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Hello and welcome back to the Neuro Transmitters podcast. A show about everything related to clinical Neurology. I am your host, Dr Michael Ken Trees. And I'm very fortunate today to have another special guest, Doctor Jamie Rights. Thank you so much for joining me today. Thank you for having me. Now, I'm extra excited to have you on the show because I, I've been meeting a lot of people on Twitter in the Medical Twitter Space. Uh You being one of them, you have some excellent posts up there for people who are curious, but you have a very unique perspective. So you're a neurologist in training, you're an MD phd. Tell me a little bit about yourself and kind of what led you into the field of neurology. Yeah. So, um I kind of say that I've almost born into it. Uh Really, I joke that I was born into it. So I um was born six weeks premature, which may or may not have had anything to do with me developing congenital hydrocephalus and I was diagnosed at four months old. Um I didn't have my first son place until I was 20 months old. That's like a whole other story. But, um, growing up I had a few revisions here and there, I've was always, you know, very studious. And I remember even in elementary school, my, my teachers joking that I'd be a neurosurgeon one day and I was like, it wasn't even, it wasn't even on my radar even though, like, I saw a neurosurgeon every year. And then, um, I didn't really give much thought to having Hydrocephalus until I had a sharp revision was six months or 66 years old. And, you know, it just kind of was what, you know, was what it was and kept going and then I had to shunt revisions 2.5 years apart in high school. Um, and it was that second one, it was my junior year of high school where it really kind of sunk in that I was gonna have to deal with this for the rest of my life. And you, you know, the key kind of moment for me was, it was a month before ap exams. And as I said, I was, you know, very studious, a little nerdy and I was talking to my neurosurgeon. Um, because thank you, thankfully, it was like a kind of a mild enough or, you know, quote unquote, mild enough, um, malfunction that we were able to kind of plan it out and I was trying to get her to postpone it until after ap exams and she, she told me, um, she's like, well, if you don't do this, you're gonna, it's gonna get worse and worse and then you're gonna go, go into a coma. And I, and I was just like, wow. Yeah, this is like 2 17 year old me. Um, and during that same conversation my mom was like, but she just had a shot revision, like, 2.5 years ago and kind of other truth bomb. Like, neurosurgeon was like, 50% of shunts have to be revised within two years of surgery and of being placed. And, you know, those were kind of two things that I never really thought about and I hadn't really sunk in. Um, so I had the surgery I did find on ap exams. Um, yeah, I did, graduated valedictorian, went on to undergrad and I really wasn't planning on going into medicine. Um, I majored in molecular biology but I kind of, I had met some doctors that I had bad enough experiences with that. I was kind of like, um, I don't know what they do to a doctor's dream med school, but I don't want it to happen to me. Yeah. Like, that is an entire conversation right there. Yes. Yes. Um, but I had all because I had all these great med school, like, premed friends because, you know, I was in molecular biology. I was in the biology. So all my friends were pre med and they're all like Jamie why aren't you becoming a doctor? Like you, like, have the perfect experience for it. Um And it wasn't until the end of my junior year of college, I was working in the lab doing research. I've gotten a fellowship to do research full time and working with this amazing pediatric intensive ist and he worked with a lot of other people, um, pediatric intensive ists and meeting all of them and just seeing how much they cared. Um and how much, how passionate they were about the work and you know, how great their attitude was and there and I was like, you know, what I do want to become a doctor, but I also want to do research. Um And so that's when I decided to go the MD phd route. So I was kind of a late, you know, late to the game from that perspective. Now, what, what has been the area of your research? Well, so that research was actually I was studying perinatal white matter injury in a mouse model. So that was kind of more in line with kind of where my future goals are. Um than for my phd. I um did my phd work in a medical genetics lab stuff being kind of some rare gene mutations that lead to cerebral vascular and cardiovascular disease. So a little bit farther away, but it was with an amazing mentor and really excellent training. And you know, that's what you really want to go for, for a phd. Unfortunately, I wasn't able to find a lab that was, like right in the niche that I was looking for future wet, you know, as far as my future research, because, you know, surprise, surprise, I wanna do research on hydrocephalus and something more focused in that direction. Like let's take it back to like a 10,000 ft view. You know, I know most of the people who listen are in the medical field in some capacity or another. But for those who might not be familiar with Hydrocephalus in broad strokes, how would you describe to someone who wasn't familiar? So how I describe it to people is kind of the definite, the at least I think the lay person definition is, it's when like we all have fluid in and around our brain and it's there to like cushion and private by nutrients and stuff. So it has a purpose. But in Hydrocephalus, that fluid for some reason accumulates abnormally. So it builds up either because it's not being absorbed back into the system correctly or it gets blocked somewhere in its circulation, but it builds up putting pressure on the brain and that can lead to, of course, uh well, it leads to a lot of symptoms um for the patient, but it also leads can lead to brain injury. And as my neurosurgeon put it, you know, so bluntly death, um if left untreated and correct me, if I'm wrong CSF dynamics or cerebral spinal fluid dynamics. There's just it's kind of a hot area this building up a little bit uh in terms of interest in the, at least I've been noticing the last few years. Yeah. And like like so many things in neurology at large, it seems a lot of the difficulty in its research is that it is there's so many different mechanisms that can lead to the same kind of uh problem. So, clinically, it's hard to differentiate the underlying cause. So for instance, like in your case, you mentioned congenital hydrocephalus. So I know a lot of times like quote unquote idiopathic, which I always explain to my patient's is like it's doctor speak for, we're not sure why it happened. Um Is that an accurate characterization of most congenital hydrocephalus? I think in large part, yes. Um one main or common cause of congenital hydrocephalus is aqueductal stenosis. So, um kind of as you know, to explain what that means. Um in the CSF circulation, there's ventricles, there's the lateral ventricles which are the largest on either side of neither hemisphere of the brain kind of up towards the top and those drain down into the third ventricle. And then that fluid drains down into the fourth ventricle and between the 3rd and 4th ventricle is this narrowing called this river aqueduct. And that narrowing can get easily. It either doesn't develop properly so that it's either too narrow or blocked um or it can become blocked by scarring, bleeding, all kinds of things. Tumor's, that sort of thing. You know, when, when I was a baby neurology resident myself, you know, they kind of teach us communicating versus noncommunicating or let us say obstructive versus non obstructive hydrocephalus. But it may not be quite that straightforward and simple. Is that something that's been on your rate? R as well? I mean, it's been on my radar from the fact that my mom like has one idea of what type of hydrocephalus, like non obstructive, obstructive versus obstructive that I have. So, you know, and looking back in my old records as a baby, I was like, I don't know what type of hydrocephalus I have. And then now my, my doctor is because originally they thought I had non obstructive hydrocephalus or noncommunicating hydrocephalus or communicating hydrocephalus, which meant it was non obstructive. And then now my doctors are think, oh no, maybe it's obstructive hydrocephalus. So I don't know much from the research fear as far as may not be as black and white in every person's case. Yeah, it's not as black and white and especially if you don't have those original images. And I know in the Hydrocephalus community, like the patient community, some people kind of know what theirs is and kind of make own it more than others. And then as far as like in the medical community, I feel like we are kind of leaning away from putting as much weight on that except for when it comes to treatment options, that's where it really comes in to play. But even now they're thinking, you know, maybe it's not as black and white as we thought it was. Yeah. So, right, because you, obviously you've mentioned, you know, the shunts several times. But, uh, could you enlighten us a little bit? Yeah. So, um, you know, the only treatment options for hydrocephalus are some sort of neurosurgery or brain surgery. There's two main ones. The kind of oldest is, well, this is arguable when you know, the history of hydrocephalus, but the most commonly used is a shunt. Um, and what it does is it's essentially a to like a long tube that they put into the ventricles, attach it to some sort of valve and then run a tube down either into the abdomen or the heart or the states around the lungs, um, to drain the fluid. So it's just a big drain. Essentially, it's like the easiest way to look at it. Um, the other option that is actually, um, goes back pretty far in history but has kind of been more refined and perfected in recent years is something called an endoscopic third ventriculostomy, um, or NDTV, which is where they take now an endoscope or a camera and down through just a small hole in the school into those lateral ventricle. So those large ventricles and they actually go through the lateral intervals down into the third ventricle. So that next ventricle down and they make a new opening for the CSF to go through. Um And that's where this whole debate of communicating versus not communicating, obstructive versus non obstructive can be important when determining who is a good candidate for any TV. Because any TV is preferred is the preferred treatment modality more and more because you have a way to shunt and all the complications that come with the sun. You know, as I mentioned, the 50% failure rate, at least in the pediatric population, the there's, you know, it has the highest, I think the highest um failure rate of any implanted medical device. Um currently and then there's also an infection rate and infections are a big deal with Johnson. So you avoid all of that if the patient, if any TV works for them. So you mentioned you had to have these revisions multiple times throughout your lifetime. Now, is it usually during your annual check up with your neurosurgeon? They're like we need to, is this or is it like I'm having symptoms that prompt a reevaluation a little more urgently. I haven't gotten to an annual checkup in alone. So, yeah, so in 20 you know, I thought I was doing pretty well because I went almost 10 years between Trent revisions and I was actually in my first year of graduate school. So for my MD phd program, I did three years of medical school and then went into graduate school. And then after graduate school, did my fourth year medical school. And, um, it was during my first year grad school that, like, during this time I've always had headaches. Like, ever since as long as I can remember, I've had headaches more than most people. But, um, during college they got, they start getting worse and I would go to my neurosurgeon and you look at my image and tell me it's fine. And so then I went to a neurologist and I started being treated for migraines and I tried does literally dozens of migraine medications and nothing was working. And I moved for medical school and actually head of pediatric neurosurgery took over my care while I was in medical school. And he started talking about this phenomenon of some people with hydrocephalus there, ventricles enlarging. It's called ventricular noncompliance. Some people call it slive interval syndrome, but that's a whole other story, but that's a whole other talk. Um As to why? That's not an accurate description, but we started talking about that and my head expecting worse orders. And then finally, I got to a point where I couldn't sleep through the night because I'd wait, be woken up by a headache and you know, imaging completely stable. And finally I had, I went to my neurologist cause I was like, this is my red flag symptom. This is the symptom I always have in my stents failing and, and that's, you know how it, usually how it was when I was growing up is I would start having headaches. It woke me up in the middle of the night and they get worse and worse and worse. And so finally, my neurologist was like, I know your imaging stable, but this is an increased intracranial pressure like this is ICP. And so she called the neurosurgeon, my neurosurgeon and I made the decision for me to have exploratory surgery. So, exploratory brain surgery cool. Um and he got in there in my entire shot was malfunctioning, like had to replace the whole thing. And so it can be, and we have no idea how long it was not functioning. He said it could have been functioning for years, you know, as your headaches get worse. Um So I've had those type of malfunctions and then after that surgery and after we knew that my ventricles no longer and large, I had, well, I've had 14. So that was 2015 and I put 14 more neurosurgery since then just in that time span. And, you know, one of them was kind of the scariest showing affection I've ever had in my life. And I was literally just fine. Like I remember brushing my teeth that morning thinking I cannot wait until I follow up with my neurosurgeon to my neurologist to tell them how awesome I'm doing because I had six surgeries, six other surgeries that year. And so I was like, we finally got it, like we finally figured it out and I went into lab and I was sitting at my desk and all of a sudden it felt like it literally felt like a bolt of like lightning or a bolt of pain just went through the top of my head down my spine. And it was just this, I don't want to use the term thunderclap headache because I don't want to, you know, leaving all of my medical people in that direction. But it was just the sudden onset, worst headache of my life. And I stood, I started to stand up. I was alone in the room and my vision started blacking out and I feel like I'm gonna pass out. I was like, oh my gosh, I don't pass out here by myself. And so I was freaking out what to do. And I finally like sat down, I sat back down my chair because like, I'm not gonna get the door to get out to the hallway. And I was like, my vision is blacking out and try to like, text somebody to let them know to something's wrong. And thankfully when my CPR tags, that's what turned out to be like my son has locked in that incident and my pressure rose and thankfully for me, I get what they call plateau waves. And so the pressure goes up and then it comes down for a little bit. And so when this gets into like a lot of ICP dynamics, that's kind of down rabbit hole. But essentially I was able to, I was actually able to, like, you know, the pain wave past, I was able to get up, walk, go tell somebody what was going on, like what had happened. And I'm like, okay, I'm gonna wait about a little bit and see if it happens again. It's just my personality. Uh, so actually, like, went to lab eating and I kept having these, you know, like these plateau waves, but I'd be fine in between. So I was able to function in between, but they were getting worse and they're getting closer together. And so finally I called my neurosurgeon and he's like, go to the, er, so I went to the, er, and I actually was still really reluctant to, uh, like, I still wasn't sure whether or not it's a shot malfunction even though now looking back was obvious. But because like, during these waves, my vision would black out. I'd be like, shaking uncontrollably, you know, horrendous pain. I started vomiting. I mean, it was like, clearly something was off but they admitted me to the ICU for the night and then it was finally like a friend of my mom and my mom being up on me over the phone and we're like your, they called my neurosurgeon at like four o'clock in morning. Like, you have to revise her shot and sure enough, my catheter going into my abdomen was locked, it was completely blocked. I've, you know, so that was kind of, that's the other extreme of, you know, how she malfunctions can happen. Um during that time, like I also had an endoscopic through ventriculostomy. So I also have cool video of the inside of my brain. Unfortunately, didn't work at all for me, but I got cool video which you can see on my Twitter. And um, but yeah, like it was just, it's been a lot of like issues with like trying new valves because of over drainage and then I under drainage, we had switched off the valves and then shut malfunctions mixed in um, last year during my intern year of residency, I had my son externalized and kind of one of the most interesting thing with that is we clamp it off and like within an hour and a half my sed reached 100 which for those of you who don't know a normal intracranial pressure, your ICP is like 5 to 15. And so it's, it's been quite a process. So, you know, I know you said right, most motions have 50% failure rate within two years. But it seems like yours have been a little more frequent than that. Yeah, I mean, this is where you get into, you know, it's, it's average is some people I know people who've gone 10, 2030 years, the same shunt. I know people who, you know, have a shot revision every year or have, you know, I, I know people who have had shot fail, have had chance fail in the pack you after surgery. So it's just very unpredictable. Know, with your history. I mean, I, for one think it's very obvious why you would choose to go into something related to neuroscience. But what was it specifically your history of hydrocephalus as a child? And through the remainder, your life that led you into neurology or, or some other path that uh that led down that road. So what it really came down to it was especially during medical school because I made the decision to share my story on social media. I mean, I started sharing my experiences as medical student dealing with hydrocephalus and you know, chronic illness. And I had so many young adults reach out to me who were in that kind of in between period between like the pediatric care, transitioning to adult care. And so many like young adults kind of fall off the map or our, it's really pushed off the map because, and I mean, I this unfortunate experiences like my pediatric neurosurgeons were wonderful. But when I came, when I turned 17 and my neurosurgeon of 17 years retired, they were like, you know, why don't you go ahead and find an adult surgeon? And that was, it didn't tell me that they don't have any recommendations they didn't have a process. There was no connections. There was no, like, let's help you transfer your records. At least there's none of that. There's no process. And you know, there was a time where I was, had like 20 something year olds or teenager or, you know, people in that kind of transition period who were like, I was hearing from somebody like once a week who was messaging me saying I can't find a neurosurgeon or a doctor to take, to take my care, to take care of my, help me to take care of my son, to take care of my hydrocephalus or manage it. And I meant this amazing neurosurgeon here at the University of Washington or here where I'm where I'm training now, who is a neurologist who specializes in particularly patient with congenital hydrocephalus who are transitioning from pediatrics. We don't care. And he is, you know, he's made an use of taking in those patients' and managing there. Hydrocephalus, managing their sons and he works with some, you know, amazing neurosurgeons here who, you know, he, he has this like great expertise in CSF circulation and ICP monitoring and shunts and, and so he takes care of the patient and he images them and you know, he does any like monitoring or anything or testing that needs to be done. And if they're, you know, if he determines that something's wrong with your shunt, then he passes it off to the neurosurgeons but he's made this, you know, great practice of being able to care for these patient's and that's where, you know, so I was like, that's why I want to go up as a neurologist. Is that Doctor Williams? Yes, that's Mike Williams. I think I heard him speak at the plenary session at the academy meeting just this year. I think he had a, uh, a pro and anti NPH doesn't exist debate. It was, it was quite, uh, quite entertaining and he gave a good account of himself. Yeah, that's very cool. Yeah, he also does, you know, he also treat a lot of patient's normal pressure. Hydrocephalus, which is kind of its own thing. John run his own thing among Hydrocephaly. Yes. But yes, he's, he's, I mean, he's helped me out so much over the years. I think the first time I actually, like, flew up to, um, see him and have to keep on a train done here in 2019. Back when I still lived in Texas. I traveled up here to get, you know, his input and testing and he, yeah, he just knows so much about Shawn's and it's so fun talking to him because he gets, like, since I got a new shot system last year and I can hear it now, like, I can hear the CSF going through it. Um, sometimes when it's going really fast, like when it high pressure and, like, draining a lot and, you know, I told him about it because I've heard people talk about being able to hear it and I thought it's crazy and I asked him about it and he's like, oh yeah, and you start talking about the science behind it and the type of valve that you can hear it with. And we both got really excited and it's so fun talking to somebody who can get as excited about yourself was so it's really excellent that you found, you know, physician who, who is that passionate. But, uh you know, you kind of alluded earlier that not all physicians are necessarily as uh kind hearted perhaps, uh very true. I was gonna say I've been very fortunate, I've worked out, but I've also all of my surgeries um up until the last two years were done by pediatric neurosurgeons. And so I looked out in that, I found pediatric neurosurgeons who would still manage my care. And I still have a pediatric neurosurgeon on my team here. So, you know, being active in kind of the, the online sort of support community as you are. Is it a common experience that people will go to the neurosurgeon and be like, oh, well, you know, your, your vegetables are normal size, you need to see a neurologist or, you know, then they go see the neurologist. It's like, well, it's your shot. And so you end up kind of stuck in the middle of this contest between your to neuro positions essentially. Is that a common story? It is. I mean, thankfully, my, my situation with the ventricular noncompliance, it's last I heard it's maybe about 10%. Although I think it may actually be more than that. So it's not as common as phenomenon. But yeah, there's still like plenty of patient's out there who even, you know, who gets stuck in the middle between either neurosurgery, just not listening to them and sending them first, you know, wanting them to go to somebody else. Or I do strongly advocate for patient's also have a neurologist because it was my, you know, if remembering back to that long story, it was my neurologist who was like, this is your shunt. This is a shunt issue at the beginning um and advocated for me from that standpoint. And so, um you know, I'm biased, but I think, you know, I think it's a neurologist is an important part of the team for patient's with hydrocephalus. Even if, you know, we don't do surgery, we still like where the great diagnostician. Um and, but also it, it can be very challenging for patient's to find neurosurgeons who will, you know, take on a patient with hydrocephalus, especially with those complex patient's whose ventricles don't enlarge anymore or um have a seemingly functioning shunt but are still having headaches due to like over drainage or under drainage. And you know, who are patient enough to figure out like try different valves and try different settings and figure that issue out. Now, I, I have to ask, I can't help but notice that you are an adult neurology training program and not a child neurology. So, so what happened? Mhm. Well, and I mean, it really comes back to that, you know, because I, I thought I going in medical school, I thought I was going to do pediatric neurology. Um, because that's where you see, you know, you see a lot of hydra selfless. But, you know, after talking to all these young adults looking for hydrocephalus care and seeing the need in the adult world, that's when I made the decision to do adult neurology instead of pediatric. Uh Yeah. And so, you know, kind of, I hope to help fill that gap and encourage others to help fill that gap for patient's with hydrocephalus. I think it's, you know, definitely an opportunity. Excellent. So you're in your second here right now. Is that right? Correct. And with shut malfunctions with, with chronic headaches. And, you know, I think anyone who's been through residency can say, you know, it's, it's hard even if you aren't dealing with a chronic medical issue, how you been holding up so far? I mean, it's been rough. Um I, you know, as I mentioned, I, well, I mean, Mitch, I had two surgeries um last during intern year and um like I had two hospitalizations to her surgeries during intern year. And thankfully, you know, the program, internal medicine program director was like, very nice about it and helped me back in and everything. But I've continued to have, like, my headaches have worsened and I've continued to have shunt issues since then. And so I had another well neurosurgical procedure in March of this year. And after that, Doctor Williams and my neurosurgeon Dr Bono, um, he's also been fantastic. They were both like, you're torturing yourself trying to work through these issues and these setting changes and these ICP changes and everything. And he's, and they're like, I think you should take extended leave of absence because at that time, I was only planning to take a month to like I was like, okay, we're gonna, you know, do the procedure, figure things out and then I'll keep going and they're like, no, we think you should take longer. And so I did make the difficult decision to take a six month medical leave. Thankfully, my program has been very patient with me about doing that cause I know I know it's very hard on them because neurology programs, you know, our aren't huge like internal medicine but you know, they've, they've been patient and I've been on medical leave and we've been slowly kind of adjusting my shunt trying to figure things out. And you know, as I said, I have, I'm very fortunate to have a wonderful medical team. You know, I, I think I have around like 12 or 13 doctors following me right now. So, uh, it's a lot of, it's a lot of appointments, um, you know, my, my weeks or generally, um, full of appointments. But yeah, we're, we're working on it and hoping that hopefully I'll be able to get back better than ever. So, you have obviously made, you know, a lot of progress. You, a lot of kids with hydrocephalus don't grow up and get double doctorates. So I think you post a little bit about this in the past online as well. But for kids who, who have Hydrocephalus or families who have Children with Hydrocephalus, what, what do you think is the most important thing for them to, to know and to keep in mind as they go into the future, I think. And it's, you know, it sounds very cliche but keep your mind open, you know, and any anything's possible, like, don't, don't limit yourself or limit your child or, you know, out of fear of, oh, but they have hydrocephalus like, um and you know, Hydrocephalus, it's very much a spectrum and it affects everybody differently. But there's so much we can we as you know, as patients' providers selfless, like there's so much we can do and there's so much possibility and you know, my advice to parents, it's always let, you know, support your child in any way possible. And you know that and like by support, you know, that can also mean like therapy, special education classes and, you know, all those supportive measures or like accommodations can also be, you know, very helpful and very important to helping them succeed and do everything they want to do. But, you know, don't knowingly or unknowingly, you know, hold them back or restrict to them because of the, because of the diagnosis. Excellent. Well, said, any final thoughts that you would want to share with our audience today? Yeah. And we, well, we kind of talked about this a little bit earlier that, you know, I think part of that aspect of not limiting yourselves is the medical community, not limiting, you know, and taking a chance on patient on a patient, on, um, physicians with, you know, chronic medical conditions and disabilities and, um, making them apart because, you know, I'm very fortunate to be able to share my experience with my co residents and even my attendings. Um, sometimes, you know, my experiences as a patient and what I've kind of gleaned gleaned from those from that. Do you want to dive into that for a minute? I, I know you've said you've had mostly good experiences, but I know, well, I shouldn't say I shouldn't assume, let me, let me, let me lay medical training can be grueling and insensitive to people at the best of times. How has your experience done? It can be a grueling agents. It's now, um, you know, and well, and that's where I like, I don't know, how much I want to get into like the nitty pretty of, you know, who, who did, what, what, what we're good decisions versus not so great decisions or not so beneficial decisions. But I will say like overall, I have had some amazing support from during my residency training and you know, everything from them just being patient with me too, you know, checking up on me doing mill trains, you know, going above a beyond. I've also had some not so great support during residency training. You know, we're all human and we all have our moments and residency training is very grueling and it's hard on my, on my co residents and my program may not being able to be there for six months and then having to cover for me for six months. And, you know, I definitely appreciate that. I think the system is a whole, can definitely do better as far as making things more accommodating to um residents with disabilities and chronic health issues because as as I said, you know, I think we have a lot to give, we have um a lot of additional perspective and additional knowledge that not every trainee um has because, you know, everybody has different experiences. And so I think there's a lot of to add there and there's a lot of benefit and I think it's worth, you know, making some accommodations to help those, you know, help residents like me succeed. Um And you know, the accommodations process is tough like, and it's tough at every level I will say, you know, I've had, I had accommodations because of all the surgeries and everything. I had accommodations starting in grad school, well, actually starting in undergrad and then grad school in my last year medical school. And you know, some people who aren't dealing with disabilities or aren't dealing with chronic illness, think accommodations give people with disabilities or kind of give unfair advantage in situations. You know, sometimes people have that idea or that kind of bitterness and I could see how it be especially strong and residency training because we are all pushed to our limits. But, you know, the process for getting and coming up with accommodations is like incredibly hard. Like I've spent, you know, I've spent so much of my free time in meetings, like, and so, you know, that's, you know, just kind of some food for thought as far as that goes. And I think that process can be made, can be simplified and made more um made easier and more appreciable. And I think a lot of residents would benefit from that. I mean, then you, you know, there's Lisa Meeks does great research on doctors with disabilities. And yeah, I think she came out with some recent research that showed like 52% of residents with disabilities. Never, never go through the accommodations process, never even try to get accommodations. And like that's a whole another conversation maybe for another day. Yeah, it does speak to the kind of the underlying philosophy. I hesitate to use the word philosophy with like kind of mental state of uh medical training as a whole, which is still very much entrenched in many corners of the United States where it's like, you know, you have to be, you know, this sacrificial lamb on the altar of healthcare uh in order to get everything, feel, pardon my overwrought imagery. But, you know, I've been very fortunate with my own health thus far in my life. But, you know, I've had co residents who, who had like, you know, really bad A dhd or, you know, like conversely, insomnia or other things like their cognitive performance just suffers and uh while I'm part of the 80 I'm doing air quotes here, 80 hour work week limitations. I think everyone knows that at some point these are a little bit of a fiction and like, you're awake for over a day and if you're already having health issues, probably not great for those health issues, right? It's not, it's not great. Like I worry because it's my own neurosis kicking in like all these times being on call or not having like, you know, seven plus hours of sleep per night. You know, how many years have I shaved off my life? How many, how much higher is my risk for dementia? I don't know, probably it's probably more than it would have been. Well, yeah, I mean, you know, it's, it's significant for all of us and I, I'm grateful that there is a push in general, like, overall to make residency more health care more humane, honestly. Um, because it's, it's not human right now. Um, I saw a Twitter thread just a couple of days ago. I was getting into the rabbit trails for a second. It was saying, like, you know, keep, uh keep the work schedule but bring back the cocaine. But for those who aren't familiar when residency programs are being developed back in the 18, I think it was the 18 hundreds. That might be a little off on my decades, maybe in the 19 tens. But the people in charge of it were a little bit high on cocaine and hence were able to get an incredible amount of work done. So anyway, tongue in cheek, I'm not truly advocating for everyone in healthcare to be on cocaine, but, but it would be nice to get something to get. Just saying more regular sleep would be good for everybody. Right. Right. Right. Very well, doctor. Right. Thank you again for coming on. Where can people find you online? Uh And what resources if any would you recommend people with Hydrocephalus or those taking care of someone with Hydrocephalus should seek out? Um So as far as resources, the Hydrocephalus Association is enemy. It's a great resource. It's a great resource for um both patient's and clinicians because they have a whole, like a whole like publication search engine. Um They're available on their website and the website is um hydro a sec dot org. So hydroassoc dot org and they also have, you know, great support resources, community, network resources. So if you have patient's with hydrocephalus, definitely check them out and, you know, I've been a volunteer with them for quite a while and they're just amazing and do amazing work. Um And then as far as you know, if you please, you know, come find me if you have any questions or if you just wanna kind of see what I'm doing. Um I'm on Twitter and Instagram as Shunted MD phd or um and my name Jamie Ride is on all of my pages as well. That's a great handle, by the way. Thank you so much. I'll make sure to put links in the show notes uh to the society and to your accounts as well. All right. Thank you again so much. It's been a pleasure chatting with you. Thank you. I just want to say thank you one more time to doctor Jamie, right? For coming on and sharing her unique experiences with us and I'll leave a link to her socials as well as the organization's she recommended in the show notes below. As always, if you enjoy this podcast, please make sure to rate and review us on Apple, Spotify or wherever you're getting your podcast. This helps with the algorithm and getting the show noticed by other people. Also, please make sure to subscribe for future episodes and you can find me on Twitter at Doctor Ken Trees or by email at the neuro transmitters podcast at gmail dot com with any questions or show suggestions and those contacts are also in the show notes below. Thank you again for listening and we'll see you all next time.