Tony: An Internist with Epilepsy

 

In September 1984, Tony was a pre-medical student anxiously awaiting the day he would begin medical school at Georgetown University.  While driving along a congested I-95 along the East Coast, the car immediately ahead swerved and crashed into the median while four lanes of traffic eked onward.  Tony, already equipped with the “helper” mindset that he would hone in medical school, stopped his car and ran to help.  The woman in the driver’s seat of the damaged car was suffering from a generalized tonic-clonic, or grand mal, seizure.

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Tony did his best to ensure the driver’s safety while he waited for emergency personnel to arrive.  Although he didn’t know it at the time, Tony’s first patient was suffering from the same illness that would plague him many years later.

Tony’s life preceding and immediately after his first brush with epilepsy on Interstate 95 was relatively worry-free and picture-perfect.  He grew up in the suburbs of Washington D.C. and was an avid tennis player, skier, and straight-A student.  He attended an esteemed private high school and was quickly admitted to an Ivy League college to continue his education.  While in medical school at Georgetown, he met his wife. Together they moved to Michigan to complete their residency training.

Immediately after completing residency, Tony and his wife found jobs in their respective fields and settled into life in the upper Midwest.  Over the ensuing years, they welcomed three beautiful girls to their family.  Tony and his family remained active and carefree until early in the morning on a winter day in November 2006. Although he does not remember all of the details, Tony recalls waking in the middle of the night with his wife hovering over him and asking him repeatedly if he was OK.  There were also two policemen and paramedics in the room, along with a neighbor sitting next to his bed and watching with concern.

Although Tony’s confusion was profound after his first generalized seizure, by the time he was transferred into the ambulance he had reassumed the physician role and gave advice to the emergency personnel.  The ensuing hospitalization and diagnostic testing led to Tony’s diagnosis of “idiopathic epilepsy” and he began to take the antiepileptic drug Dilantin.

Tony dutifully took his medication for the following year and his seizures disappeared as quickly as they came.  When the medication was weaned one year later, Tony hoped that his experience with epilepsy was a thing of the past.  However, slowly but certainly, smaller, partial seizures marched back into Tony’s life.  He had one in front of a patient, another one month later, and soon he was waking monthly in the middle of the night in the midst of a seizure.

As epilepsy reestablished itself in Tony’s life, further testing revealed a small area of atrophy, or injury, to his left anterior temporal lobe.  Tony and his doctors estimated that the injury most likely occurred years previously when his brain bounced like a ping-pong ball inside his skull after a skiing accident or trauma playing soccer.  Once the atrophic area was identified as a source for Tony’s seizures, he began the arduous process of trying to find a way to stop them.

Tony is currently undergoing evaluation to see if he is a candidate for epilepsy surgery.  He is taking two antiepileptic medications but can list the series of medications that he has tried and failed as if he were reciting a grocery list.

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“Carbamazepine didn’t work and caused horrible constipation,” he said.  “I tried oxcarbamazepine for a few days, and felt like I was stoned without the fun.  Zonisamide didn’t work and caused numbness and tingling in my hands and my feet.”

Tony states that he is currently tolerating phenytoin and levetiracetam relatively well although is emotions are more raw than ever before.  “I don’t know if that’s a medication side effect or epilepsy itself,” he mused.  “Recently my daughters saw me cry for the first time in twenty years.” Tony notes that since his seizures have escalated, his grown daughters have visited more, been in contact more, and are acting increasingly protective of their father. Tony’s wife watches him diligently and protectively.  Moments of silence and contemplation or repetitive movements like scratching his nose now warrant questions from his loved ones about a possible seizure.

Through his experiences with seizures, hospitalizations, testing and medications, Tony finds what’s most frustrating about his epilepsy is how it has changed his perspective of himself.

“My disease conflicts with my inherent personality.  Epilepsy has an incredible ability to change how I feel about myself.”

Throughout his career, Tony has enjoyed tremendous success as a physician.  He has been promoted as a physician leader in his health care system.  He repeatedly achieves the highest quality metrics in the care of his patients.  Despite this, his epilepsy undermines his success and makes him fearful for the future.

“The pride in my profession is the brain and our mental ability. Epilepsy is all about how we can hurt our brains. Being a physician with seizures is kind of like telling a football player you can’t bench press anymore.  How do you teach that person who always been the caregiver and first in line to help suddenly say ‘I need help, I need a hug?’ It’s so hard to say that.”

Despite his setbacks and frustrations, Tony has learned to ask for help and accept his limitations.  He’s recently made the decision to decrease his clinic hours in order to reduce his stress levels.  A former marathoner and triathlete, Tony has also backed off on his training and endurance exercise in the past year.  While he’s made these changes reluctantly, Tony is willing to do whatever it takes.  Like so many of us living with epilepsy, he hopes to once again live without the constant worry of when the next seizure will occur.

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Meg: An RN with Epilepsy

When the neurosurgeon who performed Meg’s left temporal lobectomy was asked to describe what he saw at the start of her epilepsy surgery, he paused and explained through a undulating blue mask, “I’m looking at a bunch of yellow, contused brain slapped up against the skull that is a remnant from Meg’s previous injury.”

The surgeon’s exact description of Meg’s brain is easy to remember because portions of her surgery are available on tape and were visible for all of the Omaha metropolitan area to see.  Over the whir of a bone cutter and the staccato beep of a heart rate monitor, you can also hear the hushed buzz of the operating room staff working as the neurosurgeon comments on the findings in Meg’s injured brain.  Prior to surgery, Meg made the courageous decision to allow a local television station in Omaha, Nebraska tape portions of her pre-surgical evaluation and then parts of her epilepsy surgery to help raise awareness and inform others about epilepsy.  Even though she’s not awake, if you look closely during the video of the surgery, you can see a wisp of Meg’s dark brown hair peeking out bravely at the nape of her neck, as if her ebullient and bright personality could not be sequestered even in the confines of the most sterile and grave settings.

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Meg’s story began in the spring of her freshman year of high school, when she felt like she hadn’t a care in the world.  She was playing on the high school basketball team, had a great group of girlfriends, and had everything she hoped for.  Then one March afternoon, everything changed.  When an older girlfriend drove Meg and a group of friends home from school, the car collided with a tree on Meg’s side of the vehicle.  When Meg was being evaluated in the Emergency Room immediately after the car accident, she suffered a generalized tonic clonic seizure — the first of many to come.

Meg remained in a coma and on life-support for a week following her car accident.  When she finally awoke and studied her face in the mirror, all she noticed that was drastically different was big brown pieces of hair standing up at an odd angle on the left side of her head.  Meg’s mother gently explained that the physicians that treated her in the emergency department had to shave the left side of her head to monitor her intracranial pressure.  Meg was relieved that after a serious accident, all that had changed was her hair.  She didn’t know what was brewing inside.

Meg’s hospitalization after the car accident and traumatic brain injury was followed by a longer stay at a local rehabilitation center where she concentrated on physical therapy, occupational therapy, and speech therapy.  Because Meg’s brain injury was in her left temporal lobe, she had particular difficulty with short term memory and speech.  Meg states that ever since her accident, she’s had difficulty finding the right words during conversations and naming objects that used to seem commonplace.

Despite her major accident and injury, Meg returned to high school with her class in the fall of her sophomore year after a period of rehabilitation with determination and confidence.  Meg wasn’t able to participate in her beloved basketball any more — the risk of further concussions or closed head injuries was too great — but she was pleased to be back amongst her peers.  As a result of her injury, Meg required extra time on her tests at school and some extra accommodations for learning, but she did well in her courses and achieved her dream of acceptance into a nursing school when she graduated from high school.

And because epilepsy is never predictable and tends to strike at the most inopportune times, Meg had her first complex partial seizure when she was standing in front of a class of nursing students giving a presentation about a pediatric nursing topic.

Meg wrote about her first complex partial seizure on the website http://www.myepilepsystory.org:  “. . .all of a sudden, out of nowhere, my heart began to race—not out of nervousness, but more like I was running from a train and couldn’t get away. I kept trying to swallow, but my mouth was too dry. I had prepared for this presentation, but the words I was planning to use just weren’t coming out.

“I tried to take some deep breaths to relieve what I thought was nerves, but I couldn’t even gather the breaths. The scariest part was knowing how important it was to make eye contact with the entire audience during a presentation, but for 15 seconds I felt paralyzed and blankly stared, unable to look away from one side of the room. After what seemed like forever, I regained my composure and was able to finish the last minute or so of my presentation”

When the event was over, Meg was able to complete her presentation.  A nursing instructor who saw the event, however, approached Meg later and suggested that she see a neurologist.  Soon Meg was started on her first antiepileptic drug which eventually led to another, and another, and then a different one.  Meg tried a total of four anti epileptic drugs at their maximum doses prior to her decision to have surgery.  As her stress at school increased, her seizure frequency increased as well.  Though Meg was passionate about becoming an RN, she had to slow down in the pace of her studies because the medications to treat her seizures were affecting her memory and concentration.  With hard work, true grit, and true devotion to her chosen profession, Meg graduated as an RN one year behind the class that she started with, yet lightyears ahead of the grips of epilepsy.

After graduating from nursing school, Meg worked as a pediatric nurse in an outpatient clinic and then as a school nurse in an elementary school.  Though she loved interacting with children, Meg eventually moved from areas of direct patient care to phone triage because of her worsening breakthrough seizures.

Several years after graduating from nursing school, Meg became pregnant.  Despite taking escalating doses of antiepileptic drugs during her pregnancy, she delivered a perfect baby boy, who is now three years old.   The significant hormonal changes that characterized the period after Meg’s pregnancy caused Meg’s epilepsy to spin out of control.  Her seizure frequency increased, several more medications were unsuccessful and she was determined to be a candidate for a left temporal lobectomy.  When the local news approached Meg and asked if she would be willing to participate in a series of feature news stories following her through the surgical experience, she agreed.  Although she was nervous to allow cameras and the public to view her at her most vulnerable, she thought it was an important way to tell part of the real story of epilepsy to the general public.

Meg in the hospital prior to her epilepsy surgery

Meg in the hospital prior to her epilepsy surgery

Meg’s surgery has proven successful.  She will celebrate the two year anniversary of freedom from seizures this April.  Meg still takes high doses of three antiepileptic medications but the constant dizziness that she assumed was a medication side-effect prior to surgery is gone.  Meg is now also working as a nurse case manager for at-risk mothers in the Omaha area to teach infant care and help with the newborn transition.

In addition to doing her part to raise awareness about epilepsy, Meg hopes to help others that are experiencing seizures cope with their illness.  To do this, she started Camp YouCan, a summer camp for children with epilepsy in Nebraska.  Camp YouCan is a day camp where kids with epilepsy can come together to play and learn about how to cope with their illness.  Meg was able to coordinate donations from local organizations and businesses so that 24 children could attend last year and she is planning for a bigger camp with an overnight event this summer.

From a fateful afternoon car ride to a news story that touches thousands and a camp that can impact a child’s life forever, Meg has turned her tragedy into a multitude of triumphs.  The links to videos of Meg’s epilepsy surgery are attached below  — you may want to grab a kleenex.

Please pass it on.

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Meg with her parents

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Meg and her husband

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Meg gives a “thumbs up” while wired for an EEG

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Meg at Camp YouCan, a camp she founded to help children with epilepsy

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Lisa

Lisa sits across from me in a crowded coffee shop and speaks in a combination of hushed and muted tones as she recounts her story of living with epilepsy.  Her bright blue eyes are rimmed with emerald specks of green, the brightness of which belies the hordes of medication I know she takes every day.  There’s a single man sitting close by, laptop open, who seems to study us in a pirate-like one-eyed stare when Lisa mentions “grand mal seizure” or “brain surgery.”  He seems to be searching for the image he would expect to accompany those words — instead of two thirtysomething women on a Sunday evening.

Lisa’s epilepsy story began in 1977 in the idyllic village of Wonewoc, Wisconsin, population 834, set in the unglaciated region of northwestern Wisconsin 30 minutes west of Wisconsin Dells on State Hwy 33.  Lisa’s first seizure began when she had a high fever and a viral illness as a small toddler.  Her parents tried desperately to cool their quaking child by struggling to put cool washcloths on her while her limbs twitched and placed her in a cool bath as the seizure continued.  Because the local hospital was not equipped to care for critically ill children, a still-seizing Lisa was transported via ambulance over country roads to Madison to seek medical care.  By the time her seizure abated, she had a temporary right sided paralysis and a permanent change deep in her brain that would last a lifetime.

Lisa doesn’t remember her first seizure, but she remembers receiving anti-epileptic medication in sugar-sweetened water every day until she was five.  She recognizes the fear in her parent’s faces as they recount the story of her first febrile seizure.  And she can remember stark details of the day when her seizures came back.

UW – LaCrosse seemed like the perfect place for Lisa to go to college.  It was a well-renowned university, a reasonable distance from home, and had a fantastic art program, which was Lisa’s chosen major.  Early in her college career, Lisa remembers waking up, almost in a trance, as EMTs and her boyfriend were talking to her. She had heard a sudden crack which she later realized this was the sound of her head hitting the bed frame as she succumbed to a grand mal seizure. Later that same day in the hospital, she had a hard time recognizing her first visitor, her mother, but as her memory returned she also began to understand that the unusual “episodes” that she’d been having throughout her childhood and early adulthood were actually complex partial seizures.

Even as Lisa’s health history was starting to make sense, her seizures were spiraling out of control.  Not too long after her first seizure, Lisa had a grand mal seizure in her residence hall at college.  Unaware of her seizure history and uneducated about epilepsy, the residence hall personnel assumed that Lisa had used drugs.  Lisa was strapped to a metal chair and “questioned” in her unconscious state until her friend found her, rescued her, and brought her to medical care.

Shortly after her seizures returned, Lisa was re-started on anti-epileptic medication.  Although she had improving control of seizures, she noticed extreme fatigue and significant difficulty focusing on her school work.  Her art work suffered enough that she had to change majors.  Lisa became a graphic design major at UW-Stout and hoped that starting over at a new campus may give her a reprieve from epilepsy as well.

Lisa continued to have a combination of complex partial and intermittent grand mal seizures.  She has tried a variety of medication combinations, each with their own list of side effects and benefits.  In 2010, she had surgery to remove the portion of her left temporal lobe that was the focus of her seizures.  In Lisa’s words, “I haven’t had any big seizures since the surgery, but I have a ton more auras so I’m on more medication than before.  I don’t know which is worse.”

Despite her obstacles, Lisa is now working successfully part-time as a graphic design artist and has learned how to predict the patterns when her seizures are most likely to appear.  She has learned how to live with epilepsy, but still feels the stigma from coworkers, employers, and friends who don’t understand the disease.  Lisa recounts a time when she had a seizure in on the way to a choir concert while she and other choir members were crowded into a taxi.  After she woke up in the hospital from her grand mal seizure, none of the choir members treated her the same again.

Lisa is excited to join our efforts to raise awareness and decrease the stigma associated with epilepsy. Even our friend in the coffee shop was searching to understand how his misconceptions could align with the normal-appearing women sitting 2 feet from his table.  The more we talk, the more we understand.  Please pass it on.