Fa­ther and son to the res­cue at MUHC

Cap­sule en­doscopy sees pa­tients swal­low tiny cam­era that can trans­mit images

Montreal Gazette - - FRONT PAGE - SU­SAN SCHWARTZ ss­chwartz@post­media.com twit­ter.com/su­san­schwartz

A fa­ther and son who both suf­fer from in­flam­ma­tory bowel dis­ease (IBD) and are deeply grate­ful for the care they have re­ceived at the McGill Univer­sity Health Cen­tre for this painful, chronic and of­ten un­pre­dictable con­di­tion have cho­sen to ex­press their grat­i­tude by fund­ing an in­no­va­tive di­ag­nos­tic pro­gram that had its bud­get slashed.

Harold Abrams and his son, Ryan, are un­der­writ­ing the lion’s share of the $150,000 cost of the MUHC’s video cap­sule en­doscopy pro­gram for the com­ing year: $115,000. Their gift, be­ing made through joieshop.com, the on­line re­tail shop of their kitchen gad­get busi­ness, means that about 140 peo­ple will be able to un­dergo the pro­ce­dure, up from just 30 fol­low­ing last year’s bud­get cut.

The two are be­ing hon­oured Thurs­day at the an­nual fundraiser of the McGill IBD Re­search Group, Laugh Your Butt Off. Since its found­ing 25 years ago, the group has raised money to fill gaps in the health sys­tem for the ben­e­fit of pa­tient care and wel­fare. Among other things, it has funded salaries for nurses and psy­chol­o­gists, pub­lic ed­u­ca­tion events, train­ing for the next gen­er­a­tion of IBD spe­cial­ists and re­search projects.

The video cap­sule en­do­scope is a tiny cam­era, com­plete with flash, housed in a cap­sule the size of a large vi­ta­min pill. Af­ter a day on a liq­uid diet, the pa­tient swal­lows the cap­sule, and dur­ing its sub­se­quent 12-hour tra­jec­tory through the small bowel, it trans­mits video images to a record­ing de­vice worn by the pa­tient. The images make pos­si­ble the de­tec­tion of dis­eases or le­sions doc­tors pre­vi­ously could not see. At the end of its voy­age through the bowel, the cap­sule is elim­i­nated and dis­carded.

In­vented in the late 1990s in Is­rael as an ap­pli­ca­tion of mil­i­tary tech­nol­ogy, the video cap­sule en­do­scope “pro­vides ex­traor­di­nar­ily beau­ti­ful and pre­cise images,” said Ernest Sei­d­man, a gas­troen­terol­o­gist and pro­fes­sor of medicine and pe­di­atrics at McGill and di­rec­tor of gas­troen­terol­ogy re­search. Among his other ti­tles, he is di­rec­tor of the MUHC video en­doscopy pro­gram and was the first in Canada to use the de­vice, back in 2001. “It has changed our field of gas­troen­terol­ogy dra­mat­i­cally,” he said.

Un­like a CT scan, vis­ual cap­sule en­doscopy in­volves no ra­di­a­tion ex­po­sure. An MRI ma­chine can be used to view the bowel, but it makes a great deal of noise, takes a long time and is po­ten­tially terrifying for chil­dren, Sei­d­man said. Ul­tra­sound is less ex­pen­sive, “but not very re­fined.” And tra­di­tional en­do­scopes, flex­i­ble tubes equipped with a video cam­era and guided down the throat or up the bot­tom, can to­gether im­age only about half a me­tre of the four-me­tre-long small bowel, he ex­plained.

In ad­di­tion, the tra­di­tional pro­ce­dure re­quires a nurse, se­da­tion and a re­cov­ery room — and yields an im­age less clear than the video cap­sule en­do­scope.

One can ques­tion whether pri­vate cit­i­zens should be fund­ing pro­grams in­sured and pre­vi­ously un­der­writ­ten by the pub­lic purse. In­deed, Sei­d­man, med­i­cal ad­viser to the McGill IBD Re­search Group, said he hes­i­tated ini­tially when the Abrams men ap­proached him to ask: “What is your most press­ing need in terms of pa­tient wel­fare?”

“To me, the most im­pact they could have with their do­na­tion is to help sup­port the video cap­sule pro­gram,” he said. “Peo­ple are suf­fer­ing be­cause of these bud­get cuts.”

Yet he was re­luc­tant at first to ask them to do it be­cause, “in my ex­pe­ri­ence, once the hos­pi­tal knows there is a donor, they’re off the hook. Hope­fully, this is a short­term so­lu­tion,” he said, and the MUHC will re­store the pro­gram’s full fund­ing.

“We are both very aware of the pain that peo­ple suf­fer, and if this can help peo­ple not suf­fer, then it’s some­thing we want to do,” Harold said.

IBD is a rarely dis­cussed con­di­tion, in large mea­sure be­cause it

re­lates to go­ings-on in the bowel, but it “can be ex­cru­ci­at­ingly painful,” Ryan said. Part of the na­ture of the dis­ease is its un­pre­dictabil­ity. “You go from feel­ing well to not feel­ing well.”

When the con­di­tion flares up, the bowel be­comes in­flamed and food and fe­ces get stuck in place.

“It’s so painful,” Harold said, “that you don’t know what to do with your­self. The only thing to do is to go to hos­pi­tal and get painkillers un­til it passes.”

What makes the Abrams gift “so no­ble” is that it will ben­e­fit not only peo­ple with IBD but oth­ers as well, Sei­d­man said. In young peo­ple, video cap­sule en­doscopy is used mostly to di­ag­nose IBD, but in adults its main func­tion is to di­ag­nose un­ex­plained bleed­ing.

“It out­per­forms all the other med­i­cal tools we have,” he said.

Pro­duc­ers of the tele­vi­sion show House ap­proached Sei­d­man for help when the plot of an episode in the med­i­cal drama’s first sea­son in­volved a case of bleed­ing in the small bowel. He re­viewed the script for ac­cu­racy and pro­vided a video clip of small bowel cap­sule en­doscopy — and his name ap­peared in the cred­its.

JOHN MAHONEY

Harold Abrams and his son, Ryan, at their kitchen-ac­ces­sory busi­ness, MSC In­ter­na­tional, in Saint-Lau­rent. They will fund the cap­sule en­doscopy project for the next year at the McGill Univer­sity Health Cen­tre.

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