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Affair of the Heart

Written by Lisa Ricciotti

Dr. Paul’s Kantor is a man of motion. The director of pediatric cardiology at the Stollery Children’s Hospital walks quickly, talks quickly and thinks quickly, too. Almost before a question is finished he’s into his response, delivering it rapidly but articulately in the clipped cadence of a South African accent still recognizable after nearly three decades away.

It’s the end of a long day for Dr. Kantor and he’s agreed to put himself on pause long enough to talk about his relatively recent return to Edmonton. He arrived at the Stollery in September 2012 from the Hospital for Sick Children in Toronto and judging by the almost Spartan appearance of his office, he hasn’t yet settled in. Clearly he doesn’t spend much time behind the large desk; its surface swept clean of papers, files and typical workday clutter.

His first go-around in Edmonton was as a researcher. From 1996 to 1998, he investigated the cardiac metabolism of heart failure under Dr. Gary Lopaschik at U of A’s Heritage Medical Centre. Now, nearly two decades later, he’s come back to head up the Stollery’s heart program.

In his time away from Edmonton, he’s moved many times in a career marked by forward momentum. Having completed his initial medical training in South Africa, he chose to leave his home country behind to pursue pediatrics in New York City. Then, to satisfy permanent residency requirements, he headed to Canada, spending two years in Saskatoon as a family doctor. Next up: pediatric cardiology training at B.C. Children’s Hospital in Vancouver and that research stint in Edmonton followed by his first staff position at McMaster’s Children’s Hospital in Hamilton in 1999. He achieved several upward promotions in Steeltown, then he moved a short skip around Lake Ontario to Toronto.

Although he’s covered a lot of geography, Dr. Kantor candidly shares that of all his moves, his recent relocation to Edmonton was the most difficult. First, it wasn’t easy to leave Sick Kids, where he founded and led a heart function and cardiomyopathy program for eight years. It was also difficult on a personal level. “It’s harder to move as you get older because you lose a lot of connections and Id o feel that acutely,” he says.

Yes stasis has never suited him and Dr. Kantor doesn’t regret coming to Edmonton, and although he acknowledges that this move may be his last. More than a year into his new position, he realized what the Stollery offered was irresistible – the opportunity for new personal challenges coupled with a chance to give back. “When you’re in mid-career, you either decide to do something dramatic, hoping to make more of a difference for people, or you stay where you are comfortable,” he explains. “I chose to take myself out of my comfort zone so I could share what I’ve learned and try to do something better than I have already. If I can leave things better at the Stollery than when I started, I’ll consider that a success.”

Not surprisingly, the mobile Dr. Kantor realized he didn’t like the idea of sitting in the same position until retirement. Yet it’s more than ambition that drives him. A man with a mission, he’s one of the few blessed with knowing exactly what he wanted to accomplish from an early age. In 1967, as an impressionable six-year-old boy with a keen interest in biology and all things medical, he sat riveted to the telly watching coverage of a historical event that shocked and amazed the world – fellow South African Christiaan Barnard had performed the first-ever human-to-human heart transplant. Three years later he devoured One Life, the surgeon’s best-selling autobiography and set his mind on following his fascination with the heart.

After medical school, he found himself walking in Barnard’s footsteps: post-graduate training at Groote Schuur Hospital in Cape Town, the site of Barnard’s seminal surgery, and later cardiovascular research in a building that bore Barnard’s name. And now he’s at the Stollery, one of the best pediatric heart transplant centres in North America.

He’s stayed true to his love affair with the heart, but as his career in cardiology progressed, Dr. Kantor realized that unlike Professor Barnard, his particular contribution would not be in heart transplantation. Instead he discovered his true niche while at Sick Kids, where he wrestled with the reality that little was known about how to help children with heart failure.

“Few of us had thought about what could be done with hearts that continue to fail after corrective surgery fixes ‘plumbing’ issues like holes and unusual anatomy,” he says. “I saw the terrible sense of hopelessness in children and their families, where there was nothing we could offer short of a heart transplant. I decided then that I needed to find a real area of specialization where I could make a difference by increasing knowledge of how to treat pediatric heart failure.”

Dr. Kantor was given that opportunity at the Hospital for Sick Children, when he set up a program devoted to developing expertise, research and clinical care specifically for heart failure in children. “Many times we were able to save children who I think would otherwise have died,” he says. “And now I want to do the same at the Stollery, by starting a similar program here.”

Dr. Kantor has wasted no time putting things in motion to achieve this goal. In November 2013, the Stollery launched the Cardiomyopathy and Heart Function (CHF) service, with five cardiologist physicians, a nurse practitioner and a clinical fellow.

Take particular note of the name – it’s heart function, not heart failure service. More than semantics, it’s a positive reminder that new treatment options now exist for pediatric heart diseases such as cardiomyopathy, genetic and metabolic abnormalities, and neuromuscular disorder, all previously classified as heart failure. In fact, Dr. Kantor wants to stop describing these conditions as heart failure entirely. “We never use that word in front of patients and families and we try not to use it ourselves when describing the condition. Heart function is more appropriate these days than saying heart failure.”

Although he’s tremendously proud of the Stollery heart transplant program, Dr. Kantor yearns to see the day when replacing the heart becomes a tool in a doctor’s back pocket that’s used only if nothing else is working. He points out that only a small number of children at the Stollery have a heart transplant, and that all the other pediatric heart patients need appropriate care, too.

Ironically, the man that inspired to pursue a career in cardiology by the world’s first heart transplant dreams of a post-Barnard era when the increasingly common surgery will keep its last-resort status. “We aim to avoid heart transplants for most of these children,” he says. “Today’s real challenge is learning more about how to reverse damage to a heart instead of replacing it. Our goal is turning heart failure into heart recovery.”

Where he once saw only helplessness, today Dr. Kantor sees hope. “I choose to focus on heart function because I never again want to tell a parent that there’s nothing more we can do,” he explains. “I want to stop wondering, ’couldn’t we possibly have done something better?’ Now my conviction is, we can.” Those days are still ahead, Dr. Kantor admits but just give him a bit more time. Every day brings him closer to his goal.

Published Winter 2014, Stollery Children’s Hospital Foundation