Wednesday, May 11, 2011

Understanding the Brain as Well as the Heart!

As we envision the hospital of the future and the service lines that will be offered in the acute setting, it is important to recall a prediction in a prior blog that "in five to eight years we will know as much about the brain as we know today about the heart". The outstanding preventive care, as well as, treatment plans that we can now offer cardiac patients is astounding and, as a result, cardic disease will soon fall behind cancer as the number one killer in the US, quickly followed by trauma., which is catching up fast (see prior blogs on this topic). It is important to note that all this advanced care for the heart, including the training of paramedics, the development of mobile ICU's , the staffing of cardiac care units, and the development of coronary artery stents occurred in the last 25 to 30 years. And now heart bumps to supplement failing heart muscle are becoming common place. All of this proves, that with focus, much progress can be made in a relatively short period of time.
Using that as a predictor of the future, I am comfortable that we are making rapid discoveries surrounding brain diseases and therefore, we are approaching the time we will know how to treat and even prevent significant brain abnormalities such as alzheimer's,  parkinson's, and other chronic dementia abnormalities. We have all ready seen significant advances in stroke prevention, as well as stroke reabilitation. The preventive measures are now being spread to small community hospitals through neurological telemedicine programs, where neuro specialists, both doctors and nurses, are available 24 hours a day to observe patients in any Emergency Department with the video equipment, guiding the local staff through the appropriate treatment plans. Numerous bairn tumors, including metastatic ones, are sucessfully remorved with stereotactic and cyber-knife techniques.
In addition to all of this great progress, we are now reading about potential treatments for parkinson disease patients using techniques to deliever drugs directly to the brain, which has been difficult in the past due to the
blood-brain barrier which inhibits normal drugs from developing high concentrations in the fluid surrounding the brain and the spinal cord. These treatments will use drug  pumps and catherters, which will require insertion in ambulatory surgery centers or in the inpatient setting for a 1 or 2 day stay. We all ready have successful treatments for some parkinson patients who have benefited from implanted electrodes that provides electric stimulations to parts of the brain that control the disease process.
How will all of this effect the healthcare industry? Some of the beds now empty in the inpatient settings because of ability to care for many patients totally in the outpatient setting will start to be filled with patients getting new therapies for brain disorders. "Brain Centers", encompassing a wide variety of treatments, some curative,  for a large number of now untreatable brain abnormalities will spring up across the country, much like the national cancer center movement we are now seeing. Locked units for dimential patients will have to change and perhaps will no longer be needed. Wouldn't that be wonderful.
We learned alot about the heart in a short period of time. We had to because of the number of people who were affected by cardiac disease. As we are successfully treating many heart patients helping them to leave more healthy lives and as the population continues to age, abnormalities of the brain are moving to the forefront. As it was the "heart's time" 25 years ago, it is now the "brain's time". Sit back and watch as we learn as much about the brain as we know about the heart!

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