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With a superhero's send-off, Dr. Walter Maxymiw, the founder and former Head of the Dental Oncology Department at Princess Margaret Cancer Centre (PM), has retired. His last day was June 30.
After 38 years of growing the first dental oncology clinic from a cramped storage room to its current seven clinic rooms, Dr. Maxymiw was bid a tearful farewell from staff – all wearing masks due to COVID precautions – and presented with a Batman hero figure, gold watch, and his own superhero story.
Created by Yvette Whyte, a dental assistant who worked with Dr. Maxymiw for 24 years, the epic tale of Volodymyr (Walter) Maxymiw was recorded in an engraved leather tome, adorned with a brass clasp.
In the tale, the gods bequeathed Volodymyr – meaning to rule with greatness and peace – several super powers to help him on his quest to establish the first dental oncology clinic in a Canadian cancer centre. A key power was a clear vision of the future, along with the requisite "thought-force" to effect change.
According to Yvette, that enabled Dr. Maxymiw "to see around the corner and to know where the icebergs lie beneath the surface."
And that perception and determination also allowed him to develop the clinic into one of the most respected hospital dental oncology departments in Canada, along with a strong educational program linked to the Faculty of Dentistry at the University of Toronto.
"Walter figured out a way to make things work," recalls Dr. Bob Wood, a student of Dr. Maxymiw's and a former Head of Dental Oncology and Maxillofacial Prosthetics Clinic at PM. "He set up the clinic, developed a database, added in a prosthetics unit. He was always looking ahead for things that would help patients.
"Whatever had to be done, we did it. We never said no to a patient referral."
Celia Filipe, a dental assistant who worked with Dr. Maxymiw for 22 years, adds that, "For me, there is no one like him. He built that clinic with passion. He built it from the ground up."
For Dr. Maxymiw, for the first five years after being hired at the Princess Margaret in 1982, that meant 12-hour days, and overseeing 800 patient visits a year, compared to the clinic's current 15,000 yearly visits.
Working alone, he performed all the oral surgeries, created specialized prosthetics and dentures, read and developed all the X-rays and did all the follow-up care – including being available for any emergencies. All this was interspersed with constant trips to the library to learn about oncology by reading books, since there was no internet at that time.
It was also meant that he was at the forefront of important changes in practice that had a profound impact on patient care.
He vividly remembers caring for a woman in her 50s who had strong, healthy teeth before receiving radiation to her head and neck. But all her teeth had to be pulled before treatment to prevent infection.
In the 1980s, the removal of all of a patient's teeth under anesthesia was part of the standard of care for radiation of head and neck cancers. This was because the side effects of radiation treatment would cause dental decay, crumbling teeth, and subsequent jawbone necrosis or bone death.
"It was awful," remembers Dr. Maxymiw. "I thought that there had to be a better way to treat people than taking out all of their teeth. I really wanted to help patients avoid this."
He began researching and thinking about the challenge.
"There were no protocols back then. I was learning, reading every book I could, and observing and evaluating the patients as they came back to me," he says.
What Dr. Maxymiw proposed instead was to remove only the diseased teeth, and leave the healthy ones intact. After radiation treatment, the patients would begin a daily, self-administered fluoride treatment, and would be closely monitored by the clinic.
He set up one of the first patient data bases at PM, with the now vintage Apple Macintosh Plus computer, linking demographic data, treatments and outcomes.
From his carefully collected data, he was able to document that this new method of preserving healthy teeth, along with the fluoride treatment, decreased the death or destruction of the jaw bone to about one per cent at PM – compared to 10 per cent to 30 per cent in other hospitals.
This is now the standard of care.
Working with renowned head and neck surgeon and former UHN Otolaryngologist-in-Chief, Dr. Patrick Gullane, he began thinking about how he could help patients undergoing surgery to remove all or part of a cancerous upper jaw.
That surgery left a gaping hole in the roof of patients' mouths, as well as between the sinus and nasal cavities, and sometimes required the removal of some teeth.
As a result, patients were left with a collapsed cheek, unable to speak correctly, with saliva pooling in their mouths, unable to eat or drink, since any ingested food and liquids would instead dribble out of their noses.
"Patients became pariahs," says Dr. Maxymiw. "They could not lead normal lives, they tended to hide away from people. They were often depressed."
So, Dr. Maxymiw set to work, developing a special, acrylic surgical splint, or artificial denture, which closed over the hole in a patient’s palate, and sealed off the sinus and nasal cavities. That allowed patients to leave the hospital after 10 days, rather than the usual six weeks.
He remembers one Christmas Eve, as a newly-married husband, he stayed at Princess Margaret all evening to fit a despairing patient with such an artificial denture.
"He thanked me with tears in his eyes, because he could spend Christmas with his family as a normal human being," says Dr. Maxymiw. "He was not sure how much longer he would live, so this Christmas was special to him and his family."
Under his guidance as head of the department from 1986 to 2007, the clinic expanded to seven specialized rooms, with about a dozen dentists, along with requests for consults from various departments such as Transplant (now the Soham & Shaila Ajmera Family Transplant Centre), Neuroscience Intensive Care Unit, Cardiology (now part of the Peter Munk Cardiac Centre) and Bone Marrow Transplant at PM.
Dr. Maxymiw's original database now holds follow-up observations and outcomes on 35,000 patients, the number of new patients seen since 1982.
During his tenure at PM, he has mentored more than a thousand interns, residents, fellows and new staff, giving them time and attention, and a window into what dental oncology can do to prevent life-threatening tooth infections before or after treatment.
"There are times when treating cancer patients can take an emotional toll on providers, leaving them burned out," says Dr. Erin Watson, who was mentored by Dr. Maxymiw, and is now Deputy Chief of Dental Oncology at PM.
"I feel that Walter was ahead of his time in opening up and speaking about this to younger staff and trainees, giving us a valuable outlet for our emotions, and reducing the stigma around expressing sadness or distress after a challenging patient encounter or less than ideal outcome."
As a prostate cancer survivor himself, Dr. Maxymiw understands what patients are going through, and always encourages them to talk about their hopes, stresses and lives.
"I love their stories. I love their ability to deal with incredible adversity," he says.
"You learn about fear, terror – because you see it. You learn about courage, love, humour.
"How can you not become a better person when you learn about all of these things?"
Dr. Maxymiw plans to spend his retirement hiking, biking, fishing, painting, getting involved in community issues, and working as a part-time consultant in PM's dental oncology clinic.