Dr. Bertrand: When you have a problem, don’t cover it up, look for its cause and fix that. My dad studied two years of engineering before he became a brain surgeon. As I was growing up, he would tell us about what he was working on, what had been done before and why it had failed, what was behind the problem and what needed to be done to fix it. He used to punish me for misbehavior by sending me up to my room, which was his library. When I was punished (which happened often), alone in my room, I would look into his textbooks and journals to check out what he was working on. That made my studies in medical school much easier and sent me on a lifelong voyage of discovery.
Dr. Kyriazis: Be yourself. I believe that it is important to be genuine, to have confidence in yourself and to be defined by who you are and not what you are. Know your strengths and limitations, don’t be afraid to say “I don’t know” and ask for help when you need to.
As a part of our series about women who are shaking things up in their industry, I had the pleasure of interviewing Hélène Bertrand, MD, CM, and Marylene Kyriazis, B. Pharm, Pharm D, two medical professionals from Vancouver who have a special interest helping people manage and relieve the pain that is impacting their quality of life.
Dr. Hélène Bertrand is a family physician with a special interest in treating pain. Since 2009, she has conducted research projects on new ways to treat painful conditions, first with injections, during which she discovered the superior pain-relieving effectiveness of mannitol, then with a mannitol containing cream. When she used the cream on 235 patients with different types of pain from headaches to sore toes, the pain relief was 53%, which is far superior to any other topical or systemic medication currently available. As a result, she and Dr. Marylene Kyriazis, who first developed the topical mannitol cream, have started manufacturing and marketing QR Cream with mannitol to help people relieve their pain.
Dr. Marylene Kyriazis is a Doctor of Pharmacy and has served as a community consultant and clinical pharmacist for more than 25 years. Since 2010, she has focused on palliative care and pain management. Her roles include consultant, mentor, product and program developer, public speaker, researcher and philanthropist.
Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit more. Can you tell us a bit about your “backstory”? What led you to this particular career path?
Dr. Bertrand: After 37 years of low back pain, I found relief with prolotherapy (injections that help rebuild and strengthen the ligaments that stabilize your joints and the tendons that hold your muscles to the bone. Overstretching of these structures is what causes most joint and tendon pain). I trained and started treating my patients with prolotherapy and attended conferences to learn more. At one of those conferences in 2011, Dr. John Lyftogt showed us how quickly dextrose (sugar) injections around nerves leading to painful areas would relieve the pain, so I started doing this. I had many diabetic patients with nerve pain, and I did not want to inject their nerves with sugar, which had already damaged their nerves, so I started injecting around the nerves with mannitol, sugar’s first cousin. Before the needle was out of the skin, their pain was gone! At that time, Dr. Marylene Kyriazis was observing my practice. We both realized that people don’t like getting injections all the time, so we decided to try incorporating the mannitol in a cream. After numerous attempts, we found one that allows the mannitol to go through the skin to reach and calm down painful nerves. I started testing this cream on all the people with pain who came to see me and found it worked much better than the creams or the medications they were taking to relieve their pain. After we realized how effective this mannitol cream was, we got to work, getting it manufactured so we could help millions of people beyond our own patients.
Dr. Kyriazis: In 2010, while completing a practicum for my doctoral degree, I had the privilege of shadowing a palliative care physician. It was at that point that I realized that I had missed the boat when it came to patient care and having a positive impact on the lives of others. So, after 20 years working in a pharmacy, I gave up my role as a traditional pharmacist, and empowered with knowledge, skills and experience, I started searching for and creating my own path forward.
Can you tell our readers what it is about the work you’re doing that’s disruptive?
Dr. Bertrand: The cream Dr. Kyriazis and I have created is highly effective in relieving both severe pain and itch. Mannitol, the new, proven, active ingredient it contains, is unique to QR Cream and will be for years, as QR Cream is patented. None of the topical pain relievers are as effective as our cream so it is likely to disrupt the current topical pain relief market, as more and more people discover it.
Dr. Kyriazis: We discovered a new use for an old ingredient. Mannitol, which has previously been used to retain moisture in cosmetics, as a sweetener in chewing gum and as a sugar substitute in confectionary and baking, is now, for the first time, being used for pain relief. We have developed, researched and brought to market a one-of-a-kind breakthrough product, QR Cream, which provides safe and effective pain relief.
Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?
Dr. Bertrand: This was a great learning experience. When I was first injecting people with mannitol around their painful nerves, with one of my colleagues observing the procedure, I wanted to make a good impression. Having run out of the mannitol solution, I had to make more. When I went to get my materials, I noticed I had run out of sterile water to dilute the mannitol solution, but I still had some sterile saline, which is just water with a bit of salt added, so I decided to create the mixture with sterile saline. As soon as I started injecting this solution around her nerve, my patient yelled, “Stop! Stop!” Flabbergasted, as everyone I had previously injected had instant pain relief, I removed the needle and asked her what the problem was. As my colleague watched with a smirk, she said, “You’ve made my pain much worse!” I felt awful for her and deeply embarrassed in front of my colleague who was visiting me because he wanted to know how well mannitol worked for pain relief. He was not impressed. I later learned that when the sodium in salt (which is sodium chloride) goes into the nerve, it starts transmitting a pain signal. No wonder I had made her pain worse; I had activated her pain signal! After that, I never injected anything containing sodium around painful nerves.
Dr. Kyriazis: Developing a product from scratch is not an easy feat. A good analogy would be baking a cake without a list of ingredients and a recipe. In addition to the final product being cosmetically elegant, we had to ensure that the active ingredient was able to penetrate through the skin to a level deep enough to provide pain relief. While experimenting in my kitchen, I dissolved the mannitol powder in a liquid, only to find out later that it had crystallized and the particles were now bigger and coarser than what I had started with. This taught me more about the sensitive properties of the ingredient and how to best work with it to achieve a stable product.
We all need a little help along the journey. Who have been some of your mentors? Can you share a story about how they made an impact?
Dr. Bertrand: Three people made an impact on my career. Dr. Murray Allen, who treated my back with prolotherapy and first taught me the prolotherapy techniques; Dr. Dean Reeves, who has guided me through my research projects, helped me with the statistics and taught me how to write them up; and Dr. John Lyftogt, who taught me how to inject dextrose around painful nerves to shut down the pain signal.
I was at a seminar on the diabetic foot with my friend, Dr. Murray Allen, when I told him, “My sacroiliac joints are killing me!” He said, “Come to my place, I’ll do prolotherapy on them.” To which I replied, “Prolo what?” I went, and three treatments later, I no longer had back pain. I started sending him all my joint and muscle pain patients. They came back happy, telling me how much better they were feeling. Six months later when he told me he was retiring, I said, “You can’t do this to me! What am I going to do with all my suffering patients?” He replied, “Don’t worry, I’ll teach you.” Every Friday for three months, he came to my office and guided me as I did prolotherapy injections on 6 to 10 of my patients. That is how I got started treating people in pain.
After doing prolotherapy for several years, and looking for articles on this treatment, I realized there weren’t that many. If you want doctors to adopt a technique, you need to test it first. You compare it to no treatment, a pretend (placebo) treatment or some other treatment. Doctors are more likely to adopt a new treatment if you can show that your treatment is better than what is currently being done. Since I couldn’t find any articles on using prolotherapy to treat shoulder problems, I decided to do research on this. I had met Dr. Dean Reeves, who has an encyclopedic knowledge of all the research projects that have been done on prolotherapy, at a prolotherapy meeting in Madison, Wisconsin. When I contacted him about doing this shoulder research, he supplied me with reams of information. When I had finished the study, he oversaw the statistics and helped me write the paper. I couldn’t have done it without him. Since then, I have completed many research projects, always with his help.
In April 2011 at a prolotherapy meeting, I attended an all-day seminar with Dr. John Lyftogt on how to inject a sugar solution around painful nerves to relieve them. Sugar? Around nerves? To relieve pain? The whole thing sounded very improbable. At the end of the day, a lot of people were questioning him about his results, so he asked, “How many of you here have severe chronic pain?” Seven doctors put up their hands, and he invited them to come on stage. One doctor had a bad headache, one had pain in his neck, one had shoulder pain, another had pain in his back and one had sore knees and burning feet. Dr. Lyftogt injected the space around the nerves supplying their painful areas with the sugar solution. He did not use a local anesthetic to dull sensation. Instantly, their pain disappeared. All seven doctors left the stage pain free and looking surprised. When I came back to my office and started injecting a sugar solution around nerves, I got the same results: instant pain relief! I have been using mannitol, a sugar alcohol, to do this ever since.
Dr. Kyriazis: Many months of observing and learning from Dr. Helene Bertrand led to years of collaboration with her. She readily shared her medical knowledge and skills. Her brilliant mind, passion and determination are truly inspiring, as was her success rate in treating patients with pain.
Dr. Paul Sugar’s selfless dedication, kind and caring approach, and deep personal connection had a profound impact on his patients. My observation of this was the catalyst that ignited my compassion and promoted change in my career, as well as a change in the way I interact with patients.
Herbert Grubel, retired professor of economics and our in-house economist, has been an integral part of our efforts to shake up the pain relief industry by providing perspective, insight and a balanced and measured approach to business.
In today’s parlance, being disruptive is usually a positive adjective. But is disrupting always good? When do we say the converse, that a system or structure has ‘withstood the test of time’? Can you articulate to our readers when disrupting an industry is positive, and when disrupting an industry is ‘not so positive’? Can you share some examples of what you mean?
Dr. Bertrand: You don’t want to disrupt something that is working well. If something is not working so well or is harmful, that is when you want to disrupt it.
I deal with pain treatments. The medications people take for pain are often dangerous: narcotics are addictive. Once you are addicted, you need more and more. On average, they relieve just 36% of pain. If you keep using narcotics, often they stop relieving your pain. Many anti-inflammatory medications can raise your blood pressure or damage your kidneys until they fail and can cause heart attacks, ulcers and stomach bleeds. Their ability to relieve pain is only 26%.
What about pain creams? Pain creams contain capsaicin, which causes a burning sensation, and with prolonged use, capsaicin can damage or kill the nerve fibers that control sweating, blood vessel tone and a sense of heat or cold. Menthol makes the skin feel cool, but it can produce a burning sensation near open wounds, near your eyes or in areas where the skin is thin and sensitive such as the anus or the vagina. Some people get an allergic reaction resulting in red, itchy or bumpy skin. Camphor, if accidentally eaten, say by a child, or if applied over too large an area, can be a deadly poison. Pain creams or gels containing salicylates have substances in them like ASA or aspirin. They do help relieve pain but can cause severe rashes or allergic reactions and other side effects, including blood problems.
Local anesthetic-containing pain creams shut down pain signals by anesthetizing the painful area but because they cause loss of sensation, a prick, a burn or other minor injuries can be aggravated. Applying too much local anesthetic or applying it under occlusion can injure the liver or even stop the heart.
On the other hand, mannitol in QR Cream has been proven, through clinical research, to provide quick and prolonged pain relief. Very rarely, some people who are allergic to it can get a rash. As it calms down the pain nerves it reaches, the longer you use it, the less you need it. Instead of creating dependency like narcotics do, it is designed to stop being needed gradually, as the pain subsides when you keep using it. Because it is effective, natural and has almost no side effects, QR Cream with mannitol is likely to disrupt the marketing of pain medications and pain creams. It will allow people to get relief from their pain without risking the dangers of these other products. In this case, the disruption caused by QR cream is good.
Dr. Kyriazis: I believe that disruption can be both positive and not so positive, depending on the lens you’re looking through. Even though disruption of an industry by an innovative product or service has a positive impact on the consumer, the same disruption may be an opportunity or a threat to competitors. For example, Amazon’s automation has provided a beneficial service to the consumer, while at the same time creating a threat to other online retailers and an opportunity for growth for some others eg. Voila by Sobeys.
Can you share 3 of the best words of advice you’ve gotten along your journey? Please give a story or example for each.
- When you have a problem, don’t cover it up, look for its cause and fix that. My dad studied two years of engineering before he became a brain surgeon. As I was growing up, he would tell us about what he was working on, what had been done before and why it had failed, what was behind the problem and what needed to be done to fix it. He used to punish me for misbehavior by sending me up to my room, which was his library. When I was punished (which happened often), alone in my room, I would look into his textbooks and journals to check out what he was working on. That made my studies in medical school much easier and sent me on a lifelong voyage of discovery.
- Think outside the box! This is something else I learned from my dad: Whether it was inventing a new machine using X-rays at right angles to each other to be able to locate a needle going to a structured deep inside the brain (1949) or a new pair of ski boots where the laces were replaced by clips (in the early 1950s), he was always coming up with new ways to do things. Like him, depending on what my medical practice required, I always tried to find a different, better solution to whatever problem I was faced with. When I was treating breast-feeding mothers, I used a new way to deal with breast infections. When I worked with alcohol and drug treatment programs, I used the medication for Parkinson’s disease (a disease due to a deficiency of dopamine, which is treated with medication supplying dopamine) to treat people going through the withdrawal of smoking cigarettes, alcohol or drugs. Those substances force brain cells to release dopamine, your pleasure neurotransmitter, so addicts get deficient in dopamine. Supplying them with this medication relieved their withdrawal symptoms. When I found out mannitol shut down the pain signal when it was injected around a nerve, Dr. Kyriazis and I started experimenting to see if we could get mannitol to reach the nerves through the skin via a cream. The sacroiliac joints — the pelvic joints just below your spine — are full of bumps and hollows, which makes them impossible to see with medical imaging. I invented a way of examining them and judging their level, using a carpenter’s level. If they were not level, the direction of this joint could determine how to do the corrective exercise I invented to relieve low back pain.
- Know your limits! My husband Herbert Grubel and Dr. Kyriazis taught me that I couldn’t run a business if I tried. Together, Herb and Marylene are solving all the problems that come at you when you are starting a business
- Be yourself. I believe that it is important to be genuine, to have confidence in yourself and to be defined by who you are and not what you are. Know your strengths and limitations, don’t be afraid to say “I don’t know” and ask for help when you need to.
- Perspective matters. I have found this to be valuable in many situations. Having perspective allows for greater insight and context. Changing one’s way of thinking and seeing things from a different point-of-view can help to overcome challenges and create new opportunities.
- Do what you love. When you do what you love, you find purpose and meaning in what you do and work is no longer work.
We are sure you aren’t done. How are you going to shake things up next?
Dr. Bertrand: I have discovered a new way to examine for and treat low back pain, which is likely to be even more disruptive. It allows people to treat themselves using a two-minute stretch exercise and pelvic stabilization belt. No need for visits to the doctor, X-rays, CT scans or MRIs, and, above all, no need for surgery, chiropractic manipulation, massage, IMS, trigger point injections, acupuncture, core exercises, physiotherapy etc. I am about to publish the research I have done on this in a medical journal. My methods will provide relief to countless low back pain sufferers and seriously upset people who earn their living treating low back pain. You can find out more about this on YouTube: https://www.youtube.com/watch?v=h7w7OcLU290&t=25s and, for detailed explanations : https://www.youtube.com/watch?v=8bJF6JiSdm8&t=711s
QR cream is extremely effective in relieving itching. I had a patient who came in with severe pain in her shoulders, as she had been scratching her psoriasis-covered head constantly for the past 15 years, which put a great strain on her shoulders. She didn’t have any hair on her head (she had scratched it all off), only scabs. I treated her shoulders then gave her some of the mannitol cream we were testing at the time. She applied it to her scalp and after two minutes exclaimed, “This is the first time in 15 years I haven’t been itching!” I gave her some of the cream to take home and when she came back five weeks later, the psoriasis on her head was gone and her hair was starting to regrow. I want to do a research project comparing QR Cream without menthol — only mannitol — to what is currently being given for itchy psoriasis. Though QR Cream only has a tiny bit of menthol, menthol can cause burning when it is applied to an open wound, and people with that kind of itch often scratch to the blood. If it works, this inexpensive, over-the-counter cream is likely to shake up the very expensive prescription psoriasis creams that are currently on the market.
Dr. Kyriazis: I am shaking up the way we care for each other by creating a supportive community model to deal with emotional pain and suffering.
In your opinion, what are the biggest challenges faced by ‘women disruptors’ that aren’t typically faced by their male counterparts?
Dr. Bertrand: Men are currently in the top positions of power, such as chief executives, prime ministers and university presidents. They tend to mentor other men to succeed themselves. So few women are recognized for our scientific discoveries or for our success running businesses. That is finally changing, thankfully.
At the University of British Columbia, I am a clinical instructor, the lowest person on the teaching hierarchy, despite the fact that I have spoken at many hospital rounds and numerous conferences, and have published research articles in well-recognized medical journals. Men with backgrounds similar to mine are assistant professors or professors. I would have loved to be able to teach medical students new and effective ways to treat pain. Thankfully, many major companies and organizations now have programs in place to promote women’s advancement.
Dr. Kyriazis: I think the biggest and perhaps the only real challenge faced by women and not their male counterparts is the time constraint related to balancing responsibilities. I believe any other challenges, such as credibility, confidence, ability to prove themselves and respect for their competence, are perceived challenges that can be overcome.
Do you have a book/podcast/talk that’s had a deep impact on your thinking? Can you share a story with us?
Dr. Bertrand: When I was a teenager, I read “Man’s Search for Meaning” by Viktor Frankl. He recounted how his survival in a concentration camp had depended on finding meaning in his life — on having a goal. At that time, I already knew I wanted to be a doctor. I wanted to know more about the human body, how it worked and how to find ways to fix it when it didn’t work. I had a goal, and Viktor Frankl had just explained to me how important that was! I never forgot.
Dr. Kyriazis: The Art of Happiness by HH Dalai Lama. This book connected the dots among compassion, purpose and happiness. It has helped me to define both my personal and professional goals.
You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Dr. Bertrand: Eight out of 10 people will have low back pain at some time in their lives. Right now, low back pain causes more disability, time off work, costs to businesses, lost earnings and costs for care than any other condition. Not to mention all that pain people feel! According to the medical literature, the cause of low back pain is “idiopathic,” unknown in 84% of cases. If you don’t know what you are treating, you will try all kinds of treatments to see if one works. Right now, all those treatments provide relief only sometimes. The test I have developed allows people to find out in what direction the pelvic bones are displaced and the specific two-minute exercise that can be done to reposition them. It almost always relieves low back pain. I would like all those who have back pain and those who treat it to learn this new way of examining the back. Perhaps it needs a movement to convince the powers that be to start examining for and finding the cause of low back pain and adopting this easy and effective treatment
Dr. Kyriazis: A movement to mobilize communities to change the way we care for each other. To create compassionate communities by harnessing and leveraging the resources available in the community to provide compassionate supportive care to those in need. We live in a world where people living with serious illnesses often find themselves alone, isolated and in fear. Activating social conscience and creating supportive relationships could be helpful to many.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
Dr. Bertrand: The summer I was 10 years old, I was lying in the grass thinking of my 65-year-old grandfather, who had died of a heart attack that spring. It occurred to me that if I followed him, I had only 55 years left — not that long. I decided then and there that I would not waste a minute feeling bad, that I would try to enjoy every minute that was given to me. Since then, I have been grateful for what I have and always looked for the silver lining behind every cloud. That has served me well. I have no regrets.
Dr. Kyriazis: “You can do it!” Those were the words of my 12-year-old son, when I was struggling with an online statistics course. My teachings to him were being echoed back to me. At the time, those words were so empowering and liberating. Through the years, they have been a constant reminder to maintain an open mind without limits and boundaries.
How can our readers follow you online?
Drs. Bertrand and Kyriazis: For more information on our research, please visit us at www.qrcream.com and @QRCream on Facebook, Instagram and Twitter. QR Cream is also available on Amazon.com and Amazon.ca (Canada).
This was very inspiring. Thank you so much for joining us!
Drs. Bertrand and Kyriazis: Thank you! We are so grateful for your interest in our story and helping us reach people in pain to give them hope and help them find relief!