Researchers Under the Scope

Stuart Skinner (MD) knew something was wrong three years ago, when patients started coming to him with vision loss, fever, rashes, and meningitis. Almost every case could be traced back to untreated syphilis — a sexually transmitted infection with caseloads exploding 1,200 per cent from 2017. Saskatchewan saw this spike just as Covid-19 entered the picture. "With the pandemic, testing dropped dramatically," Skinner said, noting this wave of syphilis entered north-western Saskatchewan from Alberta, often travelling alongside HIV. Syphilis often spreads through sores, and can remain unnoticed for months or years on end, making early detection difficult. "If you don't see it, you won't be seeking care for it." When the infectious diseases physician and the Wellness Wheel team began treating mothers with severely ill newborns, stillbirths and birth defects, Skinner knew he had to act. Treating syphilis usually means a series of clinic and laboratory appointments, followed by intramuscular Bicillin injections, and intense contact tracing. Instead, Skinner, Dr. Sean Rourke, Cara Spence and their teams pared that down to a one-hour stop. They approached tribal councils and Indigenous-led health organizations, asking for help setting up mobile locations where anyone could be tested, diagnosed, and offered treatment. Nursing teams drove vans to powwows, festivals, even pharmacies, offering quick, confidential finger-prick tests and results. "The whole concept was to be flexible and mobile and adaptable . . . . so that we weren't the barrier," said Skinner. "It wasn't easy for the nurses to set up and read the results or draw the blood in a less comfortable environment, but they did an amazing job." In Saskatchewan, a total of 1,797 people agreed to be tested, uptake Skinner calls 'phenomenal'. Roughly three per cent were infected with HIV; 16% had syphilis. "The majority were willing to get treated right then and there," Skinner said. Those teams have now visited more than 50 locations across the prairies, through a $4M national partnership called the 'Ayaangwaamiziwin' Centre — which translates to 'be careful, be prepared' in Anishinaabe. Health officials and private donors recently extended those grants for an additional year. Skinner's colleagues keep fielding requests for the point-of-care service, which in turn has created a network of trusted Indigenous health leaders. This web, he said, could create the backbone of targeted outreach and screening for other diseases, such as diabetes or cancer. But it only works with mutual respect, he warned. "This isn't going to First Nations just to help them," Skinner said. "I've learned so much from the cultural values that are built on what happens in First Nations. We have a lot to learn." Skinner said mutual respect also means predictable paycheques — not just the odd grant. He said health budgets need to pay for health promotion workers employed at Indigenous-run organizations and non-profits, the ones who stick around after the testing van leaves. Patients are more likely to stay in touch with familiar faces and staff, he said. "It's about respect, kindness, and building trust," he said. "That is really critical."

James Stempien (MD) has navigated some of the most challenging corners of emergency medicine, from the frigid isolation of Inuvik to the bustling corridors of Saskatoon's emergency departments. His experience in low-tech outposts has shaped his approach to modern emergency care. "When things aren't going well you see it in the emergency department first," Stempien said. "We're the front door. We're always open." As provincial department head of emergency medicine, Stempien sees patients on their worst days in hospitals bursting at the seams, struggling to keep pace with Saskatchewan's growing population. "I worked in emergency last night and we were really busy, hours behind. All the ER docs there and nurses were running our tails off," said Stempien. "We're seeing an increase in acuity." Stempien said the patients he sees now come in with serious medical concerns, which cannot be written off as minor ailments. One in five emergency patients in Saskatoon requires hospitalization. Amid frequent congestion, Stempien says some find themselves on stretchers in the hallway, even in former linen closets, waiting to move upstairs to an acute care bed. He said while a plan to open 109 more acute care beds at Saskatoon City Hospital 'will make a big difference', he and his staff are concerned overcrowding jeopardizes patients in the waiting room, leading to moral injury and burnout. Stempien is determined to free up space inside his department. He's also led numerous innovations aimed at streamlining emergency medicine, including a recent move to send patients their discharge instructions via text message. "They can access it as many times as they want. They're not going to lose the piece of paper on the way to the parking lot," said Stempien. Stempien, 67, said he still loves the job, in part thanks to the team atmosphere, and also because his patients are still full of surprises. "Many things I've seen thousands of times, but every now and then you run across something and you think, wow, I've never seen that," he said. "That's what makes emergency medicine interesting. And fun."

Brianne Philipenko (MD) was midway through her respirology fellowship in Calgary when the Covid-19 pandemic shut down the city. She started interval workouts at home using Nike's fitness app — when inspiration struck. "Coming up with a creative, innovative way to allow people to access an exercise program outside of the typical organized pulmonary rehabilitation in a gym setting was something that I became really interested in," said Philipenko.. As a respirologist, Philipenko was already frustrated by the lack of 'mainstay' guidelines on incorporating exercise into severe asthma treatment. "I think that's a big disservice for our patients," she said. "We're giving them these fancy medications that improve their asthma, but we're not going after the low-hanging fruit such as physical activity." "It's something cheap, accessible, that everyone can do, and it's something that I think is very much underutilized." Even before the pandemic, access to pulmonary rehabilitation programs was severely limited, as most also serve with people suffering from Chronic Obstructive Pulmonary Disease (COPD). Philipenko's asthma patients were often leery of exercise, for fear of triggering an attack. "You don't exercise, so then you get out of shape and that makes you more short of breath when you exercise," she said. "It becomes a vicious cycle of deconditioning and fear." Philipenko teamed up with a physiotherapist and a kinesiologist to develop an at-home rehabilitation program for people with pulmonary hypertension. Patients download an app, then follow the program for eight to 12 weeks, incorporating pacing strategies and breathing exercises to ease their way back into fitness. "We're still in the middle of recruitment," said Philipenko. "We have people that are extremely fit exercising every day, to people that never exercise ever, with asthma participating in the study," she said. "It's promising." By 2021, Erika Penz (MD) and Donald Cockcroft (MD) -- colleagues Philipenko met during internal medicine training — helped convince her to return to her hometown, taking on her current role as a respirologist and an Assistant Professor of Respirology, Critical Care and Sleep Medicine at the University of Saskatchewan's College of Medicine. "They have been giants in the space of asthma, and they really inspired me. They brought me back and made it exciting to participate in the research scene here in Saskatoon," Philipenko said. She's working with the Asthma Research Lab team, where her patients can now take part in bronchoprovocation studies and pharmaceutical clinical trials. "As much as I love my clinical practice, it's really nice to have something else going on that shakes things up. And for me, that was research," said Philipenko. She hopes to see a shift in the way exercise is perceived, pushing for recognition of its critical role alongside pharmaceuticals. "That's the wonderful thing about asthma, is that if it's controlled, you should be completely asymptomatic. It's not a progressive disease. And we have some medications that can achieve that for people now. So it's a pretty exciting time to be working in this field."

A behavioural neuroscientist in Saskatoon is uncovering marijuana's effects on fetal brain development. After recently winning a five-year CIHR grant of $960,076 in the spring of 2024, Dr. John Howland's lab at the University of Saskatchewan is expanding its work examining prenatal exposure to cannabis smoke. Howland's teams will assess the way cannabis exposure alters higher brain functions like memory and learning in both rats and mice. Compared to cannabis injections in the past, the professor of Anatomy, Physiology and Pharmacology at the College of Medicine said exposing rodents to high-potency smoke for up to 15 minutes at a time provides a more realistic picture of marijuana's effects on fetal brain development. Over their lives, Howland will measure changes in cortical limbic circuitruity, for both rodent mothers and their offspring. "The cortex is definitely involved, but we also look at other areas like the hippocampus and the amygdala," said Howland. "There's pretty good evidence that they are at least subtly affected after gestational exposure to cannabis." Now, it's a matter of quantifying which circuits cannabis affects in the rodent brain — under circumstances as close to real-life human exposure as Howland's laboratory can create. "It's not simple," said Howland. He notes a wide variety of phenotypes of THC and CBD strains are now available at retailers, each with its own characteristics and potential interactions with neurons. "These receptors are involved in many discrete events during brain development," he said. "We're hoping to be more controlled and more specific." Howland's team is also searching for ways to stem damage from high-potency strains, while exploring therapies like exercise to counteract cannabis exposure and help future generations grow healthier brains. He said cannabis may be legal -- but that does not make it safe. "It turns out a lot of things that are legal like alcohol and tobacco aren't that safe during pregnancy either," said Howland. "I think more knowledge has to be helpful as women make these decisions for themselves."

"When I got into medical school, the last thing in the world I wanted to be was a surgeon because I couldn't stand the sight of blood," said Dr. Mike Moser. Fast-forward to the present day, where Moser is now one of Saskatchewan's top kidney transplant surgeons, winning last year's Golden Scalpel Award for Pre-clerkship Education, the 2022 Logan Boulet Humanitarian of the Year Award, and numerous teaching awards. In this episode, the professor of general surgery at the University of Saskatchewan's College of Medicine takes us back to one pivotal day where everything changed, propelling forward his career in Hepato-pancreato-biliary (HPB) surgery and organ transplants Moser's research has pushed forward transplant science, and led to safer kidney biopsies. Along with interventional radiologist Dr. Chris Wall, Moser led the charge to bring NanoKnife technology to Saskatchewan. His team has now spent a decade using the tool to treat otherwise inoperable tumors. The NanoKnife relies on irreversible electroporation (IRE) — using electrical pulses to create tiny holes in tumor cells, causing them to die without harming surrounding structures. "I love making those little, elegant, tiny connections," said Moser, whose work focuses on destroying cancer cells, while preserving delicate tissue. Those two interests led to collaborations with various departments, including biomedical engineering, as well as chemistry, immunology, and pharmacology. Moser is most excited today to see IRE combined with immunotherapy, to enhance the body's immune response against cancer. "It's like a killed cell vaccine situation because we've got these dead, helpless cancer cells. They're still exposing their proteins," said Moser. Although the research is still in its early stages, Moser said the results so far show "great potential" in treating metastatic cancers. "One could actually treat the area where the tumor started without directly treating it," he said.

From the laboratory to saving lives, this episode brings together three outstanding researchers from the University of Saskatchewan's Department of Anatomy, Physiology, and Pharmacology (APP) as they discuss their work and its implications for cardiac care. Dr. Michelle Collins, Dr. Scott Widenmaier, and Dr. Changting Xiao are all recent recipients of research grants from Heart & Stroke (formerly the Heart and Stroke Foundation of Canada). In Canada, one per cent of newborns have congenital heart defects. Thanks to advances in cardiac care, up to 85 per cent of these infants now survive to adulthood. Meredith Rhinas is one of those survivors. Diagnosed with aortic stenosis as an infant, by her thirties, she received conflicting guidance from cardiologists, and risked congestive heart failure giving birth. She underwent open-heart surgery to replace her aortic valve after delivering her fourth and final child, surgery that led to further complications caused by an oversized replacement valve. "That's a piece that is missing," said Rhinas, who said most heart attack protocols still skew toward older men -- often overlooking younger patients and women of childbearing age. "I want the research to catch up." In this episode Dr. Michelle Collins, an expert in the molecular basis of cardiac development and function, discusses her work on congenital heart defects, seeking to understand what makes a heart beat. With her lab's focus on the movement of calcium ions and their role in heart function, Collins emphasizes the importance of understanding cardiac arrhythmias, particularly atrial fibrillation, which has traditionally been viewed as an electrical disease. "There's a significant contribution from genes that are really early transcription factors that build the heart during development," Collins said. Dr. Scott Widenmaier's work looks at the liver, an organ he has dubbed "the Amazon of our body", as it presents our first line of defence against stressors, which often are a precursor to heart disease. In this episode, Widenmaier explains how and why those stress defense mechanisms can be harnessed to prevent the conditions that lead to heart disease and stroke. "Things are happening way quicker, way faster, and the technology's there. The ability to find the genetic variants is there," Widenmaier said. "There's hope in that." Dr. Changting Xiao, known for his innovative work on gut physiology and metabolism, explores the gut's role in lipid processing and its implications for heart disease. "We want to understand how these enterocytes process the fat inside the cells," said Xiao. His research aims to identify druggable targets within the gut to correct lipid disorders and combat heart disease. Xiao passionately believes in the ancient wisdom that "all disease starts in the gut," asserting that a deeper understanding of gut functions can lead to breakthroughs in preventing and treating heart conditions. "Every small step we move forward looks small, but in the long run we build knowledge and we move forward," said Xiao. His laboratory is now one of only a handful worldwide specializing in being able to see both sides of nutrients entering and leaving the gut. With awards being administered through a rigorous national peer-review process, Carolyn Cyr praised Saskatchewan's researchers for rising to the top. She's the province's Director of Health Policy and Systems for Heart & Stroke. "It's definitely something to celebrate," said Cyr. "It's a testament to the excellent research they're doing and the high calibre of their applications that we have three researchers from the same department who are able to be funded."

Dr. Sabira Valiani was one of the frontline physicians working inside Saskatoon's critical care units four years ago, during the initial lockdowns of the Covid-19 pandemic. "It was really weird," said Valiani. Valiani said 'a lot of light bulbs went off in my head' amid the automated stillness of the unit, as she watched ventilators breathing for heavily sedated patients. Covered in head-to-toe personal protective equipment, staff in the intensive care unit struggled to simultaneously treat patients, communicate with family members, and enforce hospital policies. "Those patients aren't talking to us," Valiani said. "It was empty, it was overwhelming and it was disconnected all at the same time." Valiani has now spent seven years in critical care, a move that started with her enrolling in a critical care and ICU elective in Ottawa. "I loved it. I loved on the medical side, how you could see the life support that you were giving a patient immediately have a physiologic effect and stabilize that patient," she said. Driven by her experiences during the pandemic, Dr. Valiani delved into research focused on improving patient and family experiences in the ICU. She collaborated with a multidisciplinary team and patient partners to understand the challenges faced by healthcare providers and families alike. In this article for the Canadian Association of Critical Care Nurses, she and her colleagues examined the effect of visitor restrictions during the pandemic. Valiani remembers tearful goodbyes, families gathered around screens, unable to hug or touch loved ones infected and dying with Covid-19. "The family's role becomes significantly diminished," she said. "So much of that was disrupted during that time." In the months and years that followed, visitor restrictions relaxed, but Valiani noticed communication between families, patients and staff still felt awkward. Valiani and her colleagues turned their lens last year to key moments for Canadians of diverse ethnicities during the critical care journey, in the Canadian Journal of Anesthesia. The findings revealed the strain on healthcare providers playing multiple roles and families feeling disconnected from crucial information. She estimates 30 per cent of Saskatoon's ICU patients travel from remote communities, making it crucial to find ways to keep family members informed in a language they understand well. "People kind of naturally turned towards communication technology in the pandemic," said Valiani, noting a number of families cannot be present in-person during the day, as intensivists attend rounds. Clear and open communication between patients, care providers and families is the key, Valiani said. "What if we could use artificial intelligence or AI to just translate a medical progress note into an understandable family update?" Valiani asked. "It doesn't have to be high tech, right? Like it can be a phone call." Together with the Saskatchewan Health Research Foundation, Dr. Valiani now works at enhancing patient-family engagement through practical solutions. She emphasizes the importance of involving families in care decisions, acknowledging their unique expertise in understanding patients' wishes. Her team presented its findings in 2022 at Toronto's Critical Care Canada Forum. "We have this cohesive approach to defining the problems," said Valiani. "Now we can take this to decision makers and say….these are the things people living this experience actually want."

Haissam Haddad inadvertently horrified his family when he signed up for engineering courses in his first year of university. The teenager returned the next day to change his major to medicine -- a move he's glad he made. Dr. Haddad practiced family medicine in Syria for three years, then arrived in Canada in 1986 to visit his wife's family, who urged him to stay. Haddad faced an uphill battle when he investigated the possibility of becoming a Canadian doctor. One colleague even told him he'd be better off opening a Syrian grocery store. "This gave me a lot of energy to prove him wrong," said Haddad. His early years in Canada were characterized by relentless perseverance, as Haddad confronted the arduous process of certification and integration into the medical system. He focused on learning English every weekday, picking up back-to-back twelve-hour shifts at a Halifax laundromat every weekend, to support his family. "The first day it took me, like, almost 16 hours to read one page," Haddad said. "I had no option to fail." After three years of English lessons and intensive studying, Dr. Sam Haddad earned a passing score on Canada's medical licensing exam. In this episode, Dr. Haddad recounts pivotal moments that steered him towards cardiology, including formative experiences in cardiac surgery during his residency at Dalhousie, which took place during the HIV epidemic. "I've always liked the heart," said Haddad. "I decided to do cardiology because it has less blood and less risk." Haddad's dedication to improving patient outcomes through research soon became evident, as he tackled clinical gaps and treatment efficacy in heart failure management and heart transplant protocols. "Almost on a weekly basis, you have a patient who did not respond to the usual treatment," said Haddad. "This is the research question. How come this patient is not getting better?" As his expertise grew, Haddad became one of only two Canadian cardiologists who were part of the National Institutes of Health Heart Failure Network. His patients took part in clinical trials that led to significant advancements. "A lot of our patients didn't have private insurance," Haddad said. "We can do a lot of work to help patients who are not able to buy their own medication." Haddad led the cardiac transplant and heart failure programs at the University of Ottawa's Heart Institute, exponentially increasing the number of transplants performed. At the same time, he said at cardiovascular medicine was making revolutionary strides with artificial hearts and improved anti-rejection medications. When he began, half of heart failure patients died within a year. Now, over 90 per cent survive. After moving to Saskatoon to become Saskatchewan's Provincial Head of Medicine in 2016, Haddad continued his clinical practice, taking on leadership roles in medical education and research. Instrumental in recruiting almost half of the specialists practicing in Saskatchewan today, Haddad also established the University of Saskatchewan Cardiovascular Research Group, fostering a collaborative environment for innovative research initiatives. Last year, Dr. Haddad was appointed as an Officer of the Order of Canada.. "Nothing comes easy," said Haddad. "You have to work hard. You have to fail multiple times before you're successful."