in hospital after surgery.

“It was very cool. I could move it around — zoom in, zoom out. I could see the important veins and nerves that they try not to cut. It was also cool that I was the first to experience this.”

— Emeric Leblanc

On July 5, 2022, he became the first patient in Canada to undergo surgery using this new VR program. It was a very delicate surgery that included removing the left side of his pelvis and removing the entire tumour. Thanks to this technology, Dr. Werier was able to save the teen’s hip joint, allowing Emeric to regain his mobility and resume the activities he loved so much — like fishing and camping.

Emeric camping.
Often, Emeric can be found fishing on his dad’s boat.

Immense gratitude to have a skilled team and technology close to home

As a parent, it was a stressful time, but Hélène says seeing the tumour through the VR provided reassurance. “It was such a big surgery but seeing all this and the expertise of the team, I knew they were going to take care of my son. Dr. Werier was awesome. I mean, he saved my son’s life. We’ll always be grateful to him.” 

After Emeric recovered from the 14-hour surgery, he required more chemotherapy, but today he’s doing well. Dr. Werier explains the goal was curative, and they will monitor Emeric closely in the coming years.  

“It’s a complex operation — he’s a remarkable young man, and he did great. The VR helped us a lot. It’s much more intuitive, it gets people on the same page, and it’s much more efficient. It builds confidence in the surgical team.” 

The teen, who is now 16, is back at school, back with his friends, and getting stronger every day. The only difference now is he wears a shoe with a thicker sole on his left foot because his leg is slightly shorter. He also plays video games with a whole new appreciation for VR gaming. 

It’s this technology that is setting the stage for the next generation of surgeons and will give healthcare teams the most effective opportunities to provide the best care options to patients.

“This is the next evolution in how we look at things — a lot of this technology is homegrown in Ottawa, and I think it’s going to lead the virtual technology medical imaging industry. We’re excited about it,” says Dr. Werier.

Download or stream episode 96 to hear more about the impact of the VR technology on patient care with Dr. Kawan Rakhra.

Listen Now:

This success story began with the creation of Realize Medical in 2019, an Ottawa start-up company led by Dr. Justin Sutherland and Dr. Daniel La Russa. Both are physicists at The Ottawa Hospital, who saw an opportunity to further advance patient care using a technology most of us associate with video games. Other key contributors are Dr. Teresa Flaxman and Dr. Yusra Al Mosuli. In fact, Dr. Flaxman has been instrumental in elevating the 3D visualization program within our hospital and has been at the core of the VR modelling process with Drs. Werier and Rakhra since the early developments. Dr. Mosuli has been instrumental in the path forward including the Canadian first moment for this software program, Elucis, and Emeric’s surgery.

Research is critical for finding the best ways to use this technology and proving that it’a effective. Realize Medical has many research collaborations with various teams at The Ottawa Hospital to evaluate and implement their technology.

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa. All researchers at The Ottawa Hospital follow a Responsible Innovation framework for developing and commercializing innovations in a responsible way.

Categories: Innovation and Technology, Patient Care, Technology

A CANCER JOURNEY

Nurse Sabrina Presta’s very different perspective of life as a patient

Published: February 2024

For more than 15 years, Sabrina Presta has been a registered nurse at The Ottawa Hospital. Her home unit is B2, the General Surgery department at the Civic Campus — during the pandemic, B2 became the designated Covid unit for a year. Her team on B2 is close-knit and sticks together not only when it comes to providing compassionate care to patients but also in supporting each other.

In 2020, Sabrina needed that support more than ever. “I was experiencing some mental health challenges, like anxiety. Then, by the end of that year, I was diagnosed with thyroid cancer — that came out of nowhere,” explains Sabrina.

It was the summer of 2020, when Sabrina started getting strep throat regularly — something that she never experienced before. Then she noticed a lump on her neck, and she remembers being afraid of what it might be. She immediately reached out to her doctor.

“The nurse so deeply ingrained in me wanted to read the biopsy report right away. But my intuition guided me wisely, and I decided to wait to meet my doctor face to face.”

— Sabrina Presta

Her doctor ordered an ultrasound, followed by a biopsy. “I had access to MyChart at the time and remember getting a notification that the results were available. The nurse so deeply ingrained in me wanted to read the biopsy report right away. But my intuition guided me wisely, and I decided to wait to meet my doctor face to face. I didn’t want my anxiety to creep up on me and potentially misinterpret the results,” explains Sabrina.

It was December 15, 2020, when she learned the results — the tumours were malignant — it was papillary thyroid cancer. This is the most common type of thyroid cancer and generally impacts people between 30 and 50 years old and appears more often in women. Thankfully, most papillary thyroid cancers respond well to treatment.

“It was during the pandemic, and I was alone when I got the news. I went to my car, and I just started shaking. I was trembling like a leaf. I called a friend, and I was crying on the phone, then I drove home. When I saw my husband, he looked at my eyes and he knew,” says Sabrina.

It was a shock because this active mom of two daughters had no other symptoms, other than the sore throat and lump on her neck. The good news was that it was a non-aggressive, slow-growing form of cancer. It would, however, require a total thyroidectomy — the complete removal of her thyroid gland because there were two cancerous nodules, one in each lobe. 

Her daughters were old enough — nine and seven at the time — that Sabrina and her husband sat them down to break the news. “My eldest daughter was surprised to hear the word cancer because I didn’t seem sick. She was sad at first, then was reassured when she heard us talk about the treatment, including surgery. The hardest part for her was watching her little sister’s reaction. She quickly took on the big sister role and comforted her sister,” explains Sabrina. “Meanwhile, my youngest cried ‘Are we still going to have Christmas?’ Her world was just rattled in that moment when she heard cancer. Her great-grandmother died of cancer, and so she thought cancer meant mommy’s going to die.”

Sabrina is an active mom of two daughters.

She assured her daughters she would be well taken care of, and the surgery would make her better.

In Eastern Ontario, the General Campus of The Ottawa Hospital is home to the region’s Cancer Centre — it is the hub and supports satellite centres from Barry’s Bay to Hawkesbury to Cornwall. The Irving Greenberg Family Cancer Centre, located at the Queensway Carleton Hospital, is also a part of our cancer program. Thanks to state-of-the-art technology and world-leading clinical trials, we can provide a wide-range of care for patients across Eastern Ontario and Nunavut.

As a resident of Limoges, Sabrina was grateful to be able to have her surgery at the Winchester and District Memorial Hospital — a community partner with our hospital — in February 2021. The surgery went well, and the next day, she was sent home to continue her recovery. But days after the surgery, Sabrina developed symptoms that made her nervous, and she went straight to the Emergency Department (ED) at the Civic Campus.

“I was home and had just woken up. I walked to the bathroom and almost fainted — everything went black. I started to have tingling sensations and numbness in my legs, arms, and face,” remembers Sabrina. “After my surgery, I was given discharge instructions from my nurse. Those were two signs to look out for in the post-operative phase, as my body was adjusting to life without a thyroid gland. I woke up my husband, and he drove me to the ED right away.”

“It was an act of kindness that went a long way for me. It taught me that you can really leave a lasting impression on someone’s life experience.”

— Sabrina Presta

Now Sabrina found herself as a patient, in her own hospital, and something “magical” happened. She was waiting to be seen when a respiratory therapist she works with saw her. “He took a few moments out of his busy shift to come over to me. His kindness gave me the opportunity I needed to be comforted and to cry. My tears flowed as I was feeling overwhelmed, tired, and scared of my current reality,” explains Sabrina. “He stayed right there with me. I was very weak, and he helped guide me to the bathroom. Before he left, he gave me tea and crackers. It was an act of kindness that went a long way for me. It taught me that you can really leave a lasting impression on someone’s life experience. He was present. This respiratory therapist gave me that gift.”

As a nurse who diligently practices her profession with compassion, being on the receiving end was eye-opening. “When I was a patient, this word became the hope I needed.”

Sabrina soon received good news — what she was experiencing was normal after her type of surgery, and she was able to go home. Within six weeks, she was back at work with a different outlook as a nurse. She was inspired to create her own wellness initiative for her B2 team called B2 Steps Ahead with Sabrina — a collaboration to help colleagues with their mental health. “I created a special room on our unit, the Rest Room, where colleagues can go and recharge in a quiet space during their shift. It even has twinkling lights to relax.”

A poster for Sabrina’s wellness initiative for her B2 team.

Her experience with cancer has taught her to slow down and take care of herself holistically. When she is not working on the frontlines, you will probably find her outside either running, walking, practicing yoga, or writing. A dear colleague even gave her the nickname, “Mother Nature.” “I just love being outside! The fresh air gives me something ineffable,” smiles Sabrina.

Today, she can look back on her cancer journey with gratitude. “It is a privilege to work as a registered nurse in facility that gives me a sense of fulfilment.”

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Strengthening Critical Services, Strengthening Critical Services

A CANCER JOURNEY

Music leads Caleb Fagen through his journey with Hodgkin’s lymphoma

Published: February 2024

Music is huge a part of Caleb Fagen’s life — you could say he lives and breathes it. When the university student started to feel rundown in the summer of 2021, he thought he had been pushing himself too hard. Soon though, he was diagnosed with Hodgkin’s lymphoma. It was shocking news for this young man and his loved ones. 

“I was completely unprepared when I heard the diagnosis. I was shocked.”

— Caleb Fagen

Earlier that year, Caleb was attending uOttawa for his undergrad in music, he was teaching private music lessons and was a part of the school’s choir — something that brought him great joy.  

“I was very focused on school. It was the hardest year of my undergrad, especially with the pandemic. I practiced three to four hours a day on the piano — I was working hard,” explains Caleb.  

In addition to feeling rundown, he had also become anxious and depressed, and he wasn’t eating well.  

“I was completely unprepared when I heard the diagnosis. I was shocked. I was so focused on school and music that all I wanted to know was how I was going to be able to practice, and how was school going to work?” remembers Caleb. “I didn’t want to lose the momentum that I gained.”

Caleb with his partner Jane. 
Caleb with his partner, Jane, after they both shaved their heads in anticipation of his chemotherapy treatment. 

Shocking diagnosis of Hodgkin’s lymphoma 

Hodgkin’s lymphoma begins in a patient’s lymphatic system — that’s part of the body’s germ-fighting immune system. The white blood cells grow abnormally and can form growths (tumours) throughout the body.  

Once Caleb digested the news, there was acceptance. He credits a great deal of that to his incredible support system, including his parents, his brother, and his partner, Jane.  

“My dad came to all my chemo treatments and took time off work to be there with me, and mom was a huge support. My partner lived with me through a lot of this too, it really helped, and it brought a lot more love to this scary situation.”

The first course of action was chemotherapy, and those treatments went from October to the end of March 2022. Caleb maintained some online courses during this period, and overall, he got through the treatment fairly well. That spring he travelled to Italy, resumed working, and even thought about plans to finish his degree. 

Caleb with his family on vacation in Italy. 

A stem-cell transplant the next level of defence 

By late summer of 2022, just one year after his initial diagnosis, a PET scan showed the disease was refractory. That means while it appeared Caleb initially responded to treatment, the cancer had returned.  

The next step was a stem-cell transplant — a process that began in September. “It was quite an ordeal. I went through a few rounds of chemo, and then the stem cell collection. That was followed by the harsh conditioning chemo treatment to wipe my system clean. I felt like a walking zombie. I was very feeble,” explains Caleb. 

Caleb playing the accordion at his home. 

“The team was really good. There was a time when I had to be an inpatient and I was treated well. They told me it would be difficult post-transplant, but it would get better.” 

— Caleb Fagen

It was Halloween when he received his stem-cell transplant. He credits his care team at The Ottawa Hospital for helping him through a very difficult period. “The team was really good. There was a time when I had to be an inpatient and I was treated well. They told me it would be difficult post-transplant, but it would get better.” 

Caleb describes the following month as the worst of his life. “There were times in November when I lost my sense of taste. My tongue felt like it was a rock, it felt stiff and hard, and my appetite wasn’t good. That was just one example,” remembers Caleb. “It was a traumatizing time. I had a psychologist and support to help me work through things and to focus on breathing and to stay calm.”

Cancer and the mental health journey 

The Cancer Centre’s psycho-social oncology program was established to provide patients like Caleb the support needed to help cope with the many challenges associated with cancer and its treatment.  

One person who was an integral part of helping Caleb during this challenging time was social worker Izabela Uscinowicz Valdivia. “Isabela was terrific. I was with her since before my transplant. She was there during the really bad times. We developed a great relationship,” says Caleb. 

He also credits his hematologists Dr. Manika Gupta, who started this journey with him, and Dr. David Macdonald, who currently cares for him.   

Gradually, things started to improve for Caleb, but he admits it was a slow process. By December, he was regaining strength both mentally and physically, and he sat down to play again. “That was a great moment when I was able to start playing the piano. I missed it.” 

Looking to the future  

Because of the high risk of relapse, Caleb started a new chemo treatment in December, which occurred every three weeks and only ended on October 27, 2023. It was then that Caleb was able to ring the bell at the Cancer Centre to mark the end of his treatment.  

Today, he’s back at school in-person part-time, with two more courses left to get his degree. He’s also writing music for himself and teaching again.  

“Physically I feel a lot better. I want to start exercising more to build up my strength, but I’m in a better place. I’m still dealing with mental health issues. I have a counsellor, but I have fewer things to say, so that’s good,” Caleb says with a smile. 

Now 23, Caleb’s recent scan showed he’s in remission, however, he continues to be monitored closely with an ultrasound and then another PET scan coming in the next six months. In the meantime, he’s making plans. He hopes to travel to Portugal in 2024, and long term, he wants to continue sharing his love of music with others by opening his own music school — a dream he hopes to see become a reality one day.

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Mental Health, Strengthening Critical Services

A CANCER JOURNEY

Years after losing his dad to cancer, Robert Nsengiyumva faces his own diagnosis

Published: February 2024

When Robert Nsengiyumva was 24, he lost his dad to liver cancer. It was a devastating time for this young man and his family. Little did he know, 25 years later, he’d face a cancer diagnosis himself — stage IV stomach cancer.

After his dad died, Robert assumed the role of father figure to his four younger siblings — two sisters and two brothers. While his mother worked to help support the family, he also stepped forward to help provide care and financial support for his family.

In the years that followed, cancer was no stranger to Robert’s family — several other members also faced a cancer diagnosis. Then in 2021, he received his own devastating diagnosis after experiencing weight loss and abdominal pain, along with nausea and vomiting. “I was 53. I was an active person, and so it was a very difficult time for me,” explains Robert.

Coming to terms with the news was also difficult for those closest to him, like his wife and circle of friends. “I will not lie; it was a like a bomb dropped — it was that shocking. When I decided to tell a few friends what was going on, they didn’t believe me at first. They thought it was a joke — then they realized it was true,” explains Robert.

Understanding a stomach cancer diagnosis

Stomach cancer — also known as gastric cancer — is a growth of cells that starts in the stomach. While it often starts in the lining, it can start in anywhere in the stomach. Thankfully, occurrences have been declining, but it is still one of the most common cancers worldwide.

Robert at the Civic Campus of The Ottawa Hospital. Photo by Ashley Fraser

According to the Canadian Cancer Society, most stomach cancers are found when the disease is advanced and remission is less likely. When it spreads past the stomach wall or into other parts of the body, it’s harder to cure.

In Canada, the five-year survival rate for stomach cancer is 29%.

Due to the stage of Robert’s cancer, treatment began right away. His medical team at The Ottawa Hospital included, Dr. Dominick Bossé, medical oncologist, and Dr. Carolyn Nessim, surgical oncologist, who were ready with a plan. The first course of action was four chemotherapy treatments. These started on October 18, 2021, and the last treatment was at the end of November. Next up would be surgery.

By early January 2022, Robert underwent surgery on his stomach, led by Dr. Nessim. “It was an isolating time. I had to live within four walls because of the pandemic. I had to be careful not to get COVID,” he says.

After a successful operation, Robert was given some time to recover before he resumed chemo treatments. By the end of April, his treatments were done and deemed a success.

“The first round of chemotherapy treatment was very difficult; I suffered a lot, but the final four were much easier. After my treatments were done, I started to improve and feel better,” explains Robert.

Here to say thank you

By July 2022, Robert returned to work part-time. “Then by August, I was back on the job as a Building System Technician in the Public Service, full time. That’s something I never thought would happen when I first received my diagnosis,” says Robert.

“I wanted to support those who faced cancer like me, and so becoming a donor to The Ottawa Hospital was an easy choice.”

— Robert Nsengiyumva

Today, he shows no signs of recurrence, and Robert is making the most of every day.

Robert at the Civic Campus of The Ottawa Hospital. Photo by Ashley Fraser

He’s also deeply grateful for the team of medical experts that were ready to care for him when he needed them most. In fact, he’s always wanted to give back in some way. “I wanted to support those who faced cancer like me, and so becoming a donor to The Ottawa Hospital was an easy choice ,” says Robert.

It’s a monthly donation that allows him to say thank on a regular basis to those who helped give him more time. “This is my way to thank everyone who cared for me. The staff, including the doctors and nurses at The Ottawa Hospital Cancer Centre, who treated me during my illness. I don’t know how to thank them enough, so I decided to send my donation every month, and it feels good.”

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Donors

A CANCER JOURNEY

Diagnosis of Hodgkin’s lymphoma stops Heba Haidar in her tracks 

Published: February 2024

At age 33, and with three children under the age of five, Heba Haidar was making big plans in the spring of 2022. She and her husband were planning an eight-week trip back to Lebanon to see their family — it would be the first visit since before the pandemic. Two of her three children would meet their grandparents for the first time. But everything came to a grinding halt when Heba learned she had Hodgkin’s lymphoma.  

The first red flag came when Heba noticed random swelling in her neck. Her doctor ordered an ultrasound, and the results were inconclusive. The swelling went away on its own. “My doctor suggested I see an ear, nose, and throat (ENT) specialist at The Ottawa Hospital,” explains Heba. “Not long after I got that referral, I noticed a lump in my neck below my collarbone, but I had no other symptoms.” 

Five days before the family’s long-awaited trip, Heba met with the ENT specialist who ordered a biopsy. The results would be available in five to seven days — by that time, Heba and her family would be in Lebanon.  

“I left it to fate. I decided we’d still go on the trip, but the day before we were supposed to leave, I got the call,” remembers Heba. “My ENT doctor gave me the news over the phone knowing I was leaving. The results showed a malignancy, but not enough to give me a diagnosis.”  

Diagnosis of Hodgkin’s lymphoma flips world upside down 

Suddenly, Heba’s life was flipped upside down. “There was panic. I was in complete shock.”

“There’s no road map to navigate this news. The first thing we did was unpack for our trip.”

— Heba Haidar

Then, with the trip cancelled, Heba was thrust into a series of appointments, including tests and scans to pinpoint the diagnosis. At the time, she was on maternity leave as manager of a medical clinic — she was nursing her nine-month-old and caring for her other two children who were four and five years old. They all relied on her 24/7. 

Just two weeks after she was supposed to leave on her trip, Heba was diagnosed with Hodgkin’s lymphoma and referred to the hematology team at The Ottawa Hospital where next steps were discussed and the roadmap for treatment put in place.  

Heba during her treatment at The Ottawa Hospital. 

“That period from diagnosis to treatment plan is probably the worst period a patient can go through because everything is unknown, and your mind goes wild — wondering what’s going to happen,” says Heba. 

Both Hodgkin’s lymphoma and non-Hodgkin’s lymphoma form in the white blood cells. Those cells are called lymphocytes, and they are an important part of the body’s germ-fighting immune system. The difference between the two can only be seen under a microscope and depends on whether a particular type of cell called Reed-Sternberg is detected. If it is, then the lymphoma is classified as Hodgkin’s. If it’s not, then it’s diagnosed non-Hodgkin’s lymphoma. Hodgkin’s lymphoma is generally diagnosed at an earlier stage.  

Six months of chemotherapy with three young children at home 

Since Heba’s cancer was stage 2, her hematologist, Dr. Melissa Toupin, started her on four to six months of chemotherapy starting in mid-June. A scan in early August 2022 showed she was in remission. However, Dr. Toupin recommended she continue with a full six months of chemo to give her the best possible chance to avoid a recurrence. 

Heba described every round of chemo as a challenge. “Something that was just foreign to me two months ago was now a regular part of my life. It took me some time to come to terms with the extension of treatment, but knowing my scans were clear, it helped.” 

She also turned to our psycho-social oncology program for support. She did several sessions to help with the mental side of the cancer treatment. Over the next few months, she stayed active by walking, weightlifting at home, and of course, being a mom didn’t stop. 

Then on November 16, 2022, Heba rang the bell, signifying her final treatment. She described the moment as surreal and amazing. “It was kind of like a double-edged sword. There was relief, but then there was the whole realization of what I just went through,” remembers Heba. “I was in survival mode and then just like that, treatment was done. There was also that safety net when I was going to the hospital regularly. Now the safety net was removed. I worried about recurrence and what would happen to me.” 

Desire to give back and support groundbreaking research 

During her treatment, Heba was reflecting on the hospital’s care team that surrounded her, and she wanted to give back. She started a fundraiser with a goal of $10,000 to support cancer research at The Ottawa Hospital. “I wanted to raise awareness for the work The Ottawa Hospital is doing.”

“We have groundbreaking research right here in Canada, right here in Ottawa, and I wanted people to know about that.”

— Heba Haidar

Today, Heba is doing well and in a good place. That special trip back home finally happened in May 2023. In the midst of her treatment, it was hard to imagine the trip, but she remembers what a nurse said one day. “She said by next year, it will all feel like a bad dream.” 

It also gave her a whole new perspective on life and the hospital. “At 33, I didn’t think about The Ottawa Hospital other than giving birth to my son. Even with my background in healthcare, my thoughts of the hospital were about having babies – happy thoughts. But now I think of the team and the compassionate people. They saved my life. They save lives and prolong lives.”  

Heba preparing a lemon poppyseed loaf in her kitchen. 

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Mental Health

A CANCER JOURNEY

Randy McElligott’s unusual reaction to his cancer diagnosis

Published: February 2024

When Randy McElligott heard the words “you have cancer”, he didn’t have the average reaction to this type of news. “I was happy. Most people don’t take that attitude, but I saw it as an opportunity to change my life,” explains Randy.

That’s exactly what he did. Randy decided to train for a marathon. He wanted to try something challenging, and he’s been moving ever since.

“I had what’s known as smoldering multiple myeloma. It sits there and doesn’t do anything. It’s like a volcano just waiting to erupt.”

— Randy McElligott

It was July 13, 2005, and Randy was 49 when he received the news — it was a surprise find. His family doctor had ticked off an extra box on the requisition form for his blood test. That mark resulted in the discovery of cancer — or what would become cancer. “I had what’s known as smoldering multiple myeloma. It sits there and doesn’t do anything. It’s like a volcano just waiting to erupt,” explains Randy.

Multiple myeloma is a cancer that starts in a type of white blood cell that’s known as a plasma cell. These cells help the body fight infection, and they can be found in the bone marrow, as well as other tissues and organs.

For nine years, he waited for the “eruption” but maintained his positive attitude. And over those years, he kept busy doing the things he loves, like hosting his jazz radio show, In Transition, on CHUO-FM — a program he’s been doing since 1988. But his greatest distraction has been running. Since his diagnosis, he has completed 12 marathons and about 80 half-marathons. “That kept me sane and kept me focused. By doing marathons, I was building up my mental ability to handle what was ahead for me regarding cancer.”

Becoming symptomatic for multiple myeloma

In 2014, Randy and his wife, Nicole, were in Barbados on vacation, and he became symptomatic. “I was in excruciating pain. I returned home and was hospitalized right away. The cancer had spread to my spine, chest, and sternum.”

Randy makes bi-weekly visits to the General Campus for his treatment.

Once Randy was stabilized, he was discharged, and chemotherapy treatment began at the cancer outpatient at the General Campus of The Ottawa Hospital. He also forged on with his running.

The next big hurdle Randy faced was a bone marrow transplant in October 2015. But true to his character, seven weeks later he did a 10k run and then another marathon. “It’s all because of the cancer. I must prove, even if I have cancer, I don’t have to stop. I wanted to show other cancer patients they can keep going. Look at Sindy Hooper — she is incredible and one of the inspirations in my life to keep going and do these races,” explains Randy.

“I have a great cancer team. If any medical trials are coming up, they know I want to help.”

— Randy McElligott

This cancer journey has been a rollercoaster ride for Randy — he has been in and out of remission several times since his diagnosis almost 20 years ago. But his positive attitude is the one thing that never wavers.

He also credits the specialized team — which includes four hematologists — for always being ready when a new challenge presents itself. “I have a great cancer team. If any medical trials are coming up, they know I want to help.”

Access to clinical trials at The Ottawa Hospital

Access to clinical trials is key for patients like Randy, and thankfully, The Ottawa Hospital has one of the largest and strongest clinical trials programs in Canada. This gives patients access to even more novel therapies. And in addition to helping establish best practices for patient care around the world, clinical trials also provide new hope.

Through his own journey, Randy is doing what he can to help our scientists learn more. “I told my hematologist, Dr. Arleigh McCurdy, she can do anything. I’m your guinea pig. I’m on my second drug trial now. It’s a highly experimental drug and so far, it’s going well. The first trial, three or four years ago, was for another drug, and that worked for a while, but then I relapsed,” says Randy.

“It means the world to have access to this type of care. And if I can help other patients, what could be better?”

Randy is an avid runner.

Maintaining a positive attitude

In the last few years, Randy faced new health challenges. In 2021, within only a few weeks, he lost 30 pounds. It was a bit of a mystery as to what was happening. “It was looking like this was the end of the road for me. I thought my time was running out, but I just said, ‘Cool.’ Hospice care was being planned, but then I started gaining weight again, and I completely rebounded,” explains Randy.

“I never get discouraged. I’m always joking around. It’s been an incredible journey.”

— Randy McElligott

Unfortunately, Randy then had new obstacles to overcome. The following year, he was on a trip to Montreal with his wife when he fell and broke a leg, wrist, and two ribs. Then in February of 2023, he broke the same leg, again. After surgery on that leg, he contracted a potentially life-threatening bacterial infection. He was treated in hospital for a month, and he had to learn to walk again.

These incidents may have taken the biggest toll on him, as they’ve prevented him from running. “I never get discouraged. I’m always joking around. It’s been an incredible journey.”

Today, thanks to the clinical trial he’s currently on, Randy is once again in remission. He hopes to start back on his spin bike to regain his strength so one day he might get back to running — his true love.

Randy makes bi-weekly visits to the General Campus for his treatment.

For now, he makes bi-weekly visits to the General Campus for his treatment. “It was initially every week, but now it’s every two weeks, and it only takes seconds to administer by needle. I think my team is surprised I’ve lasted this long after relapsing several times. But as of today, there’s no trace of the myeloma,” Randy smiles.

While fatigue is preventing him from being active, he continues to entertain radio listeners with his jazz favourites and looks forward to lacing up his running shoes once again.

“It’s really an incredible life.”

The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.

Categories: Clinical Trials, Clinical Trials, World-Leading Research, World-Leading Research

Update: October 2023

Over the past few months, we’ve had the distinct privilege of working closely with Alison Hughes to share her story. Only 37 years old when she was diagnosed with breast cancer, she wanted to raise awareness, especially among other young woman like her.

We are heartbroken to learn that Alison passed away on Wednesday, October 11, 2023. We offer our deepest condolences to all those who knew and loved her, and we remain profoundly inspired by her.

Originally published: September 2023

This is Alison’s story told in her own words.

I wanted to share my story now, because I want more young women to have a story they can relate to. Sadly, breast cancer doesn’t just affect women over 50. By sharing my story, I hope I can help younger women better understand what this journey is all about, because I didn’t really have that when I was first diagnosed ten years ago. 

At that time in my life, I owned a consignment store specializing in women’s fashion. I love fashion, so it was a great fit for me. I also had two young children — life was busy.  

But then I got the shock of a lifetime. It started when I found a lump on my right breast, and I remember telling my husband at the time that it hurt. He told me not to freak out, but I just had this feeling something was wrong, so I called my doctor.  

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The Ottawa Hospital is home to one of the best-equipped cancer treatment centres and one of the most advanced cancer research programs in the country. Thanks to this expertise and support from the community, we're seeing breakthroughs that a decade ago seemed impossible.
Little did I know, that was the beginning of my breast cancer journey. I was sent for a mammogram, just to be safe. It was a Friday, and I remember walking into the office and looking around and seeing older women — I was young and hip — no one else looked like me. It wasn’t long after the mammogram that I knew something was wrong. The busy office went quiet, it was like I’d stepped into a movie. Other experts came in and examined my results. It turned out I had stage 3 breast cancer.  

My way of coping with a breast cancer diagnosis

I remember someone talking to me, but I honestly don’t remember what they said. Then a lovely nurse sat next to me, and that’s when I felt a tear drop out of my eye, and then I slowly started to cry.

“I can’t do this…I have no room in my life for this right now – this can’t be happening!’

— Alison Hughes

I drove back to my store and remember thinking ‘I can’t do this. I have a two-year-old and a three-and-a-half-year-old. I have no room in my life for this right now – this can’t be happening!’ 

But it was happening, and within two weeks, I had a PICC line inserted, and chemotherapy soon followed. The news of my diagnosis was particularly difficult for my parents because my dad’s mom died from breast cancer in her mid-thirties. So, I said ‘We have one day to cry and then after that, for the outside world, there’s nothing happening.’ We hid my diagnosis from almost everyone — that was my coping mechanism. Everyone has their own way of coping – this was mine. 

Soon, I met Dr. Mark Clemons. I refer to him as my first oncologist and now my forever oncologist. We clicked. He was well informed, supportive, and had time for all the questions we had for him. He gave me confidence to know that the choices he was making were not from just a singular perspective, he was looking at my total healthcare options.  

Alison Hughes with her two children, Rosie, and Raffi.
“Alison is an amazing woman. She is young and has such enthusiasm for life – something her breast cancer is trying to rob her of. But thankfully, the treatment we have now compared to 25 years ago, is night and day. It’s far less toxic and more effective. We also have the availability of clinical trials which Alison has been involved with, including REaCT trials. The REaCT program is Canada’s largest practical trials program, that time and time again shows that we can treat patients with more effective personalized therapies with significantly less cost to the patient and the healthcare system.”
— Dr. Mark Clemons
— Dr. Mark Clemons
“Alison is an amazing woman. She is young and has such enthusiasm for life – something her breast cancer is trying to rob her of. But thankfully, the treatment we have now compared to 25 years ago, is night and day. It’s far less toxic and more effective. We also have the availability of clinical trials which Alison has been involved with, including REaCT trials. The REaCT program is Canada’s largest practical trials program, that time and time again shows that we can treat patients with more effective personalized therapies with significantly less cost to the patient and the healthcare system.”
— Dr. Mark Clemons
— Dr. Mark Clemons
Alison is living with stage 4 breast cancer.

The specialized team ready to handle my care

But he wasn’t alone. There was an entire team at The Ottawa Hospital ready to help me have more time to watch my children grow.  

From September to December 2013, I underwent chemotherapy, but by the fifth and sixth treatment, I was hit hard. My beautiful hair fell out, my skin turned gray, and I was in bed all the time. Then in February of 2014, just as I gained back most of my strength, I had a mastectomy. During that operation, a bunch of lymph nodes from under my right arm were removed and sent for testing. We’d later learn that more than half of them were cancerous. That’s when radiation treatment started. 

The care was amazing, and so were the resources made available to me afterwards, because that is a difficult operation to undergo. I had access to psychosocial oncology, as well as a dietitian.  

By that summer, I started feeling better, and that’s when I started telling people what I had gone through. Sometimes they’d turn white as a sheet when they heard the news — I really believe it’s because there’s not a lot of women my age that relate to this kind of a diagnosis.  

Then after five years, I was doing well and released from the cancer program. I had successfully recovered from breast cancer — or so I thought.  

Devastation when cancer metastasized

In 2021, in the middle of the pandemic, I experienced a ton of pain in my back and my hips. I started physio and got relief for a few days but then it came back. One day at work, I tripped on a mat, fell, and couldn’t get back up at first. I kept getting this insane spasm. Later that night my parents found me on the floor, unable get up. They helped me into bed, and I stayed there for four days. 

Then one day my daughter noticed my leg looked like I’d been burned by a big rod. I looked at my kids and I said, ‘I think I should go to the hospital.’ Little did I know my world would be turned upside down, again. 

“I went from seeing a physiotherapist because of my back pain to stage 4 cancer with possibly only months to live. It was almost too late.”

– Alison Hughes
Soon, I discovered my breast cancer had metastasized. I had compression tumors on my spine and a lesion in my lung. I had a tumour on my liver, and there was cancer in my stomach and in my bones. I also had multiple moving blood clots, which caused that mark on my leg. It was kind of like the house was lit on fire and it was going up in flames. Suddenly, I went from seeing a physiotherapist because of my back pain to stage 4 cancer with possibly only months to live. It was almost too late.   

My body was riddled with cancer

The next thing I knew, I dove back into treatment. I had a radiation team, an oncology team, and a palliative team. I had a home nurse as well as psychological support. The resources are unbelievable.  

I moved back in with my parents, along with my kids who were then 10 and 12, because I was at a point where I couldn’t climb a set of stairs, and I couldn’t really function on my own. In addition to the blood clots, I had multiple broken bones from the cancer and crooked shoulders from all the broken bones in my back. I was either in a wheelchair or walked with a cane, and my stomach was really bloated because of the disease. There was just so much going on — my body was in emergency mode.  

While my extensive team at the hospital mobilized, my parents took care of me and the kids, and our incredible network of neighbours rallied alongside us. That meant I could be in treatment, and the kids could still have some normalcy — they could go outside and play.  

Alison with her parents and children.

Finally, there was some good news

From June 2021 through until February 2022, I had radiation led by Dr. Laval Grimard to help with the cancer in my bones, followed by chemotherapy. After a clinical trial was not successful, Dr. Clemons tried me on a new chemo option that finally brought some hope. In June 2022, I started to feel better.

By that summer, my spine started straightening, I could move better. And my health continuously improved. All my bones healed, the tumors shrunk, and I could walk unassisted most of the time. I was back working part time as a background actor in movies — maybe you’ve seen me in a Hallmark movie — I also do some modelling.

By the spring of 2023, I had a clear scan, and I went overseas to spend some time in Oxford and London — it was spectacular. But when I returned home in early June, I could feel my body grinding to a halt. I could barely walk. The next thing I knew, I was in a wheelchair — I couldn’t walk. It happened fast.

Alison on set.

Little did we know what would come next

Once again, I was thrust into emergency mode to determine what was happening. I had x-rays and scans, and I don’t think any one of us expected to see what we saw on those scans. I was pretty sure this was it for me.

There were new lesions on my lower spin and this time they also found a tumour on my brain. Immediately, my care team acted. My new plan included five radiation treatments on my back and one on my brain. Then I started a new type of chemo treatment in August. This chemo is at the forefront of treatment options, and I can’t thank Dr. Clemons enough. I call it the Cadillac of treatment — I feel really lucky. And the way I see it is, if I can be an early user of this drug and they can learn from me, that’s a good thing.

“My philosophy is, if you can test me or use my blood or do something with me that's going to make things better for someone else, sign me up.”

– Alison Hughes
In fact, when it comes to clinical trials, I’m in total favour of getting involved. I told them, ‘You can poke me, learn from me, use me as a case study. Let students practice on me.’ I’m already sick, so my philosophy is, if you can test me or use my blood or do something with me that’s going to make things better for someone else, sign me up. I just feel so fortunate to have this level of care and access to clinical trials — even if the one I tried didn’t work, it gave me time. And the medical team learned because of me.
Alison with her two children, Rosie, and Raffi.
Every day I’m so thankful to have this precious time. Dr. Clemons has even given me the nickname “Puss in Boots” because it’s like I have nine lives. He has such a unique and special way with patients. He asks, ‘What life are we on?’  
Read our Q&A with Dr. Clemons

In fact, I often find myself thinking, ‘Who gets this many chances?’ And that’s why I’m sharing my story. I’m fortunate for the care, the support, and the learning because life doesn’t always gets perfectly tied with a bow — not everyone gets a bow.

I don’t know what the future holds.

I just want the chance to be here for my kids and my family. I do my best to make every day a good day with them and hope that science continues to improve. Today, Rosie is 13 and Raffi is 11. I’m learning to become a mom of teens. I like to think about their high school graduation and university life. I just hope I’ll be able to keep watching them grow, even when they don’t need me as much.  
Download episode #86 of Pulse Podcast to hear Alison’s story and why she wants to help other young women who face a breast cancer diagnosis.

Listen Now:

Categories: Patient Care, Patient Care, Patient Care, Patient Care, Patient Care, Patient Care, Patient Care, Patient Care, Patient Care
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