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voice of st. Paul’s Hospital Foundation
s p r i n g / s u m m e r 2 0 1 2
matters
heart
of the
Heart valve replacement
procedure pioneered by
Dr. John Webb is saving
lives at St. Paul’s and
around the world
Colorectal
Surgery
Treating cancer
and other disorders
Taking it to
the Street
Mental health care
for at-risk youth
Culture
of Care
The Renal Endof-Life
Initiative
PM 40065475

fromthetop
Forward Momentum
As we enter spring and our new fiscal year,
I am truly excited about the future of St. Paul’s
Hospital Foundation. I would like to update
you on a few important developments for
St. Paul’s Hospital.
First, a search committee has been working
hard over the last few months to identify the
Foundation’s new president & CEO. I am pleased
to let you know that the search process is
proceeding well and on schedule and that we will
soon be able to introduce you to this person.
We are proud to highlight many of those
recent successes in this issue of Promise. For
example, our supporters played a critical role
in helping us purchase a new $1-million vascular
angiography system (page 4), which will support
the well-being and lives of patients in acute-care
programs throughout the hospital, and in the
success of our 2011 Lights of Hope campaign
(page 5), which raised $2.27 million for our
hospital’s greatest needs.
This issue’s cover story features interventional
cardiologist Dr. John Webb and the groundbreaking
transcatheter aortic valve implantation (TAVI)
procedure (page 8). TAVI is a life-saving solution
for those unable to undergo open-heart surgery
in B.C. and around the world – and this innovative
procedure was pioneered here at St. Paul’s
with the support of our donors.
This issue also explores the critical role of
laboratory services in the care of patients at
St. Paul’s and around the province (page 7); our
Department of Surgery’s excellence in treating
colorectal cancer and other disorders of the
gastrointestinal tract (page 12); the Inner City
Youth Mental Health Program’s expanding role
in delivering psychiatric services to homeless
teens (page 14); and the way our Renal End-of-
Life initiative and Advance Care Planning
program are creating a new culture of compassionate
care for patients at St. Paul’s (page 15).
On a personal note, my two-year term as
Chair comes to an end this summer. I would like
to thank everyone who has contributed to the
Foundation’s many accomplishments over the
past two years. I look forward to continuing to
serve the hospital as a member of the Board of
the Foundation for years to come.
I would also like to take this opportunity to
welcome our incoming Chair, David Poole.
David is the Senior Vice-President, BC & Yukon,
at Scotiabank. He is a passionate advocate for
the Foundation and has served with our Board
since 2008.
I look forward to working with David, fellow
board members, our new president and CEO,
staff, and our many donors and partners in
continuing to support world-leading patient
care, research and teaching at our hospital.
Thank you all.
Henry F. Man
Chair, St. Paul’s Hospital Foundation
President & CEO, Magellen Developments (20/20) Inc.
P.S. For the latest news about St. Paul’s Hospital, follow us!
@helpstpauls
facebook.com/helpstpauls
2 Promise n Spring/Summer 2012 Photo: Brian Smith

Promıse
spring/summer 2012
VOLUME 10, NUMBER 1
EDITOR
Ann Collette
CONTRIBUTING EDITOR
Brice Dare
ART DIRECTOR
Ren Reed
Contributing Writers
Helena Bryan, Brice Dare, Melissa Edwards,
Nancy Gratham, Gail Johnson, J.K. Malmgren
Contributing Photographers/
Illustrators
Sandra Lauck, IAS/Marcus Rose/Workers’
Photos, RS Productions, Jay Shaw,
Brian Smith – Providence Health Care
Media Services
senior IMAGING technician
Debbie Lynn Craig
ELECTRONIC IMAGING
Bernhard Holzmann, Laura Michaels
PRODUCTION manager
Suzy Williamson
studio manager
Kristina Borys
circulation
Scott Wheatley, Tracy McRitchie,
Ginger Jessamine
4th Floor, 4180 Lougheed Highway
Burnaby, B.C., V5C 6A7
Phone: 604-299-7311 Fax: 604-299-9188
chairman, ceo
Peter Legge, O.B.C., LL.D. (Hon)
PResident
Karen Foss
We welcome your comments on Promise magazine.
Please write to us c/o St. Paul’s Hospital Foundation,
178 –1081 Burrard Street, Vancouver, B.C., V6Z 1Y6.
Website: www.helpstpauls.com
Phone: 604-682-8206; Fax: 604-806-8326.
Promise magazine is published twice a year by
Canada Wide Media Limited for St. Paul’s Hospital
Foundation. No part of this magazine may be reproduced
without written permission of the publisher. Send changeof-address
notices and covers of undeliverable copies to:
Promise, c/o St. Paul’s Hospital Foundation,
178 –1081 Burrard Street, Vancouver, B.C., V6Z 1Y6.
For subscription enquiries, call 604-682-8206.
ISSN: 1703-6151. Canadian Publications Mail Product Sales
Agreement No. 40065475.
Photos: Brian Smith (cover), Brian Smith, RS
PRODUCTIONS (biker), iStock (hands)
Cover
8 Matters of the Heart
Interventional cardiologist Dr. John
Webb’s groundbreaking TAVI procedure
may soon be the gold standard
for aortic heart valve replacement.
By Helena Bryan
Features
12 Colorectal Surgery
to the Forefront
St. Paul’s Hospital is a national leader
in care, research and teaching to treat
colorectal cancer and other gastrointestinal
disorders.
by Gail Johnson
14 Taking It To
The Street
St. Paul’s Hospital’s Inner City Youth
Mental Health Program is helping
homeless youth turn their lives around.
By Melissa Edwards
15 Shifting The Culture
of Care
The Renal End-of-Life initiative encourages
physicians and staff to discuss
future care with patients to improve
quality of life.
By J.K. Malmgren
Departments
2 From the Top
Forward Momentum
By Henry Man
5 Frontlines
Donors fund new vascular angiography
system; 2011 Lights of Hope campaign
inspires support; “Treatment as Prevention”
earns global recognition; St. Paul’s
Hospital in the News; Running for
St. Paul’s Hospital at the Scotiabank
Half Marathon & 5K Charity Challenge;
St. Paul’s Hospital’s Heart Health Forum;
Five great ways to give.
7 Breakthroughs
Department of Pathology and Laboratory
Medicine impacts the care of patients
throughout the hospital and region.
inside
108
7
12
14
15
Spring/Summer 2012 n Promise 3

frontlines
Dialysis patient
William Katz is one
of the people who
will benefit from
the new vascular
angiography system.
Donors Fund New Vascular Angiography System
Beginning April 2012, patients will benefit
from a new $1-million vascular angiography
system purchased with the support
of donors to St. Paul’s Hospital Foundation.
“Thank you to everyone who helped
bring this absolutely essential technology
to St. Paul’s Hospital,” says Dr. Jonathon
Leipsic, head of the Department of Radiology.
“It will make an incredible difference in the
lives of thousands of patients who rely on
the system to maintain their well-being.”
The vascular angiography system,
featured in the Spring/Summer 2011
edition of Promise, supports patients in all
acute-care programs (those that treat brief
but severe episodes of illness) by helping to
get images of the inside of patients’ blood
vessels to diagnose problems such as
blood clots, and then correct them with
interventional procedures.
More than 400 donors supported the
campaign to replace the existing vascular
angiography system. The new system
was ranked as the most critical major
capital need at Providence Health Care,
which operates St. Paul’s Hospital and
14 other sites in Vancouver.
“Treatment as Prevention” Earns Global Recognition
Dr. Julio Montaner
is director of the
BC Centre for Excellence
in HIV/AIDS and UBC/
St. Paul’s Hospital
Foundation Chair in AIDS.
The made-in-B.C. “Treatment as
Prevention” strategy continues to
receive worldwide scientific recognition
and political support, creating further
momentum to implement this proven
breakthrough approach to combatting HIV
and AIDS in Canada and around the world.
The strategy was named breakthrough
of 2011 by Science magazine and a medical
breakthrough for 2012 by Readers Digest.
It was also recognized as one of the
top-10 medical breakthroughs by Time
magazine. In addition, U.S. President
Barack Obama and Secretary of State
Hillary Clinton both endorsed Treatment
as Prevention as a cornerstone strategy to
fight HIV and AIDS in the U.S. and around
the world.
Treatment as Prevention was pioneered
by the BC Centre for Excellence in HIV/AIDS
(BC-CfE) at St. Paul’s Hospital. The strategy
involves widespread HIV testing and provision
of anti-HIV drugs known as highly
active antiretroviral therapy (HAART) –
the gold standard of HIV/AIDS treatment
that the BC-CfE also helped to develop.
For more information on how you can
support care, research and teaching that
benefits HIV/AIDS patients at St. Paul’s and
beyond, please call 604-682-8206, or visit
us online at www.helpstpauls.com.
4 Promise n Spring/Summer 2012 Photos: Brian Smith, and ©IAS/Marcus Rose/Workers’ Photos (Montaner pic)

2011 Lights of Hope Inspire Support
frontlines
St. Paul’s Hospital shone during the 2011 Lights of Hope
campaign thanks to the generosity of the community. This
year, donors gave $2.27 million to the campaign to support
the hospital’s greatest needs, surpassing the campaign goal
of $1.9 million.
Two contributors to the campaign’s success were John
and Verna Wiens, who experienced the compassionate and
world-leading care at St. Paul’s first-hand.
John underwent a dual kidney and heart transplant in
1999, but that operation almost never happened after he
suffered a sudden and near-fatal cardiac arrest in the preceding
weeks. While doctors and nurses at St. Paul’s were able to
bring him back to life after working on him for 45 minutes,
no one knew if John would recover enough to undergo the
transplant. Miraculously, five weeks later, John did receive
a successful transplant – and his wife, Verna, saw the
effect immediately.
“When he opened his eyes after the transplant, it was like
the lights had been out and then got switched back on,” Verna
recalls. “I haven’t seen bright eyes in years. Anyone who visited
him just stood back and said, ‘What a miracle!’”
Their experiences inspired the couple and their company,
Graestone Ready-Mix Inc., to support St. Paul’s Hospital and the
Lights of Hope for the last 12 years.
“We enjoy giving to the Lights of Hope because it shows that
there is a host of support for the hospital,” John says “There are
people who volunteer to set it up, which in itself is quite a feat.
And then all the different stars that represent the people and
companies who are contributing because they feel St. Paul’s is
worthwhile. I think that’s just wonderful.”
For more information on the annual Lights of Hope campaign
or to learn more about John and Verna Wiens’ story, please call
604-682-8206 or visit us online at www.lightsofhope.com.
Lights of Hope (above) raised $2.27 million in 2011, thanks to many generous donors including longtime supporters John and Verna Wiens (top right).
St. Paul’s Hospital in the News
This spring, The Province newspaper is beginning a multi-part
series on the difference St. Paul’s Hospital is making in the lives
of patients from all over B.C. Each month, The Province dedicates
an entire week of stories focused on getting to know patients,
doctors, staff and researchers in different areas of the hospital
– shedding light on the life-and-death decisions made every day
at a hospital that provides care to 380,000 patients a year,
including our most vulnerable and marginalized populations.
For more information on The Province’s story series on
St. Paul’s Hospital, call 604-682-8206 or visit us online at
www.helpstpauls.com.
Photos: Brian Smith
Spring/Summer 2012 n Promise 5

frontlines
Scotiabank Half Marathon& 5K Charity Challenge
Run • Walk • Raise Funds for St. Paul’s
On the Run for St. Paul’s Hospital
St. Paul’s Hospital Foundation is
looking for people to run, walk and
raise funds for St. Paul’s Hospital during
the Scotiabank Vancouver Half-Marathon
& 5K Charity Challenge on Sunday,
June 24, 2012.
Anyone is welcome to join the St.
Paul’s Hospital Foundation team or create
their own fundraising teams to support
world-leading care, research and teaching
at St. Paul’s. Remember, you can walk or
run, and the 5K is a great alternative if
you’re not quite up for the half-marathon!
Registration is free for any participants
who pledge to raise $100 or more for
St. Paul’s Hospital Foundation.
For more information on how you can step
up and support St. Paul’s Hospital Foundation
at the Scotiabank Group Charity Challenge,
call 604-806-9849 or visit us online at
www.helpstpauls.com.
St. Paul’s Hospital Heart Health Forum
Chelsie Thurlow with
husband Stephan and
daughter Chloe.
More than 100 people gathered at the
Scotiabank Theatre in Vancouver to learn
how to get heart healthy during the
St. Paul’s Hospital Heart Health Forum
held on February 29.
Those in attendance had an opportunity
to hear directly from experts at the
world-leading provincial Heart Centre
at St. Paul’s Hospital and participate in a
question-and-answer session with them.
They also heard the story of former
patient Chelsie Thurlow,
who suffered a cardiac
arrest at the age of 23. After
100 minutes of advanced
cardiopulmonary resuscitation
(CPR) followed by 10
days on life-support and
several surgeries, Thurlow’s
life was saved.
“It’s an honour to be
here today to celebrate life
and recognize the medical
care I received at St. Paul’s
Hospital; it was none other
than extraordinary,” says Thurlow. “There
was never a moment of doubt that they
weren’t doing everything in their power
to ensure the best outcome for me.” n
For more information on how you can
support care, research and teaching that
benefits the heart health of patients at
St. Paul’s, or to learn more about Chelsie
Thurlow’s story, please call 604-682-8206
or visit us online at www.helpstpauls.com.
5great gıve
WAYS TO
1. Become a monthy donor
Automatic payments from your
credit card or bank account are
convenient and save you the time
and money it takes to mail in
donations. At the end of the year,
you’ll be surprised by how your
contributions and tax credits have
added up, while providing a stable
and reliable source of funding for
St. Paul’s. Call 604-806-8912.
2. Give a gift of securities
Save a significant amount of money
at tax time by donating securities,
such as publicly traded shares and
mutual funds, even if you have a
capital loss! Call 604-806-8923.
3. Honour a loved one
A gift made in honour of a family
member or friend can be a special
and unique way to pay tribute to
them or their memory, or to
celebrate a milestone occasion
such as a birthday or wedding.
Call 604-806-8912.
4. Make a bequest or a planned gift
Plan for a future gift either in your
will or through another means such
as life insurance, an RRSP or RRIF, or
a trust. Call 604-806-8271.
5. Contact Us
Mail: 178-1081 Burrard St.,
Vancouver, B.C. V6Z 1Y6
Phone: 604-682-8206
E-mail: sphfoundation@
providencehealth.bc.ca
Web: www.helpstpauls.com
6 Promise n Spring/Summer 2012 Photo: Jay Shaw

y Nancy Gratham
breakthroughs
Instrumental to Care
Innovative technology – and the pathologists and technologists who use it – play a
crucial role in patient care at St. Paul’s Hospital and health-care facilities throughout B.C.
Behind the scenes at St. Paul’s Hospital,
beyond the doors of the Teck
Emergency Centre, is a specialized
department that has a vital impact
on the care of patients throughout the hospital
and region – the Department of Pathology
and Laboratory Medicine.
Dr. Enid Edwards, medical director of
the laboratory, says that close to 75 per cent
of the decisions made at St. Paul’s Hospital
on any given day will be based on the results
of tests painstakingly performed in the lab.
“Our tentacles are everywhere,” she laughs.
St. Paul’s Hospital’s lab is potentially
involved in the care of each and every patient
at St. Paul’s, providing basic blood work
for 73,000 emergency patients and other
admitted patients per year, specialty lipid
tests for cardiac patients, helper-suppressor
ratios for people with HIV, and other, more
complicated tests for a variety of patients.
The department’s team of 28 highly-trained
pathologists and 200 technical staff relish
the task.
“We’re instrumental in responding to the
needs of many,” explains Edwards – including
patients from Vancouver and across the
province. St. Paul’s is the sole provider in the
region and/or province for specialized laboratory
tests such as certain endocrine tests
and viral tests for HIV patients, as well as for
interpreting kidney biopsies for patients living
on mainland B.C. That means the work of
these pathologists and technologists doesn’t
just play a critical role in supporting St. Paul’s
provincial programs in areas such as heart,
HIV/AIDS and kidney; they also play a significant
role in supporting the care of patients
at other health-care facilities.
According to Michael Aeberhardt, operations
director of laboratory services for
Providence Health Care, activity in the lab is
consistently increasing by five to 10 per cent
each year. Despite that added workload,
he says the department continues its “relentless
pursuit of perfection and to shorten turnaround
times.”
Microbiology technologist Stacey Solomon (left) and Dr. Marc Romney load samples into a newly
acquired blood culture analyzer.
Technological advances
Amid the test tubes and glass slides in the
microbiology division of the lab sits a big
black blood culture analyzer – a newly
acquired point of pride among those who
work here.
“We love it,” says Dr. Marc Romney, a
medical microbiologist and medical director
for Infection Prevention and Control (IPAC)
for Providence Health Care, which operates
St. Paul’s Hospital. “It’s a great machine.”
Purchased through the support of donors
to St. Paul’s Hospital Foundation, the analyzer
allows the lab to diagnose patients with
bloodstream infections and sepsis, one of the
most severe forms of infection.
It also allows the Department to recover
bacteria from patients’ blood rapidly and
accurately. The laboratory makes the
diagnosis so the most appropriate
antibiotics can be prescribed.
In a department that is expected
to be at the forefront of technology,
gifts like the blood culture analyzer
are so appreciated, whether the new
equipment is a replacement part to keep the
lab running or something new to move it into
the next era of testing, like the powerful
MALDI-TOF mass spectrometer.
“It allows us to identify bacteria in a
matter of minutes instead of days,” says
Romney. That means better care, which is
ultimately the end goal for these pathologists
and technologists who serve the patients
at St. Paul’s and across the province. n
For more information on how you can
support the needs of the St. Paul’s Hospital
Laboratory, please call 604-682-8206 or
visit us online at www.helpstpauls.com.
Photos: Brian Smith Spring/Summer 2012 n Promise 7

matters
of the heart
8 Promise n Spring/Summer 2012

Dr. John Webb’s groundbreaking
TAVI procedure, which has
resulted in the largest reduction
in mortality of any heart therapy,
could make open-heart surgery
a thing of the past.
by Helena Bryan
On a damp day in the spring of 2010, May Brown, 91
at the time and with no history of heart trouble,
was told her aortic valve was failing. She was
also told that without intervention, the condition
might eventually kill her.
The former Vancouver city councillor and Order of
Canada honoree learned that open-heart surgery would be
too risky because of the scar tissue left behind after intense
radiation treatments two decades earlier to treat esophageal
cancer.
However, not all the news was bad that day. The former
physical education teacher and avid hiker and skier learned
she fit the criteria for an innovative, minimally invasive
procedure known as transcatheter aortic valve implantation
(TAVI), which was pioneered by St. Paul’s Hospital
interventional cardiologist Dr. John Webb and his team.
The technique was available on a limited basis to
patients like Brown – people with significant valve problems
who simply couldn’t tolerate open-heart surgery.
Unlike open-heart surgery, the TAVI procedure wouldn’t
require opening up her chest, sawing through her breastbone
or putting her on a heart-lung machine. Instead,
through a tiny incision at the top of her leg, surgeons could
insert a collapsible valve on a catheter, guiding it to her
heart through her circulatory system. However, she would
have to wait her turn for it, and so she waited.
Happily, on October 29, 2010, Brown got her turn and
was brought to St. Paul’s for the life-saving procedure.
(Main picture) Dr. John Webb, director of interventional
cardiology and McLeod Family Professor in Valvular Heart
Disease Intervention at St. Paul’s (right) performs his
transcatheter aortic valve replacement procedure on a
patient; (above inset) members of the TAVI team meet
to discuss cases; (below inset) Webb uses the Edwards
SAPIEN transcatheter heart valve in the procedure.
Photos: Brian Smith, Sandra Lauck (above inset)
Dramatic impact
Brown says the wait for TAVI surgery proved to be well
worth it. She was on her feet within 24 hours of receiving
her new heart valve and back home within five days, feeling
like a new person. In less than a week, she was ready to
start walking again. Today, at 92, Brown says, “I feel great!
I’m in good shape and everything looks really good.”
Spring/Summer 2012 n Promise 9

The outcome for Brown likely wouldn’t
have been as joyful if not for the groundbreaking
efforts of Webb and his colleagues
at St. Paul’s Hospital. As director of interventional
cardiology and McLeod Family
Professor in Valvular Heart Disease Intervention
at St. Paul’s, Webb has led the efforts
of a team of researchers and cardiac specialists
in the development of TAVI – an effort
Webb says was made possible by the
cooperative environment fostered at St. Paul’s
and by funding from generous donors.
Webb is not at all surprised by Brown’s
recovery and cites a 2010 New England
Journal of Medicine article that found that
“there are 20-per-cent more deaths in
patients with severe aortic valve disease after
one year who don’t undergo this surgery
than in those who do – the largest reduction
of mortality of any heart therapy ever.”
Put another way, the success rate among
high-risk patients who undergo TAVI is more
than 95 per cent.
With the evidence on his side, Webb is
determined to make sure many more patients
at St. Paul’s and around the world experience
happy endings like Brown’s. In fact, he’d like
to see TAVI someday replace open-heart surgery
as the gold-standard procedure for aortic
valve replacement. He’s willing, literally, to go
to the ends of the earth to make that happen.
Sharing the knowledge
Since developing the first routinely successful
percutaneous valve replacement technique
in 2005, more than 500 successful surgeries
have been performed at St. Paul’s Hospital,
making it a leader in the field.
In addition, Webb has worked tirelessly to
share his knowledge and teach the procedure
so that other surgeons can perform it with
equal success. Webb travels extensively to
speak at interventional cardiology symposia
and teach the procedure. He and his team also
run three-day courses at St. Paul’s Hospital at
least once a month to teach the technique to
up to 20 cardiologists from around the globe.
Typically, the course includes one day of
lectures and two days of procedures done in
a simulated environment. It also includes
follow-up. When graduates of the course
first start doing the procedure in their home
countries, Webb and his team actually travel
to them and assist with their initial cases.
Webb’s travel itinerary over the past five years
alone has included Turkey, Saudi Arabia,
Japan, Australia, New Zealand and, most
recently, China.
In Shanghai, Webb and his team experienced
some interesting hurdles in their path
to assisting with the very first TAVI procedure
in China. The valves Webb uses in his procedure
are made from bovine tissue, but China
had implemented beef import restrictions in
response to the threat of Mad Cow disease.
As a result, Webb and his team arrived at their
teaching destination – a military hospital in
Shanghai – minus the all-important valves.
The Chinese surgeon, a general in the
army and head of the hospital, didn’t skip a
beat. Explaining to his western colleagues
Dr. John Webb (here and
opposite) teaches the TAVI
procedure to health care
professionals around the world.
that nobody would dare interfere with an
army vehicle, he immediately dispatched a
military limo to the airport to pick up and
transport back the “contraband” valves.
Since then, the team has helped with another
procedure in China, with more to come.
All told, Webb has taught the technique
to colleagues in more than 25 countries, who
have gone on to perform a total of 50,000
aortic valve replacements using his method.
In Canada, more than 10 hospitals are now
doing the procedure.
The efforts of Webb and his team have
dramatically raised St. Paul’s profile in the
national and international health-care com-
10 Promise n Spring/Summer 2012

munity, making the city a favoured destination
for conferences and St. Paul’s a favoured
destination for world-leading health-care
professionals, further enhancing care for
patients here.
Virtual lab expands
teaching program
Last year’s launch of St. Paul’s Hospital’s
Virtual Teaching Laboratory has enabled
Webb to expand his educational reach without
having to leave the hospital. The Virtual
Teach Laboratory, operated by the Media
Services and Telemedicine Department at
St. Paul’s, provides live feeds of procedures
at St. Paul’s to lecture theatres at the hospital
and around the world.
One of those live feeds enabled 1,000
attendees to watch Webb perform an
actual valve replacement at the Canadian
Cardiovascular Congress (CCC), a major
cardiovascular medicine learning event
held in Vancouver in October 2011. A further
850 saw Webb and his team in action at
the Transcatheter Valve Therapy conference
in Vancouver. And this is just the beginning.
The new lab allows Webb to “virtually”
go wherever cardiologists and cardiac surgeons
gather.
You also need the right tools to complement
the expertise. In that vein, the Edwards
SAPIEN transcatheter heart valve frequently
used in the procedure received Health Canada
approval in June, and FDA approval is on
the horizon. As a result, Webb expects the
number of U.S. centres offering the procedure
to go from five to 300 by the end of 2012.
Here in Canada, however, even with
Health Canada approval of the valve and
TAVI’s remarkable success rate, the procedure
is available only to those patients
who are not good candidates for openheart
surgery.
At issue is the cost of the transcatheter
valve, which is more expensive than a standard
surgical valve. TAVI’s higher valve cost
balances out for high-risk patients, once you
consider how much longer their hospital
stays would be with open-heart surgery. But
for those who aren’t considered high-risk,
open-heart surgery – an invasive procedure
in which the heart is exposed and temporarily
stopped to allow surgeons to suture a replacement
valve in place – is currently the only
option. However, Webb wants to change
that, and he knows just where to start.
New horizons
Part of Webb’s vision for the future is the
creation of a specialized research and teaching
facility at St. Paul’s Hospital called the
Canadian Valvular Innovation Centre, with
sophisticated equipment, specialized operating
rooms and comprehensive tracking,
evaluation and screening programs.
Here, Webb and his team could take their
work, which has already earned St. Paul’s a
reputation as a world leader in cardiac sciences,
to the next level. With such a centre
in place, staff would have the capacity to
explore all the possibilities for less invasive
cardiac procedures, starting with expanding
the applications of TAVI to include the
replacement of pulmonary valves and artificial
aortic valves that have failed after openheart
surgery. Researchers could also investigate
the use of less-expensive valves so
that cost is no longer an issue.
“We can show right now that this procedure
is cheaper in high-risk patients,” says
Webb. “We just have to come up with ways
to further decrease the costs so that more
patients – not just those who can’t have surgery
– can benefit from a technique that is
just plain better than the alternative.” n
For more information on how you can support
care, research and teaching that benefits
the heart health of patients at St. Paul’s
and beyond, please call 604-682-8206 or
visit us online at www.helpstpauls.com.
TAVI by the numbers
Interventional cardiologist Dr. John Webb performed the first successful transcatheter aortic valve implantation (TAVI) at
St. Paul’s Hospital in 2005, putting St. Paul’s on the map as a leading centre for cardiac science. He hasn’t looked back since:
25 and up .............. The number of countries in which transcatheter aortic valve implantation is now performed
50,000 .................. The number of aortic valve replacements done worldwide since 2005
More than 500 ..... The number of successful TAVI procedures done at St. Paul’s Hospital alone
95% ....................... The success rate of TAVI among high-risk patients
10 to 15 .................. The number of years a new biological valve is expected to last. l
Photos: Brian Smith Spring/Summer 2012 n Promise 11

Colorectal Surgery
to the Forefront
St. Paul’s Hospital is a
national leader in care,
research and teaching
to treat Canada’s seconddeadliest
cancer and other
disorders of the gastrointestinal
tract.
by Gail Johnson
Tim Roddick (here) is back to doing all
the things he loves following successful
colorectal surgery at St. Paul’s Hospital;
(opposite - left to right) Dr. Carl Brown,
Dr. Terry Phang and Dr. Manoj Raval are
working to create a centre for excellence
in colorectal surgery at St. Paul’s.
As an entrepreneur, husband
and father of a six-year-old, Tim
Roddick has long been used to
managing a hectic schedule.
But a few years ago, some unusual symptoms
became too troubling for the Vancouver
resident to put aside.
At first, his doctor told him that the blood
in his stool was merely the result of hemorrhoids.
But then, he started experiencing
fevers. His symptoms persisted for more
than a year, at which point Roddick discovered
that what he had was in fact far more
serious. In May 2008, Roddick was diagnosed
with a rare form of colorectal cancer.
“It was a bit of a shock,” recalls Roddick,
co-founder of MSR Innovations, a company
that makes solar roofing systems. “It changed
things a lot.”
Roddick was referred to Dr. Terry Phang
of St. Paul’s Hospital’s colorectal surgery
program – which Roddick quickly discovered
was one of the best in Canada for treating
his illness.
Centre for excellence in
colorectal surgery
St. Paul’s Hospital is home to three of B.C.’s
eight subspecialty-trained colorectal surgeons
– Drs. Phang, Carl Brown and Manoj
Raval. Their expertise has resulted in the
development of a centre for excellence in
colorectal surgery, with a focus on colorectal
cancer, inflammatory bowel disease, and other
diseases of the lower gastrointestinal tract.
Thanks to this concentration of colorectal
surgeons and their active involvement in
research, the hospital is able to offer patients
access to many innovative procedures,
including minimally invasive, incision-sparing
surgical techniques.
For Roddick, things moved very quickly
after meeting Phang. He had surgery to
remove a tumour before going on to have
radiation plus several sessions of interferon
injections. For nearly a year he had a stoma,
a surgically created opening in the abdominal
wall to eliminate waste, until Phang
performed another surgery to reconnect his
gastrointestinal tract.
Although the diagnosis initially devastated
Roddick and his family, he has enjoyed
a remarkable recovery. “I do just about
everything I used to do: I ski, swim, ride my
dirt bike, and even got back into a race car.
Dr. Phang and his staff have been brilliant.
He’s absolutely dedicated to what he’s doing,
he’s very skilled, and he’s determined – you
can’t beat a combination like that.”
Province-wide impact
A unique provincial resource, St. Paul’s Hospital’s
colorectal surgery program provides
comprehensive care, including colorectal
cancer screening and prevention, sophisticated
diagnostic techniques (such as endoscopic
tests involving flexible tubes with a
small camera on the end), and a full spectrum
12 Promise n Spring/Summer 2012
Photos: RS PRODUCTIONS (Tim Roddick), Brian Smith

of treatment options, including laparoscopic
surgery (minimally invasive procedures
performed through small incisions).
The program treats approximately 25
per cent of all rectal cancer cases in B.C.,
with about 30 per cent of patients coming
from outside Metro Vancouver. Every week,
Phang, Brown and Raval provide treatment
to approximately 20 newly diagnosed
cancer patients and follow-up care to another
50 patients.
Phang notes that the St. Paul’s Hospital
team, in collaboration with the B.C. Cancer
Agency, has improved cancer outcomes province-wide
by offering educational programs
to surgeons throughout B.C.: “We’re the only
province that has done this. We’re continuing
to lead improvement in colorectal cancer care
and are always asking what we can do better.”
Innovative care, research
and teaching
St. Paul’s Hospital is a leader in transanal
endoscopic microsurgery (TEM), a minimally
invasive procedure used to remove certain
rectal polyps and tumours. TEM can be performed
as a short-stay procedure, sometimes
without general anesthetic, meaning most
patients can go home the same day. The
advanced technique spares patients the
significant risks and side-effects of major
surgery, and their recovery is faster as well.
“Having colorectal surgery is a lifechanging
event, but TEM minimizes pain
and the duration of a hospital stay with no
abdominal incision at all,” says Brown.
As a teaching hospital, St. Paul’s Hospital
is a training centre for gastroenterologists
and general surgeons and advanced therapeutic
endoscopy fellows.
“We’re now seeing residents we’ve
trained out in practice,” says Raval. “We’re
quite proud that we’ve had a role in training
future surgeons. By giving them a good,
intensive experience we feel very confident
that they’ll go out and practise colorectal
surgery throughout B.C., and part of our goal
is improving care province-wide.”
Phang, Brown and Raval all participate in
research programs (including national randomized
control trials) to improve outcomes and
survival rates in patients with colorectal cancer
and inflammatory bowel disease. All three are
members of the B.C. Cancer Agency’s Surgical
Oncology Network as well as its Colorectal
Surgical Tumour Group, which Raval
chairs. Brown chairs the agency’s Research
Outcomes and Evaluation Committee.
The doctors are quick to point out that
many of the world-leading procedures and
treatments now available at St. Paul’s Hospital
didn’t exist a decade ago, and require highly
sophisticated, specialized and often expensive
technology. Thanks to the support of
many generous donors, St. Paul’s Hospital
Foundation has been able to play a major
role in ensuring the colorectal surgery program
has the technology it needs to be at the
forefront of cancer research and treatment.
Aside from the technological advances
available to patients, what makes St. Paul’s
Hospital colorectal program special is its
commitment to the continuum of care.
“We provide a multidisciplinary team
approach,” Brown says. “Ward nurses see as
many as five to 10 cancer patients a week, so
patients have the comfort of knowing that
they really understand their issues. Everyone
is involved: the nursing team, the gastroenterologists’
team, the stoma-care nurses. It’s
a bigger entity than just the surgical aspect.”
Follow-up care is just as important as a
patient’s initial appointments.
“We work hard to ensure that colorectal
cancer patients get fast access to surgery, but
we want to ensure that they get proper followup
afterward,” says Brown. “Follow-up after
chemotherapy is so important. For the following
five years or so, they need multiple
tests to monitor for recurrence. If they skip
this, they can fall through the cracks. A future
direction we’re working toward is a colorectal
cancer clinic, complete with a nurse
navigator to help people with things like
body image, sexual functioning and just
managing daily life. We know that follow-up
saves lives.” n
For more information on how you can
support care, research and teaching that
benefits the health of patients at St. Paul’s with
colorectal cancer, colitis and other gastrointestinal
disorders, please call 604-682-8206
or visit us online at www.helpstpauls.com.
Spring/Summer 2012 n Promise 13

Team psychiatrist
Dr. Steve Mathias with
program coordinator
Stephanie Gillingham.
St. Paul’s Hospital’s Inner
City Youth Mental Health
Program delivers psychiatric
services to help homeless
youth turn their lives around.
by Melissa Edwards
taking it to the street
In 2007, St. Paul’s Hospital’s Inner City
Youth Mental Health Program (ICYMHP)
formed a team of psychiatrists to support
homeless youth struggling with addiction
and/or mental illness and who were falling
through the health-care cracks. Despite
progress in reaching and treating patients at
Covenant House’s two shelters in Vancouver,
the team recognized within a year that safe
housing was required to ensure the longterm
success of the youth in its care.
“Some of the youth we’ve treated have
autism, severe schizophrenia or bipolar
disorder, and most have neuro-cognitive
deficits such as memory problems, learning
disabilities or fetal alcohol syndrome. Many
have experience with abandonment, abuse
or other traumas,” says St. Paul’s psychiatrist
Dr. Steve Mathias, who helped found the
program. “They’re not a group that can go
into traditional addiction residential treatment
and move on with their lives. We needed
housing where we could develop a therapeutic
relationship and get them stable.”
The ICYMHP approached the City of
Vancouver, which agreed to dedicate four
units at the Granville Residence to homeless
youth. BC Housing units quickly followed.
Within a year, partnerships with Coast Mental
Health, the Ministry of Social Development,
and Broadway Youth Resource Centre led
to the development of youth-designated,
mental-health-supported housing units in
the downtown core. By December 2011,
50 previously homeless youth were living in
ICYMHP-supported housing in three buildings
and several apartments subsidized by
BC Housing.
“As the youth stabilize, we move them
up from low-threshold buildings into buildings
with higher expectations,” says Mathias.
“They have a key, they pay rent. They respond
well to that. For some, this is the first stable
home they’ve ever had.”
Mathias recalls one young man living in a
“filthy, noisy” hotel room with no door, who
was so psychotic that he could barely speak.
After treatment from the ICYMHP team and
safe housing at the St. Helen’s residence, the
youth’s life has started to turn around.
“He’s about to begin training in bike
repair,” says Mathias. “He tells me he’s excited
to get started.”
Today, the ICYMHP team comprises
seven psychiatrists and two social workers.
It continues to provide assertive outreach
psychiatric care on-site and at Covenant
House’s shelters. It undertakes 100 to 120
new assessments annually and has cared
for more than 400 youth, plus more through
its growing outpatient service at St. Paul’s.
The ICYMHP team is looking to expand
to meet the need for its services, beginning
with an occupational therapist hired through
funding from the HSBC Group’s global
Future First program and donors to St. Paul’s
Hospital Foundation. n
For more information on how you can
support patients with mental health issues,
please call 604-682-8206 or visit us online
at www.helpstpauls.com.
A Bridge to Home
A new arm of the ICYMHP, the Vancouver Inner City Team for Outreach
and Repatriation of at-risk Youth (VICTORY) is reconnecting youth
treated by ICYMHP with family and home. If an eligible youth expresses
interest, project coordinator Stephanie Gillingham helps locate
resources in their home communities and works with them to bridge
the transition. She also communicates with family members to help
them understand the youth’s condition, which was often undiagnosed
when they left home.
“We identify and refer youth and families to community and mental
health services in their home community. We provide education
and support to family members,” says Gillingham. “We help them
re-establish a relationship that works for them.”
VICTORY identified 25 youths as candidates for repatriation,
with 10 already successfully repatriated. One client, a single
mother named Chantelle who suffers from anxiety, now lives in an
apartment in Surrey with her son, just two blocks from her sister.
“Stephanie advocates for me and helps me talk to the landlords,”
says Chantelle. “She’s helping me get connected with childcare so
I can go to school.”
VICTORY launched in 2010 with $50,000 in funding from the
Vancouver Foundation and the support of other donors to St. Paul’s
Hospital Foundation, including $42,000 raised by Board member
Paul Hollands during the 2010 Scotiabank Half-Marathon and
5K Charity Challenge. l
14 Promise n Spring/Summer 2012 Photo: Brian Smith

Shifting the Culture of Care
The Renal End-of-Life
initiative at St. Paul’s Hospital
encourages patients and
families to discuss future
care to help improve their
quality of life.
by J.K. Malmgren
Engaging patients in discussions on
their future care can substantially
enhance well-being. The Renal Endof-Life
initiative at St. Paul’s Hospital
is encouraging physicians and staff to have
these discussions with patients to understand
their health-care wishes if they cannot speak
for themselves, and address symptoms to
maximize patients’ quality of life.
The humanity of medicine
While dialysis treatment has significantly
improved care, renal (kidney) disease still
poses severe challenges.
“The symptom burden [impact of symptoms
and treatment] of patients on dialysis
is about the same as patients who have
cancer or AIDS,” says St. Paul’s nephrologist
Dr. Ron Werb. If a transplant is not an option,
the disease is incurable and may be associated
with chronic medical problems.
To help patients manage their disease,
Werb, fellow nephrologist Dr. Cliff Chan-Yan,
and their colleagues started the Renal End-of-
Life initiative, with funding from the Carraresi
Foundation in memory of Augusto Carraresi.
The initiative stems from the idea that elements
of palliative care could be incorporated
into the treatment of patients with any chronic
disease. Through it, St. Paul’s is leading a
shift in the culture of care by training careproviders
to focus on long-term spiritual and
emotional needs as well as immediate symptoms
and medical needs. Staff and physicians
learn to better understand patients’ conditions,
needs and expectations and help them
develop a plan for the rest of their life.
Photo: Brian Smith
The Renal Endof-Life
initiative
encourages staff
and physicians to
learn to better
understand
patients’ wishes
for future care.
“If we return to the humanity of medicine,
if we get back to the bedside, we start
to see positive outcomes,” says Chan-Yan.
“We see improved symptoms, better care,
better quality of life and better deaths for
the patients.”
The program supports better quality of life
for patients’ families too. For example, families
become so attached to staff that they may
feel abandoned once their loved one passes
away, so the initiative put bereavement follow-ups
in place, including condolence calls
and sympathy cards from the renal team.
Empowering patients
The initiative encourages patients to have
advance care planning discussions to think
about life goals and the likely progress of
their disease, as well as the care they will
receive – ultimately enabling family members
to make decisions based on loved ones’ wishes.
While these conversations may seem
difficult, Werb says, “asking these questions
provides empowerment to patients. Ninetyfive
per cent tell us they are pleased that these
conversations are started.”
“Studies show that grief is alleviated
when these conversations take place,”
explains Wallace Robinson, project leader for
the Renal End-of-Life initiative at St. Paul’s
and the Advance Care Planning initiative
at Providence Health Care (which operates
St. Paul’s). “There is comfort in knowing that
decisions reflect loved one’s wishes”.
In recognition of the initiative’s leadership,
the BC Patient Safety and Quality
Council awarded the Renal End-of-Life
team a BC Quality Award in the “Coping
with End-of-Life category” in March 2012. n
For more information on how you can
support care, research and teaching that
benefits renal patients at St. Paul’s, please
call 604-682-8206 or visit us online at
www.helpstpauls.com. To learn more about
planned giving, please contact Trudy Loo,
Planned Giving Manager, at 604-806-8271
or tyloo@providencehealth.bc.ca.
Advance Care Planning – What You
Need to Know
Advance Care Planning (ACP) provides guidance to your family, friends and health-care
providers if you are incapable of making health-care decisions. No one can predict what
may happen, so you should make a plan as soon as possible. Discuss your beliefs, values
and wishes for future health-care treatment with your loved ones; you may wish to write
these wishes down and identify the person you wish to make decisions on your behalf.
For more information, view the B.C. Ministry of Health’s guide to Advance Care
Planning at www.helpstpauls.com.
Spring/Summer 2012 n Promise 15