I was born in 1943, got my BA at age 17 and got my medical degree from McGill University in 1965. After a rotating internship at the Royal Victoria Hospital in Montréal, I gave birth to my first child, Claire. My 2 other children, Paul and John, were born in 1968 and 1973.
I started working part-time as a family practitioner. All my life I have enjoyed helping solve my patients’ complex problems. In 1974, as I was breastfeeding my youngest, I concentrated my practice on breastfeeding mothers and started trying new ways to treat their problems. This resulted in 2 publications on how to treat mastitis and breast abscess.i ii I also taught health professionals about breastfeeding all over the province of Québec. I did this for 9 years. In 1974 only 6% of babies were breastfed for 6 months. When I left the province of Québec in 1983, 26% of babies had 6 months of breastfeeding. I also started giving babies swimming lessons, and infant stimulation classes to their mothers at the Westmount YMCA. A few years later, these classes started being taught at Montréal Children’s Hospital and one of my former students gave these classes in Ottawa.
In 1983 my first husband decided to move to Victoria, where I worked for alcohol and drug programs. In 1987 I left my first husband and started working, at first for alcohol and drugs, in North Vancouver. At the time, it occurred to me that people suffering from addictions had deficient dopamine systems as they had used substances that forced the release of dopamine, the pleasure transmitter. Their brains had reacted by decreasing the number of dopamine receptors that could be stimulated. I decided to try bromocriptine, a medication for Parkinson’s disease (a dopamine deficiency condition) which stimulates dopamine receptors, on smokers trying to quit. 6 months later, 35% of those who were given bromocriptine and used it to stop their craving, were still off cigarettes. Unfortunately, I did not publish this as I was too busy.
I was on the staff at Lions Gate Hospital in North Vancouver, from 1988 until I retired, November 2020. During my first pregnancy, I developed terrible bouts of lower back pain which made it difficult for me to walk, bend over, go up or down stairs or even get into or out of bed. These bouts kept recurring and could be incapacitating. One day, in 2003, I was at a seminar on the diabetic foot with a friend of mine, Dr. Murray Allen, a sports medicine physician. As we sat down, I said, “my sacroiliac joints are killing me!”, to which he replied, “come and see me, I’ll do prolotherapy on you”. I said “prolo what?” … A few days later, I got my first prolotherapy treatment. After 3 treatments, my back pain was gone. I started sending him a lot of pain patients. Most of them came back enthusiastically telling me how much better they were feeling. Unfortunately, 6 months later, Murray told me he was retiring. I said, “you can’t do this to me! What am I going to do with all my patients who are suffering?” To which he replied, “I’ll teach you how to do it”, which he did. After multiple continuing education courses I started to treat people who needed it. Prolotherapy uses injections of concentrated sugar water where their blood vessel poor ligaments and tendons attach on the richly vascularized covering of the bone. This caused inflammation which generated the growth of new blood vessels into the poorly supplied ligaments and tendons. These new blood vessels were the roads the repair cells took to reach the injuries into these ligaments and tendons and deposit collagen, scar tissue, there. Since ligaments and tendons are made of collagen prolotherapy injections could repair them. After 9 months, those who received the prolotherapy had less pain and had far fewer problems using their shoulder than those who were treated with physiotherapy.iii
In 2010, as I was doing the research project, I decided to limit my practice to treating only people in pain. In April 2011, at the meeting of the American Association of Orthopedic Medicine, Dr. John Lyftogt gave a seminar on injecting sugar water around nerves which could stop them from sending a pain signal to the brain. We were obviously skeptical until, at the end of the seminar, he asked for people in pain to come up to the stage and be treated. Every single person he treated got immediate pain relief from the sugar injections!
As soon as I got back to the office, I started using his technique. Unfortunately, a lot of the people I was treating were diabetics with peripheral neuropathy, burning hands and feet caused by their persistently high blood sugars, which were in the process of destroying their nerves. I couldn’t see myself injecting around these nerves with sugar water, so I decided to inject around these nerves with a mannitol solution. Plant derived mannitol is a sugar molecule to which one OH (half a water molecule) has been added. I got the same results: immediate and complete pain relief.
Marylene Kyriazis, a pharmacist interested in chronic pain was observing me and said, “I’ve never seen pain go away so fast and so completely, but people don’t like injections, why don’t we make this into a cream?” We tried 16 different bases before finding one that allowed the mannitol to penetrate through the skin to get to the nerves sending pain signals to the brain. I started using this on all my pain patients. I would give them a 50 g container of the cream, which Marylene was making in her kitchen, together with a questionnaire asking the date, time, how bad was their pain between 0 and 10, before they put on the cream and 30 minutes later, how long it took for the relief to start and how long the pain relief lasted. I did a chart review of the 235 patients with 289 different pain conditions who received this cream between 2015 and 2017. Their average pain relief was 53%. Not bad considering narcotics give 36% pain relief, diclofenac 23%, acetaminophen 13%.
I wanted to know how the mannitol produced such quick and complete pain relief, so I did a research project. My patients were clamoring for more of the cream, so I asked them to participate. I applied some capsaicin (hot pepper) cream on their upper lip. When the burning reached 8/10, I removed the capsaicin cream and on one side of the upper lip I applied the base cream, on the other side, the base cream with the mannitol. I didn’t know what I was applying. A pink Q-tip went to the right upper lip and a blue one for the left. Every minute they had to write down on a graph how bad their pain was from 0 to 10. On the mannitol side, the pain level went away quickly. On the other side, even by 10 minutes there was still pain and everyone knew which side had the mannitol.v Tess Debelle, a medical student doing a stage in my office did a research project which showed how effective the mannitol was in providing relief to those suffering from postherpetic neuralgia, the terrible pain that can follows shingles.vi
Marylene and I formed a company, MaryHelene Enterprises Inc. We decided to manufacture the cream and to start selling it. We called it QR cream (for Quick Relief and QR: pronounced as cure).
Meanwhile, a lot of my low back pain patients couldn’t afford to be treated with prolotherapy as this treatment was not paid for by the government’s health care coverage. Because displaced sacroiliac joints, the commonest source of low back pain, were often far away from the skin surface, the mannitol in QR cream would be too dilute before it reached the painful overstretched nerves in the ligaments surrounding the sacroiliac joints. I had to teach them how to get rid of their pain themselves and how to prevent it from returning. Having, myself, tried and failed at a multitude of treatments from chiropractors, physiotherapists, massage therapists, acupuncturists, Pilates practitioners, physicians doing IMS, pain medications, self hypnosis, meditation etc., I devised a simple way to find out if the pelvic bone was displaced forward or backwards. I found that, if the pelvic bone was displaced forward, the thigh, flexed against it, could be used to push it backwards. If it was displaced backwards, it could be pulled forward with the extended thigh. As this bone moves slowly, my patients had to hold the corrective position for 2 minutes. I did a chart review of those I had treated this way between 2015 and 2017 and showed that 91% of low back pain sufferers had displaced sacroiliac joints and that 86% of those found relief with the 2-minute exercise. Vii
I devised an improved exercise and did a randomized, controlled research project on this, which showed that 90% of those with displaced sacroiliac joints found relief with this exercise.viii The research project was to be duplicated in Kochi, Kerala, India, and I went there in February 2020 to teach 6 physicians how to examine and prescribe this test to low back pain patients. Before I left, they told me that they had never seen so many low back pain patients leave their office with a big smile. Unfortunately, these were public health physicians and Covid struck.
I do hope someone will want to do the research as, as of November 1, 2020, I retired. At my age (77), Covid could disable or even kill me. I had practiced medicine for 55 years. There is one more research project I would like: in 2014, a physician referred me a patient for treatment to her severely painful shoulder. She came into the office, scratching her hairless head, which was covered in plaque psoriasis. I told her, “I can take away your shoulder pain but if you keep scratching, you keep injuring your shoulder, your pain will return.” She replied, “I can’t stop scratching, doctor, the itch is unbearable”. I said, “why don’t you try my cream?” Her answer was, “I’ve tried every possible treatment, and nothing helps!” To which I replied, “this won’t cost you anything, just try it”. 3 minutes after she applied the cream, her itch was gone. I gave her a container of the mannitol cream I was testing and, when she came back, 5 weeks later, she had 2 cm of hair on her head and no psoriasis.x
Of course, this is an N of 1 study. I would like to find 10 people with intractably itchy plaque psoriasis who would be willing to use the cream for 3 months. If it relieves their itch, then, a randomized, placebo-controlled study would be indicated. As I have retired, and as I am biased because I am selling QR cream, which is made with mannitol, another physician, Dr. Corina Ciolacu has agreed to do the research. Do you know someone with plaque psoriasis and intractable itch? Please refer them to her.
At age 80, I work at furthering the sale and distribution of QR cream. I love skiing at Whistler in the winter and, after the snow has melted, walking there and in the beautiful, forested parks where I live in North Vancouver. I enjoy showing the people I meet who have low back pain how to get rid of it, and seeing their look of pleasure and surprise when they get up after the 2 minute exercise and their pain has disappeared. My husband, Herbert Grubel, a well-known economist, former finance critic in the Canadian government, and I have traveled a great deal. Our next travels, this year, will take us to Iceland and to Taiwan.
Hélène Bertrand, MD, CM, CCFP
i Helene Bertrand Cantlie Treatment of Acute Puerperal Mastitis and Breast Abscess Can Fam Physician. 1988 October; 34: 2221–2226. PMCID: PMC2219179
ii H Bertrand and L K Rosenblood Stripping out pus in lactational mastitis: a means of preventing breast abscess. CMAJ. 1991 August 15; 145(4): 299–306. PMCID: PMC1335632
iii Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng A-L, (2016) Dextrose Prolotherapy versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Phys Med Rehabil 2016;97: 17-25, doi: 10.1016/j.apmr.2015.08.412.
iv Helene Bertrand, Mannitol Cream for Pain Control, a Chart Review Research Poster Abstracts of the 2019 Canadian Pain Society Annual Meeting: Canadian Journal of pain Page A189 | Published online: 02 Apr 2019 https://doi. org/10.1080/24740527.2019.1599266 Download citation
v Bertrand H, Kyriazis M, Reeves KD, Lyftogt J, Rabago D. (2015) Topical mannitol reduces capsaicin-induced pain: results of a pilot-level, double-blind, randomized controlled trial. Arch Phys Med Rehabil. 2015;7(1):1111-7. Refereed article
vi Tess Elaine Helen Debelle, Hélène Bertrandb, Marylene Kyriazisc and K. Dean Reevesd Mannitol 30%) Cream in the Treatment of Post-Herpetic Neuralgia Canadian Journal of Pain, Volume 2, 2018 - Issue 1Research Poster Abstracts Published Online: 21 May 2018 https:// doi.org/10.1080/24740527.2018.1476313 Download citation
vii Hélène Bertrand A new way to diagnose and treat low back pain Canadian Journal of Pain, Volume 2, 2018 - Issue 1Research Poster Abstracts Published Online: 21 May 2018 https://doi.org/10. 1080/24740527.2018.1476313 Download citation
viii Bertrand H, Reeves KD, Mattu R, Garcia R, Mohammed M, Wiebe E, Cheng AL. SelfTreatment of Chronic Low Back Pain Based on a Rapid and Objective Sacroiliac Asymmetry Test: A Pilot Study. Cureus. 2021 Nov 11;13(11):e19483. doi: 10.7759/cureus.19483. PMID: 34912624; PMCID: PMC8665897.
ix Bertrand H. Chronic Low Back Pain Forced Me to Search for and Find Pain Solutions: An Autobiographical Case Report. Cureus. 2022 Jan 23;14(1):e21529. doi: 10.7759/cureus.21529. PMID: 35223304; PMCID: PMC8863555.
x Bertrand H. Mannitol Cream for Itchy Psoriasis, a Case Report. Dermatol Res. 2022; 4(1): 1-4. I devised an improved exercise and did a randomised, controlled research project on this, which showed that 90% of those with displaced sacroiliac joints found relief with this exercise”