There was a senior citizen, quadriplegic patient of Multiple Sclerosis for a long time, with almost no mobility in his left side. He had a cather for 12 years, and though it was never comfortable according to him, recently it had become painful! His hystroscopy showed stones in the kidney, though he said they weren't causing any pain to him. However Dr. Gauthier recommend him to stay away from surgery just yet. His lung function was down to 33% of the normal. He uses IPPB to help with respiration, but he finds them uncomfortable. However, even with all this (stuck on a wheel chair, and all the other problems) he was very cheerful. He had two very nice and helpful caretakers (probably were his family). I couldn't help but contrast him with the case I saw earlier where a patient in much better physical shape, almost perfect ambulatory function, had given up to the disease. Support from family and friends goes a long way toward ensuring emotional stability. His caretaker mentioned that he loves going to Indian restaurants and have spicy food!
When he was leaving, he wished me good luck with my school, and told me something that is probably the quote of this entire summer immersion experience: "Always remeber - patient is not the only victim". Amen to that, sir!
Another, very interesting case that I came across this week exposed me to some other, previously not encountered clinical experience: dealing with the 'adverse effects of access to information' ! A person came to see Dr. Gauthier and said that Dr. Gauthier was the fourth neurologist this person saw. There were MRI scans of her brain and spinal chord from the last 1 and half years. All were clear, and showed no lesions. However, the patient(?) insisted that they were having symptoms that were typical for MS, and had changed neurologist after neurologist when they wouldn't agree! Though a spinal tap hadn't been done, it wasn't recommended by Dr. Gauthier, just yet. This whole episode reminded me of the adage, ignorance is a bliss! People shouldn't really get an MRI of their for no reason. That reminds me, I'm volunteering for a brain MRI scan myself this week! sheeeesh!!!
Another important case was of a person who was JC positive, yet was on Tysabri! Yikes! The person was very nice and sweet, and looked to be in fairly good shape. He works full time. And he was full of praises for Tysabri, even so much that he was prepared to swear by it. I was told that there currently are 120 such patients that WCMC has, which are on Tysabri and are JC positive. Dr. Gauthier was briefing him about the risks that he was being subjected too, but it seemed to me that his earlier treatment (Copaxon) must have been really unpleasant for him to deal with, as he appeared to be very comfortable with Tysabri. I learnt that according to most recent data obtained by Biogen, 145 cases out of a total of 90,000 patients have developed PML after being on Tysabri. However the risk seemed to peak at about 2 years of administration, whereas this patient had been on Tysabri for almost 3 years now!
This week I coregistered several other patient's T2 relaxometry images with their DTI images. Though the results obtained aren't that great. I've been tweaking certain parameter values to see if it helps, but doesn't help much. However, it's known that FLIRT doesn't work that well with T2 spiral. I'll go on to exploring the non-linear coregistration next week, and wrap up the project too. Hopefully, the results will be good.
Finally, I volunteered for a brain MRI scan of my own for research! It was a fun experience. I came to know that one: I am not claustrophobic, and two: I don't have a perfectly healthy brain! How reassuring!
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