Berkeley NSLC Medicine and Healthcare Camp Part 2

Part 2 of the NSLC Camp about lessons taught by Dr. Parsioon and the visit to the Berkeley School of Optometry

From July 25th to August 2nd, I was at UC Berkeley for the NSLC Medicine and Healthcare Camp. It was an exhilarating while also an educational experience where I learned so much in such little time with the help of great lecturers and team advisors who helped facilitate this program. This post is the second part of a two-part series covering the highlights of this camp.

Dr. P

Dr. Fereidoon Parsioon is a neurosurgeon from Tennessee along with one of the most impressive men I have ever met. He was born in Iran and received his medical degree there. Since his family was against the government, he was forced to join the tank unit stationed at the very front of the war between Iran and Iraq. Out of the 250 people that were in that unit, only 5 of the original 250 were alive at the end of 2 years. Dr. Parsioon told us that after facing life and death at every point during that war, he is no longer scared of anything. He escaped Iran with his family under extremely difficult circumstances, coming to the US and seeking political asylum. It took him some time to become licensed to be a neurosurgeon with one residency program director giving him a 0.5% chance of actually becoming one. Despite the odds, he became a well-respected neurosurgeon and now is the chairman of a hospital in Memphis. In addition to medicine, he always wanted to be a police officer, so he went and became one, patrolling in the night in nearby Arkansas. Thus, he gets only three hours of sleep each night, yet he is able to function and even flourish on that. Thankfully, he has a love for teaching and came to talk to us.

Craniotomy

The brain is the most important organ in the body because a patient can die within minutes if there is a loss of function in the brain, so time is of the essence. In order to get to the brain, a neurosurgeon must go through multiple layers. First, they must shave all the hair and make an incision on the scalp. After that, they make burr holes through the skull and subsequently remove the bone by connecting the burr holes. Then, the neurosurgeon makes an opening in the membrane surrounding the brain called dura to finally reach the brain. At this camp, we were able to drill burr holes into a fetal pig’s skull and subsequently remove the bone to expose the dura.

Craniotomy

Neurosurgeon Performing a Craniotomy

Hydrocephalus

Hydrocephalus is the buildup of pressure in the brain due to there being too much spinal fluid. Normal adults make 0.5 L of spinal fluid and lose 0.5 L of spinal fluid each day; if they lose less than that, the pressure is bound to increase. Normal brain pressure is 15 mm Hg, and if pressure is higher than that, then symptoms of headaches, paralysis, and loss of vision may occur. Increased intracranial pressure can be life-threatening because, as mentioned before, the brain is confined in a solid structure. The pressure pushes everything back toward the foramen magnum, which is a hole in the skull that connects the brain to the spinal cord via the brainstem. When the brain is pushed back against the skull, then control centers in the brainstem that are in charge of vital functions like respiration can be damaged leading to death; this is known as brain herniation. One common sign that a patient is having brain herniation is differing pupil dilation. Neurosurgeons normally relieve the pressure by performing craniotomies and inserting a temporary extraventricular drain (EVD) or a longer-lasting ventriculoperitoneal (VP) shunt to remove the spinal fluid. A VP shunt takes the fluid from the brain to another area of the body like the abdomen where the fluid is absorbed and goes out the kidneys as urine. Neurosurgeons can also just check the pressure using an intracranial pressure monitor (ICP monitor) into the skull. At this camp, we did a simulation of inserting the ICP monitor on a plastic skull by drilling a hole, inserting the bolt into the skull, and then by inserting the monitor.

Aneurysms

An aneurysm is an abnormal ballooning of an artery that happens because of a weakness in the wall of the artery. 95% of brain aneurysms (in the carotid or vertebral arteries) are congenital, meaning that people are born with it, but we do not know that they have it since the only way to find out if they do is to do an MRI for everyone, which is not financially possible. Often, they are only discovered after the aneurysm ruptures and brain hemorrhaging occurs (blood gushes into the brain), which can be life threatening. You can check for hemorrhage with a noncontrast CT brain scan. However, to diagnose an aneurysm, CT or MRI scan is performed with contrast dye given via a vein which makes the arteries fill with bright contrast to define the size and location of the aneurysm. The neurosurgeons can subsequently perform an angiogram and place a catheter up the femoral artery to treat the aneurysm by filling up the cavity with coils. If an aneurysm cannot be treated in this manner, the neurosurgeon would have to perform a craniotomy and place a metal clip across the neck of the aneurysm so that no blood will flow into it, diminishing the chance that it ruptures.

aneurysm clipped

Successfully Clipped Aneurysm

Berkeley Optometry

We went to the Optometry School at UC Berkeley where three students, Tiffany, Justin, and Jess, talked to us about different ocular diseases that they diagnose along with what an optometrist does.

Role of Optometrist

An optometrist does more than simply eye check-ups. They diagnose ocular diseases such as ones regarding damage to the retina that causes central/peripheral vision loss. Moreover, they can also be a part of low-vision rehabilitation and provide pre and post-operative care. They can even diagnose diabetes or hypertension before other noticeable symptoms pop up by looking at the retina in the back of the eye. Optometrists are needed in every part of the country, and they have the flexibility of being self-employed or being an employee.

eye diagram

Diagram of the Eye

Checking Pupil Constriction/Dilation and Eye Dominance

An optometrist can check for pupil constriction by shining a light in your eyes and seeing the pupils constrict (become smaller). Also, by removing the light, the pupils should dilate to their normal size. If the eyes do not respond to light, then it means there is a problem with the eye that warrants a visit to an ophthalmologist. You can check eye dominance by putting your hands in a triangle with a distant object in the center. Then, you close each eye individually. If you close the right eye and the object still stays inside the triangle, then the left eye is dominant. If you close the left eye and the object still stays inside the triangle, then the right eye is dominant.

Eye dominance.jpeg

Eye Dominance Test

Strabismus and Amblyopia

Strabismus is when the eyes are misaligned, so they do not look in the same direction. Sometimes, the patient will have double vision because the brain cannot successfully put the images each eye sees together into one. Amblyopia is a subtype of strabismus. It is commonly known as having a “lazy eye” and it occurs when one eye points in a different direction because the brain has difficulty putting the images together, so the brain ignores that eye.

Strabismus.jpg

Patient with Strabismus

Myopia and Hyperopia

Myopia is when close things are clear while distant things are blurry (nearsightedness) because the focal point is a little before the retina. Some reasons why myopia occurs is because the cornea is too steep, the lens is too powerful, or the eyeball is too long. Hyperopia is when near things are blurry while distant things are clear (farsightedness) because the focal point is a little after the retina. Some reasons why hyperopia occurs is because the cornea is too flat, the lens is not powerful enough, or the eyeball is too short.

Hyperopia-Myopia.gif

Hyperopia/Myopia along with Correction

Cataracts and Glaucoma

Cataracts are the hardening or calcification of the lens of the eye, and they are normally caused by UV rays hitting the eye. This is why it is advised to wear sunglasses when looking at the sun or going outside in general. They are normally taken out by ophthalmologists, but optometrists diagnose and monitor the patient afterward. Glaucoma happens due to damage of the optic nerve (goes from the eye to the brain) because of increased pressure in the eye. It starts by decreasing peripheral vision and causes tunnel vision in advanced stages, which makes walking around and seeing what’s around the patient hard. You can simulate advanced glaucoma by covering one eye and placing putting a hand like a tunnel with a small opening around the other eye.

glaucoma.png

Normal Eye vs. Eye with Glaucoma

 

References

Allen, Steve. Hydrocephalus (Enlarged Skull). Merck Manual, merckmanuals.com/professional/pediatrics/congenital-neurologic-anomalies/hydrocephalus. Accessed 5 Aug. 2017.

Clipped Aneurysm. Washington University School of Medicine in St. Louis, neurosurgery.wustl.edu/patient-care/specialties/aneurysm-cerebrovascular/aneurysm-169. Accessed 5 Aug. 2017.

Cooper, Jeffrey, and Rachel Cooper. “What Is Strabismus?” Optometrists Network, 2016, strabismus.org/what_causes_strabismus.html. Accessed 5 Aug. 2017.

Craniotomy. Wikipedia, en.wikipedia.org/wiki/Craniotomy. Accessed 5 Aug. 2017.

Glaucoma. Florida Eye Specialists & Cataract Institute, brandoneye.com/our-services/surgical-eye-care/glaucoma-surgery/. Accessed 5 Aug. 2017.

Human Eye Diagram. Science Kids, sciencekids.co.nz/pictures/humanbody/eyediagram.html. Accessed 5 Aug. 2017.

Hyperopia and Myopia. Family Eyecare, familyeyecare.co.uk/eyecare-extra/myopia-and-hyperopia/. Accessed 5 Aug. 2017.

Left Eye and Right Eye Dominant. Best Bow Shop, bestbowshop.net/eye-dominance/. Accessed 5 Aug. 2017.

Marazzi. Strabismus (Esotropia). Merck Manual, merckmanuals.com/home/children-s-health-issues/eye-disorders-in-children/strabismus. Accessed 5 Aug. 2017.

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