Dr. Mary Zupanc
Appearances
Nobody Should Believe Me
S05 Ep06: Human Timebomb
I wouldn't call it terminal. I think it's debilitating, certainly, with the advancements in our technology and maybe our ability. You know, there are things that could happen, like gene therapy, targeted drug therapy, that could be transformative. But even with, let's say, our current status, where we're going to treat the seizures, we're
Nobody Should Believe Me
S05 Ep06: Human Timebomb
I would call it more of a lifelong condition that with appropriate and attentive care to treatment can be manageable, not curative, not by any means curative.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Oh, we try to avoid that. No, I have not. There's so many advances now in gastrointestinal motility where you can promote motility. TPN carries a whole range of complications. I mean, that's not a long-term solution. They're important. That's why we were meant to eat and digest our food is that we haven't figured out through what I call hyperalimentation, IV treatment.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
fluids and liquids and lipids how to properly nourish an adult long term and so gastroenterologists work very closely if there is a gi problem to try to offer what we call enteral gi um feeds because the gut manages it much better than we do artificially through IVs.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
That would be unusual, particularly if the parent, usually there are well-described precipitate triggers, particularly if they tried to precipitate one of these episodes. If there is a question of the episodes, they could have done video EEG monitoring or careful surveillance because people come in and out of a room immediately.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
If it was alternating... If it was AHC. If it was AHC. Highly unlikely. Okay. It should show slowing. Most studies that have captured that... Well, if it was an epileptic seizure, you'd see the seizure. If it's an episode of hemiplegia or one side of the body is...
Nobody Should Believe Me
S05 Ep06: Human Timebomb
paralyzed, almost invariably in the contralateral, you know, if it's right-sided weakness, the left side of the brain should show slowing, and it should be pretty obvious.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
I get suspicious when a child has multiple symptoms and no specific diagnosis, and those symptoms change over time, and nobody's been able to demonstrate a specific diagnosis, nor does my exam confirm any abnormalities on the exam that are consistent. You can't take just one little abnormal diagnostic test without looking at the entire clinical picture. and family.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
You just can't because you will miss the forest for the trees. And some physicians get so fixated on this one little abnormality that they do. They miss the forest for the trees. You have to be kind of an artist, look back, stand back. What does this
Nobody Should Believe Me
S05 Ep06: Human Timebomb
entire picture look like as opposed to that one tree standing in the corner is it labor intensive to get all those details yes it is but that's to me that's what the art of medicine that's where you have to really dig a little bit deeper and then it becomes perfectly clear
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Yeah, it's more the swallowing. It's not really the digestion with these episodes. Got it. Because the vagus nerve is in the brainstem. So there is a brain-gut interaction. So if the brainstem is affected and you're having difficulty swallowing, the vagus nerve can be affected. And that vagus nerve could slow down the heart rate, autonomic symptoms. They can slow down the heart rate.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
They can slow down gut transmobility. And so, yes, you can have vomiting as well.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
No, I have not. And I've rarely seen, honestly, I've seen episodes that last for a day or two, but I've not personally. I've read about it in the literature. I don't think they comment on how frequently that happens. It just says the episodes can last greater than 24 hours, up to three weeks in duration. were reported for 38% of subjects, let's say that, of patients.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
32 days. I think that would be reportable, quite frankly. Yeah.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Oh, I would. I would personally. Yes. Because I'd want to make sure that, you know, these children can have what I call comorbidities. Let's make sure there's not ongoing seizures. Let's make sure that there isn't vasospasm. That means where the blood vessels are constricting. Let's make sure there's not something else going on. I would want to have that child be hospitalized.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Furthermore, for 32 days, that child would have had to have slept. And when the child wakes up for 10 to 20 minutes or longer, they should be pretty much back to normal. So if it's just continuous and invariable, that would make me question. I'd want to get more details about that mystery.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
Well, that would raise a lot of red flags to me. Particularly because, let's take an example of a parent... A grandmother or grandfather would occasionally take care of that child or a daycare center or other observer. These episodes are noticeable.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
They're not so subtle that nobody else would notice, particularly because I would presume the parent or care provider would say or caregiver would say, you know, Johnny has these episodes and just keep a log. Like oftentimes parents or caregivers will say, we've kept a log of these episodes and we always have our babysitter or daycare provider
Nobody Should Believe Me
S05 Ep06: Human Timebomb
or grandma or grandpa write down when the episodes occur. They're not typically subtle, particularly if they're happening frequently. And you'd want to characterize, were they alert and conscious? Could you get them to smile? Did they have difficulty breathing or heart rate? I'd be hard-pressed to wonder if that was really totally and completely true.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
that's what you need to do to figure out is this something that the parent is just worried about and exaggerating because they're worried and they're afraid nobody's going to believe them you know that's plausible or is this something that is really a fabrication and and then That's where I've done my deepest dives is I'll call the daycare provider.
Nobody Should Believe Me
S05 Ep06: Human Timebomb
I'll call grandma, grandpa, babysitters, extended relatives, because all of those are caregivers for that particular child. Normally, a single parent can't. Well, particularly a single parent. I personally can't imagine having had four daughters. I can't imagine raising them without a partner.