Welcome to charting with Doctor McNeil.

Greetings. This is Doctor McNeil, and we are about to launch into charting with doctor McNeil. This series is relatively new. The, idea behind it is to educate the public and our physician community about the offerings at Adventist HealthCare and introduce you to some of our most stellar physicians that we have.

This day, we're gonna be talking a little bit about the neurosciences, stroke, epilepsy. A lot of the diagnoses that, the public is familiar with and are very difficult to treat and are challenging to have a good quality of life if you happen to have those diagnoses. And so today, I am very fortunate to be here with two of my very favorite physicians. I'm a physician's physician who likes physicians, but I'm talking about two that are truly my my favorite.

I'm a have them introduce themselves.

Doctor Sigounas.

Thanks so much for having me, doctor McNeil. It's an absolute privilege. And and like you mentioned, I'm I'm happy to be here with, with doctor Smith, but I'll I'll introduce myself first. So I'm doctor Dimitri Sigounas, and I'm the chair of neurosurgery at Shady Grove Medical Center and the chief of neuroendovascular surgery for the Adventist HealthCare System.

It's awesome. We're gonna talk a little bit about what that means, in just a little bit. And I'm gonna go ahead and go to doctor Perry Smith. Tell us about yourself.

So I'm Perry Smith. I'm a neurologist. I am the, head of inpatient neurology and stroke care at Shady Grove Medical Center. And I've been there for about thirteen years now. Time really does fly.

That it doesn't remember when you came.

Let's get started and launch into the meat of this conversation. Let's talk about neurosciences. Before we actually talk about neurosciences, I wanna get a little bit more background on you all. You chose some of the most interesting specialties in medicine. One of you, the neurosurgeon in the room, you know, chose the specialty with the longest training time in medicine as well. I want you each to tell us a little bit about your training, why you went into the specialty you went into, and what you love about it the most. Dmitri, it's all yours.

Thanks, Patsy. So, so I went into neurosurgery being interested in the brain in general. I I thought it was a fascinating organ, you know, something we didn't know very much about. And and because of the potential for technology developments, I chose neuroendovascular surgery. So that basically means that you go into neurosurgery, knowing that you're gonna do seven years, but then additional fellowship training is a two year process.

I was at, New York Presbyterian at Cornell for both my fellowship and my residency. And then afterwards, I came down to this area, to the DC area. I have an academic appointment at, George Washington University Hospital, but I've been with Shady Grove for almost the entire time that I've been here. And I've basically helped build the neuroendovascular surgery program, along with Wayne Nolan, with, doctor Smith, and, with an amazing, group of people.

So neuroendovascular surgery basically, involves stroke care, especially when you have to do something to be able to treat a blood vessel that might be blocked. We'll get into that in just a little bit. But any problems that the brain has that involve the blood vessels fall into that same category, and you do it in a minimally invasive way. So you basically use X rays and you use small plastic tubes called catheters to be able to access these blood vessels and then be able to to treat the problems.

Amazing. Now talk about that more over time. Talk about stroke in general and the global impact and the United States impact as well. But, Perry Smith, you have had, I learned just a couple of years ago, a very interesting pathway to medicine as well. Now doctor Sagunis has talked about nine years post medical school in training, which to me is like, that's quite a bit. Having said that though, talk about your training as well and and a little bit about you and your your decisions to go into neurology.

Yeah. So so like Dimitri, you know, from the time I was a kid, I thought the brain was really interesting. When I was a kid, I read a book called, The Man Who Mistook His Wife for a Hat, by a guy named Oliver Sacks. And and I, like, something clicked in my brain when I read that.

I was like, wow. This is, like, the most interesting thing possible. And I thought, if I did this for a living, I'd never be bored. And it panned out.

You know? That's exactly what I do for a living, and I'm I'm never bored with it. The pathway for medicine, it's a long one. Right?

So, I kind of that I read that book when I was maybe ten or eleven years old. I was a kid when I read it. You know? And then, I went to college.

I realized that what I needed to do was go to medical school probably about junior year in college. And I heard about this thing called an MD PhD program where you could get, where you could do research while you were in medical school and get a PhD in MD at the same time, and the government would pay for your medical school. I was like, oh, sign me up for that. So I did that.

I got a PhD in molecular biology, and then I did a neurology residency down at Yale. And then I did, two years, doing brain tumor research at the NIH.

And then, my wife and I had a kid, and I decided, well, it's time to get a real job. And so, yeah, you guys were hiring. And so I got a real job here, and that that's the whole story.

That is the whole story. Both of you guys make me feel like I need to go back to school, work a little harder, a little harder because, that's a lot of schooling. Alright. Now tell me a little bit about what keeps you inspired in this, this these specialties. I'll say, Doctor Sigounas, your specialty when I was in training did not even exist.

So first, you know, decided at Shady Grove to go ahead and incorporate that into our abilities to offer our community, it was exciting for me. Because more and more, the older I get, there are these specialties and these things that come up that literally, you you know, didn't exist when I was in training. It wasn't that long ago, but it was long enough to see change. So tell me about what you do, the cutting edge parts of it, and we'll also talk a little bit about stroke. And before you do that, you know, stroke is something that's has a global impact that is profound. Twelve million twelve million people a year have strokes.

You know, large amount of death and disability, a lot of profound life deterioration as far as enjoyment of life when you have a stroke. And you do the type of work and doctor Smith does as well where you literally pull people back to the point that they have almost no deficits or no deficits. And it's a beautiful thing to see. The first time you see it, it's almost like sorcery. It really is. It really is amazing. So talk about talk about your specialty a little bit more about some of the types of things that you do, the time course, how profoundly impactful it is for our community as well.

Yeah. Absolutely.

That that kinda cuts to the core of, of, you know, why we do what we do. So I was talking about, neurosurgery training, and, along the way, I I thought neuroendovascular would be a good option. And at the time, we were treating, diseases of the blood vessels by, you know, ever since neurosurgery started a hundred years ago, you would open up the skull, you would go find what was, what was problematic and and try to fix it that way. But, neuroendovascular, started maybe in the in the early nineties where you basically take a small plastic tube, like I was saying, you you make a small hole in one of the blood vessels of the legs or the wrist, and then you go up using x rays to try to treat that problem.

So neuroendovascular has been around for, you know, a little more than three decades. And, specifically, stroke care, always involved giving medicines. So if you have a blockage in a blood vessel and you're not getting blood flow to a part of the brain, then you try to open up that blood vessel by giving medications that can break that up. And and doctor Smith, I'm I'm sure, is gonna talk about that in just a little bit.

But but in twenty fifteen, we realized that if you go in and you actually unplug that blood vessel, unclog that blood vessel sort of like a plumber for the brain, you're able to restore that blood flow, and you can have a pretty profound impact, what doctor McNeil was, was referring to. Patients that are are rapidly, having brain cell death because of that that blockage and and the lack of oxygen that oxygen that goes to that part of the brain because, blockage causes blood flow not to to go normally, that can really, really, you know, over the course of an entire stroke, if you don't solve it, that can cause decades worth of damage to the brain.

So, you know, you you would see a patient who is basically having a significant stroke, you unblock a blood vessel that, that's causing that stroke, and suddenly, that patient goes back to normal by the next day. I mean, there there can be nothing more rewarding than seeing something like that and knowing that you had, some part to play in that. So, you know, neuroendovascular surgery has really changed, the way that we do things. And the fact that we've been applying this technology, you know, it it came out of the, out of the forefront maybe in twenty fifteen, but we started our program at Shady Grove shortly thereafter. In twenty eighteen, we were able to get that program started and and since then we build we've been building exponentially.

And what we've been able to do for our community, I think, is is, just something that I I don't see, anywhere else in terms of the the ability to to say, look, this is a public health crisis.

We need to be able to address it. We need to have buy in from the nurses and the techs and the doctors that are part of that care from when the patient comes in the door in the emergency department to when they are discharged from, from our intensive care unit, our floor, our, rehab centers, to have that sort of, passion for making patients better, and taking pride in that is, is something that is is incredible to, to witness at Shady Grove.

It absolutely is. In twenty fifteen, twenty fifteen was a hair's breath away. It was not that long ago. And so, when I say that this is relatively brand new, though things started in the nineties, as far as practical application in a community in Montgomery County, this is light years of progress in a very small amount of of time.

And it's just a profound offering, to to the community. Now, like I said, when you see somebody come in and they can't move a right side or can't move a left side or can't speak and they, are given into your hands into our lab to be able to open that up and then you see them shortly after and they're well. It's it's just kind of it's such a fulfilling career. But stroke care in general can be the same.

Now when I was in training, the the studies were being done in Cincinnati for using clot busting drugs.

Yeah.

Let's talk about that because the public needs to know as well that it's important that they have symptoms, they get treated quickly. And if they don't, they can have permanent damage.

But talk about your work a little bit too.

I mean, that that story really starts in sort of the, late eighties, early nineties. And, historically, there wasn't a lot you could do for a stroke. Hundred years ago, you had a stroke. That that was kinda it. In the late eighties, they they realized that you can break up clots, that you use medicine to dissolve clots, and the applications for this were immediately heart attacks and stroke. Turns out that doing the studies for heart attacks is a lot easier than doing the studies for strokes. Heart attacks are a lot more homogeneous.

Every stroke is different, and so it's just a real logistic jump to be able to do clinical trials on acute stroke. Had a great people this this was the same time when CT scans and MRIs were really coming into their own. And so in the mid nineties, I think ninety four, were the first trials with a medicine called TPA, tissue plasminogen activator. That was the first clot busting medicine that was shown to to help with strokes.

And the way that the medicine works, if you take someone who's having an acute stroke, there's a very narrow window when it works. You have to really get to the hospital. We have to sort of administer this drug within four and a half hours of the symptoms starting.

If we treat people with this medicine, to a hundred people with this medicine who are having strokes, we can make about thirty three of them better. And we can make about three of them worse. The this this medicine, it's a clot busting drug. It's a very powerful blood thinner.

The side effect of it is bleeding. There's no such thing as a medicine without side effects. That bleeding is often trivial. If you bleed on your gums or bleed in your IV side, that that's not exciting.

But you can bleed in your brain. There is danger from it. If you look at the math, the the benefits far outweigh the risks.

That medicine made a real difference. That medicine made a real difference.

Oh, in the in the late nineties, early two thousands, they started working on doing endovascular therapies for sure, going in through the blood vessel and delivering these medicines, giving the tPA through the blood vessel, seeing if that would help. Going out and trying to pull out the cloth, they had all these devices. There's something called the the Mercy corkscrew device, which would sort of you corkscrew it into the clot and pull it out. And it was clear that that was sometimes effective.

But, it's, again, it's very hard to do large rigorous studies on stroke because every stroke is different. In the early twenty tens, I think in twenty thirteen, they came out with a bunch of trials showing that endovascular therapy didn't work.

And everyone said, this is crazy. We gotta do a real study that's rigorous that will show us what and it turns out it's all about how you select your patients.

And using advanced imaging technologies, something called a CT angiogram and CT perfusion studies, which weren't widely available really until twenty until twenty tens.

You could effectively identify patients that would benefit from these procedures. And what the data shows, is that if we take a hundred people who are having these kinds of strokes, who are eligible for a thrombectomy, and we do a successful thrombectomy, fifty of them will be independent within ninety days. Right?

So there is nothing in medicine that has that kind of odds ratio going for it.

Right? So fifty, you know, fifty percent of the people get better, and these are people coming in with humongous strokes who would not naturally get better from this. That is I say that, you know, that is about the same as parachutes for skydiving. Right?

It's like it's just that effective. And and like you're saying, like, Dimitri is saying, when you see it work, it is so satisfying. It's like, you know, unclogging a drain. And you often see patients get better by the same day, by the next day.

And even if they're not better by the next day, you see a lot of improvement within the first ninety days. So it's just like stroke went from something that was thirty years ago, this was an untreatable condition. There was nothing to treat it. And now we have an intervention that will help a huge percentage of the people that were doing it.

When we first built this program, we see about we see about three hundred and fifty to to four hundred and fifty strokes a year at Shady Grove. And when we first built the the machine, when we first got the the, it's called the biplane machine, the x-ray machine that helps do it, I'd sit down the math and think, I think we'll probably use this about seven times a year. Right? And I for seven times a year, it's worth it.

If we can save seven people, wow. It's great. You know?

Last year, we did fifty two of these procedures, and we're on track to do even more this year. Alright? So, like, when you have a hammer, your problems start looking like nails. Right? So when when you find that you can help people with this, you just wanna do it more and more.

I keep saying this, but I I think the public needs to know a couple of things. Number one, you have four hours.

Okay? Four hours. So if you have an arm that's not quite working right or you can't see well, you're fumbling your words, you can't speak or walk properly, it's not the time to go to bed and shake it off. This is not a shake it off type of phone. This is like, you know.

Yeah. Yeah. Well, you know, while while we've got an audience, yeah, we wanna we wanna sell that for a second. Right?

So we see a lot of times that people don't you know, when you have a heart attack, you feel like you're dying, and it feels awful, and you wanna come into the hospital right away. But having a stroke, it doesn't feel bad. It's usually not painful. You don't have a headache.

You're just like, That's funny. And so a lot of people, when they're having a stroke, they'll call their friend who's a nurse. They'll call their brother-in-law, but a lot of people don't think to call nine one one. So, like, we're trying to get the message out that if you think you're having a stroke, call nine one one.

Just just get to the hospital. We're open twenty four seven. Like, don't worry about bothering us. Like, just come.

So how do you know you're having a stroke? The the American Heart Association has this, acronym that they're trying to spread, and it's called BE FAST. So b stands for balance. E stands for eyes.

If there's a sudden change in your balance, your vision. F stands for face, if suddenly your face is drooping. A stands for arm, but it also stands for leg. Alright?

So if one of your arms or one of your legs is weak. S is if your speech is suddenly slurred, then t, it's time to get to the hospital. Alright? So that's that's what we're trying to that's that's the message we're trying to spread, and that's what we're trying to make people aware of.

So, like, if you think you're having a stroke, be fast, just call nine one one immediately. Because if you get to the hospital quickly, there's a lot of interventions we can do. But if you don't get there until the next day, the ship has sailed on treatment often.

A hundred percent. And we've all seen that over and over again. It's always very sad to see, for sure. Now two things I'm gonna touch on briefly.

One, the statistic is that eighty percent of strokes are preventable. So for everybody listening to me right now, see the Big Mac, put it down. Put it down. You need to make sure that you are doing the things that you need.

Take care of your diabetes. If you have it, take care of your hypertension. If you have it, eat better, drink better, be better as far as taking care of your health, in the one two punches that we all know to do but don't want to do. Just make sure that you're taking care of your health.

Any extra pointers there, folks, to make sure that people I wanna reiterate.

So so everything that doctor McNeil said is correct. But, so for yeah. You gotta take care of your hypertension. You gotta take care of your diabetes.

You gotta not smoke. Smoking is a huge one. A lot of people ask me what diet recommendations are, and it's surprising. The diet recommendations are eat more fruits and vegetables.

Five servings of fruits and vegetables a day. You do not have to lose weight.

Although, if you eat five servings of fruits and vegetables a day, almost everyone is gonna lose weight doing that. But you don't have to lose weight. You don't have to become a vegan. You don't have to give up gluten.

Right? Just more fruits and vegetables in your diet. And a lot of people your risk of stroke is independent of your weight more or less. Right?

So, like, if you're listening to this and say, oh, I can't do it. I can't don't worry. You don't have to lose weight. Just eat more fruits and vegetables.

That's all. And the exercise guidelines are, maybe surprisingly, walk half an hour three times a week. You do not have to train for a marathon. You do not have to do p ninety x.

Just walk for half an hour three times a week. Alright? And that's something that almost everyone can do that. You don't have to walk fast.

You just have to walk. That's it.

That's that's those are great recommendations. And for the, fruits and vegetables, people take for granted that they're eating five servings. It's actually if you pay attention to your diet, you can go a couple days.

Yeah. No no one in America eats five servings of fruits and vegetables a day. If if we did, we would run out of fruits and vegetables. Alright?

So, like, just do your best. Alright? I, you know, have this conversation with seven people a day, and, you know, it's hard to eat. It's not easy to eat five servings of fruits and vegetables, but it it's something that you can do.

It's hard to quit smoking. It's very hard to quit smoking. People smoke. It's so hard to quit.

But eating five servings of fruits and vegetables, that's that's doable. That's doable. I mean, you know, so that's it's always it's always easy to focus on things that you can do rather than things that you shouldn't be doing. You know?

I agree. I agree. Now we're gonna talk to a little bit of a of a sadder tone and then we're gonna go on to some of the other areas of of neurology and neuroscience. So, serotonin is the one thing, when I was in medical school back back in the olden days, the difficulty was, well, look, you're laughing but the truth that matters, I remember streptokinase.

I am I am that old. So just put the docs in the audience and for you too, I remember it. The thing is is that back in those days with a lot of these diagnoses, there really was no real treatment. So there's a lot of devastating conversations that can occur with people, but there's still some that you guys are having to make with folks. How do you approach those? Just tell us a little bit about that in that, you know, what is your philosophy about telling people, you know, the kind truth?

And, as physicians, it's the hardest thing we do. I I I it was my least favorite thing to do is to to talk to people about the bad outcomes that are permanent or a death, families and everything. But tell us a little bit about your approach because I think I've seen both of you, do things like that. You're kind and clear though. And education of of a public and the patients is always important.

Yeah. So so I'll address the, sort of the the acute first line conversations, and then, and then, Perry can can talk about what comes next after you kinda have a sense for for what the the outcome can potentially be. So, so the conversations that I have, as you, you mentioned, Patsy, are patient is first coming to the hospital, and, we've seen a CAT scan that basically shows that, there is a blockage in a blood vessel, a CTA that shows a blockage in a blood vessel and a perfusion scan that shows that there's salvageable territory.

And, I mean, this this happens on, you know, biweekly, triweekly basis. We see patients, that are, you know, in that window of, opportunity to be able to go in and try to try to salvage some brain. And and when we do see that scenario, then the first thing to do is talk to the family and say, look.

What from what you know about what your loved one, would be, potentially willing to live with.

What would you think that their wishes would be in terms of trying to have a procedure done to be able to salvage a part of the brain that may have already had some damage. You know, every minute that you're having a stroke, you lose two million neurons. Well, that that can add up quickly. So, obviously, time is of the essence, and and you're having these conversations in the middle of the night a lot of times.

I was gonna say earlier because, like Perry said, we're we're open twenty four seven. Getting to the hospital is is essential. Perry is probably the only human being that I can talk to at two o'clock in the morning and and and not not get in the slightest bit aggravated at the fact that I'm getting I'm getting, you know, called about something which which I know is is very, very important and and needs to happen. But I'll have these conversations with the family and and they're not ready to to maybe have these conversations, but they need to be able to to make a decision quickly.

I can I can tell you in the last month, I had a conversation with a family that, you know, their their loved one wouldn't want to have a breathing tube permanently? And so, the question was, you know, do we proceed or do we not? We decided to to proceed, and I'm so glad we did. The outcome was fantastic, but, you know, that's not necessarily the case all the time.

So the family needs to be prepared for the fact that, you know, there there can be permanent deficit, meaning there can be weakness or can be issues with the ability to produce or to be able to understand speech.

And if somebody's read any literature about happiness and your ability to adapt to a changing situation. I mean, sometimes what we project that someone would not want to live with can be very different from what a loved one would want to live with. And so I I think that those issues, sometimes later on, you reflect back and you say, okay, this was the right decision or, you know, in in some situations, this was, less frequently, this is the wrong decision. But I I think that, you know, that's the perspective from the front lines.

We we talk about something that needs to be decided immediately, but then Perry will talk about things on the after things have settled.

Tell me about it. I've seen you do this as well, and you're so passionate about what you do. And you are kind, but you are direct because this is not something you can really tiptoe around.

Yeah. So the most important principle in medical ethics is patient autonomy. Right? Here in America, the patient has the right to do what they want done to them. It's not what I think is a good idea. It's not what, you know, your wife thinks is a good idea. It's not what your kids think is it's what you think is a good idea.

And in order for us to be respecting patient autonomy, you have to have a full sense of what the options are. Right? So I think that, the truth is the truth. Right?

And there's sometimes I say I wish I could sugarcoat this. Right? But there's just no way to sugarcoat, neurologic outcomes. Like, you just have to be direct about them and say and then, without the truth, people can't make informed decisions.

Right? I think that one thing Dimitri pointed to is that, you know, a lot of times people will think and say, I would never wanna be, not have the use of my arm. I never wanna not be able to walk. And I think there is, for better or for worse, I think there's a lot of ableism baked into medicine.

Right? And that, you know, the idea is that, it's better to not be disabled than to be disabled. And it's kinda hard to get past that sometimes. Right?

The great philosopher Mike Tyson likes to say That he is. Everyone has a plan until they get punched in the face. Right? And it is one thing to talk about what your wishes might be when you're sitting around the dinner table or when your primary care doctor's office talking about your advance directives, and it's a whole another thing when it's the middle of the night in the emergency room and you gotta make a decision. Right? And I think that it always pays to talk about these things with your primary care doctor. It always pays to have advance directives, but it's like a whole another thing when it's actually happening.

It's tough. It's really tough. I've seen families struggle with that for decades. It's very, very tough. We're gonna switch a little bit from what you guys your bread and butter usually every day is and go to neuroscience in general. We'll talk a little about AI and tech and what's coming up because that's what everybody wants to hear about, of course. And then we're gonna go into things like Alzheimer's and multiple sclerosis and some of the other diagnoses.

So we're just gonna launch into the tech first, and we'll back into some of the other diagnoses that are that are, you know, around And Dimitri's got all sorts of cool tech stuff.

He's got a lot of cool things.

All the expensive toys. So go for it. Tell us what's what's in the future and what's in the present a little bit.

Yeah. We we had a I remember a lively discussion over dinner, guys a few months ago, where we were kind of talking about what the the future of, of this field is gonna potentially look like. And, obviously, being in neuroendovascular surgery, you see a lot of technological advancements. And I'm very excited about the the possibilities.

You know, I'm not sort of a a pessimist about, you know, the the direction where humanity is going because I think that these tools are gonna be incredibly useful, to be able to overcome some of the problems that, that we are facing from, you know, disease processes that can, take away our abilities to do certain things. So one of the most exciting parts is brain computer interface in neurosurgery. So brain computer interface basically means, you know, putting in some device inside the brain that's able to control an external device, whether that's a computer, whether that's, you know, an exoskeleton, whether that is a prosthetic, some way to basically use thought to be able to project it outwardly without needing use of your hands or your voice, for example.

So basically, you think it and it goes directly to, to a a screen. There are competing companies out there, in this sort of this space race for, brain computer interface. From a neuroendovascular standpoint, there's one, that is, doing clinical trials in the United States where you can basically implant a device in a vein in the brain. And that is able to be able to collect these signals through the blood vessel wall and send it to a computer.

And this is done in a minimally invasive way. You don't have to open up the skull to be able to do it. And we've had discussions with Perry about enrolling patients at Shady Grove for this clinical trial that's opening up. Because, again, I mean, for a patient that has a type of a syndrome called locked in, where you have a stroke in the base of the brain and you're not able to move anything except your eyes, to be able to do activities of daily living by just thinking about it, like online banking, texting friends, controlling devices around the house.

That's essential.

That leads to the connectedness that we need in our lives to feel human. So what is gonna be the future of this field? Who knows? But I think that being part of the conversation is is absolutely essential, and it will happen. It's just a matter of who's gonna do it best and when.

I'm gonna tell you right now, I have a mixture of, alarm and, excitement.

It's it's I wanna simultaneously just yell, I e, and run up in the room, and I also want one right now myself. So I'm just putting it out there. It is a mixed feeling. Right?

To have something foreign put, you know, in your brain. Obviously, with something severe like locked in syndrome, you know, and some other things. Three years ago, two years ago, in twenty twenty three, I went to the global TED Talks in Vancouver. If you get a chance to go, I highly recommend it.

And there was a lot about tech and AI at that time and they had someone whose name I cannot recall, a scientist who had done this exact thing. And there was somebody who's in a wheelchair who couldn't speak, who controlled a drone and flew around the theater. And it was just shocking. It was just shocking. And so the future looks bright as long as we kind of put some boundaries around some of the, you know, detect a little bit. But, what do you what do you think about all this and and what would it take you?

I mean, I think I think, something in medicine has proceeded so fast. It's like a blink of the eye, and, oh my god, we're doing it. Right? So, like, these thrombectomies, in twenty ten, they were a pipe dream, and now they're like a reality. We do them every day. Right?

I always think about Christopher Reeve. Right? So, like, Christopher Reeve's accent was at ninety five, right, ninety four. And I really thought that within Christopher Reeve's lifetime too.

There would be the prosthetic technology would be there that he'd be able to walk. I really thought that would happen. And it's been thirty years. Right?

And and it's not there yet. I kinda think it's around the corner. Right? I think that we're in a time where we don't even need a big technology leap.

Right? That the science that controls our phones, the science that, you know, that that these drones, they can control a leg. Right? How hard can that be?

We're not there yet, but I feel like we're closer than we've ever been.

Right? Of this is astounding. I think in you know, instead of a pace of ten years, a pace of three years is probably the equivalent, and I'm making that up audience. Don't chat GPT on me.

Yeah. But but the pace is really sped up, and I think you're absolutely right. There will be a lot of change. A lot of physicians think that it will replace us.

My thought is it will not replace us. It will enhance us. You know, when you're a kid and you're looking at Star Trek, you're like, when is it gonna happen? When is gonna happen?

When is gonna happen? I am a secret Trekkie. I am. I think it's around the corner.

I really do.

Yeah. Patsy, I I completely agree with your your timeline. And and the reason I'm saying it is, you know, you can look at at advancements. Talking about Neuralink having implanted ten patients, you know, that that's pretty recent.

The other company that I was saying that does it neurovascularly has also implanted ten patients, but since twenty nineteen.

So we have twenty patient years worth of data saying that this works. One of those patients wrote a book by thinking about it.

Oh my goodness.

So we're getting there, and it's gonna be sooner than than what we all think.

Magic, folks. Magic is happening in here, as far as medicine is concerned. So that's really, exciting. Now let's talk about some of the other diseases.

So I have to be honest. I don't know of much progress, and I'm looking for information from you guys. MS. MS.

The drugs have gotten better.

Yeah. So the drugs have gotten better. The drugs have gotten better. It's another thing that when I was in medical school, we had medicines that just did not work.

Muscular Right.

Tell me the whole Oh, so multiple sclerosis.

It's an inflammatory condition of the nervous system, where people get attacks of inflammation, which can add up and cause disability.

We now have treatments that actually work, that are effective. And so when I was in training, I'd see two or three patients with multiple sclerosis a week who would come into the emergency room with breakthroughs and flares. We have to treat them with steroids, and they they need rehab.

And now I see one or two a year Yeah.

Because the medicines are just so effective and so easy to take.

And it really it just quiets the medicines we have just quiet down your immune system, and people stop having flares. So, like, that's I mean, that's really been in the last that's a story in the last five, ten years. Again, that that the the trajectory of treatment for these kind of conditions has just changed. You know?

Talk about Alzheimer's.

This is Alzheimer's.

That's a little bit of a less heartening Yeah. Story. You know? So, one of the so Alzheimer's disease, it's disease that affects people as they age. Your brain cells that are involved in memory and other things start to die off. And, this is a terrible disease, and it's a huge burden.

And if there was some medicine that could stop this or slow this down, it'd be humongous.

One of the pathological things that they find in brains with Alzheimer's disease is something called plaques. They find these plaques. And for the last since I've been in medical school again, the research has been focused on clearing out the plaques. If you could find some medicine to clear out the plaques, the patients would get better. And this seems to work in rats. It seems to work in monkeys.

They've been trying this for thirty years. We haven't gotten the effects we wanted. And my concern is that with Alzheimer's disease in particular, by the time you're showing signs, the ship has sailed. Right?

So the so there may be tweaks. There may be things that are better. There this is something where stem cells might work. I I have more pessimism in my heart about fixing Alzheimer's disease in the next five, ten years than I do about having fixing multiple sclerosis.

Right? It's just it's It's unfortunate. It's a little bit less of an optimistic story in the year twenty twenty five.

There are some studies around preventive things. You know, the way your diet, your community, you know, having a sense of community, all of these things help. They're not slam dunks, though. There are some genetic factors and so forth as well.

But there's a lot of noise out there about, once again, how you eat, making sure that you have your right omega three mix and you have, what you need. Looking around at everything, I certainly sprinkle hemp seeds a lot more of my food than I used to. I'll be honest. But it is something that is a devastating disease and with the, aging of the community in general, it's about to land like a like a neutron bomb, I think, on on the world because there's a lot of older people, out there.

What other diseases can we talk about? Epilepsy. There's a lot of neurosurgical things and medication things that are happening in those. So I'll test it to you, Dimitri.

What what's implantable devices and things there too?

Right. So so for, for epilepsy, I mean, we we can have, devices that can be implanted on the surface of the brain to be able to detect seizure or foci. They're becoming smaller and smaller, and some of these same brain computer interface companies are basically looking at implanting, what they're developing to be able to collect electroencephalographic signals of brain waves to be able to also collect information about seizure foci. And so, you know, what that is gonna lead to, the devices are getting smaller and smaller.

There's also a push to do this endovascularly.

Like we said, I mean, if you can access blood vessels in the brain and you're able to access places where seizures can happen and collect signals, you're able to kind of not have to go down the route of open brain surgery to be able to treat seizures. And not just collecting signals, but stimulating parts of the brain that can lead to those seizures getting short circuited and to prevent, seizures. So epilepsy, I think, is also a disease process that's that's definitely, gonna be on the upswing in terms of what we're able to develop as is deep brain, stimulation for diseases like Parkinson's.

Parkinson's as well. Yeah. Another devastating disease or can be with with folks as well. We have covered quite the the swath of diseases, all of which we treat here at Adventist HealthCare.

Our neurosurgical entity site predominantly is at Shady Grove. You guys are right in the center in the thick of it all. And so I have to thank you guys for all the information you've given. Any final closing thoughts for the public that you would like to say? And for anybody listening who has a son or a daughter who's thinking about going to the neurosciences, what can you tell them?

Yeah. I'll I'll say that having kids that are are getting to the age where they're starting to look at, at future professions, talking with friends, shadowing. There there's a lot of burnout in medicine, but I can tell you that it really has to do with how you structure your career, your priorities outside of work, making sure that you're you're happy with the role you play, in society and, and, you know, being, being happy where you work. And I can say that, you know, Shady Grove provides, a group of people that that really do take pride in their work and they want to be able to help.

And I'm I'm always I I was saying, something to somebody about a a month ago that that I I look forward to going to work. And being able to say that means that you're not gonna get tired of it anytime soon, but you need to be able to make sure to to balance, having time for what makes you happy outside of work. And and also making sure that you stay interested. And and I think that's what neuroscience is for me.

There's so much potential that that I I you know, it's it hasn't gotten old yet, and I don't think it will for for quite a while.

Well said. Both of you you two, when I see you and there's a case going on, you guys look lit from within. It's a little creepy. I have to say it out loud. But it you are exactly who I want taking care of me if I have a stroke. Perry.

Yeah. I mean, that's, I I sometimes say I I like my job more than anyone I know likes their job. I, you know, I get to meet new people every day. I get to solve problems.

I get to help people. I can't fix every problem, but it's, it's just a tremendous privilege to be able to do this job. You know? And I feel I feel lucky to be able to do it.

And I I don't know what the future of medicine is. I don't know what health care is gonna look like in ten years, twenty years, but I think there will always be disease and pestilence with us, you know. Of course, no rejects. There will always be people who wanna stamp that out, you know.

And so I think that there'll always be a role for people who wanna help people in this world, you know.

Marvel films are very, very popular right now. In fact, I wish they would cut it out because I've seen, the Avengers twenty five times in three different ways. I'm tired of it. I think the two superheroes are in this room with me right now and across Adventist HealthCare practicing and taking care of patients.

I think the public needs to know that. They need to understand it's not how far you throw a ball. It's not how fast you run. It is not the fact that you can act like somebody you are not.

It's the fact that you're taking care of human beings and doing it exceptionally well, which you do. And so I I thank you on behalf of Adventist HealthCare and back in fact, in, you know, in part of my own self too. I will be looking for you, when I'm eighty. And have a great day.

Care of yourself. You should only stay healthy and never need our services.

I agree.

But, I wanna push this be fast thing one more time for anyone who's listening. Please. If you think you're having a stroke and be fast, balance eyes, face, arms, speech, time to get to the emergency room, call nine one one. We're open twenty four seven. We're always on call. There's always someone there. And if you need this thing in the middle of the night, we'll come into the middle of the night and fix you.

So Absolutely. Thank you very much. Alright.

Thanks so much.

Thank you.

Charting with Doctor McNeil.