Intervening for GI Cancer Care

The KGH Foundation’s ‘Closer to home than you think’ campaign is a commitment to raising $40 million to help advance health care, right here at home. The campaign is unique in that it’s structured to provide funding across multiple, priority areas of health care, including Cancer Care. 

KGH is home to incredibly passionate and talented clinicians who are deeply involved in cancer care at KGH and we’re proud to introduce the community to a few of them.

INTERVENING FOR GI CANCER CARE

Dr. Fahd Jowhari was born in Kashmir, India and spent his formative years there with his mother, sister and grandparents as part of a close-knit family. The family moved to Canada where Dr. Jowhari completed an undergraduate degree in Biological Sciences and Physics and then went on to complete his Medical Degree at the University of Calgary. He joined Kelowna General Hospital as an Interventional Gastroenterologist in 2018 and is also a clinical assistant professor with the University of British Columbia’s Department of Medicine.

My work involves looking after patients who present with illnesses associated with any part of the gastroenterological system including the esophagus, stomach, liver, pancreas and bowel. I see patients both in clinic and at the hospital.

At KGH, I perform diagnostic and therapeutic endoscopic procedures including colonoscopies (examination of the colon) and gastroscopies (examination of the esophagus, stomach and small bowel). Because of my interventional background I also perform endoscopic ultrasound (EUS) – a minimally invasive procedure used to diagnose and manage both malignant and non-malignant cases of the gastrointestinal tract, liver, bile ducts, pancreas and neighbouring structures.

The gratification associated with treating some gastrointestinal (GI) illnesses was a huge factor in me choosing this specialty as a career.

Whether treating an actively bleeding ulcer, diagnosing someone with a treatable cancer, stenting someone’s blocked bile duct to provide them relief from their pain, or removing a polyp before it has a chance to grow into a colon cancer—every day is fulfilling.

It Feels Like Home

I chose KGH for a number of reasons. First, Kelowna is a vibrant and beautiful city, and it reminded me so much of my childhood days in Kashmir with orchards, mountains, all four seasons and just the right amount of snow.

Second, KGH is a major referral centre and has an intimate cohesive environment where people know each other, and that was an important differentiator. The GI team here was robust with years of experience under their belts. Despite differences in their practices, they work together as one unit and support one another, and a well-balanced and equitable scheduling meant a good work-life balance for me.

Additionally, living in Kelowna meant a quick flight or a scenic drive to my family in Calgary, an important added bonus!

A Day in the Life …

My procedure days at the hospital are divided between general GI days and interventional GI days. On my general GI days, I do a combination of luminal (luminal refers an open space or cavity of a tubular organ, such as the intestine or esophagus) procedures including Colonoscopies, Gastroscopies and Endoscopic ultrasounds. On my interventional GI days, I do a combination of more complex luminal cases or cases requiring the assistance of X-Ray fluoroscopy.

In an average work week approximately 20-25% of my cases (sometimes more) are dedicated to cancer care. These can be cases of patients with established cancers with complications; new diagnoses (awaiting biopsies); patients with pre-malignant conditions (e.g. pancreatic cysts or advanced polyps); or patients arriving for cancer surveillance due to genetic mutations or family histories etc.

Advancing Cancer Care at KGH

The KGH Foundation has prioritized raising funds specifically for Cancer Care at KGH, which includes the acquisition of a second endoscopic ultrasound system (EUS) for the GI team.

Endoscopic ultrasound (EUS) is a minimally invasive procedure that uses ultrasound waves to produce detailed images of the lining of the digestive tract and nearby organs such as the pancreas, liver, gallbladder, bile ducts, and lymph nodes.

With EUS we can assess the lining of the gastrointestinal tract with precision—something that is not accurately possible with cross sectional imaging such as CT or MRI. This allows us to evaluate and stage cancers arising from most of these areas.

Over the past decade or so, the capabilities of EUS as a therapeutic tool have increasing tremendously and this is very well reflected in the number and types of referrals we are receiving here at KGH. Here in Kelowna we now use EUS to not only diagnose and stage cancers of and around the gastrointestinal tract but for numerous other cancer and non-cancer related issues.

A second EUS will allow us to meet the growing demand due to increased referrals and to accommodate the expanding use of the equipment. Because the scope of EUS continues to increase, we’ll be able to delve into new areas as they become more clinically pronounced and applicable, and therefore be better able to serve our patients. 

We now have three EUS trained gastroenterologists performing these procedures at KGH and we remain the largest referral centre for advanced EUS procedures for Interior Health. 

Change is Possible

KGH is unique in that it is small enough that most people who work here know each other, yet it is large enough to be Interior Health’s major referral centre with services any major hospital would have such as a cardiac ICU or a PET scanner. Having worked at a few different institutions, the biggest difference that I’ve noted at KGH is that change is possible—if change equated to better patient care, we can make that change happen – and it happens much quicker than many other larger hospitals.

Speaking strictly from a GI standpoint, I can confidently say that expanding our scope of practice with new procedures, equipment, and technologies would have taken much longer at a larger hospital. With patient safety and innovation in mind, KGH supported our need for general anesthesia for high-risk cases allowing a dedicated general anesthesia room that runs daily in the GI unit itself. This has allowed for increased safety, higher procedural success rates, and enhanced efficiencies.

The rapidity with which we have expanded our scope of practice over the past five years as it pertains to interventional GI procedures we now do, is also motivation for many, and only made possible with a collaborative team and a supportive hospital environment. 

The sky is no longer the limit

The Cancer Care at KGH campaign will allow the public to realize that no matter how established and advanced clinical care in Kelowna has become, there truly is still a real need for help. People are living longer, and research is allowing us to understand disease processes and their management better than before. And with artificial intelligence now enhancing our investigative and treatment capabilities, the sky is no longer the limit!

I hope the campaign inspires our community to understand that acquiring equipment or technology through community giving will allow for better patient care in Kelowna and attract world-class health care professionals to this community.

We can be an example for others to demonstrate how a thriving health care system supported by a hospital foundation can contribute to improved health care services, economic advancement, and most of all instill a sense of unity, pride, satisfaction, and shared purpose in our community.

I am inspired by the people that I work with. We have a wonderful team of GI doctors and nurses who understand and support each other and work collectively as a team with the common aim of providing the best patient care possible, and that is a huge inspiration for me.

If we think we are doing well, we will often review things and ask: ‘how could we make things better?’ Sometimes the answer is in improving processes and sometimes it relates to new equipment or technologies.  

Newer technology inevitably invites more complicated cases, but that stimulates critical thinking and the opportunity to positively impact patients’ lives is a huge inspiration to keep going and the real essence of why I chose this profession.

It is anticipated that 45% of Canadians will face a cancer diagnosis in their lifetime.  If cancer hasn’t affected you personally, chances are it has touched someone you love. The KGH Foundation’s ‘Closer to home than you think’ campaign is a commitment to raising $40 million to help advance health care, right here at home. The campaign is unique in that it’s structured to provide funding across multiple, priority areas of health care, including Cancer Care. Funding will specifically impact the vital areas of medical imaging, pathology and surgical oncology.

Please give today.

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