Karen Ethans, MD, FRCP(C)is anAssociate Professor, Medical Director Internal Medicine, Spinal Cord Injury Unit, at the University of Manitoba, in Winnipeg. She is also a Board member of the Canadian Association of Physical Medicine and Rehabilitation. In this conversation, Dr. Ethans talks about her work researching and treating a wide range of complex secondary complications experienced by people living with SCI.
Where were you born? Winnipeg
Where did you go to (post secondary) school? I wanted to be a doctor like my dad, so I studied Medicine and then completed my Physical Medicine and Rehabilitation Residency -- at Dalhousie University.
What was your first job? I was physician director of Spinal Cord Injury Rehab Program in Halifax at QE2 Hospital.
What inspired you to pursue a career in Physical Medicine and Rehabilitation? At first, it was about the musculoskeletal medicine and sports medicine! Later it became about the neurorehab, and the ability to actually do something to help patients with spinal cord injury, stroke, etc. -- not just diagnose problems!
What intrigues you about spinal cord injury medicine and spasticity, specifically? SCI medicine is complex, multifactored, and unique from any other specialty area. I deal with problems that are real life issues that affect quality of life such as neurogenic bowel, bladder, pain, sexual dysfunction, spasticity**, and pressure sores.
There are so many secondary complications with which a person living with spinal cord injury has to cope. Tell me about your current research looking for ways to improve those complications. People with SCI cannot control bowel and bladder in a normal manner -- they often have to catheterize their bladder every four hours but still get incontinence and frequent infections. Some have to ‘cath’ every hour to not be incontinent!
Bowel control can be difficult and very debilitating.
Spasticity can cause the legs, arms, or other muscles to be tight, jump involuntarily, be painful, disrupt sleep, and affect ability to move, transfer, etc.
Pain can be terrible, especially what we call neuropathic pain below the level of the injury.
Erections can be very difficult to get and maintain, thus sexual function can be greatly affected.
Pressure sores can occur, happen commonly, and can become infected, leading to severe illness or even death. To heal pressure sores, one must stay in bed, off the sore, for weeks, sometimes months.
With my colleagues -- Alan Casey, Robert Bard, and many others -- we have done studies in numerous areas: medications to help erectile dysfunction in SCI and be sure they are safe with people with SCI: treatments for overactive bladder with botulinum toxin and other medications such as tolterodine; treating spasticity using botulinum toxin, baclofen pumps, and nabilone; and changing pain using nabilone. We are currently looking to do a multi-centered study on treating people with SCI with pressure ulcers using in-home telehealth technology. I have also been involved in studies looking at how people with SCI can get exercise, what the optimal seating angle is to avoid pressure sores, and what are the issues that people using wheelchairs face in winter weather!
Have there been any breakthroughs in this area? The most recent breakthrough is the use of botulinum toxin for neurogenic bladder to help people with spinal cord injury not be incontinent of urine so much, or have to constantly be going to the bathroom or worrying about it. This has just been approved in Canada, in part due to work that our site and other Canadians have contributed to the research. Now we just need provincial formularies to kick in funding for this therapy. Unfortunately, that usually takes years to happen after Health Canada actually approves a medication or therapy.
What will that mean to a person living with SCI? Once funding is available it will mean that people will be able to carry on life without always being worried about incontinence, or constantly going to the bathroom to empty their bladder.
Karen Ethans with a patient.
You also teach. What would you say to students considering a career in research in the field of spinal cord injury? A career solely in research would be very difficult. Unfortunately, most of my time spent doing research, as well as in other administrative areas, is not funded or paid for, and I do it out of the goodness of my heart. So, in most cases, a career in SCI clinical research must be supplemented by clinical work. For me and many of my physiatry colleagues, when we aren’t seeing patients, we aren’t getting paid! Likely this is one area where RHI could be quite effective, lobbying government groups to allow for more support in terms of salary support for clinicians who are doing research, and for support for research personnel in academic hospitals.
Teaching, research, inpatient and outpatient clinical care…and a busy home life with two young children! How do you decompress and find your balance? This is very difficult at times Fortunately, I have my parents to help as well as a great babysitter, and, even though my husband is a busy physician also, he is a great dad and takes a very active role in our children’s lives! We use our little bit of spare time as productively as possible, enjoying our children’s activities as a family.
How are you involved with the Rick Hansen Institute? The Institute asks for my input on numerous projects, and I am involved at multiple levels from data collection, to proposal writing to obtain funding, to helping develop the rehab registry stream. RHI did help secure funding for Manitoba to give money for research in the 20th anniversary round, which has funded a couple of projects we are conducting.
How would you describe the importance of the Institute‘s work? It has helped to connect SCI clinicians and researchers in Canada. I hope, in the future, it will enable the clinicians who do research to dedicate more time and effort in the area of research, but this will require significant advocacy and funding.
To view a list of publications authored by Dr. Ethans, click here.
**Spasticity is a motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated muscle reflexes resulting from hyper-excitability of the stretch reflex as one component of the upper motor neuron syndrome. - Lance 1980