Computer generated transcript
Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.
Welcome to the neuro transmitters, a podcast about everything neurology from challenging clinical cases to practical clinical pearls with the goal of reducing your, your a phobia. We are your hosts, Doctor Ashley Paul and Doctor Michael Kim Tris. Hi, Ashley. So after long discussion's, we're finally recording and one of the things we, we both have a passion for, I think is neurology education. So, in our intro and I like that you suggested this was the inclusion of, of neuro phobia. And if you will indulge me, I, I did bring up a definition from the 1990 for Jama neurology paper by Dr Ralph Josefowicz. Um which I think sums up a lot of the neurology training that we see out in the wild. Uh You're a phobia can be defined as a fear of the Neurosciences and clinical neurology that is due to the students inability to apply their knowledge of basic sciences to clinical situations. What do you make of that diagnosis? You know, that was back in 1990 for, do you think that it still holds as true? Uh Today, almost 30 years later. Well, I think we would have to update that to include more than students. So, you know, it does in that article actually reference general practitioners uh as well. So I do think that there was that concern. So it was still a prevalent problem back then and anecdotally, it does seem to be a recurrent concern when we're dealing with learners from other fields, whether that's uh internal medicine, psychiatry, emergency family medicine. And obviously, you know, we're biased, this is our specialty, but it's a specialty that touches on facets of every other specialty. And it's something that unfortunately, a lot of people don't necessarily feel that they are naturally inclined towards or have this aversion to our words. Yeah. Why is there an adversion to neurology? I remember when I was graduating medical school, I was one out of three people going into neuro and I had friends asked me, why am I doing this, like questioning my decisions? Right. Right. There, there is this stereotype, you know, that, oh, neurology is complicated that uh it's esoteric that you can't make a difference in patients' lives, all that kind of stuff, which are, you know, somewhat archaic. I would argue at this point in time with all the advances that are being made in the field. And there there is that necessary evil. The knowledge of neuro anatomy is a prerequisite for the good practice of clinical neurology. This is true. I do remember that being painful as a second year medical student. But I think once you see the clinical application it just all sort of like, clicks into place. Yeah. And I, I do, you know, there's a lot of good textbooks out there, um, that, that hammer on, on some of those points. But, you know, one of our, like we said it in the, the intro, our goals are kind of to, to address those concerns, to reduce your, your, a phobia. And I think there's a variety of ways we, we wanna go about doing that, you know, on a regular basis. So what are there some, some of the things that we're going to look into, Ashley in terms of broadening people's neurologic horizons. Well, we can go through cases that we've experienced, some of them could be clinical conundrum, some of them could be more straightforward but things you don't want to miss um reviewing journal articles so that people know what's the latest data out there. Um Because like you said, neurology is evolving and there are so many more treatment modalities now, then there was in the past and I think we need to undo the stigma that neurology has all these diseases that cannot be treated. Yeah, I agree 100%. Um And I think that's great, you know, it's good to vary the, the way that we try and uh further neurology education. And I think all those are great ways of going about it. Um So I thought for, for this first episode it might be useful perhaps for people in the medical student or even the premedical stage, you know, how did you end up coming to the field of neurology? So that's always a loaded question. But I just um you know, I wasn't going to apply for neurology at all. Um When I was 1/4 year medical student, I had already submitted my Iras application for Med Pete's and during the month where my ear rest was submitted, I was on my neurology rotation. So I think this is also part of the problem actually that neurology, even though it's a core uh curriculum, it's not in the same years across institutions, right? So some institutions required in the third year, which then you get that exposure and then you may consider going into the field. Whereas some institutions, it's in the fourth year, which was my case. But luckily I took it early enough and I just remember every day being so fascinated. And I think what really fascinated me was that a lot of these diseases can alter a person's sense of self. And you know, it made me really think about the brain and how that relates to self identity and memories. Um And I guess I was also attracted to the neurology because these diseases, it can be just, just so starling in their presentations. And that was just interesting to see like one of the first cases I saw was a woman with anti NMDA receptor encephalitis. Uh Right. And her family describe her as someone who could uh manage a car dealership and, you know, had no issues at baseline. And then during her third trimester of pregnancy started having seizures but didn't meet criteria for eclampsia. And after she delivered her cognitive state was no better. So I I just recall interacting with her and asking her basic questions like how many quarters are in a dollar and she would just sort of repeat it back to me with this sort of dazed look. And it just, it was just so fascinating how like this these diseases just transform people and how we can serve as a bridge to help them get back to some semblance of normalcy, whatever that normalcy might be, right? For certain diseases, you might have to establish a new normal see if there's, it's chronic and progressive. Uh but some of these other diseases like anti NMDA receptor encephalitis, we've had patient's that made a complete recovery. Yeah, there's, there's a lot more options and the outcomes can be much better than they were even just a decade ago. Yeah, exactly. I mean, I could think of so many examples like that even in the world of movement disorders, which I was just talking to my medical student today about this. So he said that when he before doing this rotation with us, he felt like that same thing that many people feel, which is why do neurology. There's just a bunch of incurable diseases or chronic diseases. You, there's nothing you can really do. You just make the diagnosis and that's it. And his experience rotating with us in our clinics show that there's a lot that you can do for all these patient's and that we don't just, you know, throw cinema at patient with Parkinson's disease. But, you know, we address a lot of it. Well, we do give them the gold standard medication. Yes. But, but we also, you know, address their cognitive issues or they're, I mean, I even prescribe medications for urinary incontinence. And right now, now that's a good point. Now, you've, you're doing a fellowship right now. Correct. Yes. So I'm doing my fellowship and Movement Disorders at Johns Hopkins and you've, you're in your second year fellowship there? Yes. And you know, what, what was it that drew you, you know, like you said just now, right? Neurology is such a vast field. What lead you towards movement disorders as a specialty and what, what is kind of encapsulated in that specialty. So I think I was drawn to movement disorders actually, since medical school too, I had a chance to spend time with the Movement Disorder Clinic at my med school and I appreciated that these patient's are chronically ill. And so you have the opportunity to develop longitudinal relationships which I really liked. And there were so many advancements already coming out in the field. You know, like deep brain stimulation for Parkinson's disease or for essential tremor and it's so transformative. It's like magic. Yeah. Some of those videos online are pretty amazing. Yeah. Imagine seeing that in person. You're the one who makes it happen. Just a push of a button. Right. Yeah, it's very satisfied. I can only imagine. So, getting back to the point there is a lot we can do in neurology for your, your passionflower for Parkinson's and movement disorders is certainly coming through. Yes, I do love it. And I love the patient population. I see. I think I, I just really love old people also. Not that I don't like my young patient's, but they're just like the sweetest people. Yes. Yes. There, there, certainly. And like you said, that longitudinal relationship, many neurologists become kind of like the primary point of medical care for a lot of these patient's, you know, with Parkinson's disease, other chronic neurologic issues. Um just because it is something that perhaps their usual primary care doctor isn't as comfortable or uh knowledgeable about. So they do rely on their neurologist to a large extent. And you know, as we know, right there is a national shortage of neurologists. So again, kind of coming back to our whole purpose is to increase knowledge, to help the population at large in terms of caring for these patient's. Yes, exactly. And hopefully in cars, medical students listening to this, to consider neurology because it is such an amazing and rewarding field, you will never be bored. I also would make the argument that, you know, a lot of people look at these, again, chronic diseases as incurable and progressive. And I mean, diabetes is also a chronic disease that most people don't, you know, reverse just through diet and exercise alone. So I think every field has its chronic patient's that they have to follow and treat. That is true. Yes. You know, you can't otherwise if it weren't work, they wouldn't call it work. Uh, so it's always good to find some spark of joy in your day to day activities. But, but there will be those challenging moments. Yes, definitely. Yeah. But even after those challenging moments, even in, through those challenging moments, sometimes you find a rewarding experience to like, um when I had um uh that patient and residency with cryptococcal meningitis. It and I had to sit down with the family of like 20 people. It was just me and the family and the nurse and she thankfully also called in the chaplain. I think, you know, I learned to tell them bad news, but it was nice to be able to connect with them, you know, on a emotional level. And I don't know, it was very sad, but it was also in some ways, I don't know if I would call it rewarding because it was not, it was an unhappy ending. But right knowledge that you did did the best you could and you know, provided closure for the family, right, you know, answering, making sure there's no lingering questions, you know, and that, that is, you know, i a way in which neurology intersects with another field, right? Palliative care where we unfortunately frequently do do have uh some overlap with that field. Um in terms of end of life discussion's and, you know, planning uh for end of life care. And, you know, some of these diagnoses, we see that coming down the road sooner than others and having a frank and open conversation is an important part of that. I know when I was a fellow. Um, yeah, I, I spent some time in the LS Clinic and obviously that is very much present in terms of, you know, we know this person has a LS and we know that they likely have so many years left based on their progression and so on and so forth and yeah, uh having those conversations sooner rather than later so that both the patient as well as their loved ones uh are able to make appropriate plans is a very important part of neurology. So even though we don't quote unquote, treat it, um, treating the patient, not the disease is really the goal. Exactly. Meeting them, meeting the patient and their family where they're at. Exactly. Yeah. You know, like some people's goals are to be able to walk their daughter down the aisle or her wedding. Right. So, yeah, you know, so I think about how I can titrate the Sinemet to make that happen. Exactly. Like you got the, this, this and this, you know, at the stopwatch. Uh, but yeah, you know, and that, that is satisfying, um, from a, you know, medical practice perspective, you know, as a physician providing even that small comfort to people who are dealing with very challenging situations. Yeah. Yeah. Sometimes just being there makes all the difference. Yeah, and it is something that is neglected unfortunately. Um more often than not. Well, the other thing I also love about neurology and part of the reason why I went into movement disorders is is how much, well, the how much your diagnosis is reliant on the exam and the localization. Right. So, yeah, that, that is an excellent point to bring up, right. The neurologic examination, um daunting to every medical student. Yes. Right. And to some attendings I have gone consulted to do a neuro exam going forward again, we'll be looking into different case presentations, kind of do a walkthrough of how we would approach a patient things that go on the differential potential treatments um uh that we see in our clinical practice. And then uh we'll hopefully have some uh colleagues on intermittently to go through kind of round table discussions on uh journal articles, uh newly developing uh findings and treatments in the field of neurology and medicine at large, potentially and uh hopefully have some stimulating discussion's that will continue to both be interesting to the new learner in the neurology field as well as those who have been practicing neurology because we all have something new to learn. Absolutely. Uh, too much, too much to learn. There's too much. Yes. But that's why we're here. Yes. Right. So, going forward and we would also love to have any listener questions or suggestions for future topics, uh, emails to the neuro transmitters podcast at gmail dot com. Or you can find us on Twitter at Neuro underscore podcast.