Andrew Macdonald: From N.B. to The Mayo Clinic to Dartmouth General Hospital

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Rothesay native Dr. Jonathan Moore this fall will celebrate his tenth anniversary of graduation from medical school. He was part of the first class of future doctors at Dalhousie Medical School’s Saint John Campus, enrolling in 2010 and graduating in 2014.

Typically, the Saint John Dal Medical campus has 40 students a year.

“It’s a satellite campus of Dal (Halifax). We were all part of the larger classes and had the same lectures as Dal Halifax.”

He decided to become a doctor in high school.

“I knew when I was going through high school, that is what I wanted to do.”

His parents still live in New Brunswick.

“We have family there and my wife’s family is from Sussex. We try to go there frequently, and family comes here quite frequently.”

After graduating at the Saint John campus, he later did a residency in Halifax, and would later come to specialize in urology care.

He is now practicing in metro Halifax, at Dartmouth General Hospital.

He came to Dartmouth via a two-year fellowship at the Mayo Clinic in America and was interviewed and eventually accepted. A fellowship comes after one does a medical residency.

“After medical school, I did a urology residency for five years at Dal. Then I went on to do a fellowship for two years,” he said in an interview.

After finishing his urology residency at Dalhousie University, Dr. Moore undertook a fellowship in endourology and laparoscopic/robotic procedures at the Mayo Clinic in Phoenix, Arizona. Throughout the fellowship, the clinic was among the pioneers adopting the Moses 2.0 holmium laser.

Innovation is a key component for Dartmouth General Hospital Foundation when it comes to purchasing medical equipment and devices, and a current fundraiser is going to position the 50-year-old hospital as a pioneer in Atlantic Canada when it comes to prostate care.

Leading the $250,000 fundraiser is Dartmouth General urologist Dr. Moore, and the effort will help the hospital buy a state-of-the-art Moses 2.0 Holmium Laser, a transformative piece of medical equipment for prostate care. It will be the first of its kind in Atlantic Canada and will change the approach to benign prostatic hyperplasia (BPH) with a same-day discharge and catheter removal and reduced risk of bleeding.

There is both a safety and a cost-benefit from the device. The major cost benefit comes from the reduced hospital stay at no increased risk of unexpected return to the emergency room or for doctor visits. This has been calculated to translate into at least $1,000 in savings per case using a U.S. database and numbers, said Dartmouth General’s Foundation CEO Stephen Harding.

“The procedure can be also done more efficiently with better visibility and less bleeding. Overall, this improves patient safety and reduces the time under general anesthetic,” added Harding. “Holmium laser technology has been the workhorse of urology for the last three decades for use in kidney stone, urinary tract obstruction and BPH treatment. The Moses technology has emerged as the ‘platinum standard’ for the treatment of BPH with the versatility to also provide state-of-the-art treatment for stone and obstruction. It has been adopted by almost every major HoLEP program in North America as the preferred laser energy source.”

“The biggest difference will be how we treat patients with large and extremely large prostates. Until very recently, those patients were meant to have an invasive, open procedure that typically required a three-to-seven-day hospitalization. This will benefit those patients immensely as well as patients with moderately enlarged prostates who will also qualify for the procedure with an expected same-day discharge. As a result, we will free up hospital beds and reduce some of the strain on the health care system,” said Dr. Moore.

BPH affects a significant portion of the male population. About 70 per cent of men between the ages of 60 and 69 experience BPH, and this prevalence increases to 80 per cent among those aged 70 and older, indicating the widespread occurrence of the condition, stated Harding, who is a native of New Brunswick.

“We’re thrilled to fund this technology and be the first site in Atlantic Canada to offer this service to our patients. By creating this world-class innovation culture, we are thrilled that specialists from across North America, like Dr. Moore, are joining our team. This will be a game changer for the prostate care we are delivering,” Harding said. He says the laser will be installed in May, requiring electrical upgrades in the surgery room to handle this new machine.

Meanwhile, Dartmouth General recently acquired a thulium laser, used for ureteric and kidney stone management. DGH is now well-positioned to become a provincial and Atlantic Canadian leader in laser technology procedures.

The Dartmouth General Hospital Foundation board approved the purchase of the laser and the fundraising campaign is happening in tandem. The idea is to get the laser in operation as quickly as possible, so patients can benefit from the same-day procedures.

I spoke to Dr. Moore, the son of Rothesay, N.B., realtors, about the prostate laser, his journey to medicine and his fellowship at the Mayo Clinic.

He started working at Dartmouth General in 2022 and his fellowship at the Mayo Clinic lasted two years.

“I did take a job in California at UC Davis Medical Center in Sacramento and was there under a year. Our intention was always to come back to the Maritimes. Our families (my wife and I) are here and that was the real reason to come back.”

At the Mayo Clinic, he helped pioneer the next-generation holmium laser.

Throughout the fellowship, his clinic was among the pioneers adopting the Moses 2.0 holmium laser, conducting one of the initial randomized trials.

“This is replacing the procedure which used to be done with a big incision and was more of an invasive surgery which required patients to stay in hospital for quite a long time. The idea is that doing this surgery with minimally invasive surgery is a really positive thing.”

The new laser is an upgrade of a current laser in Dartmouth. “It is my preferred laser and it is that much better to keep the bleeding down, and it is what I trained on and sometimes allows patients to go home the same day following surgery. That is the biggest bonus associated with it,” Dr. Moore told me.

There are 11 urologists at Dartmouth General and the QE Health Sciences Centre, and three are dedicated to the IWK. Last yea the QE hospital saw 7,000 patients from New Brunswick, as it is a regional hospital.

I asked Dr. Moore about the innovation practiced by Dartmouth General Hospital Foundation, and he says the foundation is very supportive of the urology wing.

“They have been very supportive of everything we do at the urology department. They are always producing ideas and trying to make our plans and ways to help patient care and make it positive, to make things as good as possible and go above and beyond.”

Andrew Macdonald is a Halifax-based business and political journalist with an online publication called The Macdonald Notebook. He writes a biweekly column focused on Maritime business issues for Brunswick News.