Every day, Dr. Bernard Thébaud creates futures for Ottawa’s youngest community members. As a senior scientist with the Ottawa Hospital Research Institute, and as a neonatologist with the Children’s Hospital of Eastern Ontario (CHEO), Dr. Thébaud provides care to critically ill newborns. Born and raised in Munich, Germany, Dr. Thébaud studied medicine in Strasbourg, and pediatrics in Paris, ultimately starting his research career at the University of Alberta after completing a post-doc there. In 2012, The Ottawa Hospital recruited Dr. Thébaud to accelerate the use of stem cell-based therapies for lung diseases.

In 2022, Dr. Bernard Thébaud received the Chrétien Researcher of the Year Award for his pioneering research on neonatal health, including a recent paper showing that nano-therapy for micro-preemies protects not only the lungs, but also the brain in lab models.

Read on to learn the sport that led him to medicine.

Q: Can you tell us a little bit about your childhood?

A: When I think about my early years, they were clearly marked by my passion for a particular sport: soccer. It was school, homework, then soccer until dusk.

I had a former German national player as a coach, and he taught us really everything about the “beautiful game”: the discipline, the perfection, the importance of a healthy lifestyle, the resilience. And all these lessons, they turned out to be very helpful in my later life.

Munich Olymic Stadium

Munich U12 Olympic Stadium, Dr. Bernard Thébaud.

U14 game against Inter Milan

The most important thing I learned was impact. In competitive sport, the goal is always winning. And so the question is: Can you make a difference? Can you be a “game-changer”?

Here at The Ottawa Hospital, it’s exactly the same: How can we impact the game for our babies? The bottom line is improving the outcomes of babies born too soon. And whatever is not geared towards this, you shouldn’t waste your time with.

"We're at a point where we really need another breakthrough. I hope my research will contribute to that."

— Dr. Bernard Thébaud

Q: How did you wind up in neonatology?

A: I remember the day very clearly when I decided to go into medicine. I was 14 or 16, and my dad asked, “So, what do you want to do later in life?” I said, “I don’t know.” He said, “how about sports physician?” And I said, “That’s it.” From that moment on, I wanted to become a physician.

Of course, as you go through medical school and meet people, you realize what you’re passionate about. I did a rotation in pediatric surgery, and I loved it. Immediately from the first day, I knew I would become a pediatrician.

Later on, I discovered a new dimension, through research — that you could actually answer some of the big questions in the lab. That was fascinating.

Later, I was drawn towards neonatology because it had that element of urgency and physiology. I had great teachers, and they taught me a lot about the beauty of neonatology — about not just accepting the status quo and applying protocols, but thinking every day about how you can improve things, make them a little bit better.

Q: How has the field of neonatology changed since you started?

A: There were amazing breakthroughs in neonatology in the ’90s with using surfactant to treat acute respiratory distress syndrome in preterm babies. Through research, it was discovered these babies lacked surfactant, and then it took another 30 years to actually turn that into medication. Many of my colleagues practiced neonatology when surfactant didn’t exist, and they could really see the switch between the before and after. When you see how fast surfactant works, it’s really impressive.

Then inhaled nitric oxide came; this is more for high blood pressure in the lungs, pulmonary hypertension, and that was also a game changer.

So, survival in neonatology improved over time, but in a sense, neonatologists are the victims of their own success. We got to care for more preterm infants that were born and saved at lower gestational ages, but that came with more challenges. The organs of these premature babies are younger, more immature, and more fragile. The task of protecting them becomes more difficult.

Every 15 years or so, we have seen the patient population change, and we have to get better at things. We’re at a point where we really need another breakthrough. I hope my research will contribute to that.

What is surfactant?

Surfactant is a liquid produced by the lungs that keeps the airways open. Production starts at 26 weeks gestation, and babies born before 37 weeks may not have enough yet, causing breathing issues.

Q: Can you tell us a little bit about your research?

A: We may have really reached the limit of biological viability; the lungs in the youngest NICU babies are so immature that a breakthrough is required to protect the lung from injury and at the same time promote growth. We believe stem cell-based therapies for regenerating the lungs will be one such breakthrough.

I’m specifically looking at these therapies for chronic lung disease of prematurity, or bronchopulmonary dysplasia. This is the most frequent complication in preterm babies, but it’s also an independent risk factor for adverse neurodevelopmental outcomes. It also requires a lot of oxygen, and giving babies the oxygen they require is not good for their eyes, which puts them at risk of blindness or eyesight impairment. If we could treat this one disease, we could actually get rid of three. If we can protect the lungs with these cells, that will positively impact the overall outcome of these preterm babies.

Q: What does a well-funded Ottawa Hospital Research Institute mean for your research?

A: It’s absolutely critical. It’s an absolute priority. A well-funded research institute means better quality research and faster translation from the lab to the patients. It means discoveries today, revolutionary medications tomorrow.

We compete for funding at the federal level, but if you really want your research to make an impact in patients and bring discoveries from the lab into the clinic, there needs to be additional funding, otherwise, it’s not going to happen.

"A well-funded research institute means better quality research and faster translation from the lab to the patients. It means discoveries today, revolutionary medications tomorrow."

—Dr. Bernard Thébaud

Q: What is so exciting about your award-winning research on nano-therapy protecting lungs and brain?

A: Currently, babies who develop lung disease have adverse neurodevelopmental outcomes. Their brain function is impaired, and we won’t know why that is.

The current treatment we have for this is corticosteroid called dimethicone. The problem is the dimethicone stops brain growth and it stops lung growth. On the one hand it does something good, on the other hand it does something bad.

With our research, we used our classical model, and instead of looking at the lungs, we decided to look at the brain. We showed that whatever causes bronchopulmonary dysplasia also causes the brain stem to be abnormal.

Then, we showed the cell therapy we’re trying to develop actually protects the lungs but also protects brainstem cells. It’s basically the ‘perfect’ therapy because it doesn’t have the adverse effects.

Q: What does winning the Chrétien Researcher of the Year Award mean to you?

A: For me, the award is a marker that we are doing something that matters. It is definitely motivating. This award is very prestigious, underscoring that this is important work and we are on the right path.

Q: What is the most inspiring part of your work in neonatology?

A: For me, the resilience of these babies is fascinating. Their lungs are so immature, and yet they still succeed in breathing — yes, with our help, but they have the potential; we’re just supporting them with what they need.

The most exhilarating is when they go home. This is when you have tears in your eyes, because you say, “Wow, they made it.” And the parents, of course, are over the moon. You know once they go home, they will thrive.

"Working with babies is, I think, the most beautiful job on Earth. Because they're born, and they have all their life and all their potential in front of them. Our task is to give them a great jumpstart."

— Dr. Bernard Thébaud

Honouring our top researchers of 2022

Striking a chord with stroke research

Meet Dr. Ronda Lun — recipient of a rare honourable mention for the 2022 Worton Researcher in Training Award.

Lighting up cancer research with firefly proteins

Meet Dr. Taha Azad, recipient of the 2022 Worton Researcher in Training Award.

A self-proclaimed nerd with a knack for nephrology

Meet Dr. Kevin Burns — the 2022 winner of the Grimes Career Achievement Award.

Dr. Mark Clemons’ keen sense of humour and sharp wit have earned him an enduring and respected reputation among cancer patients at The Ottawa Hospital, where he is a medical oncologist. His patients regularly comment on the positive difference his unique approach has made in their care.

Born, raised, and educated in the UK, Ottawa was fortunate to entice Dr. Clemons to join our team in 2009.

In addition to his work with cancer patients, he is also a medical oncologist and scientist at The Ottawa Hospital and led the creation of REaCT (Rethinking Clinical Trials), which helps remove barriers for patients participating in clinical trials.

Staying true to his unique personality, Dr. Clemons did not disappoint when he competed onstage in front of a sold-out crowd of 800+ to win the coveted Medicine Ball Trophy during Dancing with the Docs in 2017.

Q: When did you realize you wanted to become a doctor, and why oncology?

A: There wasn’t an epiphany moment, and looking back on 30 years of clinical practice, I don’t think I could have done anything else. I think the beauty of medicine is that it allows you an amazing opportunity to sample multiple subjects from basic science, physiology, psychology, through to global healthcare disparities. In addition, oncology also offers frequent and often raw exposure to the challenges we all face as human beings. Quite simply, joy, suffering, and death surround us all the time. Oncology has given me an amazing opportunity to learn about and experience the whole smorgasbord of human existence.

Q: You’re from the UK originally, why did you choose to work at The Ottawa Hospital?

A: I had finished my doctorate and had what my boss described as “the best job in the world” lined up in the UK, and I realized I didn’t want what someone else perceived as “the best job in the world.” One afternoon I saw an advert that said, “do you want to come to Canada and research breast cancer?” I think life is about serendipity and taking opportunities to travel when they come. Too many people spend their lives in one city, but life is about getting experiences in different places. So, off I went to Toronto for a couple years. Then the unexpected and unplanned scenario of (English) boy meets (Canadian) girl occurred. Canadian girl then explained that English boy’s life would be much better and much more straight forward if he simply did whatever she told him to do. After subsequent jobs in the UK and back in Toronto, the tremendous opportunity to come to Ottawa appeared.

Q: Your patients regularly comment on how your personality and humour help them through difficult times. Can you tell us a little about your approach with patients?

A: I think personality and humour are not the same thing. My wife and kids will certainly tell you that I am not funny. Not all patients want humour, but most people want to be treated as real human beings. The reality is, life on the whole can be quite funny, and we’re all in this game of life together. As so many patients have said to me over the years, “if you don’t laugh, you’ll cry.” My philosophy is not to be terrified of cancer, but to treat the cancer with respect it deserves so you can help the patient and their family make their own personal way through a very challenging journey.

Q: If someone has just been diagnosed with cancer, what advice would you give them?

A: Despite the feeling of your world turning upside down, try not to panic, and try to get information from a reputable source. Once you have the fundamentals of information, you’re in a much better place for decision making.

Dr. Mark Clemons is a medical oncologist and clinical investigator at The Ottawa Hospital.

Q: As an oncologist, what is the most exciting advancement you have seen in recent years in the field of cancer care?

A: Treatment options are night and day compared with when I started – they’re less toxic and more effective. I’ve been in practice for over 30 years, and what is fascinating is how much longer, and indeed how much better, people are living. A lot of these advances were driven by public health and family medicine working on such broad topics as cigarette smoking cessation, vaccinations, blood pressure, and cardiovascular risk management, to name but a few examples. The increasing average age of our patients presents itself with new challenges as we try to manage cancer patients with increasing non-cancer related health issues. This is likely where my interest in reducing the toxicities of so many of our treatments comes from.

Q: You’ve treated Alison Hughes, who was first diagnosed with breast cancer at 37. What has defined her case?

I think Alison is an amazing woman. She is young and has such enthusiasm for life — something her breast cancer is trying to rob her of. We have the availability of clinical trials, which she has been involved with, including REaCT (REthinking Clinical Trials). The REaCT program is Canada’s largest practical trials program, which time and time again shows we can treat patients with more personalized therapies with significantly less cost to the patient and the healthcare system. REaCT has received amazing funding from The Ottawa Hospital Academic Medical Organization (TOMAMO).

Q: What led to the creation of REthinking Clinical Trials (REaCT) at The Ottawa Hospital?

A: It was the realization that, despite cancer now being the most common global cause of premature death, the amount of practical and applicable research being done is less and less. Also, the highly preselected patients entered into clinical trials don’t usually reflect the reality of patients we see in clinical practice. This is, in part, because the rules of entry to traditional clinical trial select towards younger, richer, fitter patients than we’re seeing in clinical practice. We realized that by involving our patients and their families in the types of studies they want performed, we could do research that actually impacts patient care. Then, by designing trials that had less restrictive eligibility criteria through the REaCT program, we could actually perform true practice-changing research. Ottawa has been the ideal place to lead such a program as we serve a large patient population and have great clinical trials infrastructure, knowledge synthesis, and the Ottawa Methods Centre’s resources in place to enable such studies to be performed. REaCT is one of those ways we’re challenging dogma, we’re saying, “Why did we do that? What is the evidence?”

Q: In addition to treating cancer patients, you are involved in what has been described as an “eclectic” range of research, touching on things like retirement planning and oncologists’ quality of life. Can you describe your research work at the Ottawa Hospital Research Institute?

A: I think it reflects my personality, which is one of a broad interest in many topics, as well being very aware of the realities of life. If there is one overarching thing we can learn from the COVID pandemic, it is a reminder of the foibles of the “human condition.” For me these include the facts that we all have a limited time to live, our period of life with good health is variable, and ultimately it is our friends and family that add the greatest qualities to our lives. To paraphrase far greater minds than mine, “no one on their deathbed wished they’d spent more time at work.” I constantly question dogma and find it abhorrent to do things a certain way just because it’s always the way we’ve done them. For me, choosing to take the easy path isn’t something I’m interested in. I would rather be able to say to a patient, “I really don’t know the answer to your question, I’ll try to find it.” Too many people still find the inability to live with doubt far too uncomfortable. Perhaps this should be added to my list of human foibles?

“As soon as he walked in the room, he made me laugh. He takes away the fear. He’s incredible.”

— Gina Mertikas-Lavictoire, REaCT trial participant says of her first meeting with Dr. Clemons

Q: How does support from the community help advance cancer research?

A: There are so many great ideas going on here, but without the funding, they won’t go forward. Philanthropy, in its broadest definition of the desire to promote the welfare of others, is quite simply an essential component of the human condition.

Dr. Christine Dickson, psychiatrist in the DBT Program at the Ottawa Hospital

For patients taking part in the Dialectical Behaviour Therapy Skills Group (or DBT-Lite Program) at The Ottawa Hospital, Dr. Christine Dickson will be a friendly and familiar face. She has co-facilitated the program since 2013, along with social worker Vicki Larsen before Larsen’s retirement in 2021.

Combining a compassionate approach with evidence-based therapy, Dr. Dickson and the team are helping patients live their most fulfilling lives by learning to balance the acceptance of intense and challenging emotions, thoughts, and urges with behavioural changes. Our program is unique, and for a long time, it was the only English DBT skills group available under OHIP in the city.

Q: Who does The Ottawa Hospital’s DBT-Lite program serve, and how is our program unique?

A: This program is for individuals with borderline personality disorder (BPD) who meet either full or partial criteria. These individuals have high sensitivity to emotional cues, with intense reactions and long-lasting feelings. They feel empty and struggle with a sense of self. They have intense interpersonal sensitivity, and relationships can be chaotic. They have urges to, and often engage in, self-harm and other impulsive potentially harmful behaviours. DBT views these behaviours as ways of dealing with painful experiences that work in the short term but are harmful and sometimes life threatening. DBT offers validation of the pain and the desire to find relief, and at the same time engages the patient in learning new effective behaviours.

A principle of DBT is that clinicians treating BPD need support, so we offer the skills group to complement the treatment and support that patients are already receiving from clinicians in the community. That way we are not only supporting the patients but also their clinicians.

Q: What makes DBT different from other therapies, and how does it help patients like Anita who are struggling?

A: It’s a combination of validation and change strategies. DBT has been described as CBT (or cognitive behavioural therapy) plus validation plus mindfulness. DBT sends the dialectical (or seemingly contradictory) message that everything you think, feel, and do makes perfect sense, and here are the tools to help you change, reduce your suffering in more functional ways, and get closer to your ultimate goals. It really reduces shame and self stigma. Overall, we want to convey a message of hope — BPD is highly treatable; it is not static and can go into remission even on its own and much more rapidly with treatment.

Q: What makes borderline personality disorder such a challenging condition?

A: I have loved working with individuals with BPD since my psychiatry rotations in medical school. They are often creative and passionate about life, society, and the environment. They are often empathetic and helpful to others, and they are really trying their best and want to get better.

That said, the suffering that people with BPD experience is intense. Some believe they cannot get better. Some have learned to invalidate and stigmatize themselves. Some clinicians may also believe it is untreatable and may find it challenging to validate behaviours that don’t make sense to them. It is also really important that clinicians treating BPD get support from other treating clinicians. So, time, training, and expenses can be a challenge. Obviously, the resources must be present.

The first recorded mention of plastic surgery was found in an Egyptian medical text that dates back to 1600 BCE! In it, there are instructions for fixing a broken nose. Plastic surgery has come a long way since then, but it is a great example of reconstructive surgery, which, along with cosmetic surgery, makes up the two main types of plastic surgery. While reconstructive surgery aims to repair or improve the functioning of part of a body, cosmetic surgery aims to change the appearance of a body part. Within those subcategories, there is a huge range of procedures. The Ottawa Hospital’s Plastic Surgery Program Director Dr. Kirsty Boyd knows how varied plastic surgery can be, and that’s part of what initially drew her to it. Read on to learn more about why she chose plastics, some of her most complex cases, and what she’s excited about in her field.

Q: When did you realize you wanted to become a doctor, and how did you end up as a plastic surgeon?

A: I honestly can’t remember a time when I didn’t want to be a doctor. I come from a family of physicians in all disciplines. There are stories about me rounding with my parents on the weekends, climbing right up on patients’ beds. When they moonlighted as residents, they used to sometimes take me with them, and I would colour or read at the nurses’ station. There are even photos of me picking up sponges while my parents were working — which could never happen now! But I never really knew what discipline I would practice in until the summer after my first year of medical school, when I rotated around working with friends of my parents. I spent one day in the operating room with Dr. Martin Lacey watching him operate on a combination of a cleft lip, a burn, a hand, and a breast case and decided that day that I would be a plastic surgeon.

Q: When someone hears “plastic surgery,” they might think only of cosmetic surgery. Why is plastic surgery a critical field in healthcare?

A: Cosmetic surgery is an important part of plastic surgery, but it only represents a small portion of what we actually do. We restore form and function to patients in all areas, including hands and wrists, burns, craniofacial cases, nerves, skin cancers, pediatrics, traumas, and complex wounds. We are the “surgeon’s surgeon,” and we literally operate in combined cases with every single other surgical discipline, often getting involved to solve difficult problems and rearrange and reconstruct tissue. Plastic surgeons need to know anatomy from every part of the body. We operate on every single type of tissue (bone, cartilage, nerve, muscle, skin etc.) and in every area. It isn’t infrequent for people to be surprised to hear that I am a plastic surgeon and for them to say that they didn’t realize that plastic surgeons do reconstruction too.

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Q: You worked on Karen Toop’s case following a severe injury from a snow plow. What made her case so incredibly challenging?

A: I was only three weeks into my surgical practice at The Ottawa Hospital when Karen sustained her injuries. The extent of her injuries was absolutely catastrophic, and she is very lucky to be alive. Part of what made her case so challenging is that she lost so much, and we were trying to provide her with as much function as possible with very little to work with. Karen truly required a multi-disciplinary effort, and her team involved specialists from plastic surgery, orthopedic surgery, vascular surgery, physiatry, ICU, general surgery, trauma surgery, and physiotherapy. She was an example of people coming together and applying rare and complicated surgical techniques in a novel situation. It was also an opportunity for me personally to be mentored by an amazing senior colleague — especially at such an early point in my surgical career.

Read Karen’s story

Q: You also did the first nerve transfer surgery to restore upper extremity function in a spinal cord injury in Canada on patient Timothy Raglin. How does that surgery reflect the groundbreaking work happening at The Ottawa Hospital?

A: Tim approached me after reading about a surgery that had been performed by my fellowship supervisor, Dr. Susan Mackinnon, at Washington University in St. Louis, Missouri. At the time, this was a novel application of a strategy to re-wire nerves after injury — in this case, using a redundant nerve above the level of spinal cord injury to power a non-functioning nerve below the level of injury. I was very hesitant, as I had never operated on this patient population before, and the potential for downgrading function in a patient with tetraplegia — meaning they have paralysis in all four limbs below the neck — was very worrisome. Dr. Mackinnon volunteered to come to Canada to assist me with the surgery. She and her colleague came at their own expense and we completed the nerve transfers together. I feel very fortunate to have had the support of my division head and of the chief of surgery to bring this groundbreaking work to Ottawa and to have done the first surgery of its kind in Canada.

Q: What is the most exciting research happening in the field of plastic surgery right now/where is it heading?

A: Personally, I find the research in nerve surgery, both basic science and clinical, the most exciting. Clinically, indications for nerve transfers are exploding, and function is being restored to injuries that were previously not considered operable. In addition, newer techniques have allowed us to expand our procedures to operate earlier, and on more patients, to achieve excellent results. Currently nerve transfers are being performed on patients with spinal cord injuries, pinched nerves in their spines, peripheral nervous system disorders, and other nervous system conditions — and these transfers are occurring in both upper and lower extremities. At The Ottawa Hospital, Dr. Gerald Wolff and I regularly perform research and contribute to this literature and run one of the largest peripheral nerve trauma clinics in the county. From a basic science perspective, new knowledge is allowing for improved nerve recovery and better outcomes.

Q: As a plastic surgeon, why did you choose to work at The Ottawa Hospital and what is the most gratifying part of your job as a plastic surgeon at The Ottawa Hospital?

A: Ottawa provided a perfect opportunity for me. There was no one here at the time doing complex peripheral nerve reconstruction in plastic surgery. I had the opportunity to found the Peripheral Nerve Trauma Clinic with my good friend and excellent colleague, Dr. Gerald Wolff, and to truly build one of the largest and most successful nerve programs in Canada. I had the opportunity to join Canada’s newest residency training program, to help shape the program from infancy, and then ultimately to take over the position as Residency Program Director. Most importantly, I was able to work with excellent colleagues who I consider to be both mentors and friends. This has enabled me to tackle the really complex cases, like Karen’s and Tim’s, and to feel supported while doing so. The work we have done in these areas has been recognized nationally and internationally, and I feel very proud of what we have accomplished. Without doubt, the most gratifying part of my job as a plastic surgeon at The Ottawa Hospital has been to follow our patients along and see them regain function following devastating injuries.

As the Chief of Vascular and Endovascular Surgery at The Ottawa Hospital since 2012, Dr. Nagpal is leading what is now considered a renowned vascular surgical team that is on the cutting edge of new surgical techniques.

Dr. Nagpal is also a Clinical Investigator at the Ottawa Hospital Research Institute, and both his commitment to research and excellence in care are changing the outcomes for patients at our hospital.

Q: When did you realize you wanted to become a doctor, or, how did you end up as a vascular surgeon?

A: I have always been interested in the sciences, starting back in middle and high school, and consistently received encouragement from teachers to pursue higher education. Growing up in a small town in Nova Scotia, I interacted with my family doctor and remember being quite impressed with his calm demeanour and temperament. He was a person that one would clearly want to emulate.

Going on to Dalhousie University and having discussions with students at the medical school, I knew this profession would be challenging and fulfilling. After finishing Dalhousie Medical School, I worked as an emergency doctor for approximately four years before returning for general surgery training. During the general surgery residency program, my favourite rotations were in vascular surgery. Performing operations on blood vessels can be quite technically challenging but ultimately quite satisfying as the results are often immediate. Also, vascular patients tend to be elderly, and this patient population tells the most extraordinary personal stories during clinic visits!

Q: What is something unusual or surprising about the field of vascular surgery?

A: The field of vascular surgery has undergone nothing short of a revolution in the past 10 or 15 years. Vascular procedures that were done with major operations requiring large incisions and significant duration of stay in the hospital can now be done by minimally invasive procedures, called endovascular therapy. These patients often are home within a day or two. Though less physically intrusive, a minimally invasive surgery may not compare favourably to a more complex open procedure.

This conundrum, which procedure is best for a particular patient on a long-term basis, has been a major challenge for vascular specialists. We were fortunate at The Ottawa Hospital to acquire one of the first advanced hybrid operating rooms which allows us to do both minimally invasive and open procedures on the same patient at the same time. This has allowed us to become a national leader in these innovative procedures.

Q: You worked on Mina Jean King’s case. What made her case challenging or unique?

A: Mina’s particular situation showed significant blockages in both legs. We were able to improve the circulation on her right leg with endovascular therapy, but on her left leg, where she had developed limb threatening ulcers (open non-healing areas on skin), endovascular therapy had not worked. She had a significant risk of losing her left leg to an amputation, which would have immensely affected her quality of life.

Performing complex bypass procedures in this age group requires a team approach with the assistance of skilled anesthetists, nurses, surgical teams, and postop care. Fortunately, at The Ottawa Hospital, we have these skilled people in abundance. In particular, this bypass required us to sew blood vessels two millimetres in diameter in the lower part of her leg. This procedure took approximately four and a half hours, and she pulled through with flying colours thanks to the whole team.

Q: The bypass surgery you had to do on one of Mina Jean King’s legs was incredibly complex. Why do you think The Ottawa Hospital has had remarkable success in these complex bypass surgeries?

A: The Ottawa Hospital performs more complex bypass procedures than any other hospital in Ontario. The Division of Vascular Surgery at our hospital is committed to limb preservation as a major focus. We have created a Limb Preservation Clinic, which is being used as a model for care throughout Ontario and Canada. Again, this requires a significant team approach that includes experts in wound care, infectious disease specialists, plastic surgeons, and orthopedic surgeons. This collaborative approach has allowed patients to receive expert medical care by multiple specialists on one visit. Ottawa has one of the lowest amputation rates following bypass surgery in Ontario. The coordinated care and follow-up is done through the Limb Preservation Clinic is a major reason. The division is initiating a limb preservation clinical fellowship to teach young vascular surgeons complex operative and endovascular techniques, optimizing wound care and risk factor management. Hopefully, the excellent results seen at our hospital can be taught and spread throughout Ontario and Canada.

Q: What is The Ottawa Hospital doing in vascular research that is exciting or groundbreaking?

A: Vascular research is also a significant focus for the Division of Vascular Surgery and undoubtedly has improved patient care. Multiple impactful research endeavours have allowed the division to become a national leader for vascular research and innovation and some recent research projects have received national awards and international recognition.

New exciting projects underway which have received significant grant funding include: a research program in peripheral vascular disease, quality control for access to vascular risk factor management, artificial intelligence in the vascular operating room, and assessing mindfulness to improve mental health in surgical residents. This is a glimpse of the multiple projects that are ongoing in the division.

Q: How important is community support/donation for pushing research forward?

A: Funding for ongoing innovative research is a persistent concern for any academic division. This is especially true for a busy surgical division devoted to patient care. Community support allows us to leverage research support for innovative ideas originating from surgeons and residents. This research support is invaluable from the onset of the research idea to the completion of written manuscripts. We are thankful to the donors who have allowed us to maintain and improve our research focus over the years. The costs of research continue to rise, and the need for new resources and support also remain.

Q: The Ottawa Hospital is currently working towards the creation of a new, state-of-the-art health and research centre to replace the aging Civic Campus. What will this new hospital mean for your patients?

A: We have reviewed the plans for the New Campus Development and research centre — it is exciting to be involved in the planning of this new modern health facility. Vascular patients will be well-served in this new facility through integrated outpatient care, including our limb preservation clinic, collaborating specialties, and our vascular diagnostic centre. They will receive their vascular tests and clinic appointment in the same location, allowing prompt diagnosis and therapeutic decisions. The new operating rooms will have advanced hybrid endovascular and operative infrastructure allowing us to maintain and continue to lead with innovative procedures advancing patient care.

Q: What keeps you motivated during stressful times as a vascular surgeon at The Ottawa Hospital?

A: On a professional level, vascular surgery can certainly prove taxing at times. A complex lifesaving operation lasting four to five hours can proceed successfully only to have the patient suffer complications due to the magnitude of stress to the body. This can certainly take a professional, and personal, toll as many of our patients have pre-existing conditions.

Vascular surgery is also a tremendously satisfying specialty, knowing you had a part to play in saving many lives and limbs, indeed this is the primary motivating factor for the long hours and stressful times.

Dr. Carolyn Nessim is a Surgical Oncologist at The Ottawa Hospital, as well as a Clinician Investigator at the Ottawa Hospital Research Institute (OHRI).

Before arriving at our hospital in 2013, her training took her from Montreal to Toronto and even as far as Melbourne, Australia. While she specializes in soft tissue sarcoma, melanoma, and gastric cancer, her expertise is wide-ranging as she collaborates with other researchers in addition to treating patients.

Dr. Nessim also has rhythm. In 2018, she was one of a handful of physicians who competed on the dance floor in front of a sold-out crowd of 800 for Dancing with the Docs, a fundraising event that raises funds for patient care and research at our hospital.

Q: When did you realize you wanted to become a doctor? How did you end up in oncology?

A: I have wanted to be a doctor since I was seven years old — it’s as if it was a calling. In my 20s I had a personal health scare, and the nicest doctor took all my fears away with a simple conversation. I remember thinking, “I want to do that for people too.” By my second year of surgical residency, I knew I wanted to specialize in oncology. I was fascinated by the complex tumours and surgeries and new therapies that were changing the face of cancers, but more importantly, I was moved by the relationship that develops with patients and how rewarding the work is. I’m often asked why I chose cancer because people assume it must be so sad. But on the contrary — it is a privilege. To cut is a chance to cure and patients unconditionally trust us to take care of them.

Q: What is the most interesting thing you have learned during your time as a surgical oncologist?

A: For patients we cannot cure we still provide support and empathy through a difficult journey, so I believe we still help in those cases as well. No one lives forever, but how we live our journey is what will make the difference, so I believe in hope and positive thinking.

Q: What innovations have you seen in the field of oncology since you started?

A: The role of immunotherapy in cancer is revolutionary. It’s a type of treatment that boosts your immune system to fight off the cancer. Although it does not work in all cancers, for others it has turned metastatic patients that used to die within six months to now live for 5-10 years and beyond. It has taken decades to perfect and in 2018, it won the Nobel Prize.

Q: What is The Ottawa Hospital doing in oncology that is exciting or groundbreaking?

A: I have done some translational clinical research with Michele Ardolino, Jean-Simon Diallo, and Luc Sabourin at the Ottawa Hospital Research Institute to better understand the genetics and biology of both melanoma and sarcoma and how they respond to oncolytic viruses or why they resist to immunotherapy. It’s very exciting work.

Q: You helped uncover Bryde Fresque’s diagnosis of a rare pheochromocytoma, why was this diagnosis a challenge?

A: In Bryde’s case, he had a spontaneous rupture which led to a large hematoma that hid the underlying tumour on imaging. Also, most pheos release adrenaline which you can detect in a 24-hour urinary test, but Bryde’s was non-functional making the urine tests negative. These factors made the diagnosis more difficult to make. Eventually we could see a mass on the imaging, and it was clear the only next best step was to remove it.

Q: The surgery he needed to save his life was incredibly complex, lasting 12 hours. Explain why.

A: The tumour was quite large —over 20cm — and very inflamed because of the bleeding. His tumour was also attached to several organs which required what we call a multi-visceral resection en bloc (removal of organs that are touching). This takes time as it involves very careful dissection of large vessels that we do not want to injure. We removed Bryde’s tumour en bloc with the kidney, adrenal, spleen, distal pancreas, colon and diaphragm and then reconstructed the diaphragm and colon. Most sarcoma surgeries take anywhere from 5-24 hours. Some can take even longer — over 48 – hours.

Q: What makes rare cancers, like pheochromocytomas such a challenge to diagnose and treat?

A: The reason rare cancers are hard to treat and diagnose is because we need more investment in research. Also, the rarer the cancer the less we are able to run large randomized clinical trials, because there are so few patients. We need more international collaboration for rare cancers to increase the number of patients to better understand these diseases and how to manage them. In the last ten years, we have created an international research collaboration for sarcoma called the Trans-Atlantic Australasian Retroperitoneal Sarcoma Working group of which I am the Chair of the Research Evaluation Committee. This has made a huge difference in sarcoma research. It includes experts from around the world designing research studies and clinical trials and it will change the face of sarcoma research.

Q: What is the most gratifying part of your role as a surgical oncologist at The Ottawa Hospital?

A: My relationship with my patients. It is the best thing ever. I am inspired by their strength, motivation, and humility. Being even just a small part of their journey is the most fulfilling and gratifying part of my job and pushes me out of bed every morning to come to work.

Q: In your opinion, how important is support from the community in advancing cancer research?

It is very important. If there were more awareness and more community support, we could expand our research and study more about diseases like rare cancers.

The Ottawa Hospital was fortunate to welcome renowned neurosurgeon Dr. John Sinclair back to Ottawa 2005, following two fellowships at Stanford University in California. As the Director of Neurosurgical Oncology and the Director of Cerebrovascular Surgery, he is an expert resource for our patients facing brain tumours, including glioblastoma multifome.

Dr. Sinclair is an innovator and always on the lookout for the latest treatment options for our patients. It was this drive that helped bring the CyberKnife, Advanced Awake Craniotomy techniques and most recently Fluorescence-Guided Surgery to our hospital. With tools like these at their disposal, Dr. Sinclair and his colleagues have increased survival rates for our brain tumour patients.

Q: Why did you choose to work at The Ottawa Hospital?

A: I grew up in Ottawa. The sense of community here is strong. I wanted to be a part of that community. I felt that I could make a difference by helping to develop outstanding care for our patients in the community and beyond. I have treated a number of patients who I have known from my years growing up in Ottawa. There is a bond that builds trust and hope in patients when you have a common connection. Ottawa is that connection for me.

Q: As the Director of Neurosurgical Oncology what, in your opinion, sets The Ottawa Hospital apart from other hospitals?

A: The thing that sets us apart is the incorporation of awake surgery and advanced mapping for the resection of most brain tumours and more recently Fluorescence Guided Surgery. These innovations place us alongside our Ottawa Hospital colleagues in cancer treatment and research within the complementary specialties of neuro-oncology, neuroradiology, neuropathology, neurophysiology and neurological oncology. These two advances in particular have allowed a wider scope of a patient centered focus as we collaborate closely through all aspects of care and treatment.

Q: You were instrumental in bringing the community-supported fluorescence-guided microscope to our hospital. This microscope illuminates malignant brain tumours during surgery allowing you to successfully remove more of the tumour. How has this microscope impacted our patients with brain cancer?

A: Without this microscope, we would not be able to do Fluorescence Guided Surgery (FSG). FSG allows for maximal safe resection of malignant tumours which in research has proven to increase length of time to recurrence and overall survival rates. Without a doubt, this offers our patients a better chance to fight against brain cancer.

Q: Another piece of equipment made possible thanks to donor support is the CyberKnife. How has the CyberKnife technology helped patients of The Ottawa Hospital over the past decade?

A: Over the past decade, we have been able to treat thousands of patients using CyberKnife. It allows for a targeted approach to radiation treatment resulting in decreased side effects and decreased risk to the patients. This precision treatment also typically allows for shorter treatment time resulting in viewer visits to the hospital.

Q: You removed Stefanie Scrivens’ grade 2 oligodendroglioma brain tumour through a successful awake surgery, and she didn’t need chemo or radiation. What made this incredible outcome possible?

A: Using advanced subcortical mapping during Stefanie’s surgery allowed us to provide maximal resection of the tumour, taking a rim of “normal” tissue where the tumour had been. This was done in hopes of removing any microscopic tumour cells that extended beyond the tumour. By doing so we were able to indefinitely postpone radiation and chemotherapy.

Q: The Ottawa Hospital has incorporated Canada’s advanced brain mapping techniques to help during awake brain surgery. How does this mapping system help brain surgeons?

A: Traditional approaches to awake craniotomy deal with basic brain function; speech and movement. In many cases this is sufficient. Advanced cortical and subcortical mapping allows testing of advanced brain function that can impact higher brain function, such as cognition, personality and visual perception. The ability to map these functions allows us to safely preserve brain function; improving outcomes and the quality of life for patients. With basic mapping it is often necessary to leave a portion of tumour behind rather than continuing surgery in these eloquent areas.

Q: The Ottawa Hospital is currently working towards the creation of a new, state-of-the-art health and research centre to replace the aging Civic Campus. What will this new hospital campus, which will be the most technologically advanced facility in Canada, mean for your patients?

A: The new hospital campus will allow us to build from our strong foundation, a centre that will provide our patients with multidisciplinary care that will bring together all facets of healthcare. A centre like this will attract world-class physicians and care teams. It will help to advance treatment and research within our community. In doing so we will be able to provide a centre of excellence. This is a perfect opportunity to really bring patient care to the highest level.

Q: What message do you want to convey to your patients with brain tumours?

A: Quoted statistics often reflect dated technology and treatment protocols and new advances in treatment are always occurring and evolving. Our patients need to keep that hope and our community must foster that through continued support of The Ottawa Hospital in order for this to become a reality in the years to come.

Go behind the scenes with Dr. John Sinclair in episode 35 of Pulse Podcast.

Dr. Fahad Alkherayf is a skull base surgeon at The Ottawa Hospital.

Dr. Fahad Alkherayf is the Director of the Clinical Research Program in the Neurosurgery Division of The Ottawa Hospital. As a neurosurgeon, he specializes in minimally invasive surgeries, which use much smaller incisions than traditional surgeries. As a result, they can mean less pain, lower chance of infection, and quicker recovery time. As part of a highly skilled team at The Ottawa Hospital, Dr. Alkherayf is broadening the horizons in neurosurgery treatment and research — not just in Ottawa, but across Canada.

Q: How did you decide to go into the field of neurosurgery?

A: In my Grade 7 science class, we learned about the human body and how all the systems function together. It really started my interest in medicine, especially the brain. There were three of us in that class who were very close friends, and we shared this interest. All three of us became doctors: one is a psychiatrist, one a radiation oncologist. I went to medical school based on this, and during my schooling I spent time in neurosurgery and realized this would be my future.

Q: What have you learned since becoming a neurosurgeon?

A: I have learned that despite what the textbooks show and say about the brain, in real life each patient is unique, and what works for one patient might not work for another. This has inspired me to individualize each of my patients’ care.

Neurosurgery is also evolving at a fast pace, and a lot of the equipment we now use was not invented or used when I started in the field. A lot of historical neurosurgical procedures have been replaced with modern techniques.

Q: You used minimally invasive surgery to remove a meningioma tumour from behind Michele Juma’s eye. How did these new techniques help her?

A: Michele came to see me almost blind because the tumour was attached to her optic nerve. Identifying the margin between the tumour and the nerve without causing damage to her nerve was one of the biggest challenges in her surgery.

This type of tumour is not new, the presentation is not new, but the treatment is relatively new. We used to do craniotomies, which involve a big incision in the skin. You need to remove part of the skull, go underneath the brain, lift the brain up, and then work all the way to the centre and remove the tumour, aiming not to injure any of the structures around it. The challenge with that is it’s a long path, and it’s through a really big incision. We know with these, there is a higher risk of inuring the optic nerve.

With patients like Michele, now instead of going through the old, traditional way — going through the scope, and lifting the brain up — we go through the nose.

Minimally invasive skull base surgery uses a narrow scope with a light to access and remove tumours through the nose.

Q: You also use a unique technique you call “vision monitoring” during certain minimally invasive surgeries like Michele’s. Can you talk about that and what else The Ottawa Hospital is doing in neurosurgery that is exciting or groundbreaking?

Continuous evoked visual potential goggles are used by surgeons during some brain and skull surgeons to monitor a patient’s vision and avoid damaging the optic nerve.

A: The vision monitoring is teamwork where a neurophysiologist continuously monitors any changes in the patient’s vision during the surgery. This technique is done by applying goggles — similar to swimming goggles — over the patient’s eyes, which send signals through their eyes, and then we record the response from the patient’s vision centre. This allows the neurophysiologist to monitor any changes to the patient’s vision happening during the surgery. This live feedback helps the surgeon to achieve maximum resection (or removal) of tumours while minimizing the risk of injury to the visual pathway.

I am proud that this technique was significantly modified by our team here at The Ottawa Hospital. In addition to this unique technique, at The Ottawa Hospital we have advanced equipment including 3D endoscopes, along with techniques to inject the tumour with certain dyes to allow the tumour to be better visualized during the surgery.

Q: The Ottawa Hospital is currently working towards the creation of a new, world-class health and research centre to replace the aging Civic Campus. How will this new hospital campus, which will be the most technologically-advanced facility in Canada, make a difference for our neuro patients?

A: The new Civic Hospital will have the state-of-the-art technology that will advance the focus on individualized patient care.

The “one-model-fits-all” approach is changing in neurosurgery. Current research is focussing on individualized patient care. I see a future where each patient will have their surgery planned specific to their situation and needs — where artificial intelligence techniques would be part of planning for patient surgery.

Q: Why did you choose to work at The Ottawa Hospital instead of a different hospital?

A: One of the biggest advantages of The Ottawa Hospital is that all of us are connected. What happened in Michele’s case, for example, is that everything could go very quickly, because we are all in one centre. We are more advanced because we’re able to work as a group. We have brought all the expertise under one umbrella here.

I am a strong believer that the key thing for success is having a collaborative and supportive work environment. Of the many offers I received early in my career, The Ottawa Hospital, together with The Ottawa Hospital Research Institute, were the right fit for me. This kind of workplace, and the great city of Ottawa, was the best decision for my family.

Q: Where would we find you outside of work?

A: Depending on the time of year, you can find me playing soccer, hiking, camping with the kids, or taking care of the garden.

Q: What is something about you people might not know?

A: I have arachnophobia.

Soccer skills and stem cell science