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‘A remarkable era’: Groundbreaking innovations in treating spinal cord injury offer new hope for patients

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Gert-Jan Oskam could no longer walk after a cycling accident 12 years ago in China.

He suffered an incomplete spinal cord injury, so while he had some sensation in his lower body, he used a wheelchair after he returned home to the Netherlands.

But he wanted to be able to stand.

That’s why Oskam, 40, agreed to be one of three participants in a Swiss pilot study of an experimental brain implant in 2017.

The implant would allow him not just to stand, but to walk. When he pressed a button, a processor worn in a backpack would analyze his brain signals to try to activate his leg muscles for walking.

It worked, but not completely — his gait was stiff and robotic, and his steps were delayed because they were automated.

Oskam’s implant system is an upgrade on a previous version he used in a pilot project. He can now walk further, more fluidly and over uneven ground. (Nature)

Then a few years later, the researchers recruited Oskam to “test pilot” an upgraded implant system that would translate his thoughts into motion. When he thought about walking, electronic implants on his skull would pick up his brain signals, register them as instructions to move his legs, and send them to the corresponding muscles through another implant on his spine.

“You’re creating a sort of digital bridge” between the brain and spinal cord, said Canadian neurosurgeon Jordan Squair. Squair treats spinal cord injuries at the Swiss Federal Institute of Technology in Lausanne, Switzerland, where work on Oskam’s implant is based.

In May, the researchers reported on Oskam’s progress more than a year into the study. His walking is now fluid. He can climb stairs and handle rough terrain; he can walk faster and farther; and he’s able to use the technology outside the lab at his home.

“The stimulation before was controlling me, and now I’m controlling the stimulation,” Oskam said in a media briefing.

In 2024, medical researchers plan a pivotal clinical trial to test the safety of the implant in more subjects. Their goal is to miniaturize the system and make the technology available worldwide.

Implants have multiple benefits

Oskam’s progress and other advances in treatment of spinal cord injury — including a pioneering type of microsurgery that’s now being performed in Toronto — signal a promising turning point for the field.

In Canada, more than 86,000 people live with spinal cord injury, according to Praxis Spinal Cord Institute (formerly the Rick Hansen Institute). Doctors say about half to two-thirds of those are incomplete injuries like Oskam’s.

Quirks and Quarks8:39Digital bridge for spinal cord allows paralyzed man to walk again

Researchers in Switzerland have developed a system to restore communication between the brain and the spinal cord in a paralyzed man who was told he’d never walk again. By surgically implanting devices in the patient’s brain and spinal cord, they were able to digitally bridge the communication gap to allow him to control his legs again. Henri Lorach, the head of the brain interface unit at NeuroRestore and a neuroscientist at École Polytechnique Fédérale de Lausanne, said the patient can now walk with crutches even when the device is turned off. Their research was published in the journal Nature.

Squair said linking spinal cord stimulation to help people walk better by decoding their thoughts, as Oskam’s implant does, is a true technological step forward.

Not only does the approach help people with spinal cord injuries regain mobility — which they often rank as their top priority, say Squair and Praxis  — but it can help people whose injuries are in the neck to control dangerous spikes in blood pressure.

“People are experiencing a lot less episodes of what we call autonomic dysreflexia — these hypertensive episodes when blood pressure goes up really high,” he said.

“We found that over time, as people use the stimulation, that is starting to go away, which is really exciting because those episodes can be life-threatening.”

Until now, few existing treatments have worked long-term, he said.

Man smiling in his wheelchair while wearing a Maverix shirt.
Venture capitalist John Ruffolo is recovering from a spinal cord injury. A new type of microsurgery helped ease the pain in his spine. (Submitted by John Ruffolo)

‘You will feel this deadness’

John Ruffolo of Toronto takes a keen interest in how the field of spinal cord treatment is progressing as part of his own recovery from severe injuries.

When Ruffolo watches videos of Oskam walk, his reaction is: “I’ll be there soon.”

He hasn’t received an implant, though he says he would get one if he had the opportunity.

An avid cyclist, Ruffolo, 57, was riding his bike on a sunny day in September 2020. He was heading down a rural road about 50 km north of the city when he heard the screeching air brakes of a tractor-trailer coming up on his rear wheel.

He doesn’t remember the pain of being hit.

After he landed, he tried to move his legs as his upper body seared with pain.

“You will feel this deadness on your body,” he said. “My first reaction was, ‘Oh s–t, I’m paralyzed.’ I was trying to wiggle my toes, and nothing.”

On impact, his pelvis split into six pieces. The force broke every rib in multiple places, collapsing a lung and taking out a kidney. Doctors said he lost 50 per cent of his blood volume.

Witnesses, paramedics and physicians expected he’d suffocate to death because of the broken ribs around his chest, which can hinder breathing.

Paramedics rushed him to Toronto’s Sunnybrook Health Sciences Centre, a major trauma hospital.

When he made it 36 hours past the accident, doctors performed multiple surgeries to repair his pelvis and then his back, drilling vertebrae and then delicately placing rods and screws.

Each move had to be carefully planned, like removing a block from a Jenga tower, without causing more damage or even death.

Ruffolo and his wife, Carryn, were told he’d never walk again.

Asked about his reaction, Ruffolo lowers his voice to a whisper, his voice cracking.

“The issue is, never remove someone’s hope, right?”

Sunnybrook’s surgical team considered Ruffolo to have a complete injury of the spinal cord, which traditionally has a guarded prognosis.

The surgeon had to leave several large bone fragments floating in his spinal fluid because they were located in an area that made them too risky to remove. Ruffolo said his spinal cord felt like it was being squeezed and bruised.

A few weeks later, he met with neurosurgeon Michael Fehlings at the Krembil Brain Institute at Toronto’s University Health Network. Fehlings told Ruffolo he could remove the fragments with a type of microsurgery called decompression surgery.

Man in a grey suit jacket and white shirt.
Dr. Michael Fehlings, a neurosurgeon with Toronto’s University Health Network, says new international guidelines on spinal cord injury coming out in 2024 will highlight the benefits of early decompression surgery. (Submitted by Michael Fehlings)

Fehlings told him the surgery could help relieve the squeezing to improve his odds for a significant recovery, but there were risks.

“I looked at him and I said, ‘Dude, I’m a VC,'” said Ruffolo — a venture capitalist in the tech industry. “I make investments when there’s a one per cent chance. I didn’t even flinch, and I said, ‘Do it.'”

Ruffolo, founder and managing partner of Maverix Private Equity, now does 18 to 20 hours of intense physiotherapy a week. He can walk with a walker, walking poles or on a treadmill.

“You just gotta keep on going,” he said.

“I’m not stopping until I walk independently.”

Patient’s recovery ‘gratifying’ for surgeon

Ruffolo is also able to ride again using modified recumbent and upright bikes. When he shares video of his rides with Fehlings today, it inspires the physician.

“While the injury presented huge challenges to him, where he’s at now and where he might have been without the decompressive surgery, I think is quite striking,” Fehlings said. “That’s very gratifying for me to see.”

 

Rick Hansen reflects on rehabilitation journey 50 years after crash

 

Premier David Eby joined Rick Hansen and health officials at the G.F. Strong Rehabilitation Centre in Vancouver to mark Hansen’s 50 years of spinal cord injury rehabilitation, and to present the Difference Maker Awards to those who have helped him on his road to recovery.

But Fehlings, who is also a professor at the University of Toronto and a clinician scientist, notes that Oskam’s and Ruffolo’s injuries should be kept in perspective: not every patient will respond as well to treatments because no two patients are identical in the degree and location of their spinal injury. It also helps that both patients were physically active before and after their accidents.

Not everyone with a spinal cord injury is keen to receive implant technology, either, Fehlings said, although he added it is possible the Swiss implant could help Ruffolo’s motor recovery.

“The technology was really quite remarkable,” Fehlings said. He isn’t involved in the experimental device but sees how it could fit in with efforts in restorative and regenerative medicine.

Another thing giving him optimism is the set of international guidelines on treating spinal cord injury, created with Canadian input, that is set to be published in early 2024. They include evidence on the benefits of early surgical decompression to reduce pain, improve mobility and manage other symptoms like bowel and bladder control.

“We’re really on the cusp right now of a remarkable era in regenerative neuroscience,” Fehlings said.

 

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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