BLOG # 65: Why Neurology? How I Champion Epilepsy

 

     This blog explains my choice to become a neurologist and how I became a champion raising epilepsy awareness. A large, multi-clinic epilepsy group, the Northeast Regional Epilepsy Group, which has clinics in the New York City area, New Jersey and in Connecticut (http://www.epilepsygroup.com/newsletter-detail24/), recently chose me as their “epilepsy star” to be featured in their December, 2015 newsletter They served up several questions that explored my background, how I came to write my epilepsy novel, DINGS, and my activities in raising epilepsy awareness. The article follows:

Northeast Regional Epilepsy Group Epilepsy Star: Lance Fogan, MD

     For this issue we have the fortune of interviewing doctor and author, Dr. Lance Fogan.  As a neurologist, he worked for years treating patients diagnosed with epilepsy and now retired, he continues to advocate and educate the public on epilepsy through his wonderful book "Dings" as well as giving lectures, participating in epilepsy events, and through an active on-line presence.  Because of his tireless efforts in epilepsy he has been chosen to be our December epilepsy star!

Please tell us about yourself.

     Born in Buffalo, NY in 1939, I attended public schools. I majored in Anthropology and Linguistics at my local university, the State University of NY at Buffalo, living at home with my widowed mother. Although I knew that a medical career was my calling, I'm so glad I chose this undergraduate major. It opened a more complete "life" for me. I had pet dogs growing up and veterinary medicine seemed like a good fit for me. I got a job on a dairy farm sixty miles south of Buffalo near Jamestown, NY the summer between my sophomore and junior high school years in order to fulfill future veterinary college requirements. I lived on the farm during that summer of 1956. I soon realized that I was not enamored by the large animals. My career goal switched to human medicine. Upon returning from the farm I got an after-school job operating a cigarette-smoking machine in a research lab at Roswell Park Cancer Institute in Buffalo. That fanned my ambitions to enter medicine even more. The scientists collected the cigarette tars, painted them on the skin of mice, and tumors resulted. In 1964, between my third and fourth years of medical school, I sought an experience out "bush" in a remote part of the world. I worked on an Anglican Mission Hospital in Papua New Guinea with an Australian general practitioner for two and a half months. After that, I returned to my Buffalo home by flying around the world for the next six weeks. My future fiancée met me at the airport in New York City when I returned to the United States; we married two weeks after medical school graduation nine months later. Our 50th wedding anniversary was June 13, 2015.

How did you decide to go into neurology and how much of your work involved working with epilepsy?

     The neuroanatomy course in the first of the four years of medical school was fascinating for me. Two students shared a human brain that was donated by the person or his family. We dissected it over several months, memorizing all of its parts--the blood vessels, nerves and the eyes. As med school continued, my goal became training in neurology or neurosurgery. Further exposure to the practice of medicine showed me that neurosurgery would demand too much of my life in the operating room away from a future family―I chose to practice neurology. After internship of one year, and then satisfying my military obligation during the height of the Vietnam War by serving two years as a tuberculosis control officer with the U. S. Public Health Service assigned to the Oklahoma State Health Department in Oklahoma City, I began three years of neurology training at Case Western Reserve University Hospitals in Cleveland, Ohio in 1968. I joined the Kaiser Permanente Health Plan in Southern California in 1971. My career as a clinical neurologist was most satisfying and I became chief of the department. As a clinical neurologist I took care of many epilepsy patients of all ages, along with the typical neurologic diseases: stroke, brain tumors, headaches, multiple sclerosis, Lou Gehrig's disease, muscle and nerve diseases, and etc.

Tell us about your book Dings: what inspired you, what was your purpose in writing it, what is it about?

     I retired from full-time neurology practice in 1997. A literature/writing class each Saturday in my teacher's private home since 2000 has enriched my life. I and my fellow students--half of whom are in their 80's and 90's―create and write something each week and we read a page or two of our writing in class. In 2009, I read an article in the Los Angeles Times. It told David and Susan Axelrod's (he is former advisor to President Obama) story of their adult daughter who developed severe epilepsy. An idea popped sprang up. "Here is a subject I could write about for my class. I will tell a story about a young child failing school because of unrecognized complex partial seizure blank outs." (This scenario is not uncommon in neurology practices). Because his fictional father is on a combat tour in Iraq, everyone believes the third grader is suffering from anxiety and stress which is why he can't concentrate on his school work. The novel is told from the mother's point-of-view telling of her family's experiences and her attempts to support her son. His teachers say he's not keeping up and they recommend he move back a grade. Since no adult has witnessed―or at least recognized--his covert, non-convulsive seizures, his learning difficulties remain a mystery. Finally he is evaluated by a neurologist. It is only when the specialist asks specific questions about possible blank outs and hallucinating bad smells (classical occurrences in partial complex seizures) that the boy describes his heretofore never mentioned strange symptoms: his confusion episodes, his occasional urinary incontinence (which he hides), and his imagined smells of burning rubber. He calls these symptoms his 'dings.' I immediately appreciated how my novel can educate the reader on epilepsy. The book details what epilepsy is, how it is diagnosed, what tests can be helpful, its treatment and how full and successful lives are very compatible with an epilepsy diagnosis. A practical epilepsy glossary concludes the book.

Have you been able to use Dings to raise epilepsy awareness?  How?

     I have been posting educational blogs about epilepsy every month since 2011. You can read the blogs on my website: LanceFogan.com. Recent blogs feature excerpts from the novel about the neurological examination.

     Teaching is my forte and joy. The title of a PowerPoint presentation I have made to the California Association of School Psychologists at two of their annual state meetings is "Recognizing Covert, Non-Convulsive Epileptic Seizures in the Classroom." In addition, I have given lectures about epilepsy to nurses in my local school district and to student teachers. I raise epilepsy awareness on Twitter (@lance_fogan), LinkedIn and on Facebook. I have appeared at local book signings discussing DINGS and epilepsy. I am always available to give epilepsy presentations in my area, the Greater Los Angeles, California region.

     The Mayo Clinic's Neurology Dept. is using DINGS as a teaching aide for their students and neurology trainees. The Epilepsy Foundation of America ("Epilepsy.com" Wednesday, June 12, 2013 Summer Reading: Two Books on Epilepsy) and other epilepsy organizations in the United States and in Great Britain (http://livingwellwithepilepsy.com  30 July, 2015 "Emily's Perspective: A review of 'Dings,' by Dr. Lance Fogan) have favorably reviewed DINGS. One comment on Amazon.com epitomizes my purpose for writing the novel. A woman told of her 18 year-old grandson's recent diagnosis of epilepsy. Before that he was thought to have a “learning disorder.” She wrote that if she had read DINGS sooner, a correct diagnosis of epilepsy could have been made earlier and treatment could have been prescribed much sooner.

Tell us about your continued work to raise epilepsy awareness through other venues.

     I am currently raising epilepsy awareness in my teaching as clinical professor of neurology at UCLA of medical students and non-neurology physician trainees and practitioners. I think most lay people would be surprised at the lack of knowledge non-neurologist physicians have in recognizing non-convulsive epilepsy. Individuals suffering complex partial seizure blank outs are frequently found confused; some wander in traffic. When police find them they bring them to hospital emergency rooms where they are misdiagnosed as "alcoholics" or "mental patients." The ER doctors too frequently fail to recognize their true condition and refer them to psychiatrists. 

What plans do you have for the future?

     I plan to sponsor a table at the Epilepsy Foundation of Greater Los Angeles Annual Walk to End Epilepsy in November, 2015. I will discuss epilepsy from a doctor's point of view and highlight the epilepsy-educational value of DINGS. 

Any closing words?

     Non-neurologists, especially pediatricians, do not warn their patients who have epilepsy of the great risk of their drowning at home. Whenever I discuss epilepsy I highlight the seventeen people I know of, to date, who have drowned in their bathrooms. Five of these patients fell face-down in the shower blocking the drain and dying in two inches of water. Consequently, I recommend that people who have epilepsy never take a bath or shower unless someone is at home and the door left open, if possible. Individuals with poorly controlled seizures, especially, should be instructed to sing in their bath/shower. If the singing stops, an attentive relative/housemate should rush to see if they are all right. Non-neurologists, especially pediatricians, do not warn their patients of potential home drownings in epilepsy.

     I also recently met the family of a woman with poorly controlled epilepsy. Her father showed me several old severe burns on her forearms and hands. He told me, "Tell your patients to cook only on the BACK burners on their stove tops." I hadn't thought of this. Terrific idea! Let's disseminate that suggestion to further safeguard our friends and patients.

     After reading DINGS, only $2.99 as an eBook, patients will be teaching their physicians about epilepsy. The novel is available as audiobook, too.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Blog #64: Epilepsy: Preparing for the Holidays

     The holidays are here. As many of us prepare to travel—and welcome—friends and family to share our holiday feasts, people who have epilepsy should take some extra precautions to stay healthy and safe.

• Get enough sleep: Excitement, stress and jet lag can disturb sleep patterns. Extreme sleep deprivation is known to cause seizures. For example, soldiers returning home from Vietnam during the 1960’s and 1970’s were so excited that they would be up for 36 hours straight. This extreme lack of sleep caused a convulsion in people who do not have epilepsy; it could certainly precipitate seizures in people who have this condition.
• Alcohol: Alcohol is often served at holiday meals. People with epilepsy can probably tolerate a beer or a small glass of wine or spirit. However, excessive use/abuse of alcohol is more likely to bring on a seizure than in a person without epilepsy.
• Nutrition and hydration: In my experience, people who have epilepsy do not need to follow a special diet; just follow routine recommendations for good nutrition and water intake.
• Bring an adequate supply of anti-seizure medication when you travel: Be sure to bring enough anti-seizure medication with you to last the duration of your trip plus a couple extra days to be safe. Keep the medications in their original bottle/container with the prescription (dosage) and your doctor on the label. (This information may be required if you must cross state or international borders.)
• Stress: No matter how much you enjoy the festive season, holidays can be stressful for anyone. Emotional stress can definitely bring on a seizure in people who have epilepsy. If possible, minimize the amount of time you spend in a stressful environment. Meditation and light exercise are good ways to reduce stress.
• Carry identification when you go out: People who have epilepsy can have a seizure at any time. During a seizure, a person cannot tell bystanders that he or she has epilepsy. When a seizure occurs, it’s usually not necessary to call an ambulance; the person will stop jerking and shaking after a minute or two and just sleep it off. A MedicAlert bracelet or necklace would reassure observers that the person has a known chronic condition that may not be that serious. This information is also useful if emergency personnel are called. Always carry a card in your wallet that states your condition (type of epilepsy) and up-to-date medications you take to control it. Be sure to include a contact address and phone number of one or two relatives that emergency personnel or a Good Samaritan can contact in an emergency. If you are away from home visiting friends or relatives, be sure to provide similar contact information about your hosts.
• Cook on rear burners of stove-top: I was recently shown the burn-scars on the forearms and hands of a young woman with epilepsy. The risk of burns during a seizure will be significantly decreased by keeping the front burners off.
• Danger in bathtub/shower: Seizures, of course, can happen in the bathtub and shower. I know of seventeen people with epilepsy who drowned, including five people falling face-down and blocking the shower drain. They lost their lives in just two inches of water. Frightening, yes, but make plans to protect yourself and lessen this risk. Try to have someone always close-by when bathing and do not lock the door if you must close it. Arrange with your companion, if that person cannot stay close that you will sing while in the tub or shower. If the singing stops, that’s a danger signal.
• Wear a helmet: After eating the sumptuous meal, a lot of people like to get out and exercise to work off the calories they have just consumed. Everyone—and especially people with epilepsy—should wear protective headgear (a helmet) if you ride a skateboard, bicycle, horses and even ski. A helmet will protect your precious brain from injury if you fall and hit your head while participating in one of these activities.

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.

Blog #63: What Your Doctor's Exam Tells About Your Nervous System (Part 2)

 

The following blog comes directly from Chapter 26 of my novel, DINGS. DINGS is described on my website: LanceFogan.com. It follows a family and their 8-year-old whose non-convulsive epilepsy had not been recognized. DINGS is available as an audiobook, softcover and an eBook at popular internet stores. I will continue excerpting from the book if this blog entry receives comments from my followers on lancef46@gmail.com.

(Continued): The neurologist walked over to a shelf and picked up a dark vial. He shook it a couple of times, unscrewed the cap and sniffed. He returned to Conner, who was swinging his dangling legs over the edge of the exam table. Our boy appeared quite comfortable being the center of attention.

The neurologist gently pressed Conner’s left nostril closed and waved his other hand with the open vial under his right nostril. “Can you smell this?”

Conner jerked his head back and contorted his face. “Ahhhh! Nooooo!” He covered his nose and mouth with his hands.

“No, Conner. You don’t have to do that,” Dr. O’Rourke reassured him. “This one’s a good smell. Can you tell me what it is?”

Cautiously, Conner bent forward and took another sniff. Before he could answer, Dr. O’Rourke repeated, “Can you smell that?”

“Yes.”

He tested the other nostril.

“It’s good,” Conner pressed. “Is it gum?”

The neurologist turned around and held the vial under my nose. I sniffed. “It smells like something, uh…is it, uh, some spice? No. Cloves! It’s cloves.”

“Right! That’s what it is.” Then he placed it under Sam’s nose.

“Yeah. It smells good. You’re right, son. It did smell like chewing gum.”

The neurologist replaced the cap and placed the vial back on the shelf. Then he picked up a handheld eye chart. Conner tested twenty-twenty in each eye.

“Good job. Now, keep your right eye closed and look into my eye.”

The doctor stood three feet in front of Conner. Dr. O’Rourke closed his own left eye and pointed to his open right eye. “Keep looking right here in my eye,” he instructed. The neurologist stretched out both of his hands to the sides. “Look only into my eye, Conner. I want to out find how well you can see out of all of the corners of your left eye.” Dr. O’Rourke wiggled a finger off to the side and had Conner say “now” when he saw the movement.

After the exam the doctor explained, “You did great, Conner! The fact that he sees my fingers move when they’re off to the sides means that the visual nerve tracts between Conner’s eyeballs and the visual cortex at the back of his brain are working well. All of that function takes up a lot of space in the brain. My finger-visual field-testing suggests that there are no hidden abnormalities where these pathways are. That’s very important.”

I sat back and shook my head. My mind churned with his explanation and trying to visualize what he was talking about. I had never seen a neurologist at work, and I was so proud of my Conner’s mature cooperation.

“He’s doing great, Sandra!” Sam whispered.

The neurologist switched off the overhead lights and lifted a cylindrical instrument off its perch on the wall behind Conner. “You’re doing very well. Now I am going to shine a light into your eyes so I can check the area where the retina and nerves are. Keep looking straight ahead and try not to move your eyes. Just stare at the X on that wall. Keep looking at it even if my head gets in the way.”

The doctor aimed a beam of light at Conner’s right pupil and moved within a couple inches from our son’s face. As Dr. O’Rourke peered through the instrument, he told us he could see where the optic nerve entered the back of Conner’s eye and the little veins pulsating around it. Then he examined the other eye. “There’s no abnormal pressure inside Conner’s head,” he announced and replaced the cylindrical device on its wall holder.

“That’s a relief,” I sighed. Sam and I looked at each other. We chuckled. Conner’s face had a quizzical expression, but he smiled, too.

During this neurological evaluation, I thought that Dr. O’Rourke had evolved from being just a medical specialist to now being a powerful member of our family. We were literally in his hands. He had the power to guide all of our futures. For this little while—and possibly for years to come—Conner would be his charge, too. I wondered how long he would be around and when he would retire.

The neurologist removed a small flashlight from his breast pocket and twisted the end to activate its bright white light. “Just keep looking at that X on the wall behind me, Conner,” he instructed.

Conner squeezed his eyelids closed and turned his head away. “That’s too bright! Ow! It hurts!”

“I know,” Dr. O’Rourke commiserated. “It’s very bright. Try not to close your eyes or move your head, though. This will take just a second.” He aimed the light at one pupil and then at the other. Then he swung the light quickly back and forth several times between Conner’s eyes. “Good. That’s all normal.”

“Doctor, I’d like to ask you…Everyone sees doctors shining lights into pupils on those medical shows. I have always wondered about that. They make it seem real important. What does it tell you?” Sam asked.

The neurologist turned to us as he replaced the switched-off light to his coat’s breast pocket. Conner watched Dr. O’Rourke with disinterest as Dr. O’Rourke started to speak. Conner looked at the wall and back at us and then back to his neurologist. Then he made little bubble- bursting popping sounds with his lips as he looked down at his swinging feet.

“The pupil normally gets smaller when a light shines into it. If it doesn’t constrict—if it doesn’t get smaller—we suspect that something’s wrong, but we need other information from the total neurological examination in order to isolate the problem. The pupil might not get smaller to light if there’s something wrong in the pupil itself or with the optic nerve and retina.

“Now, Conner, follow my finger with your eyes. Don’t move your head, just move your eyes.” The doctor moved his finger to the far right and then left, up, down and in toward the tip of Conner’s nose.

Conner’s eyes obediently followed the doctor’s finger. I put my hand over my mouth to hide my smirk when Conner looked cross-eyed at the tip of his nose. “Good. Okay, Conner. Now, smile real big and scrunch up your eyelids tight, like you have soap in them.” The doctor gently attempted to pry Conner’s eyelids apart, but he couldn’t. Next, he broke a wooden tongue depressor and touched different parts of our Conner’s face with its sharp point. “Does this sharpness feel the same all over?”

Conner nodded. “Uh-huh. It tickles, it doesn’t hurt.”

Then Dr. O’Rourke rubbed his fingers together near one of Conner’s ears and then the other. “Hear that?”

“Yeah.”

Dr. O’Rourke pulled out his pocket flashlight again. “Great. Now, open your mouth and say ‘Ahhhh.’” The doctor peered in. “Now, stick out your tongue and move it from side to side. Good! His throat and tongue muscles are moving normally, Mom and Dad.”

The doctor returned the flashlight to his breast pocket. “Okay, lift up your arms and hold them out straight in front of you. Good. Now, close your eyes and keep your arms right there. Don’t move.” Dr. O’Rourke stood still and watched Conner’s hands for about five seconds. “I’m looking for downward drifting of either arm, which could indicate a subtle weakness. There is none. Conner’s fine.”

Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a mother’s dramatic story that teaches epilepsy, now available in eBook, audiobook and soft cover editions.