This article first appeared in the Spring 2014 issue of Dalhousie magazine.
Monica Brown has a pain in her stomach, a fist-sized passenger stowed away behind her belly button. Its effects, which are constant and vary only in intensity, include an agonizing swelling that Brown calls “The Bloat.” It is not a simple tummy-ache or the result of any commonly understood affliction like cancer or gastrointestinal illness. Since it escalated in severity at age 13, Brown’s pain has defied easy explanation and denied her a normal life, forcing her to miss months of school at a time.
Al Isnor, on the other hand, knows exactly what caused him to hit “rock bottom” several years ago at 24: Tourette’s Syndrome, with symptoms including such violent jerking of his head and neck that he required medication for the resulting pain. Isnor’s symptoms were threatening the steady hands he required in his woodworking job and despite trying countless medications and treatments, he hadn’t found any lasting relief.
Two different ailments. Two desperate patients. But after years of pain and frustration, Brown and Isnor were able to tap into the network of Dalhousie medical research. Their lives were about to get better.
When Dr. Christine Chambers met Brown a decade ago, she saw a young girl suffering from both debilitating pain and the anguish of not knowing its cause. “It’s hard enough to be a teenager when you don’t have any health challenges,” says Dr. Chambers. “Then you layer on a mysterious disease, which is really what pain is.”
In addition to treating patients like Brown, Dr. Chambers is a Canada Research Chair in Pain and Child Health working out of the Centre for Pediatric Pain Research at the IWK Health Centre. Thanks to her efforts and those of her colleagues, Dalhousie has become recognized as an international leader in pediatric pain research.
“What we know about pain now is that it’s a very complex biological and psychological experience,” says Dr. Chambers. “Pain is an alarm system that’s supposed to go off when something in your body is wrong, but just like alarms can go off for no reason or be overly sensitive, that can happen in your pain system.”
Armed with that knowledge, Dr. Chambers worked with Brown with the hope of helping her manage her pain in a healthy way. With Dr. Chambers’ guidance, Brown found some relief in yoga, breathing and meditation, as well as medication. By explaining her research, Dr. Chambers also gave Brown the words to tell friends and family how she felt. Perhaps most importantly, Brown found in Dr. Chambers someone who could listen and understand.
“It was the first time in my life I felt believed.”
In contrast to the steady, incremental gains made by most medical researchers, Dr. Chambers says the field of pediatric pain lends itself to quick transitions between discovery and care. Her research into how parents respond to children in pain, for example, has already yielded new recommendations for parents, which Dr. Chambers has conveyed in a TEDx Talk and through a lighthearted YouTube video. “When parents try to offer reassurance, kids pick up on the fact that their parents are nervous and that anxiety seems to make the pain worse.”
Because pain research isn’t expressly tied to defeating a single major disease, Dr. Chambers says the field doesn’t generate much awareness or many resources. She says that in her field, bridging and matching funds can be essential to continuing important research or getting new research off the ground. For researchers working grant to grant, bridge funds can keep projects afloat between grants. Matching funds allow researchers to aim higher by seeking out research opportunities partially funded by external parties.
Dr. Christine Chambers (right) with Monica Brown.
“Those types of funding are absolutely critical for researchers like myself who might be going from one grant to another, or who have an idea for something interesting and innovative but might need matching funds to make it happen,” says Dr. Chambers.
From the basics to the benefits
“Al had exhausted all other avenues and his life was becoming a living nightmare,” says Sandy Isnor of the moment a little more than seven years ago when Al walked into neurosurgeon Dr. Robert Brownstone’s office. Now Al’s wife, Sandy was at the time his long-distance girlfriend.
One of Dr. Brownstone’s specialties is the implantation of deep-brain stimulation (DBS) devices in people suffering from tremor and movement disorders. He says it is rare for someone with Tourette’s Syndrome to have symptoms so severe that they require this kind of procedure, so when Al Isnor walked through Dr. Brownstone’s door he knew he was, by definition, dealing with a serious case.
According to Al, Dr. Brownstone explained the DBS surgery in a way that was easy to understand, which helped Al make the decision to go forward with it. Within a few months of the procedure, both Al and Sandy noticed his symptoms decreasing in frequency and intensity. “It was like seeing a different person in front of me,” Sandy says.
Dr. Brownstone knows that the distance between basic research discovery and practical application is often measured in years, even decades. He works on both ends of this timeline, operating on patients like Al Isnor while also studying the fundamental circuitry of the nervous system as the principal investigator at Dalhousie’s Motor Control Lab.
“Hopefully what I do [in the lab] will help patients 20 or 30 years from now,” he says. Dr. Brownstone is building toward breakthroughs in our understanding of how movement works. He studies four distinct groups of circuits: those between the spinal cord and the muscles; those within the spinal cord; the “command circuits” between the brain and the spinal cord; and the “decision-making” circuits in the upper levels of the brain. Researching at this fundamental level, Dr. Brownstone describes himself as “disease-agnostic,” in that he is not targeting particular illnesses. “The hope is that some of these discoveries will have applications for many different diseases.”
Like most medical researchers, Dr. Brownstone has benefitted from technological advances and ever-improving equipment. As an example, he cites cellular molecular digital imaging microscopes, which allow researchers to see fine details that their predecessors could never have imagined. The need for top technology is behind the Dalhousie Medical Research Foundation’s (DMRF) Core Facilities Fund, a resource that is used to acquire and maintain advanced equipment that can be used by multiple researchers and departments.
“These facilities are absolutely critical and the only way we can support them is institutionally,” says Dr. Brownstone.
Having the best technology at his disposal will help Dr. Brownstone change future patients’ lives through his research. In the meantime, he makes an immediate impact for patients like Al Isnor as a neurosurgeon.
Al Isnor with his wife Sandy.
The term “medical research” conjures up the idea of lifesaving new treatments and cures, major diseases wiped out in flashes of brilliant insight, and Dalhousie has contributed a great deal in the fight against killers like cancer and heart disease. Dr. Tom Marrie, Dean of Medicine at Dalhousie, points to the work of Dr. Patrick Lee, who has pioneered a virus that can be implanted into—and destroy—cancer cells. Dr. Marrie also notes that Dalhousie’s cardiology research team is renowned for expertise about heart rhythm.
Dalhousie researchers have also shown leadership in fields that support quality of life. Dr. Brownstone and Dr. Chambers are two examples, working with patients suffering from chronic illnesses. And as better treatment allows more people to survive serious conditions, the need has further grown to examine quality-of-life concerns. Whether the research is aimed at curing major diseases or bolstering scientific knowledge, saving lives or making them better, each aspect feeds the other.
“These little things that each lab discovers, other labs learn from that and it just keeps going,” says Alison Edwards, executive director of the DMRF. “That’s why health research matters.”
Al Isnor and Monica Brown don’t need convincing. Theirs are just two lives that have been improved by medical research and Dalhousie researchers. Now 32, Isnor is married to Sandy. He’s been driving for the past five years after previously staying away from the wheel because of his symptoms. Whereas once he couldn’t sit still through a movie or a plane ride, he is now an enthusiastic traveller who has visited Toronto, New York and South Africa. His condition requires minimal management, including an annual procedure to change the batteries in his deep brain stimulation device. “My quality of life has gone from zero to 1,000 in seven years,” he says.
At 23, Brown is in the Bachelor of Education program at Mount Saint Vincent University and gives speeches through the IWK that promote understanding of pain as a chronic illness. Dr. Chambers and the team of clinicians and researchers she collaborates with continue to give Brown the tools to manage her pain, for which Brown is grateful. “I don’t know where I’d be without Dr. Chambers and her dedication to her research and her patients.”
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