Wednesday, May 5, 2010

Affirmation

It truly was nothing short of a medical miracle.

Today a woman came to speak to our class about what it was like to have Parkinson's.

She told us about how she had diagnosed herself 14 years ago while watching the 1996 Olympic Games. As Muhammad Ali lit the cauldron at the opening ceremonies the commentators made reference to his Parkinson's disease, and in that moment her life changed. She recognized the symptoms he showed as the same ones she had been developing, and trying to ignore.

The woman spoke about when her suspicions were finally confirmed. How she went home from the appointment lost and afraid for her future. She talked about the horrible side effects she suffered from the medication treatment and how walking had become an impossible feat.

As she told her story I started thinking, "hang on...she doesn't appear to have that severe of symptoms". I couldn't see much of a tremor, she didn't appear stiff or show the Parkinson's mask, her gait seemed almost completely normal.

She then spoke about deep brain stimulation (DBS) and how she had had the treatment several years earlier. I vaguely recalled some lecture during nursing school where they mentioned this treatment but I couldn't grab on to any info in my brain. I thought, "wow the treatment must have really worked for her!" Still thinking that they just drilled into your skull, inserted the electrodes, zapped and then took them out.

But she went on to talk about the plastic grommets that the wires go through on her skull and how the pacemaker was near her waist, that she could turn the DBS on or off, or adjust it (within parameters) at will. Apparently some people develop slurred speech or other unwanted side effects so they only turn it on (or up) when they want to move.

I was now sitting straight up. This is clearly a much cooler procedure than I had thought.

The National Institute on Health gives a good summary of the procedure here, but in brief:

"DBS uses a surgically implanted, battery-operated medical device called a neurostimulator—similar to a heart pacemaker and approximately the size of a stopwatch—to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.

Before the procedure, a neurosurgeon uses magnetic resonance imaging (MRI) or computed tomography (CT) scanning to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. Some surgeons may use microelectrode recording—which involves a small wire that monitors the activity of nerve cells in the target area—to more specifically identify the precise brain target that will be stimulated. Generally, these targets are the thalamus, subthalamic nucleus, and globus pallidus."

She finished her lecture and then said, "ok now I am going to turn the DBS off so you can see what happens".

With that she pulled a remote-control looking device, held it to her abdomen and clicked a button.

Within moments her arms shook with pronounced tremors, her face changed to an unexpressive stare, and she slowly turned her body in an attempt to walk. She lifted up a jerky arm to show us her attempt to count on each finger but only a profound tremor showed. Her speech became slow but her voice cleared of what sounded like a mild sore throat. She explained that the 'resident frog' in her throat was the only mild side effect the DBS had in her case. With a difficult maneuver she switched the DBS on again by clicking the button.

Her tremor vanished. The frog in her voice returned, her speech slowly returned to its normal tempo and she turned back toward the podium.

I was actually on the verge of tears, even now as I am typing this. I really don't think I am able to convey the impact this demonstration had on me. She was two different people with the press of a button. One would have been unable to drink from a cup and the other had just given a one hour presentation. I really believe that I witnessed a miracle. And I don't use that term lightly. I have been in the room when people who were without a pulse or breath in their body were brought back to life using medications and electricity.

But this moved me in a completely different way.

Suddenly all of the stress, and studying, financial burden, and lack of sleep, became worth it.

Medical conventions often get under my skin. I wonder some days why I am going into a profession that pushes drugs, ignores preventative health, and sees peoples lives as a business.

But if modern medicine means I get to be in the field of work that can do that for patients, I am happy.

Thrilled in fact. And strangely humbled.

It has been a good day.

16 comments:

Old MD Girl said...

The only bad part about DBS is that eventually it usually stops working. But while it's working, it can be truly transforming to people's lives, just as you described.

Does this mean you're going to be a neurosurgeon now/ ;-)

Albinoblackbear said...

Ha! My plastic-surgeon-in-the-making housemate was heard uttering his new career plans on the way out of class.

(I think it was because the neurosurgeon in the picture had a nice silk tie on). :)

It did give me pause for a minute but then I remembered my plans to have a life outside of the hospital.

Then I just smiled at the fact that there were people in the world who could perform that procedure and give patients that extended quality of life.

ForeverRhonda said...

Very cool, I was under the same assumption, that they did a procedure once and that was the end of it.

Reasons like this are why I want to go into medicine.

Albinoblackbear said...

FR--Do it! :)

Josiah O. Morris said...

Ahhh, that's fantastic! What a great post...left me smiling.

I'd heard of DBS before but never knew any of the specifics. Sounds absolutely brilliant. Is it known why it won't work indefinitely?

Pissed Off Patient said...

That is amazing and very moving.

Thanks for posting.

M

Grumpy, M.D. said...

To OMDG- DBS (and all Parkinson's treatments) don't stop working. The disease, unfortunately, progresses to a point where they are just no longer of benefit.

To all- Rasagiline is the closest thing we have to a true "cure"- and it isn't. It simply slows down the progression of the disease, but doesn't stop it. But the other drugs are all just treatments. That isn't a bad thing, though, if thye improve your quality of life and add more functional years to your life.

Yeah, it's impressive stuff. Similar to the remarkable way Levadopa changed the game in the 1960's (rent "Awakenings", with Robin Williams, for the story of Levodopa).

I've been doing this for years. I know the general perception of neurology is that we can diagnose a lot, but can't really treat anything.

People like your lady show that such sentiments are far from the truth. I argue that the point of medicine is NOT to prolong life. It is to improve the quality of the life you have.

And for most people I can do that. Or at least try. And doing that is what gives me meaning, and reminds me every day that I have no regrets about what I do.

Albinoblackbear said...

JOM/POP--I am glad you enjoyed it.

It was by far the best day of medical school so far so I wanted to share.

This blog can't only be for me to whine! :)

Grump--I am in complete agreement about improving quality vs quantity. I think that is why I was as blown over as when I see someone come back from the dead in the ED.

That event is always mixed with the fear that you are bringing back someone who will have zero quality of life. And that scares the shit out of me every time.

P.S Props again to your mad neuro skillz. You're a lege. :P

Sigmoid Freud said...

It's always nice to hear when science gets something right. I also was reminded of the movie Awakenings - and you got to see something similar during a live presentation which is very cool. Thanks for sharing your enthusiasm.

Fordo said...

Very, very cool. What a rush it must be to feel like you made such an improvement in someone's life. I can't imagine what that must be like.

I'm glad you got to witness that ABB- its given you back the old spark and excitement.

Albinoblackbear said...

SF--Yes I remember seeing Awakenings years ago and finding it very moving and disturbingly sad. And I agree, it is nice when science gets something right. :)

Fordo--Indeed, it was the affirmation I really needed! I know, I was telling my mom about it on the phone and said--you know that was one guys 'day at work'! Yet it was the patients most profoundly pivotal day in terms of the trajectory of her condition.

It is something that health care workers need reminding of sometimes I think, to put things in perspective. And yes...very, very cool!

Maha said...

That is simply amazing! I think I too would be in tears.

Albinoblackbear said...

Maha--Yes! And I realised that is one of the things I missed out on in the ED for all those years!

You never really get to see the inspiring side of medicine. It seems to mostly be the adrenaline or the mundane or the drug seeking or the broken. (All of which I take as part of the package deal but a little inspiration is nice from time to time too!)

A NURSE said...

That is pretty cool. My dad has Parkinsons...but i am suspecting he wouldn't go for the implant thing. Altho...he does like to complain a lot about every last symptom....
:)

Albinoblackbear said...
This comment has been removed by the author.
Albinoblackbear said...

ANurse--I am sorry to hear that your dad has Parkinson's. I wonder how common the surgery is in the West?

I know Ireland just lost the one neurosx that could do them so there are only about 15 people a year here that qualify to be sent to the UK for the procedure. It's too bad that it is that inaccessible. I guess that is part of the trade off of having a public/private system here.