Researchers Under the Scope

As Saskatchewan drops its proof-of-vaccine requirements and masking orders, doctors and nurses are angry and frustrated, as they care for record numbers of Covid patients.

"There's this tension of how to manage all of this going forward so that we don't have surge after surge and wave after wave continue to basically crush our healthcare system," said Dr. Alex Wong.

The infectious disease specialist based at Regina General Hospital said Saskatchewan politicians ignore medical advice in their rush to drop Covid restrictions.

Some, Wong said, have spread half-truths misinformation about the Omicron variant, and the efficacy of the vaccine.

Roughly half of adults in Saskatchewan have received a third Covid booster, something Wong said makes a 'colossal' difference with Omicron.

"If I could pick one thing to leave in place. It would be the proof of vaccine program," said Wong.

Without it, "there's not going to necessarily be that sense of urgency and motivation," Wong said.

The associate professor of infectious diseases at the College of Medicine said variants will keep emerging, as the virus circulates through unvaccinated populations in other parts of the world.

Wong said public health messaging on masks and vaccines must be clear and it must be driven by scientific principles, not political fear.

"It's not really right to let society just forget about people who are on the fringes, who are marginalized, who are medically frail or immunocompromised or vulnerable or kids under five," said Wong.

"That's just not okay. That's not what a caring, functional society does."

Wong said Saskatchewan's public health message must be clear: get vaccinated.

"That is the one most sustainable way out of all of this towards some normalcy."

Audrey Zucker-Levin estimates it's been more than 30 years since she first poked her head into a researcher's office at New York City's Hospital for Special Surgery.

Back then, the clinical therapist spent her days treating hospital patients, stopping by the laboratory after her shifts.

"I was very intrigued by the prosthesis, by the mechanical and the physiologic connection," said Zucker-Levin.

"I kept basically showing up any time I had spare time," she said. "They just put me to work."

After long hours spent studying patients in early video work, Zucker-Levin recalled studying muscle movement and function through patients' knees, hips and lower-leg placement. She learned more about missing feet, and became curious about the neurological connections producing phantom sensations -- messages trying to connect and control the places where limbs once grew.

Zucker-Levin went on to study prosthesis innovations, and welcomes today's gait lab advancements.

"We were very dependent upon the technology of the prosthesis, as well as the ability of the person, and we were trying to match them," she said. "It was fascinating work."

Zucker-Levin enroled in a part-time doctoral program at NYU, but didn't complete it right away.

She followed her husband to Bethesda and a fellowship at the National Institutes of Health. After a few years, Zucker-Levin, her husband and two young sons relocated to the University of Tennessee in Memphis. She took on a faculty position there, determined to complete her PhD.

"We had a babe in arms and a toddler," she said. "And I flew back and forth to New York every other week with the two little ones."

Today, she empathisizes with parents who are students. She admits it was not easy finding balance as a full-time faculty member, as a part-time doctoral student, and as a full-time mother.

"But I had lots of support," Zucker-Levin said. "I really enjoyed the research. I really enjoyed that ability to try and figure out how to help people function easier, or better."

After she and her husband moved to Saskatoon in 2017, Zucker-Levin was hired as a professor at the University of Saskatchewan's School of Rehabilitation Science.

The move north gave her research a different direction as she pivoted from helping high-functioning athletes and dancers, to helping more sedentary patients after amputations.

With support from the Saskatchewan Centre for Patient-Oriented Research, and the Saskatchewan Health Research Foundation, her team now focuses on improving function in people affected by lower-leg amputations.

Zucker-Levin started by assessing rates of amputation in Saskatchewan compared to other countries. From there, her team went on to use MRI scans to assess phantom sensation, watching the neurological connections the brain uses to keep or regain function; they're also experimenting with exercise programs aimed at using phantom sensations to help patients heal, along with studying a host of other factors affecting post-operative care.

She's the principal investigator in "Wheeling to Healing"; research aimed at healing and preventing diabetic foot ulcerations, and she currently has four publications set for review.

Dr. Ayisha Kurji first noticed the uptick in children and teens admitted to hospital in the spring of 2020.

Some had cardiovascular damage. Some had gastrointestinal issues.

But it wasn't because of Covid-19.

Instead, she kept seeing children and adolescents hospitalized with eating disorders.

"They were so sick, so medically unwell," said Kurji. "We started to track it."

As familiar routines evaporated and face-to-face interactions vanished after school cancelations, Kurji said across Canada, outpatient referrals for eating disorders shot up 60 per cent, largely driven by an increase in anorexia nervosa.

Kurji is one of the only paediatricians in Saskatchewan who specializes in treating children and teens with eating disorders.

During the pandemic, she said inpatient hospitalizations for eating disorders tripled.

The phenomenon is not isolated, with doctors in Canada and internationally observing the same spike, Kurji said.

"In the pandemic where we've seen school closures and things like that, we've also seen more kids with depression, more kids with anxiety, and this eating disorder trend is huge," she said.

Kurji shared red flags for eating disorders, and emphasized the need for parents to keep an eye on children and teens who develop new habits around food and exercise.

"As a pediatrician, as a mom, we need to be putting our kids first," said Kurji.

In this episode, she talks about her path to pediatrics, one that included a bachelor's degree in psychology before she entered medical school at the University of Calgary.

Kurji completed her residency in Saskatchewan, and is now an assistant professor of pediatrics at the University of Saskatchewan's College of Medicine.

Almost two years into the pandemic, she's now compiling her observations on the spike in eating disorders into an article for peer review.

As Omicron infects a growing number of people, she said it's important to learn from the early days of the pandemic.

"I think we need to be really careful how we approach things like school closures and delays," she said.

"Sometimes they might be needed, but we need to keep in mind that that's going to have an effect on our kids and we need to be prepared."

Kurji also said popular culture and social media sites also tend bombard young people with questionable messages about food, body image, and beauty.

"When you're watching together, or if you see something like that, it's a good idea that you say 'let's pause this and let's talk about it," Kurji said.

She said parents need to actively reframe discussions around outward appearances, in favour of talking about active living, and what a person's body can do.

"Eating disorders really speak to me as my special thing where I feel like I can make a difference," she said.

Left untreated, she said patients who suffer from anorexia and purging often go on to struggle with food as adults, increasing their risk of death by five per cent each decade.

"Catching things early makes a huge difference," said Kurji

Further resources are available at The National Eating Disorder Information Centre (NEDIC) and at the Kelty Mental Health resource centre.

Dr. Erique Lukong grins, pointing to two bracelets on his wrist. One inscribed with the word 'focus'; the other 'believe'.

"I'm passionate about what I do,' he said, describing his journey through medicine as a series of 'lucky breaks'.

In his home country of Cameroon, Lukong was identified early as a promising scholar. Upon graduating from high school, he won an eight-year government scholarship to master both biochemistry and French linguistics.

"They were looking for technical and medical translators to come back to the country," said Lukong, who enroled at Keele University in the United Kingdom, earning double bachelor's degrees.

Lukong then moved to the University of Montreal for his masters-level work.

But his career path changed, after Cameroon's economic and political crisis during the early 1990s. With a young family to support, Lukong opted to stay in North America.

"I had nobody to guide me," said Lukong. "I didn't have somebody who looked like me anywhere."

Undeterred, his work on lysosomes and identifying mutations brought him to McGill, Harvard, and finally the University of Saskatchewan.

Today his lab focuses on the biochemistry of breast cancer.

"From the very first person that I saw, I was already welcome," said Lukong, who vividly remembers the contrast between his job interview in Saskatoon and Quebec. "Everybody was welcoming."

Lukong is a biochemistry professor and a member of the University of Saskatchewan's Cancer Research Cluster.

His lab aims to pinpoint what BReast tumor Kinase (BRK), non-receptor tyrosine kinase is doing in these patients' bodies. Lukong is also investigating whether its presence is what's leading them to become drug-resistant.

"The big problem we have right now is drug resistance," said Lukong.

He said nearly a third of breast cancer patients taking Tamoxifen will develop some resistance to it.

It's even tougher with Fulvestrant, a secondary treatment, one whose effect wears off in almost all patients over time.

"That's the new direction my lab is taking now," said Lukong.

Lukong also makes time to mentor his researchers, and to find out what their goals are.

For him, one of the most difficult aspects of pursuing a career in biomedical science was that no one else looked like him.

Even today, Lukong said a number of promising Black students often drift away from their studies, or give up on academia.

"All they need is that role model" said Lukong.

Last year, he became the vice-president of the Canadian Black Scientists Network, which is set to hold its first conference for Black Excellence in Science, Technology, Engineering, Mathematics and Medicine/Health next month.

The four-day "BE-STEMM 2022" virtual conference begins January 30, 2022.

"That's why I'm here. To tell them, you can do it," said Lukong.

Without a car, without childcare, without a grocery store, a pharmacy, or a place to get blood work done, how is a person with diabetes in rural Saskatchewan supposed to keep their disease in check?

Those are the questions Dr. Stu Skinner and his Wellness Wheel team members face each day, as they treat Cree and Saulteaux patients on the Day Star, George Gordon, Kawacatoose and Muskowekwan First Nations in south-eastern Saskatchewan.

"We see a lot of patients with diabetic foot infections," said Skinner, a University of Saskatchewan-trained physician who specializes in infectious diseases and internal medicine.

Some of his patients typically walk 5 km or more in a day. Some don't realize their feet are injured until it's too late -- when gangrene appears.

In this episode, he describes the complications of uncontrolled diabetes, which can lead to heart attacks, strokes, kidney failure, vision loss, and amputations.

Facing tough financial choices, discrimination and long travel times, he said a number of his patients won't seek health care until it's too late.

"I always joke that we need to go back to the old doctor model with the black bag where you go to people's houses and you treat them there because that's what works," Skinner said.

To build trust and to help patients better control their diabetes, Skinner's team will spend the next year recruiting 'peer champions' in the area who also have diabetes — people who better understand what day-to-day life as a diabetic is like.

"People who have that lived experience have a lot to contribute and really are key," said Susanne Nikolai, nurse lead and Wellness Wheel's clinical coordinator.

Nikolai said working with Skinner and his team has been "absolutely the best nursing that I've done in my almost 30 years as a registered nurse."

Earlier this year, the Saskatchewan Health Research Foundation approved a $7,500 grant for 'Culturally Responsive "Diabetes 101" Training and Knowledge Mobilization Among Indigenous Peers Living with Diabetes in Regina Urban Hub and Indigenous Communities'.

Skinner plans to use the money to build trust with his patients, to connect them with diabetic peers in their community, and to find out what's stopping them from getting the care they need.

"Many of our patients don't have transportation or they need childcare," said Skinner.

"If I, as a physician, mail out a letter for an appointment to someone, but they can only check their mailbox maybe once every three to four months, how are they ever going to know about the appointments, even if they could make it there?"

Hear why this matters so deeply to Skinner, Nikolai and the Wellness Wheel team in this episode.

For senior citizens, fracturing a hip is more often than not a life-changing injury.

One in three of those patients will die within a year. The second will recover and return home. The third often needs to move to a long-term care facility, to cope with reduced mobility.

Dr. Cathy Arnold makes it her mission to stop those falls and fractures in the first place.

On this episode of the podcast, she joins us to talk about breakthroughs in rehabilitation techniques and research, as Canada marks fall prevention month every November.

After practicing physiotherapy for 25 years in hospital settings, in the community, and in private practice, Arnold is now the director of the School of Rehabilitation Science at the University of Saskatchewan's College of Medicine.

"What led me to research were those opportunities and interactions that I had with my older clients," said Arnold.

She said their questions often led her to uncover conflicting scientific advice about how best to heal after surgery, and how to cope with aging.

"I became very interested in what did keep people living longer," said Arnold. "I found working with older adults was really rewarding."

Arnold said older adults need to practice balance exercises, and work at increasing their strength, even if they're frail, or if they've been diagnosed with osteoporosis.

A stronger, more flexible person can catch themself during a fall, said Arnold. That strength and balance can mean the difference between a life-changing fracture -- and escaping from a fall with bruises.

"The next time you fall or you lose your balance, you might be able to catch yourself," said Arnold. "You might be able to put out your leg and your muscles are strong enough to stop you."

Dr. Marek Radomski says research pays off, in attracting dollars to post-secondary institutions, in creating healthier citizens, and in lowering health costs.

He's the vice-dean of research at the University of Saskatchewan's College of Medicine, a member of Canada's U15 Group of Canadian Research Universities,

But in a province that will spend $6.5 billion on health care this year to fight a raging coronavirus pandemic, biomedical research spending is stuck at levels last seen at the turn of the century,

For decades, the Saskatchewan Health Research Foundation, the major grant agency, has seen its budget stagnate at around $5M dollars a year.

"My suggestion would be to double the SHERF budget," said Radomski.

"It's worth investing in research. It's worth investing in very talented people," he said.

"It's worth investing in hungry young wolves. It's worth investing in our very gifted and overworked clinicians."

Radomski said for each dollar Saskatchewan spends on biomedical research through SHERF, his medical scientists bring three additional dollars back.

Most use SHERF grants as seed money to pursue larger grants from highly competitive grant programs through national agencies and organizations.

Radomski was born in Poland, and grew into one of the world's top pharmacological scientists, after four decades spent working in academia and in private industry. A quick scan of Google Scholar shows his publications are now cited by more than 28,000 researchers.

A gifted mentor, Radomski moved from Trinity College to Saskatoon five years ago, and said Toronto, Montreal and Vancouver needn't be Canada's only high-profile destinations for scientific research.

"There's lots of room for us to be the leaders," he said.

Radomski pointed to clinician scientists at the College of Medicine leading the way in the treatment of strokes, along with Multiple Sclerosis.

Under his watch, he's hired 12 "hungry young wolves" -- outstanding young scientists who have relocated to Saskatoon to push forward new discoveries, techniques and treatments."

"We want to compete with Harvard," he said. "Maybe not in everything but there might be some areas where we can make a huge difference."

Radomski said even with Covid-19, a breakthrough may be on its way, as scientists at the U of S Vaccine Infectious Disease Organization (VIDO) push a low-cost SARS-CoV2 subprotein unit vaccine toward its final round of human clinical trials.

Radomski admits he's made the case for targeted research spending to politicians 'for some time now'.

He won't stop until he sees results.

"We've heard you need to keep on repeating your story," he said. "We've got amazing champions across the campus. Covid brought us an opportunity to highlight the work of these champions."

In this episode, he points to the work of several Saskatchewan physicians and scientists whose efforts are already improving patient health -- and who may ultimately pull Saskatchewan out of the pandemic.

"This is our ambition. It's a tough one to accomplish, but worth going for," said Radomski. "We want to be the top."

Julia Boughner knows primates carry a deep-seated instinct to gather together. An associate professor of anatomy with the College of Medicine, Boughner is a biologist who specializes in evolutionary development. On the last Tuesday of the month, she also hosts Café Scientifique Saskatoon. The gathering is essentially a pub night where a scientists talk about their research, mingle with members of the public and answer questions. "I think a lot of speakers enjoyed the fact they could give a podium talk with a beer," she laughed. "Researchers welcome the opportunity to be out there with the public, to share something that they care very deeply about." The pandemic forced Café Scientifique Saskatoon to move online, but Boughner hopes to bring the events back downtown to Winston's Pub. "One of the missions of Cafe Sci is to personalize or humanize researchers," said Boughner. "I really hope that we get to go back into a face-to-face environment." In this episode, Boughner shares insight on the nights that drew the biggest crowds, and how the pandemic highlighted the need to build trust between research scientists and ordinary citizens.

Dr Michael Levin is a neuroscientist unravelling the mysteries of nerve degeneration in Multiple Sclerosis patients.

He's also Saskatchewan's inaugural MS Clinical Research Chair, whose team recently won a New Frontiers in Research Fund award.

"In my lifetime, there's been a dramatic change in how we treat MS," said Levin. "There's a lot of hope when people come into the clinic."

But after taking steroids for a number of years, many MS patients still relapse.

"It's this kind of slow degenerative kind of nickel and diming of people's function that we would really like to nip in the bud," said Levin.

His task now is to find a drug that re-shapes a key protein involved with nerve degeneration, sending that protein back into its normal position.

In this episode, hear why this could be a game-changer for MS patients across Saskatchewan and the world.

One of the trickiest parts of treating patients with neuromuscular diseases such as Parkinson's and Multiple Sclerosis is figuring out how to keep them active and moving.

Fourth-year medical student Kyra Ives dove in, spending one summer studying the effect of deep brain stimulators on patients with Parkinson's disease.

She and her team watched participants experience major differences in tasks involving gait and balance.

Through that work, Ives also uncovered a number of obstacles for people with both Parkinsons and MS.

That's something she and the mobility lab team analyzed more closely the next summer, after MS patients sent in photo dispatches of their daily lives.