Researchers Under the Scope

Taking a daily puffer with inhaled corticosteroids is a mainstay for millions of people who have eosinophilic asthma.

But doctors don't always know what dosage will be most effective for their patients, in preventing inflammation.

Up to now, studies of different corticosteroids have been hit and miss, with a patchwork of different approaches to brochoprovocation, subject groupings, and wash-out times. A study may prove a drug is safe, then neglects to accurately measure the dosage a patient needs.

Over the past few summers, Christianne Blais looked at what asthma patients need, to breathe easy.

"Our ultimate goal was to see the relative potency," said Blais. "How do they measure up?"

In this episode, the fourth-year University of Saskatchewan medical student weighs in on what works, and what doesn't, in bronchoprovocations studies of corticosteroids in treating patients with eosinophilic asthma.

Our podcast host, Jen Quesnel, has undergone two Caesarian sections -- lifesaving interventions that deliver babies safely.

She's not alone. In Saskatchewan, roughly one quarter of mothers giving birth are doing it via abdominal surgery. More than one in three births in British Columbia are C-sections.

After avoiding driving, stairs, and lifting anything heavy for a month or so, most mothers recover smoothly.

But some don't.

Belma Kamencic spent her past two summers analyzing those with surgical site infections.

She then conducted interviews with dozens of mothers with infected incisions, to better understand their experiences.

In this episode, we hear what patients told Kamencic, who said there are four specific changes she'd like to see hospitals make, to cut the risk of future C-section infections.

One patient Shivani Tauh interviewed had to remove his ventilator tube to speak with her.

Another told her it felt 'disingenuous' when able-bodied health care providers looked at his spinal cord injury and assured him 'this will pass'.

Shivani Tauh kicks off our undergraduate summer research series in this episode, discussing her work on spinal cord injuries, and how they change a person's outlook, mobility and prognosis.

Tauh, who is now entering her fourth year of medical school, has gathered concrete policy suggestions for those whose work deals with medical assistance in dying (MAID).

Over two summers, Tauh interviewed both health care workers, and people who had suffered spinal cord injuries, to elicit their opinions and experiences, as Canada overhauls and modernizes its laws around end-of-life care. Tauh's research was done under the supervision of Dr. Lilian Thorpe and Dr. Darren Nickel.

Tauh said the field is fraught with ethical questions, and this research has changed the way she views end-of-life care.

In this episode, she describes in-person interviews with spinal cord injury patients as "eye-opening", pointing to one patient's account of feeling isolated and alone.

"He never felt like his health care providers, specifically his physicians, really understood what he was going through," said Tauh.

"It's difficult to have somebody that really has no true insight or understanding into what you're going through say, 'oh it'll be okay'.

Taugh said her summer work underscored the need to protect vulnerable people within the health care system while also preserving their autonomy.

"I would like to incorporate end-of-life care into my practice, regardless of what specialty I end up going into," said Tauh. "This is an area of medicine I feel very passionate about."

For doctors in Saskatchewan, depression and anxiety have skyrocketed during the pandemic.

We check in with Dr. Camelia Adams, an associate professor of psychiatry, who's been tracking physicians' mental health during the Covid-19 pandemic.

Just one of the 118 physicians she surveyed reported asking for help with mental health issues.

That's no surprise to Angie Wiebe, one of the psychologists working with the University of Saskatchewan's Employee Assistance Program.

Wiebe said almost everyone she's counselling has experienced emotional distress because of the pandemic. In this episode, she shares warning signs to watch for, as mental health becomes "a bit of a pressure cooker".

When Dr. Katherine Knox first arrived in Saskatchewan more than two decades ago, the province covered one prescription drug for patients with Multiple Sclerosis.

Beyond that, patients had to pay for drugs out-of-pocket.

Today, Knox said the province reimburses MS patients for 14 different drugs.

"MS is an expensive disease on many levels," said Knox, noting Saskatchewan's coverage is now the most favourable for MS patients anywhere in Canada.

In Saskatchewan, three in 1,000 people have Multiple Sclerosis — one of the highest incidences of Multiple Sclerosis in the world.

As treatments improve, the number of people living with this chronic autoimmune disease is rising.

"It's probably a combination of genetic and environmental factors that play a role," said Knox, who first learned about the disease as a student volunteer with the MS Society of Canada.

"Everyone had such a unique disease experience," Knox said. "So I just became more curious."

Her research these days focuses on non-drug approaches which prevent the onset of disability.

After 15 years with the disease, it's estimated roughly half of MS patients need a cane or walking aid.

"Understandably many people don't want to use a walker for good reason," said Knox.

"It's bulky, it's awkward, it certainly lets people know that you have an issue with your walking."

To delay that, Knox turned to researchers at the College of Kinesiology's Biomechanics of Balance and Movement Lab, to look at the power of a 'light touch'.

The goal is to help people with MS regain — and keep — their balance and mobility.

"Patients would tell us you know when I walk the dog and hold the leash, my balance feels better. Or when I lightly touch the back of the chair I can be re-orientated," she said.

By teaming up with Dr. Alison Oates, fourth-year resident Najala Orrell, and Pawan Kumar, an engineer and kinesiology research fellow, Knox studies patients' balance and stability, using various haptic inputs.

"Even just a light touch on a walker or perhaps a different object can help them regain their balance," said Knox.

In this episode, she said keeping her patients moving and avoiding falls is crucial.

"We do need innovation and technology to come up with ways that can provide sensory feedback that would be discreet, socially acceptable, and easy to use," said Knox.

Dr. Alexander Wong remembers forcing himself to hide his fear last year, as he treated his first Covid-19 patients.

"It kind of felt like we were staring down the bottom of a big gun barrel," said Wong, an assistant professor in the College of Medicine's Department of Infectious Diseases.

The virus has killed 546 people in Saskatchewan.

In this episode, Wong looks at public health, at politics, and at 'really complicated' decision-making during the pandemic, as Regina's critical-care teams fought to save severely ill patients.

Manuela Valle-Castro remembers growing up in a home where social justice was frequently part of the dinner-table conversation.

She spent the first six years of her life in exile, after her family joined thousands of Chileans fleeing Augusto Pinochet's oppressive political regime.

Upon her family's return to Chile, she watched her parents and their friends organize and push back, even when dissent could lead to jail time, torture, or death.

"It wasn't a very conventional way of growing up," said Valle-Castro, who watched her loved ones document human rights violations, and rally against injustice.

"I had a voice I wanted to use for things I felt passionate about," she said.

Valle-Castro eventually moved to Canada, where she trained as a community psychologist, completing her PhD in Gender, Race, Sexuality and Social Justice at the University of British Columbia.

"I looked up to Canada," said Valle-Castro. "But what I did not know was how much of Canada's identity has been created over a layer of colonialism that is very violent."

In 2020, she was hired as the Director of the College of Medicine's Division of Social Accountability.

In medical training and biomedical research, Valle-Castro's job is to tackle and dismantle bias and unconscious discrimination.

In this episode, she discusses the 'extreme politeness' ingrained in Canadian culture, and why it often tends to oppress and silence marginalized people.

"It's not necessarily about racist slurs and impolite words," she said. "[Oppression] can come in a very benevolent and polite shape too."

She said the key to health equity is to listen, promote, and act on advice from racialized people, immigrants, those with disabilities and different lived experiences.

"Research needs to not be redundant," she said. "How many times do we need to study bad housing or bad water before those issues are addressed?"

"I see a need for this shift all over the College of Medicine," she said, noting indigenous academic leaders have already taken the lead in changing Saskatchewan's dominant narrative.

Medical trainees, researchers and faculty all need to become more outspoken about their work, Valle-Castro said, pushing governments and decision-makers to take action.

"There's no research that happens in a void," she said. "Make those decisions transparent and have people be accountable for those decisions."

Valle-Castro said the end goal for the College of Medicine is better health for all people in Saskatchewan, not just the able-bodied white population.

"Community engagement and health equity need to be absolutely at the forefront," she said.

Dr. Ron Geyer is the man behind the Saskatchewan Therapeutic Antibody Resource, the Advanced Diagnostics Research Laboratory, and the Centre for Biologic Imaging Research and Development.

But when the biochemist and pathologist began university, he was more interested in improving his downhill race times.

"I was very into skiing," Geyer said, recalling his experiments with different waxes and techniques, which set the stage for a lifetime of tinkering.

After being sidelined by a knee injury. Geyer turned to molecular biology and organic chemistry, developing a deep fascination with the building blocks of life.

"I was interested in understanding how cell processes worked, how pathways in cells were wired and linked together," said Geyer.

His post-doctoral work took him to the Molecular Sciences Institute at Berkeley, then to the University of Florida, with a focus on synthetic biology.

But building synthetic molecules felt 'fairly slow and tedious' for Geyer. Upon his return to Canada, he founded a now-defunct biotechnology company focused on improving cancer treatments.

"I decided to harness the power of nature and work with biological molecules, rather than synthetic derivatives of them," Geyer said.

When he arrived at the University of Saskatchewan to accept a faculty position, Geyer's focus turned to developing new therapeutic antibodies, and better techniques for diagnosing mutations and disease.

To make it happen, he brought together the Western College of Veterinary Medicine, the Saskatchewan Centre for Cyclotron Sciences, the Saskatchewan Cancer Agency, Royal University Hospital and the College of Medicine, creating an antibody 'pipeline'.

Geyer's teams now work inside the Health Sciences building, in a fast-expanding research cluster.

"The goal was originally to repatriate all the tests we'd been sending out to other provinces," said Geyer. "More recently, we've developed our own tests."

In this episode, he explains why this work has led to faster diagnosis, better monitoring, new treatments, and a sense of hope for thousands of Saskatchewan people with leukemia and lymphoma.

"It's really exciting and really state-of-the-art," said Geyer.

"Ultimately, it serves to provide better medical care for the people of Saskatchewan, not only in terms of the availability of tests, but also in attracting physicians to the province."

"The medication that I'm taking today would not have happened if we weren't doing this research 30 years ago," said Lois Miller.

In this episode, she offers a patient's view of research, and how it can change lives.

Miller is 52. Once again she's able to walk, to work, and to live a relatively normal life five years after her diagnosis with multiple sclerosis.

But that didn't happen overnight, nor was it easy.

Miller initially had 'incredibly painful' side effects with the drugs her neurologist prescribed.

From welts and burns, to peeling skin, headaches, and crippling abdominal pain, she was on the verge of applying for long-term disability coverage, when she was referred to University of Saskatchewan MS specialists working at Saskatoon's City Hospital.

"I didn't know MS medications are not covered in our health system," said Miller. "The only way we get better medications is through research."

Miller said researchers and clinicians at Saskatoon's City Hospital brought new medications and treatment protocols to Saskatchewan, which gave her a new lease on life.

"I wouldn't be living with the independence that I have today," said Miller. "It made all the difference."

As a young man finishing his biology degree, Adam Baxter-Jones (PhD) was decidedly more interested in being a punk than a professor.

"I was far more interested in things like music and fashion than I ever was in academia," he said.

But Baxter-Jones needed a job, and eventually found one testing the lung function of hospital patients. Then, he found himself measuring aerobic fitness for up-and-coming teenage swimmers, gymnasts, soccer players and tennis players.

As he earned his PhD in medical sciences, he observed growth variations in teen athletes that led to gaps of up to five years between a child's chronological and maturational age.

"In professional sports like hockey and soccer, most players are born between January and May," he said, noting coaches often choose the tallest, most mature children for elite teams.

But fast-growing teens often lose that advantage as the rest of their cohort catches up, said Baxter-Jones.

In this episode, he explains his formula for predicting a child's adult height, why coaches and parents should think twice before writing off late-bloomers, and why elite sport training for teens leads to "bone in the bank" -- especially for gymnasts.

"If you get strong bones during your growing years, those strong bones stay with you as long as you keep active throughout your life," said Baxter-Jones.