Taking a Moment to Appreciate How Far We ’ ve Come
by GEETA GANESH , MD , MPH
Most neurologists would agree that the history is the most important part of the neurological assessment . It guides the exam and determines the list of possible diagnoses . While some might find obtaining a history to be tedious , I enjoy the process . It ’ s actually my favorite part of a clinic day . Sometimes , a patient ’ s history can provide a window into medicine ’ s past .
It ’ s not always easy to obtain an accurate history . When you ’ ve had a disease that spans years , seen many physicians and undergone multiple evaluations , summarizing your history for a new doctor can be difficult . My new patient with multiple sclerosis was in his late 70s . I could tell I had asked him a question he wasn ’ t expecting .
“ Can you tell me how you were diagnosed with MS and what your first symptoms were ?”
“ You want me to go that far back ? That ’ s a tough question ,” he sighed and closed his eyes . “ I lost vision in one eye . I can ’ t even remember which one . It was some time in the 1970s . It got better after a few weeks . About six months later , my right leg was paralyzed . Back then , there were no MRIs . I didn ’ t have my first MRI until the 80s or 90s . Can you believe it ?”
I nodded , accepting his timeline . The first MRI scan of a human brain was in 1978 . Commercial use of MRIs began in the 1980s , with some patients having to drive quite a distance to get one . Throughout the years , a few of my patients have claimed they were the first to get a brain MRI in Kentucky , but this is a piece of trivia that I ’ ve never been able to confirm . Who was the first person in Kentucky to have a brain MRI , where and when did it happen and why was it done ? These are facts that may seem small to some , but they ’ re significant to me . MRIs would forever change how neurologists diagnose multiple sclerosis , this terrible disease of the brain and spinal cord .
“ Can you tell me what MS medications you were on in the past ?”
“ There was nothing in the beginning . I would just go to the hospital and get an IV full of steroids .” He paused and held out his arm , as if a new IV was about to be placed . “ I can ’ t remember the name of the first medication , but I remember I was placed in a lottery to get it .”
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