Researchers Under the Scope

• In the Trenches: Dr. James Stempien on Emergency Medicine

  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."

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• All’s Not Lost: A Roadmap to Treating Hepatitis C on the Prairies

  As the world aims to eradicate hepatitis C (HCV) by 2030, Carrielynn Lund and Dr. Alexandra King’s team created a how-to guide.  Journeys to Wellness: Prairie Hepatitis C Roadmap is a step-by-step guide to tackling a spike of new infections across the three Canadian prairie provinces. Hepatitis C (HCV) causes severe liver disease, and was notoriously difficult to treat until the introduction of direct-acting antivirals a decade ago — antivirals which boast a remarkable 95% success rate. Despite this advancement, Lund and Dr. King say Saskatchewan, Alberta and Manitoba need to know why HCV cases keep rising, particularly in jails, in remote communities, and in people who lack adequate housing and nutrition. The virus is not picky, as Carrielynn Lund learned when she was first diagnosed in the 1990s. Her doctor wrongly told her back then the blood-borne illness could be spread only through injection drug use. Shocked, Lund said “I went out of that room and drove home thinking, oh my God, I'm gonna die.” A single mother of two, she resumed her professional life and never disclosed that “dark, dirty secret” until nearly 20 years later, as she became friends with Dr. King. The Waniska team, led by Saydi Harlton, brought together researchers, health professionals, and people who’ve lived with hepatitis C in sharing circles, workshops and interviews. “The stigma around this needed to be addressed and I wanted to be a part of it,” said Lund. “People often feel really alone in this journey, and it’s so important that we create spaces where they can share their stories and be heard." Participants identified barriers to care, including confidentiality breaches, misinformation and inadequate access to testing. “My priority right now may or may not be my hepatitis C. It might be, where am I going to sleep today? Or, what food am I going to be getting?” said Dr. King. In the Roadmap, King said the disproportionately high number of cases in Indigenous people shows a need for true elimination strategies, rather than pockets of “little pilot projects.” "There aren't necessarily a lot of resources, so you're dealing with fairly fragile systems," Dr. King noted. Recent provincial government decisions to axe needle exchanges, and cut public transportation routes to remote and northern communities have taken their toll, she added. Given the hurdles faced by Indigenous and two-spirit people, both Dr. King and Lund say prairie people need culturally informed care. They point to Indigenous-led hepatitis C elimination strategies with predictable funding and resources.   “It really helps you to understand the importance of really good evidence-based policy that supports people and meet them where they're at,” Dr. King said. Lund and Dr. King believe making a fiscal case for early detection and treatment may also swing policy-makers back toward patient-centred care. Peer support also plays a role, Lund said. “When someone who has been through it helps a newly diagnosed person, it can truly change everything for them," she said.   

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• Exercise Your Right to Breathe: Dr. Brianne Philipenko & Asthma

  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.”

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• Dr. Sarah Forgie: Why the New Dean of Medicine Taught Herself the Ukelele

  In this episode, we gain insight into Dr. Sarah Forgie, the new Dean of the College of Medicine. She discusses her innovative teaching methods, her career as a pediatric infectious disease specialist, and her vision for advancing Saskatchewan’s College of Medicine. Dr. Forgie also shares the story behind her decision to learn the ukulele. Born to family physicians, Dr. Forgie grew up in Lynn Lake, Manitoba, a remote fly-in mining community. Her family later relocated to Winnipeg, where Dr. Forgie credits much of her motivation to her mother, who encouraged her to pursue both medicine and leadership roles. As a pediatrician and professor at the University of Alberta, Dr. Forgie’s journey into university leadership can be traced back to her willingness to deploy creative teaching methods. Faced with the challenge of teaching infectious diseases to first-year medical students, she re-wrote the Talking Heads hit “Psycho Killer” to reinforce best practices in treating Streptococcal pharyngitis -- with ukulele accompaniment. It worked. Those who attended her “Take Five” bacteriology lectures at the University of Alberta retained 98% of the key concepts, compared to a 50-60% retention rate among students in standard classes. Dr. Forgie strived to instill strong clinical reasoning, and challenged her students to present key concepts in their own creative ways. “With every session, I would do something, they would do something, and it just made it a fun environment,” she said. Following her appointment as Saskatchewan’s first full-time female Dean of Medicine on July 1, 2024, Dr. Forgie returned to clinical service this fall as a pediatrician at the Jim Pattison Children’s Hospital in Saskatoon. In her role as Dean, she aims to strengthen connections between the College of Medicine and Saskatchewan’s medical practitioners. “What I would love to see in Saskatchewan is that every physician approaches their work with an academic lens,” Dr. Forgie said. This 'lens' may encompass participating in clinical trials, exploring ways to alleviate physician workloads, or collaborating with learners, she said. Engagement with Indigenous communities remains a critical component of Dr. Forgie’s vision for wellness. “I am all about collaboration... with First Nation, Inuit, and Métis communities to better prepare our trainees to work within these communities,” she stated, affirming her commitment to cultural sensitivity in healthcare. As a lifelong resident of the prairies, Dr. Forgie understands the isolation often experienced in rural medicine. She aims to foster connectivity among healthcare providers and new learners. “How can we help and how can we reduce some of those feelings that you're having around burnout and frustration?” she asked. “Helping with that leads to a virtuous cycle of how do we make things better in Saskatchewan?”

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• Grey Area: Dr. John Howland on Cannabis & Budding Brains

  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.”

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