Shane and Ellen Ottens have seen their four boys go through their fair share of bumps, bruises and broken bones over the years. However, nothing prepared them for the diagnosis their son, Spencer, would receive in the fall of 2017.
Category: Creating Tomorrow
A parent’s worst nightmare
14-year-old Spencer’s eye became reddish and tearing for more than a week; and this strange blockage was protruding from his nose. Despite repeated efforts, it would not come out.
That’s when Spencer’s mom, Ellen, knew he needed help and they would ultimately end up in CHEO’s emergency department. Doctors ordered a CT scan. It was around midnight; Ellen recalls when the results came in.
“A gravely concerned looking doctor asked me, ‘Did you know that Spencer has a tumour in his head?’”
It was not the news any parent wants to hear.
The growth, which was protruding from Spencer’s nose, was biopsied. While benign, that tumour was resulting in the quick deterioration of Spencer’s health. When Ellen asked to see the CT scan, she recalls searching the picture for a grape or golf ball sized image attached to a nose growth.
“I didn’t see any and asked where it was. ‘It’s the grey area’, the doctor said.”
The grey area was over half of his face.
“I didn’t even want to think about what his face would end up looking like after all the cutting they’d have to do to remove so much material, but I had to ask.”
The doctor revealed the tumour was larger than any he had ever worked with. It was for that reason and the fact it was reaching up to the floor of the brain, he told Spencer’s parents they couldn’t perform the surgery.
This type of tumour would need a specialized team of an ear, nose and throat doctor along with a neurosurgeon working together. Ellen recalls thinking she would take her son anywhere in the country to get the help he needed.
Specialized care at The Ottawa Hospital
However, the specialized care was nearby at The Ottawa Hospital. A highly skilled team would perform minimally invasive surgery and remove the tumour through Spencer’s nose.
Just over a week later, with his condition worsening, Spencer was to be admitted to The Ottawa Hospital. He had another CT, an MRI, and the specialized team was monitoring his optic nerve behind his bulging eye to ensure it wasn’t being severed by the growing tumour.
Two days later Spencer underwent a 4-hour surgery, which helped stop 80% of the blood flow feeding the tumour. The remaining 20% would maintain blood flow to his brain.
The next day the highly skilled team, which included Drs. Fahad Alkherayf and Shaun Kilty performed an eight-hour surgery. With expert precision, and state-of-the-art technology, they would remove the large tumour from Spencer’s face and base layer of the brain. They also rebuilt that layer to prevent the fluids that protect the brain from leaking out.
This minimally invasive surgery, removing the tumour and rebuilding the layer, was performed through Spencer’s nose by Dr. Alkherayf who has the greatest number of surgical hours of training for this procedure in Canada.
Dr. Fahad Alkherayf
Dr. Shaun Kilty
A Canadian Medical First
In order to rebuild the brain layer, 3D printing technology also aided doctors during the surgery. Ellen says it’s remarkable. “It’s really pretty cool the advancements which have been made to help patients in our community.” In 2016, The Ottawa Hospital became the first hospital in Canada to have an integrated medical 3D printer.
Ellen says her initial concerns of recovery completely faded thanks to this minimally invasive technique. “It was incredible. Spencer was home again only three days after surgery!”
When she thinks back to the fear of the initial diagnosis to where Spencer is today, back at school and active, several thoughts comes to mind.
“I was immensely grateful to God and The Ottawa Hospital, and I truly feel that we were in the best hands.”
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Neuro, Technology
Story by Vesna Zic-Côté
“In 2012, I was diagnosed with early stage breast cancer. Despite the standard treatment of surgery, chemotherapy, radiation and hormonal treatment, the cancer returned four years later, having spread to my lungs, bones and lymph nodes.
I received my diagnosis of incurable stage 4 metastatic breast cancer on my son’s birthday. He was nine.
My world as I knew it ended. I was sitting upstairs on my bed. I could hear the kids playing downstairs. I called my husband at work and he came home and we cried.
It is a tradition in our home that on our kids’ birthdays, we go out to a restaurant of their choosing for dinner. So on the day my world ended, I sat in a restaurant and ordered some food and tried to eat cardboard, but couldn’t get the food to go down. I looked at the birthday boy and held the tears in, and my heart shattered in a million pieces.
Metastatic breast cancer is treatable, but not curable. When I was first diagnosed, my life expectancy was being measured in months. Now with cautious hope, it might be a few years. I go to the Hospital every 28 days to get injections. They are part of a series of targeted treatments I receive to keep the cancer cells at bay. One day, the cancer will figure out how to grow despite this treatment, and I will move onto something else. And I’ll continue this endless cycle of treatments and scans and progression and change until I am out of options. But I am a 43-year-old mother. And wife. And daughter. And sister. I need more time. Time to see my young children through elementary school. Time to watch my family grow and share in all the joys that life brings. Time to celebrate anniversaries with my husband and birthdays with my niece and nephews. Time with my beloved family and friends.
There is so much that needs to happen to make this a reality for me. I will need new treatments when my current regimen stops working – because it will stop working. I need research in cancer therapies and a health-care system that is streamlined and accessible.
Sadly, early detection does not prevent all cancers from returning and spreading. We need research to understand why, and treatment to extend our lives.
When I was first diagnosed, my focus was limited, directed inwards, focused on those dearest to me. During that time of learning about this new world, I absorbed every detail I could about metastatic breast cancer; living with metastatic breast cancer, treating metastatic breast cancer, dying metastatic breast cancer. A few names came to the forefront; those making noise, shifting opinions, moving the dial on research and progress. Months into treatment, when I could finally breathe again, I knew that I wanted to be part of this movement, part of the noise, part of the shift. I needed to validate this situation that I didn’t ask for in order to accept that it was part of my story whether I liked it or not.
For now, I have energy to cast outward. Not every day, but some days. Writing, fundraising, speaking, meeting. And I would say that the way I live my life has influenced my children who actively participate in my fundraising efforts with enthusiasm. They don’t need to feel embarrassed that their mom has cancer. Instead, they can feel like they are doing something to help me by climbing trees and selling apples, doing presentations on their fundraising efforts, wearing pink laces, and making signs, helping the doctors and researchers to find better medicines. Regardless of where we eventually land, I want them to be able to look back on all the good things that they did, and know that their efforts warmed many, many hearts… mine most of all.
On behalf of all of us living with incurable cancer – finding joy between injections and scans and blood work and appointments, living with hope and making a difference – thank you for your support.”
– Vesna
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Cancer, Cancer
April 6, 2019, OTTAWA, ON – A sold-out crowd was brought to their feet when Dr. Natasha Kekre and Dr. Arleigh McCurdy were announced the winners of The Ottawa Hospital’s Dancing with the Docs Gala, presented by MD Financial Management, on Saturday night. Nine physicians and researchers partnered with a dance professional from Arthur Murray Dance Studio to compete for the Medicine Ball trophy. Scores from a panel of four judges were combined with the votes given for each contestant’s fundraising efforts.
This annual fundraiser raised $455,156 supporting innovative patient care and world-class research at The Ottawa Hospital. Tim Kluke, president of The Ottawa Hospital Foundation, said it was a thrilling night. “This truly is the most entertaining fundraiser I’ve seen in our city. Where else could you have nine, active, working doctors take to the stage and put on a show? It’s a big party and the whole room gets involved. It’s really a night like no other in our region. Thanks to the incredible success of Dancing with the Docs, funds will be supporting ground-breaking cancer research, our orthopaedic department, the SIM Centre, women’s health initiatives and so much more.”
“Thanks to the incredible success of Dancing with the Docs, funds will be supporting ground-breaking cancer research, our orthopaedic department, the SIM Centre, women’s health initiatives and so much more.”
Tim Kluke, President and CEO of The Ottawa Hospital Foundation
The fancy footwork of the nine competitors from The Ottawa Hospital was contagious. After the official ceremony was over, guests hit the dance floor at the Hilton Lac-Leamy to show off their own dance moves, potentially vying for a spot to compete next year.
The Ottawa Hospital is one of Canada’s largest learning and research hospitals, with more than 1,200 beds, over 12,000 staff members and an annual budget of approximately $1.2 billion.
Our focus on learning and research helps us develop new and innovative ways to treat patients and improve care. As a multi-campus hospital affiliated with the University of Ottawa, we deliver specialized care to the Eastern Ontario region, but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care.
From the compassion of our people, to the relentless pursuit of new discoveries, The Ottawa Hospital never stops seeking solutions to the most complex health care challenges.
For more information about The Ottawa Hospital, visit ohfoundation.ca.
A bystander only sees neurosurgeon Dr. Adam Sachs wearing large goggles, looking at the air between the two wands he moves back and forth in front of him. What Dr. Sachs sees is a three-dimensional image of a patient’s brain, with its electrical activity superimposed. This isn’t a video game. It’s the cutting-edge of deep brain stimulation and neurosurgery technology.
Wearing virtual reality goggles, Dr. Sachs can view an accurate, computer-generated 3D image of a patient’s brain with Parkinson’s disease, created using the patient’s own MRIs. The patients’ brain activity recorded from microelectrodes can be visualized in this virtual world. With the two wands, or joysticks, he can move the three-dimensional brain around, seeing it from all angles. He can also remove layers of the brain to look inside at the exact spot where he will place a DBS electrode during deep brain stimulation (DBS) surgery. He is hoping to soon use this technology in the operating room.
Neurosurgeon Dr. Adam Sachs is planning to use 3D virtual reality in his deep brain surgery for patients with Parkinson’s.
This medical 3D virtual reality system was developed at The Ottawa Hospital, and is expected to be the first of its kind in the world to be used for deep brain stimulation surgery. Drs. Justin Sutherland and Daniel La Russa are clinical medical physicists in the hospital’s radiation oncology department. The two used their imaging expertise to develop a virtual reality system that combines a patient’s MRIs and CT scans to create a 3D image of a patient’s organ or body part to give surgeons a detailed, accurate representation of the surgical area.
Historically, medical virtual reality programs were used by patients mainly for rehabilitation. Patients would wear VR-goggles to help relearn how to move through and cope with different environments. Until recently, the technology wasn’t good enough to create images of organs or tissue that could be used by clinicians in a manner that improves on current practice.
“What we are trying to do in our virtual reality lab is come up with new ways to leverage technology to help doctors and nurses, or any medical professional, do what they do better. And how better than with 3D visualization,” said Dr. Sutherland who is also an assistant professor in the University of Ottawa’s Department of Radiology. “We think the technology has only reached that point now. We’re now at a place where we want to pursue the avenue of clinicians-as-users.”
“Nowhere else in the world are they using virtual reality in this fashion.”
— Dr. Adam Sachs
One Ottawa Hospital surgeon interested in using 3D virtual reality was Dr. Sachs, who performs deep brain stimulation surgery for people with Parkinson’s. During this procedure, a microelectrode, no wider than a human hair, is implanted into a very specific area of the brain. The microelectrode then records activity from and stimulates that part of the brain and alleviates some of the patient’s symptoms, such as tremors and akinesia or the loss of ability to move their muscles voluntarily. The virtual reality system allows the electrical activity, stimulation effects and the MRI to be visualized together.
“In deep brain stimulation surgery, because the target is very small and in the middle of the brain this leaves the surgeon with the problem of how to visualize the person’s brain to understand the area and where to put the electrode,” said Dr. Sachs.
Neurosurgeon Dr. Adam Sachs uses virtual reality wands to manipulate a 3D image of the brain.
He said neurosurgeons use MRIs and brain atlases to get a mental image of what the patient’s brain looks like. The problem is these atlases are maps created from many different people’s brains, but each patient’s brain is unique. As well, the brain atlases are only two-dimensional, while the brain is three-dimensional. This makes it difficult to place the microelectrode in the exact spot in the patient’s brain where it will have the best chance of halting or reducing the Parkinson’s tremors.
Dr. Chadwick Boulay, a senior research associate in the neuroscience program, understands the challenges faced by neurosurgeons when implanting an electrode at the optimal position in the brain. When Dr. Boulay learned about the 3D virtual reality technology being developed at The Ottawa Hospital, he realized the potential this had for increasing the accuracy of deep brain stimulation surgery. He and Dr. Sachs worked with Drs. Sutherland and La Russa to develop a virtual reality program that would enable them to see the patient’s brain in three dimensions.
“This is really exciting,” said Dr. Sachs. “The deep brain stimulation electrodes will be more precisely placed because we’ll be able to integrate accurate images from the patient’s anatomy and visualize it in three dimensions,” said Dr. Sachs.
He anticipates that the resulting precision of the placement of the electrode will improve outcomes for patients with Parkinson’s disease, but this will be confirmed through research. About 15 people undergo deep brain stimulation surgery at The Ottawa Hospital every year.
“We’re excited about working with the Sachs Lab because it is a perfect clinical example of using 3D visualization to better understand a spatial problem,” said Dr. Sutherland. “In this case, actually seeing a target for deep brain stimulation removes the burden on the surgeons of trying to create a 3D model in their head.”
Drs. Daniel LaRussa, Justin Sutherland, and Chadwick Boulay have teamed up to design a 3D virtual reality program for Dr. Adam Sachs’ deep brain stimulation surgery.
Dr. Sutherland foresees that this 3D virtual reality technology will one day be in every department throughout the hospital. He says the overall system is surprisingly inexpensive, as the computer that runs it and the goggles only cost a few thousand dollars. The possibilities for this technology are endless. He said it has huge potential for education—teaching medical anatomy—and for surgical planning. Dr. Sutherland sees Dr. Sachs’ endorsement of this system as a shining example of how doctors can use this technology to improve what they do.
“Nowhere else in the world are they using virtual reality in this fashion,” said Dr. Sachs.
The Ottawa Hospital is quickly being positioned as leaders in 3D virtual reality technology and has already gained international attention. Drs. Sutherland and La Russa have given demonstrations and been invited to talk at large medical conferences, and other institutions have contacted them with interest in using this technology.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Innovation and Technology, Innovation and Technology, Innovation and Technology, Neuro, Parkinson's, Technology
Three years ago, Sandy Patenaude was given the devastating news that she had stage 4 colorectal cancer. It had spread to her liver and lungs, and was inoperable. Sandy’s oncologist asked if she would like to go on a clinical trial, testing a new cancer stem cell inhibitor drug along with her chemotherapy.
“Cancer stem cell inhibitors, why not?” said Sandy who agreed to be part of the trial.
Dr. Derek Jonker, Medical Oncologist at The Ottawa Hospital, is leading the international trial for people with colorectal cancer, with the experimental drug napabucasin. He explained that cancer stem cells are the rare, immature cells in a tumour, which are often resistant to chemotherapy. They can give rise to the more mature cancer cells that make up the bulk of a tumour. Cancer stem cells are not the same as the normal stem cells that live in many healthy adult tissues and help with healing and repair.
“With chemotherapy, we can deliver treatment that can shrink the vast part of the cancer,” said Dr. Jonker, who is also an associate professor at the University of Ottawa. “Often the bulk of the tumour disappears, but what’s left is a small tumour with lots of these chemo-resistant cancer stem cells, which are able to spread and seed other places in the body. Often, we keep giving the same chemotherapy and find the tumour has regrown, but it’s not the same tumour it was when we started.”
Dr. Derek Jonker led a clinical trial for colorectal cancer with a cancer stem cell inhibiting drug that has helped Sandy Patenaude.
Dr. Jonker is switching up the treatment to target the cancer stem cells that aren’t affected by standard chemo. In a previous randomized clinical trial he led , patients either received a placebo or napabucasin to test its effectiveness at inhibiting, or preventing, the growth of the cancer stem cells. The trial was carried out at 40 sites in Canada, Australia, New Zealand, and Japan. The 562 patients enrolled had advanced colorectal cancer and chemotherapy no longer worked for them.
Looking at the results of the trial, Dr. Jonker said they didn’t see much benefit in the group overall. “But when we looked at patients who had a tumour that had characteristics of a high cancer stem cell (phospho-STAT3) over expression there was very significant improvement in their survival.”
Dr. Jonker presented his findings in October 2016 at the European Society for Medical Oncology, showing that where the cancer stem cell inhibitor didn’t work in all patients, there was an improvement in the survival of the 22 percent of patients who had tumours with high phospho-STAT3. He said it’s “proof of principle that stem cells are an important target for cancer patients.” Napabucasin is now being combined in the current trial with chemotherapy to attack the cancer on two fronts at the same time.
“We know with results of the clinical trial that the majority of patients did not respond to it, but we have two patients here in Ottawa who have responded and definitely developed benefit from the clinical agent,” said medical oncologist Dr. Christine Cripps.
I thought I’d be part of the trial, because I thought well, it’s new.”
Sandy is one of those patients who benefited. Her tumours shrank, and the surgeons were able to remove spots in her liver and the primary tumour in her rectum. Dr. Cripps said she believes that part of the success in keeping Sandy’s cancer at bay is the napabucasin she is taking as part of the clinical trial.
“A stem cell inhibitor works differently than traditional chemotherapy, in that it prevents new disease from appearing,” said Saara Ali, research coordinator for clinical trials in gastrointestinal cancers. “The hope is that the pill [napabucasin] will prevent new disease from showing. And in Sandy’s case there hasn’t been new disease since her treatment. Everything was there before, so it may be doing its job.”
Next steps: Dr. Jonker hopes to start another clinical trial with the cancer stem cell inhibitor that will be used specifically for patients who have lots of phospho-STAT3 in their tumour. These patients could be identified for the clinical trial with molecular testing, using The Ottawa Hospital’s Molecular Oncology Diagnostics lab. This would target the patients presumed to be the most likely to benefit most from the drug.
“We would repeat our study, randomize those patients with napabucasin and a placebo, and if we can prove that napabucasin is effective for them, then it would be an option for patients who have run out of all other treatment options,” said Dr. Jonker.
Dr. Cripps said that Sandy is a candidate for this next trial, and her tumours will be analyzed by the molecular lab to see whether she has high phospho-STAT3 cancer stem cell expression. Regardless, Sandy will continue using the trial drug as long as it is working for her. And it is working. The mother of three adult children said she’s busy doing a million things, playing euchre, the ukulele, skiing, hiking, biking, and enjoying life.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Cancer, Clinical Trials, Stem Cell
Although the connection between the immune system and cancer has been recognized for over a century, understanding how the immune system works against cancer has been the biggest challenge for scientists like Dr. Michele Ardolino.
Initially, efforts were made to stimulate the immune system to make it attack the cancer. But the game changer was the discovery that there are key molecules, called immune checkpoints, on cancer cells that suppress the immune cells and prevent them from attacking the cancer. There are many types of immune cells. T-cells have been recognized as key immune cells and the ones that immunotherapy drugs have been designed to target.
Dr. Michele Ardolino’s discovery focused on ‘natural killer’ immune cells.
“What we didn’t know before is that some of these receptors are present in other immune cells,” said Dr. Michele Ardolino, scientist at The Ottawa Hospital and assistant professor at the University of Ottawa. “What we discovered is that these receptors are present on another type of immune cell called natural killer cells.”
He said that even though most of the immunotherapy drugs target the T-cells to make them work better, not all cancer tumours are responsive to T-cells.
“But,” said Dr. Ardolino, “These tumours might be very effectively killed by natural killer cells. So, if we know what kind of tumour the patient has, we can design therapies to elicit the most effective immune response. Which in some cases could be a T-cell response and in other cases could be a natural killer response.”
“We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way.”
“This is cool for a number of reasons,” said Dr. Ardolino. “We now have a better idea of how the immune system suppresses cancer. This means that we can now target the mechanism that suppresses the immune system in a more specific way. And we can elicit a stronger natural killer cell response against cancer.”
It is becoming widely recognized that not only is cancer unique to each patient, but the immune system is also unique to each person. Researchers and clinicians are realizing the importance of tailoring the immunotherapy not only to each person’s cancer but to their own unique immune system. It is a complex problem to give a drug that would have maximum therapeutic effect with the least side effects, to be as targeted as possible.
Dr. Ardolino recently published a breakthrough discovery that has potential to make immunotherapy treatments to work for more people, and more types of cancers.
In October 2018, immunologists James Allison and Tasuku Honjo were awarded the Nobel Prize in Medicine for their discoveries of immune checkpoint inhibitors, considered a landmark in the fight against cancer.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Immunotherapy
A strange thing happened before John Chafe started working in Kenora in 1993. His eyes crossed. He didn’t know it at the time, but it was the first sign of a debilitating disease that would change the course of his life forever.
His family doctor told him he had the flu and prescribed antibiotics. But after a week, when his eyes remained crossed, he bought an eye patch and drove five hours from Thunder Bay to fill the temporary posting at a bank in Kenora. A week later, his eyes straightened and returned to normal. But then other symptoms started appearing, he was losing his balance and couldn’t walk in a straight line.
“I then started have difficulties walking straight. I completely failed a simple balance beam experiment at the Ontario Science Centre,” said John. “I mentioned these symptoms to a friend, who mentioned them to a friend, who fortunately happened to be Dr. Heather MacLean, a neurologist at The Ottawa Hospital.”
To Dr. MacLean, John’s symptoms sounded like multiple sclerosis (MS), an autoimmune disease where the body’s immune system attacks its own central nervous system, brain, and spinal cord. John needed an MRI and spinal tap to properly diagnose his symptoms. The results were analyzed by Dr. Mark Freedman, Director, Multiple Sclerosis Research Unit, Neurology, who confirmed his diagnosis. John had an aggressive form of multiple sclerosis.
John Chafe skiing at Blackcomb just after diagnosis in 1994.
A different life after MS diagnosis
Incredibly interested in rock climbing and skiing, John didn’t give up his active lifestyle after his diagnosis, despite the fact that he was experiencing MS exacerbations – an attack that causes new MS symptoms, or worsens old symptoms – every eight months. He returned to Thunder Bay and opened a rock-climbing gym, thinking, “MS is not going to affect me.”
But it did. It completely sidetracked his life.
After suffering another MS exacerbation, John realized it was becoming more difficult for him to get out to see clients for financial planning sessions.
“I was stumbling along and thought, ‘How can I ask them to trust me with their money?’ My MS was getting worse and worse,” said John. “I needed a desk job, so I went into computer programming.”
His treatments weren’t helping. He needed a miracle. So he moved to Ottawa to be close to The Ottawa Hospital where we could receive the very best treatment.
Leading-edge clinical trial in Ottawa
Dr. Harold Atkins and Dr. Mark Freedman conducted an innovative stem cell treatment for MS that has halted the disease in over 50 patients
One day, John heard Dr. Freedman on the radio talking about an innovative stem cell transplant study that he described as akin to pressing reboot on the immune system. Dr. Freedman was working with hematologist and scientist Dr. Harold Atkins, a professor of medicine at University of Ottawa, to see if a groundbreaking treatment would halt an aggressive form of MS.
When John met with Dr. Freedman, he told him he was interested in participating in this new study. Dr. Freedman agreed he might be a good candidate because he was young, generally healthy, and his symptoms were quickly getting worse.
“If you saw his trajectory, how fast he was becoming disabled going into the transplant. He should’ve been completely wheelchair bound, or worse, within two to three years,” said Dr Freedman.
John was willing to try an experimental treatment that had the potential to change that trajectory. “MS robbed me of my ability to climb, ski, and walk. I said, ‘I’m going to take a chance.’”
“John was very enthusiastic. That was a very important facet of his recovery,” said Dr. Freedman. “John has never been a quitter. He’s a stubborn guy. His goal was someday to end up on the ski hill again.”
Preparing for treatment
For almost a year, John underwent the exhaustive testing by Dr. Atkins and Marjorie Bowman, the bone marrow transplant nurse, to see if he was physically and mentally suitable for the clinical trial. They wanted to ensure he was prepared to go through the intensive trial treatment and accept the risks, which included death.
“This is fundamentally different than every other treatment,” said Dr. Atkins. “What we’re doing is getting rid of the old immune system and creating a new one that behaves more appropriately.”
“MS robbed me of my ability to climb, ski, and walk. I said ‘I’m going to take a chance.’”
— John Chafe
Replacing his immune system was a rigorous procedure. John would undergo intensive chemotherapy to help eliminate his immune system. In November 2001, he was given a dose of chemotherapy to stimulate and move his stem cells into his blood stream. These stem cells were then collected and cleansed of any traces of MS.
A month later, John was given huge doses of chemo in an attempt to destroy his immune system and started getting weaker and weaker. On December 13, 2001, after the chemo had wiped out his immune system, John had the cleansed stem cells re-infused by an intravenous drip.
“I didn’t feel better immediately,” said John, who was only the second patient in the world to undergo a stem-cell transplant of this kind for multiple sclerosis. “But I started getting stronger in the days following, so much so that Dr. Atkins released me on Christmas Eve.” He spent three months living with his parents while he recuperated. By spring, he was ready to move back into his own home again.
John Chafe rock climbing outside Thunder Bay in 1994 after his MS diagnosis.
Groundbreaking research in Ottawa
Dr. Freedman said that he and Dr. Atkins had anticipated that by rebooting MS patients’ immune systems, they fully expected the disease was going to restart.
“At that time, genetic researchers said, ‘If people are genetically prone to develop MS, there’s nothing you can do to stop it. They’re going to keep redeveloping MS,’” said Dr. Freedman. “If that was true, it would be a matter of time before people started having active disease again.”
Dr. Freedman explained that nobody knows what causes MS. He and Dr. Harold Atkins hoped that through the trial they could reboot a patient’s immune system and monitor it with all the latest immune system monitoring and imaging technology, and then watch as the disease restarted and discover the secret of what triggers MS. However, none of the 24 patients in the trial developed new symptoms of MS again.
“In that respect, the trial was a failure. It halted their disease and in some cases their disabilities went away too,” said Dr. Freedman. “We’ve followed these patients for 18 years, and nobody’s developed anything.”
“Those patients at the beginning, like John, are probably the bravest because there were more unknowns about the treatment,” said Dr. Atkins. “Each patient we’ve treated over the years has taught us something, but we learned more from the early patients at that time.”
A second chance at life
Prior to his stem cell transplant, John had a final exacerbation, which crippled him. After the transplant, his MS did not return. John remained healthy, but the damage caused by the disease wasn’t reversed and he still walks using a cane and walker.
“You almost wonder what would’ve happened to John if he’d had the transplant five years earlier,” said Dr. Freedman. “Today, when we see a patient that has the same profile as John’s, we offer them the stem cell treatment. We’re not waiting years. We’ve become more savvy, able to pick out individuals who warrant this aggressive approach.”
About 77,000 Canadians live with MS. However, only five percent of patients with MS warrant a stem cell transplant. They are generally young and have the most aggressive and debilitating forms of the disease.
After his transplant, nothing was going to hold John back. Three years later, he met Patricia, and they married in 2005. Five years later, his beautiful daughter Mary was born.
John Chafe with his daughter Mary and wife Patricia in 2013.
“I recall that as Mary started moving more, she motivated me to get more active again. She became my personal trainer,” said John. “I joined the Canadian Association of Disabled Skiing. I was terrible at first because I didn’t have the strength. But I’m stubborn and refused to give up, and today I can ski independently for hours – albeit with outriggers for balance.”
“I saw John a few years ago. The problem with this business is patients get better and so I don’t see them much afterwards,” said Dr. Atkins. “I do remember him showing me pictures of his young baby, and pictures of him on the ski slope. It is exciting to hear that people can have these treatments and go skiing again.”
John Chafe, Mary and Patricia skiing at Edelweiss in 2016.
“I’m not a bank president, but my life is better than incredible. I ski, I dance with my wife, and have an nine-year-old daughter. Because Dr. Freedman and Dr. Atkins were persistent about finding the answers to stop a disease like MS, they saved my life.”
— John Chafe
The following video focuses on Jennifer Molson who was also one of the early patients on the MS clinical trial, and includes interviews with Drs. Atkins and Freedman.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Clinical Trials, Stem Cell
June 20, 2017, was a day like any other on the construction site, until the 14-inch diamond blade on Adrian Molloy’s power saw jammed in the concrete he was cutting and kicked back into his arm, slicing through to the bone. Though he was not particularly close The Ottawa Hospital’s Trauma Centre at the time, a new 60-minute bypass initiative brought him straight there to an assembled team of trauma experts who were ready for him.
The 40-year-old contractor had been using power saws on the job for 20 years. He was down in a hole cutting concrete when the saw kicked back. He was covered in dust so couldn’t see his arm, but knew he’d hit himself. He grabbed his right arm above the elbow, and his fingers landed on bone. Adrian knew it was a serious injury, and managed to get out of the hole and head to the road for help. His arm was bleeding badly.
“It happened so quickly, I didn’t even know I was injured,” Adrian said.
Contractor Adrian Molloy underwent two four-and-a-half-hour surgeries to repair his partially severed arm.
Quick thinking
At the road, two Hydro One workers were sitting in their truck getting ready to leave. When they saw Adrian, the passenger called 911. The driver jumped out, and quickly took off his belt and tightened it around Adrian’s arm in a tourniquet. He was calm, and kept Adrian talking until the ambulance arrived.
In the ambulance, Adrian heard the paramedics talking with the dispatch.
“I knew they were looking to bypass Kemptville, but didn’t know what was going on,” said Adrian. “I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”
60-minute bypass initiative
What Adrian didn’t realize was that he was one of the first patients to be part of a quality improvement initiative that the Ottawa Regional Trauma Program was testing in an effort to get patients to trauma care and provide more successful outcomes.
“Adrian was a direct recipient of our 60-minute bypass initiative,” said Mathieu LeBreton, Trauma Coordinator of the Ottawa Regional Trauma Program at The Ottawa Hospital. “Provincially, paramedics have rules that can permit them to bypass local hospitals to get to a lead trauma hospital if they are within 30 minutes of getting to a trauma centre. With the approval of all regional community hospitals, we expanded it to 60 minutes. Much of the literature suggests the sooner a patient receives definitive trauma care, the better.”
Where Adrian was injured was about a 45-minute ambulance drive to the Trauma Centre. Previously, he would’ve had to go to the nearest community hospital. LeBreton said trauma patients who need resuscitation from life-threatening injury need very resource-intensive care. They require more medical staff, access to operating rooms, imaging capabilities, more blood, and other resources that community hospitals do not have in their emergency departments. There is a team of health-care professionals at the Civic Campus specifically trained to deal with trauma situations.
Trauma team assembles
When paramedics notify the Civic Campus Emergency Department that they are bringing in a patient with multiple or life-threatening injuries, a Code 1 Trauma is called over the hospital’s intercom. This alerts the trauma team, which includes trauma surgeons, emergency physicians, nurses, anaesthesiologists, respiratory therapists, and trauma coordinator Mathieu LeBreton, to prepare for the patient’s arrival. A Code 1 Trauma also notifies the blood lab, radiology department, and operating room staff that blood-work, X-Rays, CT scans, and surgery may be needed.
“Sometimes a trauma code comes in without advance notice, and then we’re reacting to it in the moment,” said Kelly Barnett, Clinical Manager of the Trauma Unit. “Everyone has a job, and it’s a code that runs smoothly to diagnose, triage, and save the patient.”
“I’d never been to a hospital injured like this before,” said Adrian. As he lay in the ambulance, his mind raced with concerns. “I asked, ‘Do they know I’m coming? Are they ready for me?’”
Rushed to surgery
The answer was yes. The trauma team was ready and waiting for him when the ambulance arrived. When he was rushed through the emergency room doors, Adrian said he couldn’t believe, “You can get so many people in one room for one patient.” He was in the operating room within 47 minutes from the time he entered the emergency department.
“I knew my best hope was The Ottawa Hospital, so was happy they said we were heading to the Trauma Centre at the Civic. I was going somewhere where they could handle my injury.”
The power saw had cut 75 percent of his right bicep, two arteries and a nerve. In the operating room, surgeons reattached his arm. The four-and-a-half-hour surgery repaired arteries and his severed nerve. He underwent a second four-hour surgery to repair the damaged bicep with a donor muscle in November 2017.
The Ottawa Hospital’s Civic Campus is the adult lead trauma hospital for eastern Ontario. This takes in an area of 1.3 million people that includes Ottawa, stretches west to Pembroke and east to Hawkesbury. People with life-threatening injuries from Gatineau and western Quebec, as well as patients from Baffin Island and eastern Nunavut are brought to the Trauma Centre. Twenty percent of the population it serves lives in a rural area.
The Centre treated 856 trauma cases last year. One hundred and ninety-two of those patients benefited from the extended time guidelines from accident scene to trauma centre, with the average transfer time being 42 minutes.
Trauma care for 1.3 million people
The power saw had cut 75 percent of his right bicep, two arteries and a nerve. In the operating room, surgeons reattached his arm. The four-and-a-half-hour surgery repaired arteries and his severed nerve. He underwent a second four-hour surgery to repair the damaged bicep with a donor muscle in November 2017.
The Ottawa Hospital’s Civic Campus is the adult lead trauma hospital for eastern Ontario. This takes in an area of 1.3 million people that includes Ottawa, stretches west to Pembroke and east to Hawkesbury. People with life-threatening injuries from Gatineau and western Quebec, as well as patients from Baffin Island and eastern Nunavut are brought to the Trauma Centre. Twenty percent of the population it serves lives in a rural area.
The Centre treated 856 trauma cases last year. One hundred and ninety-two of those patients benefited from the extended time guidelines from accident scene to trauma centre, with the average transfer time being 42 minutes.
The eight-bed trauma unit is dedicated to patients who have multiple injuries. This could include head or brain trauma, limb loss, vascular, spinal cord, internal organs, multiple broken bones, broken spine, or neck injuries.
“Patients come into trauma from emerge [emergency department], and once they are stabilized, they then move through the hospital, as soon as possible, in order to get them back home, into rehab, or somewhere they can convalesce,” said Kelly.
Kelly said a patient’s length of stay in the trauma unit can be as short as 24 hours or as long as several months, depending on the severity of the injury and the ability to recover and heal. The health professionals in the Centre plan the patient’s follow up care or work closely with physiotherapy, and rehabilitation services to assess their need for rehabilitation.
“I know we often compare ourselves to similar standards from regional trauma perspectives: other hospitals we benchmark against in standardizing trauma care. We look to hospitals like St. Mikes [St. Michael’s Hospital] in Toronto to see their practices, and share ideas and common goals that we are trying to achieve,” said Kelly.
The Ottawa Hospital is part of the Trauma Association of Canada where members from across the country share vibrant practices about ways to improve patient care.
Hamilton and Kingston also have trauma centres, though The Ottawa Hospital is bigger because of the larger area patients come from.
The Ottawa Hospital has one of the largest trauma centres in the province, with Sunnybrook and St. Michael’s as the two largest. However, both Toronto hospitals cater to a dense urban population. The Ottawa Hospital covers a larger geographical area, so the timing to get patients to the trauma centre from a distance and the reason why the 60-minute bypass initiative is critical.
“What we found is there have been no negative outcomes yet. People like Adrian have benefitted directly from this,” Mathieu said.
Back to work
A year later, Adrian is back on the construction site with full use of his right arm and hand.
“I lost the motion for using a screwdriver. I use it as an excuse to get out of work I don’t like. I use it to my advantage now,” laughed Adrian. “I’m doing everything I was doing before.”
Adrian Molloy stands with his wife Shelly outside their home.
The Ottawa Hospital is a leading academic health, research, and learning hospital proudly affiliated with the University of Ottawa.
Categories: Patient Care, Trauma
Imagine not being able to control a trembling in your hands and limbs, the inability to speak loudly, losing your sense of smell, dealing with unexplained pains. Unfortunately, these are just a few of the symptoms affecting Parkinson’s disease patients every day.
More than 100,000 Canadians live with Parkinson’s, including 8,000 here in Ottawa. Parkinson’s is a progressive neurodegenerative disease that primarily affects voluntary, controlled movement. The exact cause of the disease is unknown. Discovered almost 200 years ago, there is still no cure or proven treatment available to slow its relentless progression. People can develop Parkinson’s disease at any time in their life.
“Our society will be faced with many more patients with Parkinson’s over the decades to come. In many ways Parkinson’s is complicated and also complex. I strongly believe that although it’s complex and complicated, we can solve that riddle. We have the expertise in Canada to make a major contribution to a cure for this disease.”
– Dr. Michael Schlossmacher, Senior Scientist, The Ottawa Hospital Canada Research Chair in Parkinson Disease and Translational Neuroscience
Partners Investing in Parkinson Research (PIPR)
In 2009, a group of investment advisors from the Ottawa financial community formed Partners Investing in Parkinson Research (PIPR). The group set an original goal of raising $500,000 in support of research to better understand and diagnose Parkinson’s. Since then, PIPR has expanded to include many individuals and families affected by Parkinson’s who are committed to supporting research, and has raised over $1.7 million.
PIPR has provided important base funding to the scientists, allowing them to leverage further grants. The advancements have been impressive. PIPR has not only helped to fund research for the treatment and cure of Parkinson’s disease, it has galvanized the community to support the cause that previously received little attention. Above all, the PIPR team has given hope to those who live with this unremitting disease.
“Parkinson’s Disease had already been part of our lives for over 20 years, so how could we not get involved? Raising funds for research was the obvious action, but fundraising at first seemed daunting. We soon learned that our family, friends, neighbours, and colleagues all wanted to help – they just needed to be asked. But our group has become more than fundraising – we have become an extended family, supporting each other as we faced many of the same challenges dealing with this disease as well as sharing all of the same fears and hopes.”
– Bobbie Driscoll, PIPR co-founder
PIPR is always open to new members and encourages anyone interested to join!
Learn more about PIPR and hear about some of the exciting research advancements on Episode 34 of Pulse, featuring Dr. Julianna Tomlinson and Kim Teron.
Parkinson Research at The Ottawa Hospital
Researchers at The Ottawa Hospital and the University of Ottawa came together in 2004 to form the Parkinson Research Consortium under the leadership of Dr. David Grimes and Dr. Michael Schlossmacher. The consortium brings together clinicians and scientists from various disciplines to improve our understanding of Parkinson’s disease, conduct novel and innovative research, and develop new treatment options, with the ultimate goal of developing a cure.
Developments in understanding how genes contribute to onset and progression of the disease.
Development of innovative therapeutic strategies including targeted gene therapy.
Development of an experimental spinal fluid test to improved diagnosis.
Discovery of a new genetic mutation that makes some people more susceptible to this disease.
Development of a new mouse model that mimics a familial form of early on-set Parkinson’s disease.
Publication of Canada’s first Parkinson’s care guidelines.
Support Parkinson Research
Support ongoing research efforts by making a donation, or by calling 613-761-4295. For more information about the research or how to join the team, contact Graham Thompson, Manager, Philanthropy, at 613-798-5555, ext. 19818, or grthompson@toh.ca.
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“In 2012, I was diagnosed with early stage breast cancer. Despite the standard treatment of surgery, chemotherapy, radiation and hormonal treatment, the cancer returned four years later, having spread to my lungs, bones and lymph nodes.
