Telemedicine works, but … where are the doctors?

It’s great to hear, via a paper presented at a recent conference, that it’s possible to deliver excellent health care to people with Parkinson’s via video link. Telemedicine might help bridge the accessibility gap that I’ve seen seen here in rural northern New England. People who reside in the Bennington, Vt., area, for example, are about as far away from Boston as they are from Burlington.
This is great news for the patient, but what about the doctors? Caseloads for many motion disorder experts are already high. How would an influx of new cases be managed? 
I could see the MDS assuming more frequently a consulting role, a second-opinion source, to a telemedicine session originating from the office of the patient’s primary care provider. I don’t want to see this technology used to increase bill-able throughput. We risk burning out more doctors that way, and then everyone loses.

The exercise benefit, explained

Exercise just works. I’ve often said that it seems to reset the brain at a fundamental, system-wide level, kind of like re-initializing a computer. 

Now researchers are starting to understand what happens inside the brain when we are pushed to perform at a higher level of exercise than we might normally engage in. From Medscape:

Patients with Parkinson’s disease (PD) who exercise on a stationary tandem bicycle with a healthy partner during a single 40-minute session experience a 35% improvement in motor function and increased brain activation similar to that found with levodopa treatment, new research shows.

The study, by researchers at the Cleveland Clinic in Ohio, found that maintaining a steady rate of 80 to 90 revolutions per minute (rpm) on the bicycle not only improved function in lower extremities but also in upper extremities.

I don’t want to reprint the entire article, but this quote resonated for me:

The researchers surmise that the exercise may facilitate central motor control processes in Parkinson’s patients. “For lack of a better word, we may be ‘overdriving’ the central nervous system by providing an increase in the quantity and quality of sensory information provided to the patient,” said Dr. Alberts.

The Choice Matters: Go With the Specialist

An article in The New York Times makes a point that might seem self-evident: Patients fitted with heart devices had fewer problems when those devices were implanted by doctors who had special training. I think this finding is very relevant for devices implanted in other areas of the body, particularly in the brain. Consider this point:

Most implant procedures, about 70 percent, were performed by electrophysiologists, the study reported. The remaining implants were done by other types of cardiologists or other kinds of doctors including thoracic surgeons. The study found that the highest rate of serious complications about 2.5 percent, occurred among thoracic surgeons, who accounted for only 1.7 percent of the procedures reviewed.

Knowing this, if one had the choice, why would you *not* want to have a brain implant done by anyone except a specialist with a long track record of performing that specific procedure? I suspect that it is on this point that the surgeons with the record of excellent results differ from those that are merely very good.

The article also provides a strong argument for the creation of a national electronic medical records system. The findings were based on filings made to a national database created in 1995 when Medicare and Medicaid agreed to paying for more implanted defibrillators. One can only imagine the other bits of hard science to be gleaned from records based on data from millions of eople.

PGATOUR.COM – Interview: Michael J. Fox at Outback Steakhouse Pro-Am

I guess it would take something extraordinary to blast me out of my extraordinary demotivation when it comes to writing. But this interview did it. Not so much the Michael J. Fox bit — although he is an incredible person — but the golfer he played with at this event. 

Tim Simpson is a pro golfer who had to put his clubs away because of his inherited tremor — and who got his game back after having DBS surgery. His account of having the surgery is truly inspiring to someone like me, who is thinking seriously about having the surgery, possibly as soon as later this year.

Thank you Tim, and Michael. It’s time for me to get back on the cart and get serious about this aspect of my life. I’m headed to NYC this week to interview a DBS neurosurgery team. I’m looking forward to it, with much excitement and a bit of dread.

Research in Context: Back to Basics

It’s useful to remember that all research is ultimately aimed at developing therapies that can help people with Parkinson’s, Dr. Steven Lee said during his remarks on research Saturday at DHMC. 
Lee’s remarks, at a Parkinson’s disease symposium attended by more than 200, provided valuable context for understanding the flurry of research news 
Treatments developed through research can be symptomatic (easing the symptoms, without addressing the underlying degeneration); neuroprotective (designed to slow the progression, and thus prolong life); or restorative (reversing the progression and restoring functionaility).
Research itself takes place along a continuum, or “road map,” that ranges from basic discovery, to refining and validating the targets that are uncovered, to pre-clinical testing, “phased” trials in people, and, ultimately, FDA approval applications.
Parkinson’s research can also be categorized as being oriented toward genetics, or divided in two other ways broad categories (or a combination of the two): genetics and cell biology, and environmental influences.
Your correspondent is still working through the research discussed at the event. But one other observation, from a colleague of Lee’s: To be a study participant: do not have to be a patient, and if you are a patient and accepted into study, you can still be a patient.