Episode 59 - Spotlight on Women in Neuroscience

Anna talks to Anna Solth and Victoria Wyes about their experiences of being neurosurgeons and women in the field of neuroscience.  They share their passion for neuroscience, discuss the work they are doing now and their plans for the future.

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Transcript

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Unknown: 0:00

Music.

Sarah: 0:10

Welcome to Let's Talk about brain tumors. The podcast where we'll be talking to people who've been affected by a brain tumor diagnosis, either their own diagnosis or the diagnosis of a loved one. We'll also be sharing news and updates and The Brain Tumor Charity about what we're doing to have the harm and double survival.

Unknown: 0:28

Thank you so much, Anna and Victoria for joining me on the podcast today. It's great to have you here. It'd be great if you could just each tell us your job title and a little bit about what your role consists of. So my name is Anna Salt, and I'm a consultant neurosurgeon working in Ninewells Hospital, which is in Dundee, northern Scotland. This is a small unit, and with my interest is in neuro oncology surgery, and I'm the lead for this and chair the MDT meetings. I will also do other surgical procedures, because our unit is quite small. I trained in the UK. So I'm originally from Germany, as you might hear. And I had a fellowship with Paul Grundy in Southampton in neuro oncology. And following this, I came to Scotland, essentially, where I've been working since 2020 so since covid, essentially, which is a bit odd. So my name is Victoria Wykes, and I'm actually a academic, Clinical Professor at the University of Birmingham, and also an Honorary Consultant a neurosurgeon at the Queen Elizabeth Hospital in Birmingham, specializing also in neuro oncology. So similar to Anna, I also did a fellowship, a neuro oncology fellowship with Paul Grundy in Southampton, and and also a fellowship in London prior to coming to the Queen Elizabeth Hospital Birmingham and the University of Birmingham back in 2019 so just pre covid, both an interesting start to our careers. So my job role is really similar to Anna's from the neuro oncology perspective, seeing patients, operating on patients, but also providing that link, particularly for Neuro oncology research into brain tumors, and also setting up sort of a patient public involvement group to really ensure that we have the patient voice in our research. I also work closely with the brain cancer group, where we're really looking to better understand brain tumors, why they occur, why tumors grow, and hopefully to look into new models of brain tumors to better understand this and also develop new treatments for patients. Well, both your work sounds super interesting, I guess when you both talk about going through your fellowships and kind of joining the roles that you're in now, pre covid. I'm just kind of interested in why did you each decide to get into neuroscience, and specifically neuro oncology, what drew you to that field? So first of all, I still believe that Neurosurgery is probably the most exciting subject in medicine. The way I came to it was almost random. I was having to do some attachment with with nursing teams in Germany when I started off in medicine or in medical school. And the first first attachment was in neurosurgery. And the first patient I encountered was absolutely reduced to tears from their sciatic pain. And I saw him after the surgery, when he was, you know, when he was so incredibly relieved and, you know, grateful for this, like something completely not neuro oncological, to be honest. So the thing I like about neurosurgery, I think it's like the sort of like topography, the more you think about it, everything seems to make sense that the patient has a problem of their body or their mind because of what's going on in their brain. And neuro oncology that reflects this very well as well. And tools that we use during an operation, again, reflect this sort of like beautiful, you know, way that things make sense, which is very satisfying to realize. And one other thing I think about neuro oncology surgery, which I find really great, is, I mean, why do people become doctors? You know, there are different reasons, of course, but many people become doctors because there doctors because they want to help their patients. And in neuro oncology surgery, you you have ability to help your patients on so many different ways you operate on them, but you're also there for them after the operation and to to support them, even if there might be no further operation possible. And and I think, to have someone who has empathy and can support their patients. You know, that is something that is very important in neuro oncology, and that's something that I find also satisfying. And what I enjoy about the subject, yeah, I echo that. For me, neuroscience, I started, actually, I'm doing a pharmacology Bachelor of Science at the University College London, and really enjoyed the mechanisms of how molecules interact with receptors and how that also interacts with cells talking to each other. And actually I did the MB PhD program, again, focusing my PhD on really how cells talk to each other, and then really sort of work to develop the network. To really provide that neurological function. I think the brain is absolutely fascinating, because it's through these networks that really make us us, and how each one of us is unique. And I think that also then sort of couples into my interest with with neuro oncology, because it's really that sort of functional aspect of of meeting patients, you know, at a really vulnerable time of their lives, to be diagnosed with a brain tumor or brain cancer really is life changing. And I think being able to to plan operations using the sort of neuroimaging, knowing about the function adjacent to where the tumor or the cancer is to really tailor make an operation for each patient. And like Anna said, actually providing that really holistic aspect, that actually giving the patients, you know, really telling them and sort of almost educating about the disease process to support them making the decision. And sometimes, actually, like Anna said, patients either choose not to have an operation or reach a point where an operation isn't actually sensible and through as a surgeon, but also as part of that wider neuro oncology team with our oncologists and nurses to really help support patients and their families through this what is really quite a devastating diagnosis. So I think that's, that's what sort of draw me to neuroscience and particularly to neuro oncology. Yeah, wow, both of your passions really shone through in those answers. Obviously, there's no doubt that Neurosurgery is a difficult job at times. I imagine is there any biggest challenges that you face in your career as a neurosurgeon, I think some of the challenges really come to when you know that actually patients maybe have come to the end of their care. I think that's what really motivates me in research as well, to really, hopefully, over the long term, provide new options for treatments, and certainly on the research aspect, we're really focused on achieving improved patient outcomes, whether that's regarding precision surgery and also sort of precision medicine, and we've recently rolled out the whole genome sequencing here in the West Midlands. So I think that's one of the biggest challenges of trying to find new treatments based in sort of research and science, and really working between the clinical and the research arenas. I think the other challenge is that unfortunately, sometimes there are risks. Well, that there are always risks with our surgery, and that sometimes, you know, if you operate on enough people, unfortunately, some of those patients do have a complication of the operation that I or the team are responsible for, and I think that is that's very difficult to to come to terms with, but I think through sort of frank discussions with families up front regarding risks and discussing those if and when they come, and then From learning from those mistakes or those challenges that have been encountered. I think that's that's absolutely essential. Yeah, I fully agree with this. So the biggest challenges that I've encountered so far, where was my direct involvement and quite, you know, tragic and sometimes devastating, patient stories, really, some can be very, very tough to deal with. For the surgeon as well, it's challenging and can be very hard, and it's important to make sure that the patient is always aware, as it can be in their family. But it is something that that I have come, I guess, not necessary to accept, but I I'm aware that is part of what is unavoidable. But it is. It remains challenging. Sometimes in my training, there have been other challenges, particularly in the very early years. I've got two children when they were just very, very little, then it can be quite difficult as well to keep it all going in a way, but certainly with support at work and at home, and certainly from my impression how things were and how they are becoming it is tough, but it is possible. I would think I can imagine it must be incredibly hard to find that, find that balance. You mentioned Victoria a bit about how the research will hopefully make some of those challenges slightly easier when you do have those breakthroughs, etc. How do charities like The Brain Tumour Charity assist in helping those challenges. I mean, The Brain Tumour Charity is a really fantastic organisation and a really great advocate for patients with and their families with brain tumors. I think there's a really super advice and support for patients on the website. The Brian app as well is really a sort of an app that's available to patients to help us document their symptoms, and also in some units, there's a sort of direct link in to the clinical setting as an extra tool for contacting the teams. I think there's very good sort of funding facilities for researchers who. I think knowing sort of the challenges of the NHS, and really, if one wants to push that translational aspect of research forwards, it's also maybe sort of thinking about how we can either pump prime positions in the NHS, or really sort of include those transitional sort of careers in the funding structure as well. It's great to know that the work that the charity does kind of goes hand in hand with helping you guys do your job as well, because ultimately, we all have the same goal, right? Half that harm and double survival. So we're recording this in March, which is Women's History Month. So it's all about kind of celebrating women who are making a difference in our society, such as both of you guys. So historically, obviously, women haven't necessarily been in jobs like neurosurgery, but that is changing. And actually, I was reading an interesting statistic recently, which said that 35% more young girls are now taking a stem subject at a level. What advice would you give to any young girls that are interested in getting into neurosurgery or neuroscience, I would say absolutely go for it. Like we've mentioned, it is absolutely fascinating career. I think it has got challenges and absolutely juggling a career. There's never a good time to have children. You know, it's always going to be a challenge, as it is for our partners, but it's about sort of juggling all of that together. But I think, you know, the brain neurosciences, it really expands a huge field, from zebrafish models to psychology to neuroimaging and many, many more. You know, get stuck in sometimes some of my best opportunities have come from projects that have completely failed, or through discussing with people about various projects. You know, a complete different tangent has popped up, and that has been the most interesting, and it was never, ever part of the plan. So I'd say, keep talking to people, grab those opportunities, explore, keep talking. And you know that, like we said from the the women who came before me in in neuroscience and neurosurgery, there's, I think things are getting easier, and there's a lot of support there. And I think our male colleagues are fantastic and really supportive. And I think there is a place for everyone in neuroscience, whether it's that sort of ethnicity diversity, it's a huge field and go and enjoy and explore, is what I would recommend. Well, I think I totally agree with you, and I don't think I can say it actually any better. I wanted to say exactly the same sort of like, just with three different words, I guess, which is, just, just do it. One of the best advices that I had when I was completely intimidated, just arrived in the UK and had a post neurosurgical sort of service post and King's College Hospital, and everything was incredibly overwhelming. And then one of the doctors there just said, so you really want to do it, so just do it. And I think that means just, you know, pursue it. I think what's important, I guess, if you want to, because it can be tough, because there will be sacrifices, because it can be quite hard, is that you just need to make sure that you feel is the right thing. And what I always tell students that come and come to theaters also, or come to speak with me, or come into the wards, is that if you are interested in your surgery, you should probably, you know, visit theaters, see an operation, see maybe the brain and and often you can then maybe get an idea whether this is something you want to pursue. And I got the impression that most, most students and later, doctors who want to do neurosurgery are very, very keen to do neurosurgery, and will therefore be, you know, willing to just do it, or, you know, to to have the long and, you know, sometimes hard training for this as well. But yeah, I would absolutely encourage it. And this, this, you know, this long and hard for men and women, and, you know, for everyone, really, I would say, and it is possible, though, and incredibly rewarding. There are amazing opportunities. And I'd say absolutely, go and grab them, whether it is from neurosurgery, you know, go and speak to the sort of local teams and do sort of either electives or as part of modules, especially study models modules, and also as part of training, you can do intercalated BSCS, intercalated PhDs. And I think talking to people and establishing mentors or speaking to people and getting advice, there's never, ever, I think people love talking about what they do and actually really sort of ensuring that you tap into that. Because I think medicine, surgery, science, it is absolutely there's some wonderful stories out there and wonderful opportunities, and people like to talk about them. So sometimes when one is Junior, one is a bit nervous or a bit frightened to go and approach people. But actually, that passion will come through, and people will love to share their opportunities and. We really want to support the next generation coming through, because at some point we might need medical help, and we want to help train that next generation, and also, particularly in the clinical aspects, please do speak to the patients, because they will teach you so much and actually asking about their stories and what happened with their disease processes, if you keep their symptoms, their thoughts, how they want to have their treatments and how they want to direct research, I think they will absolutely guide you forwards in your career aspirations. Last time we met, we were talking about how many female neurosurgery consultants there. And I think the number was 5% but I don't know Victoria, whether you've seen this the last sort of, like, it's not a census, but the last time that they looked at this, 10% of neurosurgeon, neurosurgery consultants are female. So that's a still, you know, a small number, but it's it is definitely becoming more normal and more exactly, which is quite encouraging, I think, definitely, definitely, and anything we can do to support more women coming into surgery and the neurosciences has got to be a good thing. You both touched on little elements there where it sounded like you had really positive experiences and people who kind of pushed you at the beginning of your careers, and avenues that you went down that you found quite rewarding. What do you think your proudest achievements have been in your career so far? With I think that the recent proudest achievement is that we've regards to proudest moments or most rewarding there can be so plentiful and individual patients I have clearly helped who've done well that's incredibly rewarding. And then on a less directly individual patient orientated point would recently consented our 200th patients to whole genome be that I'm very glad to have been able to introduce a awake crainiotomy to me and in my hospital find a team that is willing to proceed with this and support me. And having been able to operate the first patient with no you know, was a good outcome. So expanding the service and making sure that people have have all options close to where they live and do not have to go too far away to have their treatment. I think sequencing for brain tumors, and that's in the West Midlands, and it's very important for me as well. this has been quite a large undertaking, involving sort of training for consent, also really sort of training and educating our surgeons, our anesthetists, and really smoothing the pathway for the tissue to travel from any surplus tissue, from the patient in the operating theater, to pathology, to our regional Genomics Hub, and then off to Cambridge for it to be sequenced in Illumina, and also to set up the infrastructure of where the results go and how they are reported at the genomics Regional Advisory Board, and then fed back to the oncologist. When this this chalice was passed, I didn't realize it was quite going to be so difficult, but actually, we've set up all of that infrastructure, and I'm delighted to say that we are now providing that information to our patients. Not all patients will have a variance that we can target with precision medicine, but hopefully as we as we get this more back to patients in a more timely manner, and moving forwards in the future, more drugs will come with the targets that we are identifying. Yean, congratulations, Victoria. That's a huge test, in my opinion. It sounds incredibly difficult. You know, navigating all the all the logistics of this and and to have 200 patients for for for the whole genome project, consented, is fantastic success. I would say it is quite challenging, you know, to to set it up in the whole country, but you're really spare adding this. And this is very impressive. Hopefully we have done a lot of the difficult learning, and hopefully we'll be publishing the sort of how we've done it locally. There is never a one size fits all in the NHS, and there are definitely local challenges for each unit. But hopefully we have done some of that process and started the discussions to be able to learn from that and to hopefully roll this out to a national level. So we really hope that the UK will spearhead this whole genome sequencing for brain for brain tumor patients. That's amazing. Now, that sounds absolutely amazing. Really exciting as well, for you to be involved in it. You've obviously touched massively on something there that you kind of want to achieve in the future and that you hope happens in the future. Is there anything else that either of you are hoping to break through neuroscience in the future. yes I mean, I think Victoria probably can say more about this and more educated than me as well. But there's so much that needs to happen in, you know, in active research into high grade gliomas. So little has happened in the last decades, really. And I think molecular diagnostics, whole genome seek. Thing and very tailored sort of treatment is, I'm sure, the way to go, and I hope that certainly, as a smaller unit, we will be able to get more involved in this as well and contribute to like, a real difference being made and some real progress being made soon. I don't know what you think Victoria, where the I mean, the challenges, I think, are clear, probably. But what do you think, what is the sort of most promising, sort of like, approaches to treatment of high grade gliomas, where it lies? Yeah, I mean, I think during our training, and maybe that's one of the reasons that I really enjoyed neuro oncology, that there really was quite a seismic shift in surgery for brain tumors during Anna and my training that it really went from sort of get a biopsy, get a diagnosis, to maximal safe resection of tumors where possible. And certainly there's a lot of new adjuncts during our training, and new techniques that have really been sort of mastered and are now sort of more commonplace, like sort of awake craniotomies, etc, but we have been doing very similar things, really, from the treatment perspective, of the maximal, safe section, followed by really, the real sort of Stillwater treatment has been a team well radiotherapy and temozolomide. And certainly during the life of temozolomide, over the last of 20 years has been over, over 1250 trials on new drugs that just haven't really worked. So we really need to have a push to understanding if these drugs are getting into the brain. And I think there's a really a new discussion to be had about how we how we run trials, and actually, the surgical teams need to be very much involved in that, to potentially do an upfront biopsy, treat the patients with a drug, a sort of near adjuvant trial, and then reset resect the tissue to see whether the drug has even penetrated into the brain. I think also, like I said, that it's got to be precision medicine, seeing if there are new targets. This has certainly been revolutionary in breast and lung cancer, and that also whether there are other sort of more molecular targets that can be can be looked into to provide novel treatments. And I really hope that's part of the sort of tissue pipeline at Birmingham, and that link in with our scientists that really that and sort of developing new brain tumor models to really, sort of better understand these processes and work with the clinical trials teams to roll that out over the country, to really see how patients react to novel drugs and whether there really is a benefit from that. Anselational science, it sounds like there's definitely still a lot to be achieved, and hopefully, thanks to things like research and funding, etc, we will start to see some of those, hopefully, hopefully, sometime soon. Thank you both so much for giving me the time today. I appreciate your incredibly busy women. So it's actually been such a privilege talking to both of you and hearing more about your careers. So yeah, thank you so much for coming on the podcast. Thank you so much for having us.

Sarah: 23:05

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