Monthly Archives

February 2018

Helping kids with chronic disease be kids

By | Uncategorised

Bennett Walkinshaw is a typical six year old boy, full of energy. He’s quite the character and will have you laughing in no time.

Two years ago, Bennett started having issues when he went to the bathroom. Most people would assume that, since he was only four, he was probably just still potty training. But, his parents Travis and Rachel knew better: Bennett had breezed through that milestone a while ago. When he started having blood in his stool and his urgency to use the washroom increased each time, his parents’ concerns grew.

Finally, after a bad bout of bleeding, Bennett was admitted to McMaster Children’s Hospital (MCH). Two days later, he was diagnosed with a type of inflammatory bowel disease (IBD) called ulcerative colitis.

IBD in children is on the rise

Inflammatory bowel disease involves continued inflammation of the digestive tract. This disrupts the body’s ability to digest food, absorb nutrients, and eliminate waste in a healthy way. Crohn’s disease and ulcerative colitis are the two main forms of IBD. Ulcerative colitis affects the inner lining of the colon, causing inflammation and ulcers. It’s a lifelong disease with no cure, making it a hard diagnosis for families to swallow.

“Being diagnosed with a chronic disease presents a scary and very uncertain new way of life for kids and their families,” says Dr. Nikhil Pai, pediatric gastroenterologist at MCH. “We’ve come a long way over the past few decades at being able to get IBD under control, but keeping it that way involves life-long medications. For many parents, that realization is almost more overwhelming than the diagnosis itself.”

“IBD is a difficult disease to control when you’re an adult, let alone a kid.”

Historically, IBD developed mostly in teens and young adults, but it’s starting to affect more and more young children. In Canada, the disease occurs in more kids than most countries in the world, and these numbers are steadily rising. Existing treatments for IBD include ongoing medications that can have side effects.

“IBD is a difficult disease to control when you’re an adult, let alone a kid,” says Dr. Pai. “Parents are often looking for an alternative to lifelong medications, which can have significant side effects. They just want their kids to be kids.”

Dr. Pai and his research team are exploring ways to make “just being a kid” possible for kids with IBD.

Finding a way to help kids with IBD be kids

Children with ulcerative colitis have unique bacteria in their intestines that differs from children who are healthy, which may be a contributing factor in IBD. In the “PediFETCh” study (Pediatric Fecal Microbiota Transplant for Ulcerative Colitis) – the first and only of its kind in Canada – Dr. Pai is testing whether the transplantation of healthy fecal matter from a donor can improve symptoms in kids with IBD. It’s something that’s already been shown to be effective in adults.

“This study will tell us whether fecal transplants can be a viable treatment for kids with ulcerative colitis who can’t manage the disease with their current medications,” says Dr. Pai.

Through it all, Bennett has remained his talkative, outgoing self.

Kids enrolled in the PediFETCh study receive two fecal transplants each week for six weeks, followed by a six-month monitoring period.

“We were thrilled when Bennett was recommended for the study,” says Rachel. “We tried medication for a year, but we never seemed to be able to get his symptoms under control.”

Through it all, Bennett has remained his talkative, outgoing self.

“Bennett looks forward to all his appointments,” says Rachel. “The staff have been amazing.”

Dr. Pai, along with research coordinator and co-investigator Jelena Popov and the rest of their team are hopeful that fecal transplant therapy will prove to be an effective option for kids who struggle with the often debilitating symptoms of IBD, and that this work may offer clues towards preventing IBD altogether.

“We don’t have all the answers yet, but we’re determined to try and find better ways to help kids and their families living with IBD get the very most out of life.”

Click here for more stories of our explorations.

Acknowledgements: The Pediatric Gastroenterology team at MCH and Dr. Mary Sherlock, co-Director of the Pediatric Inflammatory Bowel Disease Clinic at MCH, for Bennett’s ongoing care of ulcerative colitis.

Research at Hamilton Health Sciences is conducted in partnership with McMaster University.

Dr. Nikhil Pai, pediatric gastroenterologist, researcher, explorer

BLOG: Creating an alternative treatment option

By | Uncategorised

By: Dr. Nikhil Pai
Pediatric gastroenterologist, McMaster Children’s Hospital
Assistant professor, department of pediatrics, McMaster University 

Coughs and colds, stomach aches, and fevers are part of every child’s life. But being diagnosed with a chronic disease is a reality for some children and their families, and presents a scary, and very uncertain new way of life. As a doctor and researcher, I’ve focused my career on exploring how to make life easier for some of these kids who struggle with lifelong diseases.

I take care of a lot of children with inflammatory bowel disease (IBD), a chronic autoimmune condition that affects the intestinal tract. When parents are told their child has this diagnosis, they react with shock, disappointment, and feeling totally overwhelmed. We’ve come a long way over the past few decades at being able to get IBD under control, but keeping it that way involves life-long medications. For many parents, that realization is almost more overwhelming than the diagnosis itself. Daily medications that have tough side effects are not what parents look forward to for their kids. Families ask about other options. Up until recently, “other options” have always involved different kinds of medications – a repetitive path that can be discouraging.

The trial was ambitious, and it worked.

When I was doing my pediatric gastroenterology training, I began research on the role of bacteria in the intestinal tract and how this can affect our overall health. Studies showed that kids with IBD had different types of bacteria than kids who were healthy, and my research gradually focused upon whether diseases could be treated by changing that bacteria itself. When I came to Hamilton Health Sciences in 2014, several colleagues in McMaster’s Department of Adult Gastroenterology had launched a groundbreaking study on the role of transplanting healthy, intestinal bacteria into adults with inflammatory bowel disease. The trial was ambitious, and it worked. Many of these patients got significantly better after this intervention. This type of treatment had never been explored through a carefully designed, formal research study in kids. With parents continuing to ask about other options, we decided to launch a trial that could give these families another option.

In 2015, with the assistance of extremely supportive senior mentors from Hamilton Health Sciences and our research coordinator, Jelena Popov, Hamilton Health Sciences’ Division of Pediatric Gastroenterology became the very first center in the world to offer families participation in a randomized controlled trial of fecal transplant for pediatrics. After extensive planning and approvals – as is required for all clinical research to ensure safety and ethical care – we successfully enrolled our very first participant in the winter of 2015. This patient was a young child with IBD who had already failed numerous high dose medications, was considering potential surgery if her condition worsened, and whose family was given one more option: even stronger medications. Our trial offered her something else, instead.

 Research trials like PediFETCh don’t offer families a guarantee, but they do offer options.

Since then, we’ve enrolled numerous other patients, have gained two partner sites in London Health Sciences Center and Montreal Children’s Hospital, and are expanding our trial to include another set of chronic inflammatory bowel disease patients later this year.

Our trial is ongoing – we aren’t even close to analyzing results yet – and a few other centers across the U.S. and Europe have started running their own studies for kids. Research trials like PediFETCh don’t offer families a guarantee. But, experimental therapies like fecal microbial transplant do offer families options. When a child gets a diagnosis like IBD, overnight a parent can go from being responsible for every part of their kid’s life to feeling like a bystander. Hospital admissions, invasive tests, confusing terminology, and medications delivered in unmarked IV bags and plastic cups take a toll. Having choices puts families back in charge.

We hope our research will show that fecal transplant is a choice that works. We don’t have all the answers yet, but we’re determined to try and find better ways to help kids and their families living with IBD get the very most out of life.

Dr. Richard Whitlock, cardiac surgeon, researcher, explorer

BLOG: The stubborn pursuit of “Why”

By | Uncategorised

By: Dr. Richard Whitlock
Cardiac surgeon, Hamilton Health Sciences
Principal investigator, Population Health Research Institute
Associate professor of surgery, McMaster University

I entered medicine with the aspiration of impacting people’s lives; I think most physicians do. The opportunities to comfort, to cure, to make lives better; these were motivation to endure the long process of becoming a physician and, eventually, a heart surgeon.

Like any other physician, I’ve experienced the losses of dear patients. Sometimes, I’ve felt that I failed them. But overall, my first decade of independent practice has been extremely satisfying. There is little better than receiving a grateful hug from a family member after you operated on their loved one.

It wasn’t until I began my residency training that I realized the added satisfaction that clinical research could bring to the work I was already doing as a physician. It posed challenges that were very different from those of clinical practice, but with the same purpose of clinical care: to improve people’s lives.

Once that research bug has bitten, the realization soon comes that, instead of helping one patient at a time, a clinical researcher has the opportunity to impact tens of thousands of lives.

Clinical work is something that chases a physician; the moment you walk through the hospital doors, it’s almost impossible to escape the hustle of the health system. Research, on the other hand, requires you to chase it. It starts with asking an unanswered question, but will easily end if it’s not approached with a stubborn unwillingness to let it go. Finding good, reliable answers to big research questions is an elusive pursuit. Many things are required to enable research to happen – it’s a bit like assembling a puzzle, and it requires the support and expertise of many people and resources. But once that research bug has bitten, the realization soon comes that, instead of helping one patient at a time, a clinical researcher has the opportunity to impact tens of thousands of lives. When I experienced that epiphany, I began exploring even more. I became more aware of the gaps in knowledge in cardiovascular care. Identifying gaps is the first step in improving care for patients, and I began to notice the impact of these gaps on the patients I was treating. My questions continued to grow, as did the size of studies I was undertaking to answer them.

Naturally, my network of fellow research colleagues also grew: collaboration is key to research. I have had the pleasure of working with many talented researchers from over 30 countries, many of whom I now call friends. This large network that has formed as the result of questions that my colleagues and I have posed is unique in surgical research. It’s something that my research team should be truly proud of. In this network, we’re now answering questions that will have dramatic impact on tens of thousands of patients globally, in my lifetime. Together, we’re addressing the gaps in knowledge that affect the patients we care for every day. We’re actively working on finding ways to prevent strokes, to minimize common complications after heart surgery, and to ensure that available medications are used in optimal ways.

The child in me still exists, constantly asking “why”

This is why I love research. The child in me still exists, constantly asking “why”.

With the motivation and momentum of our vast research community at Hamilton Health Sciences and beyond, I have the satisfaction of helping to find answers to these questions every day. Answers that change one life at a time with the use of a scalpel and a surgeon’s hands and, at the same time, hundreds of thousands of lives that our hands will never actually touch.

Curbing the perfect storm for stroke

By | Uncategorised

On a gloomy day last April, Richard te Boekhorst was doing yard work when the clouds above him threatened to open up. He sped up his pace in a race against the impending storm. In his haste, he stumbled and fell. He must’ve tripped on the hose, he thought.

What Richard didn’t realize was that he hadn’t tripped on the hose. He was having a stroke. It came over him as unexpectedly as the clouds above and, last he remembers, left him helpless on the ground as the rain began to pour. He was changed.

Before the stroke, Richard was a local 63-year-old financial planner who led a fast-paced, healthy lifestyle. He was your typical “type-A”, despite having atrial fibrillation (AF), a common condition that causes an irregular heartbeat.

People with AF have a higher risk of stroke since blood isn’t being moved properly through the heart which can cause blood to pool and, potentially, form a clot. If a clot gets pumped to the brain, it can cause a stroke. Atrial fibrillation currently affects more than 350,000 Canadians. Age increases their risk of stroke and so as our population’s age rises, so do the number of strokes.

Exploring a world without stroke

Dr. Richard Whitlock, cardiac surgeon at Hamilton General Hospital (HGH) and researcher at the Population Health Research Institute, is exploring ways to give peace of mind to people like Richard who live with the constant threat of stroke. It’s a challenge he and his team tackle every single day, and they’ve started with a small, seemingly innocent piece of the heart that’s actually proven to be an ideal breeding ground for dangerous clots.

“This could have a dramatic positive impact for AF patients and, so far, the evidence is promising.”

The left atrial appendage (LAA) is a little pocket of tissue on the upper chamber of the heart that, as far as we know, has no real purpose. But, what is known is that the LAA is the main source of most blood clots. Blood pools in its cozy pocket and forms in to clots which dislodge and can wind up in the brain.

“It a perfect storm for a stroke to occur,” says Dr. Whitlock. “We think that, if we remove the LAA altogether, we can significantly reduce the threat of stroke for patients,” says Dr. Whitlock.

Through the Left Atrial Appendage Occlusion Study (LAAOS), Dr. Whitlock and his team remove the LAA in patients who are already undergoing open-heart surgery since it’s accessible, simple to remove and has no impact on the primary procedure. There are 4,700 patients participating in the study across 20 countries. They’ll be tracked for four years to see whether the absence of the LAA reduces the rate of stroke.

“The only risk to the patient is the initial surgery, which carries less of a risk than the alternative, a lifetime of being on blood thinners,” says Dr. Whitlock. “This could have a dramatic positive impact for AF patients and, so far, the evidence is promising.”

“My biggest worry is that it could happen again.”

If the study proves that LAA removal is a worthy and effective tactic in stroke prevention, it could become an option for people like Richard, and would likely inspire further research on whether it’s a method that can be applied beyond those with AF.

Richard’s Recovery

Thankfully, moments after his stroke, Richard’s wife found him rolling in the grass in the pouring rain. He had been unable to get himself up off the ground – his whole right side was paralyzed, and he couldn’t call for help. His wife called 9-1-1, and soon after paramedics whisked him away to the General, the regional stroke centre for Central South Ontario.

Thanks to the all-around speedy response of his wife, his paramedics and his care team at HGH, Richard got his motion back quickly, but still required months of speech therapy. He’s gradually returned to work, but at a reduced capacity. His energy level is far lower and he still gets stuck with his speech.

“Having a stroke has changed my life,” says Richard. “My biggest worry is that it could happen again.”

Dr. Whitlock and his team are finding a way to make sure it doesn’t.

Click here for more stories of our explorations.

Dr. Richard Whitlock, Explorer

Research at Hamilton Health Sciences is conducted in partnership with McMaster University.

discussing surgery recovery

Weighing the costs and benefits of surgery

By | Uncategorised

If you knew that your recovery from surgery would last months or even years, would that change your mind about having it?

Hamilton Health Sciences researchers at the Population Health Research Institute (PHRI) are looking to shed some light on that question and hopefully make the decision making-process easier for patients.

At the root of this work is functional ability, which includes basic actions like bathing and eating, and how these everyday tasks relate to quality of life. Studies have shown that many adult patients requiring health care would rather live a fulfilling life than a longer one.

According to Dr. Jessica Spence, a medical resident and PhD candidate whose thesis is investigating this topic, there’s a significant knowledge gap when it comes to functional outcomes following elective surgeries.

“This study is the first step in establishing a means to improve patient decision-making regarding whether or not surgery is the right choice for them.”

“We’re very good at determining a patient’s chance of surviving a procedure, but we don’t know a lot about day-to-day living after the fact,” she says. “We’re essentially looking to develop a risk-benefit framework so patients know what to expect. Currently, this doesn’t exist.”

The main reason why so little is known about functional outcomes is that no one has developed a way to test it. But that may be about to change. “This study is the first step in establishing a means to improve patient decision-making regarding whether or not surgery is the right choice for them. Our work is looking to lay the foundational pieces to help this emerging field of study,” says Dr. Spence.

Focusing on patients who recently had heart surgery, researchers are looking at this through global and local lenses. Using patient data collected through another study involving 15,000 patients across 12 countries, the team is running this information through an internationally recognized tool developed at PHRI called the SAGE scale, which was created to assess activity in elderly patients. Data are being collected at 30-days after surgery and then again at the one-year mark to determine progression in patient function over a 365 day period.

“I want to empower patients to make informed decisions about their health and their health care.”

Dr. Spence is contrasting this work with hands-on research in the Hamilton area by supervising a team of occupational therapy students from McMaster University who visit and observe patients who have also recently undergone heart surgery. Using the same 30 day and one-year timeframe, the goal is to determine if the SAGE scale can produce the same results as in-person assessments. Results of this study should be available within a year.

“I want to empower patients to make informed decisions about their health and their health care,” Dr. Spence says. “Surgery is significant and recovery can be difficult. Patients need to know that they may not be able to return to work or play with their grandkids for a long time. The only way we can do that is find a way to tell them what they can expect if they choose to have surgery.”

Hamilton researchers discover combo therapy works best for heart disease

By | Uncategorised

Hamilton researchers have made a discovery that could prevent complications and death in thousands of people around the world living with heart disease.

A major international study, named COMPASS, led by the Hamilton Health Sciences (HHS) and McMaster University Population Health Research Institute (PHRI) found that the combination of two drugs – rivaroxaban and aspirin – is superior to aspirin alone in preventing further heart complications in people with cardiac and vascular disease. Currently, aspirin is the preferred method of treatment.

The study of 27,400 people with coronary or peripheral artery disease (PAD) from 33 countries worldwide showed that the combination of 2.5 mg of rivaroxaban twice daily plus 100 mg of aspirin once daily was significantly better than only aspirin or only rivaroxaban in preventing heart attacks, strokes and death. Rivaroxaban, often known by the brand name Xarelto, is an anticoagulant, aspirin is an antiplatelet drug, and both are blood thinners.

The findings are significant because there are about 300 million people around the world living with cardiovascular disease, and every year as many as five to 10 per cent have a stroke or heart attack. Although aspirin reduces the risk of major cardiovascular events by 19 per cent, a more effective drug therapy strategy could have added benefits for the large population of patients with stable cardiovascular disease.

The results were presented on Aug. 27, 2017 at the Congress of the European Society of Cardiology (ESC) in Barcelona, Spain, and the overall results will be published in the New England Journal of Medicine.

“Even small improvements in the effectiveness of treatments that prevent stroke and heart attack are important because cardiovascular disease is very common. In COMPASS the treatment effect was unexpectedly large,” says Dr. John Eikelboom, hematologist at HHS, associate professor at McMaster and principal investigator at PHRI.

A second paper from the same study, which will be published in The Lancet, shows that the same drug combination is superior to aspirin for the risk of losing limbs or severe limb ischemia (limitation of blood flow to a limb), as well as decreasing cardiovascular events, among patients with peripheral artery disease (PAD).

“This is an important advance for patients with peripheral artery disease,” says Dr. Sonia Anand, vascular medicine physician at HHS, professor of medicine at McMaster, and principal investigator for the PAD component of the COMPASS trial.

Dr. Salim Yusuf, executive director of PHRI, McMaster professor of medicine and chief scientist at HHS, said the large size of the study, broad inclusion criteria and consistent results in all regions of the world means the results are widely applicable around the world, and could reduce the risk of recurrent cardiovascular events by two thirds.

child with autism

A collaborative approach to autism research

By | Uncategorised

Staff and researchers at McMaster Children’s Hospital (MCH), McMaster University and Hamilton Health Sciences have come together to form the McMaster Autism Research Team (MacART) to explore how to improve the delivery of care and services for kids with autism and their families.

Following the launch of the new Ontario Autism Program, MacART has begun the Pediatric Autism Research Collaborative (PARC) Project.

This will lead to improved individualized, family-centred treatment and care within the available services.

The aim of the Ontario Autism Program is to ensure child and youth ASD services are delivered consistently across the province, while the PARC Project is working to develop a research protocol that can be embedded into the delivery of these services. This will help researchers gain a better understanding of what contributes to healthier outcomes for children with autism. In turn, this will lead to improved individualized, family-centred treatment and care within the available services.

“Our researchers are global leaders in the study of autism heterogeneity,” says Stelios Georgiades, founder and co-director of MacART. “The PARC Project will make use of novel methods, developed by our team, to examine the variable trajectories of children and families receiving services in the new Ontario Autism Program.”

“We’re excited to have researchers and clinicians working together in a collaborative way.”

The PARC Project will allow the ongoing collection of data from children who receive a new ASD diagnosis. It’s been designed for minimal burden on families as the data used is data that’s already collected during a child’s visits to the ASD service program at MCH. There are additional optional stages to the project whereby families allow additional data to be collected.

child with autism playing

“We’re excited to have researchers and clinicians working together in a collaborative way,” says Dr. Caroline Roncadin, clinical director of ASD services at the MCH Ron Joyce Children’s Health Centre. “The PARC Project will have the potential to produce research findings that can directly inform the clinical care we provide families.”

This unique approach of moving autism research into the clinic encourages collaboration among the families, researchers and clinicians whose lives are touched by ASD. The eventual goal of the PARC Project is to enroll every child and family within the ASD service program into the research protocol. These efforts contribute to the MacART vision to advance autism care through meaningful research.