Empathy is part of the Dupré family genetic make-up

It is safe to say Dr. Nicolas Dupré knows a thing or two about genetics. The focus of Dr. Dupré’s research is the search for genes associated with neurodegenerative diseases such as ALS.  So, he is pretty confident when he jokingly predicts his daughter Emma, 8, has the ‘health care provider’ gene. “Whenever someone is sick or injured Emma is by their side helping. In fact, she has already declared she will be a surgeon.”

When not taking care of patients, conducting research, teaching or travelling to medical conferences Dr. Dupré loves to spend time with his family and proudly talks about his kids Emma and Émilien, 12.

Dr. Dupré recounts why his son, Émilien, is walking around bald. “He shaved off all of his hair for a fundraiser after a friend’s dad was diagnosed with lymphoma. I always tell my kids if you are upset or sad about something, don’t mope around do something about it. My son and his friend did just that and raised $3,000 for Leucan.”

The apple doesn’t fall far from the tree

The neurologist credits becoming a doctor to his mom and aunt who were nurses.  “My aunt was an ER nurse and whenever she came over she would tell me about the hospital and how much she enjoyed working there.” He also clearly remembers when he was six and his mom was taking a course in nursing care.  “I would look at the medical pictures in her text books and be completely intrigued.”

The young Dupré studied day and night to ensure he got into medical school. When he was only 18, he started his medical degree.  In addition to his MD, he went on to obtain a masters degree in neurobiology and another in epidemiology.  He studied neurology inspired by Dr. Jean-Pierre Bouchard, an expert in genetic diseases of Quebec.  He also did fellowships at the Montreal Neurological Institute working with Dr. Guy A. Rouleau and at Harvard University with Dr. Robert H. Brown Jr.

Today, he spends his time caring for patients at the ALS Clinic of the Centre Hospitalier Universitaire de Québec (CHU de Québec), as well as teaching or conducting research. He’s been involved in more than 80 peer-reviewed papers on inherited diseases of the nervous system. One ongoing study is a large epidemiological review launched 10 years ago. The aim is to determine if there is a link between neurological disorders, such as ALS, and environmental factors such as exposure to pesticides, head trauma or vascular risk factors.  The study’s findings should be published in 2015.

Supporting patients and giving them hope

“At the CHU de Québec’s ALS clinic, we employ a multidisciplinary approach in which everyone works towards to same goal: to support patients with this devastating disease, and especially to give them hope. A number of challenges still lie ahead, but anyone who has ever been around an ALS patient could never again be indifferent to their cause,” says Dr. Dupré.

He takes solace knowing the care available today to patients with ALS is significantly better than it was 10 or 15 years ago.  Dr. Dupré is working to ensure the care continues to improve. He and colleagues of the ALS clinic in Quebec (Dr. Annie Dionne and Dr. Denis Brunet) are presently involved in producing a series of YouTube educational videos for health care providers and family members of ALS patients living in remote communities of Quebec.  The goal is to give them the knowledge and skills to be better able to care for patients with ALS.

In addition, he is working with the ALS Society of Canada and a team of clinicians to create Clinical Practice Guidelines for ALS. Currently, Canada has no such guidelines and as a result the care and treatment available to patients is variable.  The team is adapting the U.S. Guidelines to the Canadian health care system. It is a one to two year undertaking; the published document will guide decisions and criteria regarding diagnosis, management, and treatment of patients.

“It will be a big plus for patients as these guidelines will standardize care for such things as respiratory, nutritional and palliative care,” says Dr. Dupré. He also hopes the guide will prompt health care teams everywhere to better pre-plan care. Dr. Dupré says he tries to anticipate a patient’s needs, for example, he will start informing patients ahead of time about inserting a gastrostomy or a feeding tube in the future even though they are still eating normally.  He doesn’t wait until a patient is in a crisis situation with acute weight loss and swallowing issues to suggest a treatment like this.  He says preemptive treatments make the patient’s care a little smoother, easier and less stressful. In all the attention we give to the care of our ALS patients, the essential person involved in coordinating patient care is our nurse practitioner Manon Gravel.

Compelled to comfort patients with a devastating disease

Helping patients through their health care journey is paramount for Dr. Dupré. He admits it takes a certain mindset to work with people living with a degenerative disease like ALS. “Looking patients in the eye when you have difficult news, isn’t easy. At the end of a trying consultation, I feel challenged, but I keep coming back because I feel compelled to comfort these patients and help them deal with the disease,” says Dr. Dupré, “With more than a decade of clinical experience, many technical skills have become second nature to me. As a doctor, I believe the most profound impact I can have on my patients is through our personal connection. It is a matter of being empathetic, sympathetic and compassionate.”

“An older colleague taught me the six words that doctors should live by: ‘Cure sometimes, treat often, comfort always.’”

It required a certain frame of mind to consider working with chronic disease sufferers.

As a young medical student, I was fascinated by the science of genetic diseases. I longed to discover the genes that would help us to better understand the biology of rare and complex neurological diseases. As a neurology resident, I learned to phenotype hundreds of nerve disorders, some of which were treatable and some not. An older colleague taught me the six words that doctors live by: “Cure sometimes, treat often, comfort always.” It required a certain frame of mind to consider working with chronic disease sufferers. When I did my specialization in Boston, my desire to understand the biology of incurable diseases and my interest in working with patients with chronic diseases came together, crystallizing in a curiosity and an empathy for patients with amyotrophic lateral sclerosis. At the ALS clinic at the Centre hospitalier universitaire de Québec, we developed a multidisciplinary approach in which everyone works toward to same goal: to support patients with this devastating disease, and especially to give them hope. A number of challenges still lie ahead, but anyone who has ever been around an ALS patient could never again be indifferent to their cause.

Dr. Nicolas Dupré
Neurologist