Spinal cord injury repair update

Reggie Edgerton, and collaborators at U Kentucky, have successfully helped a paralyzed man regain some function in his lower extremities -- both with motor control and autonomic function -- thanks in part to the years of work Dr. Edgerton has done at UCLA in the study of spinal cord "learning," repair, and re-learning. Expect more to come from this work in the future. UCLA is an exciting place to be.

Losing one's voice

Christopher Hitchens is dying of esophageal cancer. Despite his diagnosis, grim prognosis, and aggressive treatment course, he continues to write, principally, for Vanity Fair. His most recent piece waxes about losing his voice, the inevitable result of the cancer interfering with the function of his recurrent laryngeal nerve. But never mind the anatomy, this is a beautiful piece, and more reason that I love the work of, and the man who is, Chris Hitchens.

Not surprising, but still...shocking

Have you seen this? Getting chronic disease management/prevention under control are essential to any plan overhauling health care in this country. It's one area in which "ObamaCare" got it right. We'll see how the pilot projects play out and whether they are fed into mainstream (i.e. medicare/medicaid) health care delivery.

Remembering a photo-journalist

No one life is more valuable than another. Yet people have talked extensively about two photo-journalists who recently died while covering the fight for Libya. Indeed, there is something haunting, deeply saddening about someone dying while trying to cover the horrors of war. In an effort to bring the carnage to light, photo-journalists are not immune to the dangers of their work. Although this is off the topic of medicine, it is certainly a reminder of our mortality and the sacrifices involved in dangerous work; this moving tribute to Tim Hetherington struck me especially hard.

Is sugar toxic?

A perspective on sugar - refined cane sugar (sucrose) or high-fructose corn syrup - and some of the current research into the havoc it wreaks on the body. Worth a read. The research isn't entirely convincing, but again, why take the chance by eating simple sugars in excess? Regardless of whether everyone who eats large quantities of sugar or not gets diabetes, it's not healthy to binge on the sweet stuff. So again, it's worth a read.

"New Normal"

It has been some time since the tragic Tuscon shootings of January, 2011, and much of what needs to be said was covered elsewhere -- the tragedy, coming together, partisan bickering, blood libels, etc., etc. -- but I am interested specifically in Congresswoman Gabrielle Giffords' remarkable recovery progress. Anyone who has followed the news since January has seen the numerous news reports on a rapid recovery: holding her husband's hand, following commands, breathing on her own, opening her eyes and tracking movements, speaking, asking questions. It all sounds very good, heartwarming, and promising. Gabby may even be back to work in the House of Representatives one day, and she may run for the Senate seat, soon-to-be vacant due to John Kyl's retirement.

But what is her recovery really like? What happens when the rhetoric (101% chance of survival, remarkable progress, determined, brave, courageous) is replaced by realism? What is Gabby's "new normal"? Though difficult to read, this piece in Newsweek attempts to paint a realistic image of what a life of intense rehabilitation is like. There's no discussion of the Senate seat, and, I think most importantly, there's been little discussion of what happened on 8 Jan, 2011.

And it makes sense not to force the discussion on someone who probably has many, many questions but who, because of the ongoing rehabilitation, lacks the full capacity to ask these questions. But this is nonetheless important, because it speaks to the magnitude of the change in Gabby's life. The New Normal is very different from 7 Jan, 2011.

Although Gabby Giffords' story is one of the most high profile post-traumatic recoveries in recent history, her New Normal is similar to that of a war veteran, accident victim, or anyone recovering from a catastrophic injury or illness, regardless of the cause.

Update: 4/25/2011 -- another piece, from the Arizona Republic.

Offer stands

People considering UCLA's MSTP, feel free to comment, email (MSTPLA at gmail dot com), or get in touch w/ us through the UCLA MSTP's official website.

Man, this sucks

High school basketball player makes game winning basket. Then collapses and dies.  It's a cruel world.

Update (4:42 PM): this wasn't unexpected, but still sad - the deceased player had dilated cardiomyopathy.  Although hypertrophic cardiomyopathy has a greater prevalence and is more often a cause of sudden death in young athletes, DCM can also lead to untimely deaths.

Hockey players get it too

C.T.E.

This week in Chronic Traumatic Encephalopathy

Dave Duerson committed suicide last week. That he was a successful NFL safety and businessman in retirement alone justifies the reverberations felt throughout the sports world.

Then there's this: Dave shot himself in the heart, not the head. He suspected the depression with which he suffered mightily in the final years of his life was connected to a career filled with jarring head trauma. So he wanted a post-mortem examination of his brain, believing that he was afflicted with chronic traumatic encephalopathy (CTE). Although the results have not yet been revealed, I suspect they may show the hallmarks of CTE.

Until the results are released, and no doubt in spite of whatever the diagnosis, the NFL remains big business. But what happens in the wake of successful careers is nothing short of astonishing; not to mention tragic.

YOU try the individual market

NYTimes linking begins again.  This time, one well-off, healthy family of three tries to get insurance in the individual marketplace and BOOM, epicfail.

Look, I'm not saying I think ObamaCare is the panacea to our problems with health care. Many of the criticisms (other than "socialized medicine", "death panels", "bankrupt our country", etc) are valid. But have YOU tried recently to get healthcare? Any congressmen/women trying?

Crickets.

Last symposium as a PhD student

Holy crap, tomorrow is the last MSTP symposium I will attend as a PhD student.  Next year, I'll be a third year medical student.

In some ways, time has flown by quickly; in other ways, it's gone by very slowly.  ~5 1/2 years at UCLA, and still ~2 1/2 to go.

I have a boat-load of work to finish in the next few months for this all to be realized, and according to some of the powers-that-be, "productivity" has "declined" over the past few months.  So be it; point taken.  Finishing is indeed a challenge, and in many ways since I turned in the "return from leave of absence" form to the medical school, I'm psychologically had one foot out the door w/r/t being a graduate student.

All that said, I can't complain.

Oh and I get a chance to talk about my research at the symposium tomorrow as one symposium speakers, which is both exciting and daunting: it's challenging to convince people what you do is interesting and very important.  In reality, it's all just another variation on the same theme of nitty-gritty, slow-and-steady work-- character building.

Batshit crazy

Amy Chua confirms what some people have told me about Chinese mothers.  I'm not rendering an opinion about all Chinese mothers, but Chua is clearly, by her own admission, batshit crazy.

And I'm not the only one who thinks this.

Hey Arizona, ur doin' it 'rong...

Gail Collins comes up with a stunning, refreshing rebuke of the idiocy of Arizona's new approach to cut $4.5 million dollars from its state Medicaid expenditures by denying certain types of organ transplants.  The bottom line: government bureaucrats allowed the plug to be pulled on a 32 year-old father.  No, seriously.  This is from a state run by people who said "Obamacare" was going to do just that; when in fact health care reform was put in place, in part, to avoid such devastating consequences of cost cutting in the setting of poor information.

Update (12-17-2010): still sounds like death panels to me.  Wasn't this kind of thing supposed to happen under the watch of "liberals"? Never a state like AZ...

I was, am, and hope to always be naïve.

I hope you think the picture is pretty, but I don’t expect you to be as taken away as I am: I understand that discovering the sight was part of the fulfillment’s process. I take that back, actually. I didn’t discover anything. I just observed some already-well-characterized phenomena.

A couple of months ago, when I just started my PhD training, I saw this image under the microscope. I forgot how much time I spent staring at all the different motor neurons, how they extended their processes to hold figurative hands and pass along chemical love messages. I spent more time taking the highest resolution picture I could, which has been edited to its current state.

If I gave this image to a polite, random neuroscientist, he/she would give me a coy smile and say that the picture was “nice and the TUJ1 antibody stained very well.” If I gave this image to an impatient and nasty, random neuroscientist he/she would scowl at the piece of paper and ask me why I was wasting his/her time: I’m not showing anything new!

I hope this figure will be as stunning to me in a few years, when I’ve read more literature and seen more figures and done more research and graduated with a PhD. Sure I’ll see a lot of similar images; I might be bombarded by them. But I hope to appreciate that the ordinary is beautiful too: because you see it once, doesn’t mean the allure has to fade.

Monday afternoon football update

This weekend in American football:

1. A Rutgers' University student athlete was paralyzed from the neck down after an in-game incident against Army.
Update (10-19-2010): The most recent medical literature says that 90% of patients with complete tetraplegia (aka quadraplegia) at one month post-injury remain complete tetraplegics for good.  After 6 months, there is little change in a person's neurological status caudal to the spinal injury.  In other words, the coming days and weeks will be hugely informative of the athlete's function long into the future.  Here's hoping he regains function.  Also, from what I have gleaned from the news reports, it does not appear that therapeutic hypothermia (TH) was tried.  Recall that TH was used when Buffalo Bills' player Kevin Everett was injured back in 2007.  Although the use of TH in his case is still being debated, he was able to walk within ~one month of the injury.


2. Yesterday's NFL games featured several instances of traumatic brain injuries.

walking, chewing gum

In my recent interactions with one of UCLA's true physician-scientists, I start to get the sense, more than ever before, how this journey is about learning to walk and chew gum...at the same time! Hackneyed cliche aside, I guess I have begun to realize how all of this research and medicine "stuff" isn't so incredibly difficult, but juggling different responsibilities requires intra- and inter-personal patience: transitions are hard, and a deep breath and calm go a long way.  But it's still hard work.

Rethinking traumatic brain injury and its consequences: “repeated brain injury can change your life and your family’s life forever.”

I watch the NFL most weekends, and I won’t lie: I’m mesmerized by the horrific collisions and the looped instant replay that progressively slows down so that I can see faces grimace on impact. After most hits, the players bounce back up, dust and readjust their jerseys, and run back into position to get hit again. After the bad hits -- a lot of the times on the quarterback -- the trainer and then the team physician and then the medics come to the field. An awkward fall or collision can cause a player’s helmet to hit the ground at a ridiculous velocity.

In 2009 Roger Goodell, the NFL commissioner, testified in front of the House Judiciary Committee and did not recognize an association between head trauma suffered in games and brain diseases later incurred by those players. The league promised to “do better” and later that year issued “stricter” concussion guidelines.

Since Goodell’s testimony, the NFL has slowly changed its outlook regarding traumatic brain injury. A sobering poster in team locker rooms acknowledges that concussions can cause “problems with memory and communication, personality changes, as well as depression and early onset of dementia.”

Omitted in the list of concussion-associated conditions is a Lou Gehrig’s-like disease. Lou Gehrig’s disease (amyotrophic lateral sclerosis (ALS)) is a progressive, neurodegenerative condition that affects upper and lower motor neurons. Patients, like Stephen Hawking, are left weakened and atrophied to the point where they can no longer support breathing. The etiology of ALS was thought to be primarily organic. Current studies, however, suggest head trauma can cause a similar disease state. So Lou Gehrig may not have had Lou Gehrig’s disease. A New York Times article reviews his well-documented history of head trauma. Spinal cord pathology samples have shown that others athletes -- boxers and football players -- have been misdiagnosed with ALS. It is hypothesized that the neurodegeneration related to chronic traumatic encephalopathy (CTE) is mediated by neurofibrillary tangles, which are also seen in Alzheimer's.

Whether the neurofibrillary tangles and neurodegeneration are taking place in the motor neurons or temporal or frontal lobes, the fallout is real and serious. Chuck highlighted the sad story of Chris Henry, a former wide receiver for the Cincinnati Bengals, who demonstrated behavioral changes leading up to his accidental death. An autopsy revealed CTE. Malcolm Gladwell surveyed some of the NFL’s horror stories:

“Mike Webster, the longtime Pittsburgh Steeler and one of the greatest players in N.F.L. history, ended his life a recluse, sleeping on the floor of the Pittsburgh Amtrak station. Another former Pittsburgh Steeler, Terry Long, drifted into chaos and killed himself four years ago by drinking antifreeze. Andre Waters, a former defensive back for the Philadelphia Eagles, sank into depression and pleaded with his girlfriend—“I need help, somebody help me”—before shooting himself in the head.”

The sad stories aren’t limited to professional sports. This past April a University of Pennsylvania football player committed suicide. An autopsy revealed CTE, a surprising finding considering his age. These stories are receiving more and more attention, and congress is listening. House committees are working on the Concussion Treatment and Care Tools, and Protecting Student Athletes From Concussions Acts.

While the sports community has slowly increased the awareness of traumatic brain injury, the US Army has some work to do. An NPR investigation reported that Army officials have denied Purple Hearts to soldiers who suffered concussions following explosions. The denial is not a surprise to Gen. Peter Chiarelli who acknowledges the “ongoing resistance to awarding the Purple Heart for so-called ‘invisible’ wounds.” The Purple Heart is a “badge of courage” and a medical resource: recipients receive prioritized medical care from Veterans Affairs hospitals.

Soldiers shouldn’t need a Purple Heart, though, to receive appropriate medical care. Physicians should investigate the association between psychiatric and neurological conditions and traumatic brain injury. Soldiers should be warned of the risks. And the institutions should provide the appropriate medical and social resources. The consequences of traumatic brain injury do not happen overnight.

Friday food for thought

Med students/schools ur doin' it wrong.  Some ideas.  I'm too tired to have an opinion right now.

It gets better

Advice columnist and openly gay activist Dan Savage found himself so moved by the recent suicide of a 15 year-old, bullied and picked-on boy in Indiana, that he started a youtube channel called the "It gets better project."  It's wonderful to see multimedia having potentially life-saving effects; and in the young (particularly openly gay or lesbian), suicide is a leading cause of death.