Sunday, October 14, 2012

Scalpel... sponge... white out...

Here is the kind of thing I am delighted to have lived long enough to say, the sort of thing that would have read as nonsense a few short years ago. Frankly, it still looks a little weird when I type it. But here it is: Last Friday, during brain surgery to provide relief from Parkinson's Disease, cartoonist Richard Thompson drew a picture of his brain. (You may see his drawing by going here, and scrolling down.) Naturally, you have many questions about this. As a cartoonist who has undergone this same procedure, I'm here to help. First question?

Q: My God! He drew this WHILE the team had his skull open and his brain exposed????
A: Correct. When the doctors are trying to find the ideal placement of the electrodes in the brain, it is necessary to see how the patient responds to the electric stimulation from the wire, and where the wire is in the brain. Different electrode locations, varying by millimeters, can produce markedly different outcomes. Based in part on the real-time reactions of the patient, they will tweak it to the optimum possible.  So, for this phase of the operation they wake the patient up to assess how they are doing. Richard and his doctors were probably trying out a placement or setting to see how well it worked for drawing. What better way to do this than by actually drawing?
Q: Wait, doctors were putting electrodes in his brain?
A: Yes. The operation is called Deep Brain Stimulation (DBS). For reasons that are poorly understood, many symptoms of Parkinson's Disease can be fairly well controlled in some patients by "stimulation"- zapping certain regions of the brain constantly with mild electric shocks.
Q: Ouch! Doesn't that hurt?
A: No. While the scalp area is plenty sensitive, the brain has no nerves within it that detect pain. Pain is your body's way of telling you that you have a problem that needs addressing. It's like the robot in the old TV show exclaiming "Danger, Will Robinson!" Unfortunately, if something dangerous has made it through your skin, your skull, and past the Blood-brain barrier, you are most likely FUBAR, and pain is useless. So the brain does without it.
Q: Cartoonists have brains?
A: Security, eject that man.
Q: So why did Richard draw a brain?
A: Likely because brains, in all their squiggly moistness, are fun to draw.
Q: This is amazing, and sort of cool.
A: No kidding!
Q: Does this mean that Richard will be able to produce his wonderful loose and confidently masterful drawings and paintings again?
A: I believe so, but it depends to some degree on his tolerance for frustration. The apparatus installed by the doctors must be adjusted to Richard's particular case. His anatomy, the progression of the disease and the way it manifests itself must all be taken into account as the device is tweaked.  This can take months of trial and error, during which symptom control will likely be less dependable than it will eventually become. Fortunately for Richard, he lives near Washington DC, and there are many highly-trained  medical professionals around. But with countless possible settings. finding the perfect mix will take time.

And DBS is not a cure. Parkinson's will always lurk in the background, subdued, but not banished. From time to time it will leap out from the weeds and send his stroke askew. This can be dreadfully demoralizing, especially for a perfectionist like Richard. It can mean doing things again and again to capture the look you want. 

Creativity is all about overcoming limits. Parkinson's is all about imposing limits. My money is on Richard's creativity. I can't wait to see what comes next.


Adele said...

Excelllent, as always. Thank you for the clear explanations you consistently give.

I am going next Monday morning to be evaluated off my drugs for the next step in preparing for DBS surgery. The stories of Richard Thompson's surgery and your stories help me look at this with more hope than fear. Thank you. Adele

Peter Dunlap-Shohl said...

Hi Adele, This is the hard part, choosing a doctor and team you trust, researching them and the process until you are satisfied that this is the procedure that you want with the experienced people to handle it properly, and then enduring the evaluations to make sure that they can actually help. Once that is done, all you must do is lie still and follow simple instructions.

If you haven't already, Google Yahoo groups DBS users and join this mailing list for a constantly changing and wide-ranging discussion of DBS by people who have had the procedure. I recommend signing up for the digest version to help control email overkill.



Adele said...

Thanks Peter. I have been getting those digests for a couple of months, based on your recommendation. It has been sobering to read some of the things there but, overall, people have seemed glad they have had the surgery.

Patient-Online said...

Hi Peter, I always enjoy your well-written, creative pieces. This one caught my eye having just come off of the same DBS surgery in July, as you know. I thank you for your humor and great way of presenting topics. This post gets the word out more. I have benefited from my DBS procedure. It was an arduous thing to undergo, but well worth it. Dan

Peter Dunlap-Shohl said...

Thanks Dan, I am very glad to know that your surgery was helpful. Promising news for all people with atypical Parkinson's Disease, I hope.