Strange, Weird & Bizarre Medical Cases & Facts

What do Gottlieb Burckhardt, Egas Moniz, and Walter Freeman have in common?  Other than the fact that I had never heard of them before researching this topic, it turns out that they were all dudes who lobotomized their patients.

photo by OpenSkyMedia

A lobotomy is a brain surgery that cuts the connectors between the front bits and the back bits of the brain.  European doctors started performing the procedure on mental patients in the early 20th century, along with other radical therapies for extreme mental illness and insanity.  Other procedures included electroshock (or electroconvulsive) therapy, drug-induced deep sleep therapy, and more.

I am not, by any means, denouncing the entire psychiatric community for coming up with risky, damaging, and invasive radical treatments to try out on helpless mental patients.  Nope.  Not me.  Anyway…

Gottlieb Burckhardt was a psychiatrist in the late 1800′s and he performed lobotomies on six patients with varied diagnoses.  Two of the patients simply became more subdued, one died shortly after surgery, two were unaffected altogether, and one seemed to improve but then later committed suicide.

Egas Moniz was a Portuguese neurologist changed the surgery a bit – he drilled holes into the heads and injected alcohol to kill the frontal lobes.  I guess that didn’t work, because he came up with a tool called a leucotome that was really just a wire loop that scrambled stuff around in the patient’s heads.  This work, which took place in the mid-thirties, had better success rates than one would expect, earned Moniz the 1949 Nobel Prize for medicine.

Walter Freeman studied Moniz’s work and along with a guy named James Watts altered the practice and created their own procedure.  Called the Freeman-Watts procedure, they would drill into the scalp, and then later would go in through the eye socket.

1949 was the big year for lobotomies, with more than 18608 lobotomies taking place in the United States by 1951.  JFK’s sister had a lobotomy when she was 23 and she was never OK after that.  Same with Tennessee Williams’ sister Rose.  Other people, like Howard Dully and Alys Robi turned out just fine, but at the same time lots of people died.

That’s probably why they don’t do them anymore.

Understanding Staging Lung Cancer

Staging is the process by which once lung cancer is confirmed, the degree to which the cancer has established itself and how it presents in a patient is categorized.  This is essential if an appropriate and effective treatment regime is to be recommended and implemented in a lung cancer patient.
Staging is frequently referred to as “TNM” by oncologists (cancer specialists).

TNM refers to the three main factors used in staging:

•    Primary Tumor (T) – whether there is a tumor or tumors which can be established;
•    Lymph Nodes (N) – whether the cancer has occurred in the lymph nodes; and
•    Metastasis (M) – whether the cancer has spread to or from other parts of the body.

Each of these factors is further assessed to provide more detailed clarification.  For instance, where a tumor cannot be located but it is confirmed by the presence of cancer cells, the assessment will be TX.
A detailed explanation follows:

Primary Tumor (T)
TX – no tumor is located but is confirmed by presence of cancer cells
T0 – no evidence of a primary tumor

T1 – primary tumor of less than 3cm and not in the main bronchus
T2 – primary tumor which is any of the following:

•    Larger than 3cm
•    Is present in the main bronchus or other important parts of the lung

T3 – primary tumor of any size invading surrounding tissue or chest wall
T4 – as T3 but affecting the heart, trachea, great blood vessels – more serious than a T3 tumor
Regional Lymph Nodes (N)

Lymph nodes are small, bean shaped objects which are reservoirs of immune cells and materials vital to protect the body.  Regional lymph nodes refers to those lymph nodes in the surrounding vicinity of the lungs.
NX – no assessment

N0 – no regional lymph node metastasis (i.e. the lung cancer has not spread to the lymph nodes)

N1, N2 and N3 – metastasis has occurred to increasing severity

Distant Metastasis (M)

Metastasis refers to the spreading of the cancer to or from other parts of the body.  This is important because primary cancer (i.e. cancer which has originated at that location in the lung) is susceptible to treatment by surgery whereas metastasized lung cancer usually is not).

MX – no assessment of distant metastasis
M0 – no distant metastasis has occurred

M1 – distant metastasis has occurred and includes separate tumor(s) in other parts of the lung or body
Allocation of a Stage

After assessment of the tumor, lymph nodes and metastases, a stage is allocated which depends on the findings of how many tumors, where they are located and how they have spread?

The stages are allocated as follows:

Occult carcinoma – TX, NO, MO – cancer is present because of the presence of cancer cells but it cannot be located or assessed.  This is not allocated a distinct stage but is classed as an “unknown” or medical wildcard.

Stage 0 – any Tumor, N0 and M0
Stage IA – T1, N0, M0
Stage IB – T2, N0, M0
Stage IIA – T1, N1, M0
Stage IIB – T2, N1, M0 or T3, N0, M0
Stage IIIA – T1-T2, N2, M0 or T3, N1-N2, M0
Stage IIIB – Any T, N3, M0 or T4, any N, M0
Stage IV – Any T, Any N, M1

This is obviously a complicated exercise which may require repeated visits to the hospital and your doctor, but it is vital to effective treatment that this staging process is properly conducted.  How well staging is conducted has a direct bearing on survival rates of patients with lung cancer.

While the independence of driving can be important for senior citizens, it should never outweigh the importance of safety. As people age their bodies begin changing in ways that can affect an individual’s ability to drive. These changes can be slow or sudden and in either case should be taken very seriously. Ignoring these signs increases the chances of automobile accidents which could result in serious injury or death to the driver and others on the road.

Because the aging process affects people in vastly different ways and at different ages, each individual should examine their own ability to drive rather than use their peers as comparison. Changes in health do not mean you have to stop driving, but you should evaluate your skills and change your driving habits as necessary.

Have your hearing and eyesight checked every year. Changes in eyesight and hearing can have a huge effect on driving ability. Peripheral vision or seeing well while driving at night can be affected by certain eye conditions. As you age you may notice an increase in sensitivity to lights or a decrease in depth perception; both of which could be a detriment to driving ability. Hearing loss can interfere with driving as well. Being able to hear the noises of traffic, honking cars, and the approach of emergency vehicles is crucial to being a safe driver.

Changes in medication can affect a person’s driving ability at any age. Prescriptions and medications can affect a person’s reflexes and senses. Make sure you talk to your healthcare provider about the side effects of any medicine you will be taking and how it could affect your driving ability. Also check labels on any new medication, see how the medicine affects you and look for any side effects that may affect your driving.

Aging drivers may find that their response time is slowing. It may be time to change your driving habits if your reflexes have slowed or you find yourself becoming flustered behind the wheel. Split second decision making and quick responses to other cars is crucial to safe driving. Being able to brake suddenly and make quick lane changes is also a necessary skill.

Understanding personal limitations and how they affect your driving ability will help assure that everyone on the road is safe. While age and changes in health don’t necessarily mean one must stop driving, they do require awareness and evaluation and could mean it is necessary to change your driving activity.

About the Author: Paul Christopher Guedri is a personal injury lawyer with The Allen Law Firm. He works at the Richmond office at Allen & Allen but handles cases all over the commonwealth. He has focused his legal career in helping injured victims primarily in tractor trailer and trucking accidents, car accidents, bus accidents, product liability and wrongful death. He is a very successful lawyer and has been in the book Best Lawyers in America for the past 17 years.

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