Category Archives: Carrying The Black Bag: A Neurologist’s Bedside Tales

Dog Lessons on Living

Forty years of practicing medicine and having lived long enough to acquire some gray hair have allowed me to observe people dealing with illness and impending death. These challenging periods prove difficult for sure , but I believe our pets can help to cope with and even model helpful behaviors that benefit their owners. The mindfulness of the pet owner becomes necessary in order to learn these pet-assisted lessons.

At our house we’ve had two experiences that I wish to share that have brought me to this conclusion. Our Border collie, Buddy, unfortunately injured himself many years ago while leaping over a cattle guard. I found him shortly after the accident, dragging his paralyzed hind limbs. We were to learn that Buddy had ruptured a disc that had extruded into the spinal canal and traumatized his spinal cord. After evaluation, treatment, and rehabilitation Buddy slowly recovered. He now has the reasonable use of his hind legs and moves about without any assistance. For this we are incredibly grateful.

Buddy had always loved to run and herd cattle. His racing around the ranch with his tongue flapping deliriously and with a goofy look plastered across his muzzle has for me defined unbridled enjoyment. With time he has regained the ability to both run and herd, although not with quite the same proficiency as prior to his injury. Nevertheless, Buddy still loves to ride in the pickup, watch the cattle, and when needed to jump out of the bed of the pickup and do a stint of herding.

It strikes me that Buddy during his convalescence never gave up on himself, nor did he permanently abandon his valuable role as chief herder on the ranch. Despite lingering weakness, he continues to carry out his job with typical Border collie passion and enthusiasm. A job for a Border collie is vital. As the old saying goes, “If a Border collie doesn’t have a job, he’s liable to become self-employed.” Trust me, when this happens it’s never a good thing!

Buddy sleeps more now following his injury

Our second pet-assisted experience resulted with our Shetland Sheep dog (Sheltie), Taffy, and occurred years ago when we lived in Lubbock. Taffy’s favorite activity and what she most anticipated was her evening walk. She would become so excited when we presented her leash for our walk. Unfortunately Taffy eventually fell ill and was diagnosed as having cancer. While we knew the cancer would eventually take her, we were given the encouraging, if incorrect, prognosis by her vet that she had at least weeks if not months to live.  Despite Taffy not feeling well, she still agitated quite demonstrably at the end of each day for her walk.

Taffy during her healthier days

I distinctly remember her recruiting us that last night. Trudy and I dutifully leashed up Taffy and began a slow trek around our block. Taffy seemingly sniffed  every tree we encountered and observed the goings-on in the neighborhood with her eyes glistening with excitement. Unfortunately despite her wanting to, her energy gave out a third of the way around the block. She simply was unable to muster the strength necessary to walk any further.

On recognizing this I reached down to gather our sweet dog in my arms and then continued our walk around the block. Taffy gazed out from the crook of my arm and noted the happenings of her final trip around the neighborhood. Later that night she died peacefully in her bed. I like to think Taffy died  happy having made one more glorious trip around her block.

The thing is, Taffy continued to do what she most enjoyed despite her serious illness. Her willpower and determination continued despite her substantial depletion of energy. It seems to me that a broader and more personal message exists for pet owners much like the messages both Buddy and Taffy have given us.

I will continue discussing this topic in a subsequent post and plan to give a few human examples. These people-related corollaries will come from my book, Carrying The Black Bag.

Please share your thoughts as to what you may have learned from your pet regarding illness or impending death.

TO BE CONTINUED

 

Best New Debut Author for 2017

Recently received the very good news that my book, Carrying The Black Bag: A Neurologist’s Bedside Tales, won a national book award for 2017 from The Feathered Quill. This is a really big deal!

Will you please share this good news? The marketing/publicity from a regional publisher is limited and your help in networking my book would be much appreciated. Below is the news release for this award.

 

FOR IMMEDIATE RELEASE

Contact:                Maryglenn McCombs (615) 297-9875 maryglenn@maryglenn.com

 

TEXAS DOCTOR WINS NATIONAL AWARD FOR MEMOIR:

Carrying the Black Bag by Tom Hutton, M.D. among honorees in literary awards competition

 

LUBBOCK, Texas – Texas doctor Tom Hutton, M.D.’s memoir, Carrying the Black Bag: A Neurologist’s Bedside Tales has been named among the winners in the Feathered Quill Literary Awards.

 

Sponsored by Feathered Quill, a leading web-based book review, the Feathered Quill Literary Awards is a national awards program that celebrates excellence in publishing. Recognizing books from both large and independent presses, the Feathered Quill Literary Awards honors the best books in numerous categories.

 

Carrying the Black Bag: A Neurologist’s Bedside Tales, a memoir of Hutton’s career in medicine, was awarded the Bronze medal in the “Best Debut Author” category. Published by Texas Tech University Press, Carrying the Black Bag is available in hardcover edition (6 x 9, 257 pages; photographs; ISBN: 978-0-89672-954-4)

 

According to Ellen Feld, Editor at Feathered Quill “We were overwhelmed by both the number and extraordinary quality of entries for this year’s awards program. In particular, The Best Debut Author category was filled with worthy entries: consequently, it was difficult for our judges to pick among the many excellent contenders. Tom Hutton, M.D.’s memoir, Carrying the Black Bag was a real standout: compelling, well-written, and an incredibly beautiful and hopeful testament to the human spirit. It is our great honor to recognize Dr. Hutton among this year’s Best Debut Authors. We can only hope he has more books in the works.”

 

During his thirty-plus years of practicing in West Texas and Minnesota, physician and neurologist Tom Hutton discovered that a doctor’s best teachers are often his patients. From these (extra)ordinary individuals, Hutton gained a whole-hearted respect for the resourcefulness, courage, and resilience of the human spirit. Hutton’s patients—and the valuable lessons they taught—served as the inspiration for Carrying the Black Bag. Part memoir and part tribute to the patients who faced major illness with grace, grit, and dignity, Carrying the Black Bag invites readers to experience what it is like to be a doctor’s hands, eyes, and heart. Imagine the joy of witnessing a critically ill five-year-old who, against all odds, claws her way back from a coma and near certain death. Meet a lonely Texas widower with Parkinson’s disease who hosts elaborate pinochle parties for a pack of imaginary canines. Step into the surgical booties of the author when he attempts to deliver his own child amid heart-stopping obstetrical complications—during a paralyzing Minnesota blizzard. Through real-life patient narratives, Hutton shines light on ordinary people facing extraordinary challenges. Moreover, this captivating tale captures the drama of medicine—its mystery, pathos, heroism, sacrifice, and humor.

 

Tom Hutton, M. D., is an internationally-recognized clinical and research neurologist and educator. The past president of the Texas Neurological Society, Dr. Hutton served as professor and vice chairman of the Department of Medical and Surgical Neurology at the Texas Tech School of Medicine. He now lives on his cattle ranch near Fredericksburg, Texas. Visit Tom Hutton online at: https://jthomashutton.wordpress.com/

 

Members of the news media wishing to request additional information about Tom Hutton, M.D. or Carrying the Black Bag are kindly asked to contact Maryglenn McCombs by phone: (615) 297-9875 or email: maryglenn@maryglenn.com

###

 

Appearance on Alternative Talk Radio

What fun I had as a guest on KKNW 1150 AM, alternative talk radio for the hour long program “Sunny In Seattle“. Sunny Joy McMillan hosts this wonderful program and asked insightful and probing questions about my book, Carrying The Black Bag: A Neurologist’s Bedside Tales.  We also had well-informed callers who  provided thoughtful observations and questions.

Any opportunity to discuss my book and writing method is always welcome, but particularly when it is carried out with the joy and intelligence shown by Sunny. Below is a MP3 link to the interview on “Sunny in Seattle” should you wish to listen to the full program

I wish everyone a marvelous Thanksgiving. It is good to stop and ponder that which we are grateful among which I am grateful for you, the readers of my blog.

Does Hillary Clinton Really Have Parkinson’s Disease?

I usually avoid writing about political matters. In recent days though, I’ve been asked by multiple friends, both lay people and physicians alike, to share my views on a video put out by Dr. Ted Noel, suggesting Hillary Clinton suffers from Parkinson’s disease (PD).  https://www.youtube.com/watch?v=Zr1IDQ2V1eM

The implications of a potential President of the United States having a progressive neurological disease tends to focus our attention and require careful consideration. For that reason, I’ve decided to share my thoughts on Dr. Noel’s assertions that Hillary Clinton has PD.

My  professional background is that of a practicing clinical and research neurologist. I  treated patients with PD for decades and also directed a Parkinson’s Disease Center of Excellence for the National Parkinson’s Disease Foundation. My background qualifies me to comment on the assertions made by Dr. Noel. He trained as an anesthesiologist and admits to strong political views on his video blog. As for me, I am neither a registered Democrat nor Republican and possess the strong belief that medical and scientific facts must not be viewed through a convenient political lens. Politically driven science leads to bad science.

I have a great interest in the impact of medical disorders on the decision-making of public figures. Toward this end I’ve appeared on History and National Geographic channels discussing the likelihood that Adolf Hitler suffered from PD. I’ve also written on the topic; most extensively in my recently published book entitled, Carrying The Black Bag: A Neurologist’s Bedside Tales. I refer those interested to Chapter 13 and my argument that Adolf Hitler, in addition to his other medical disorders, also suffered from PD and this disorder affected, not only his movements, but also his memory and cognitive function. Hitler’s PD may have impacted his conduct during the latter phases of World War II and influenced the outcome of the war.  The evidence that Adolf Hitler had PD is in my view  substantially stronger than that purported by Dr. Noel for Hillary Clinton.

I support Dr. Noel’s contention that, in the absence of a hands on examination, observing videos of someone with Parkinson’s disease can lead to a strong conclusion that the person had PD. This is possible because the disorder demonstrates easily recognizable tremor, slowness of movement, stooped posture, lack of arm swing, gait abnormalities, and blank facial expression. The neurological examination allows the examiner to feel the particular type of muscular rigidity in PD (so-called cogwheel rigidity) which cannot be observed from a video.

Sketch of a man with PD with the typical features

Sketch of a man with PD with the typical features

What is missing from Dr. Noel’s “facts” is a discussion of how PD develops over time and its typical order of presentation. The medical field refers to this as the natural history of the disease. It is here that Dr. Noel makes several errors, no doubt because his training and experience are in Anesthesiology, not Neurology, nor does he likely have extensive experience in the diagnosis and treatment of people with Parkinson’s disease.

For example, he claims the onset of Hillary Clinton’s alleged PD dates to a fall she suffered eleven years ago, the fall resulting from her PD-related loss of balance. While loss of balance (referred to as loss of postural righting reflexes) is a well known feature of PD, this is NOT an early feature, nor it is a first sign of the disease. Rather balance problems are a late finding in the natural history of the disorder and follow the onset of the more major features, such as tremor, rigidity, slow movements, blank facial expression, and lack of arm swing while walking.

Hand tremor (not head tremor) is the most common presenting sign of PD. This is a slow rhythmic tremor of the fingers, a so-called “pill rolling tremor” named after the apothecaries of old. parkinsonsTo my knowledge, Clinton has never shown this type of tremor. As Dr. Noel points out, the hand tremor can be suppressed by holding the hand against the body or by manipulating an object. Nevertheless, the hand tremor returns periodically, especially when under emotional pressure, and is the most obvious feature of the disorder. Given the many public appearances of Hillary Clinton, this type of tremor, if it existed, should already have been observed many, many times.

Dr. Noel instead refers to the head-bobbing Clinton demonstrates in several videos as her purported tremor. While some people with PD have head tremor, this is unusual and not seen in my experience without tremor elsewhere in the arms or legs. In addition, the tremor of PD is rhythmic and of a certain, predictable rate. Her head bobbing is non-rhythmic and does not appear at all typical in rate or form for the head tremor of PD.

Slow movements, so-called bradykinesia, are another major sign of PD. I have not viewed any video that shows Hillary Clinton demonstrating slow movements beyond what would be expected of a 68-year old person. While treatment can mask the signs of PD, they can still be detected by experienced examiners, at least after the so-called “levodopa holiday” passes which typically lasts no more than a year or two.

Stooped posture, lack of arm swing and leading with the back of the hands while walking (simian posture) with forearms flexed, along with shuffling feet with short steps are convincing features for PD. Again, I am unaware of Clinton demonstrating any of these diagnostic features.

What Dr. Noel points to is a “bug-eyed” facial expression occurred only when Clinton was startled or overwhelmed by reporters shouting questions at her. A person with PD typically has wide-eyes, blank facial expression, and reduced frequency of blinking which Clinton does not demonstrate. A person with PD demonstrates these facial features all of the time, not episodically.

The blank staring facial expression of PD in Muhammad Ali

The blank staring facial expression of PD-  Muhammad Ali

 

Likewise his contention that her recently diagnosed pneumonia resulted from a swallowing abnormality associated with PD fails to be adequately supported. While swallowing problems exist in many persons with advanced PD and may lead to aspiration and pneumonia, they are present in association with the cardinal features of PD, such as tremor, slow movements, and muscular rigidity. The swallowing abnormalities do not occur in the absence of the cardinal features of PD.

We have no evidence these cardinal features of PD exist in the video, nor do we see the minor signs of PD, such as a blank facial expression, lack of arm swing, stooped posture, shuffling gait, soft and muffled voice, simian posturing of the hands, oily skin, dandruff and acne. Clinton’s speech patterns are readily available to anyone who follows the campaign. She does not demonstrate soft and muffled speech as is seen with more advanced PD.

In summary, the evidence presented by Dr. Noel is far from convincing that Hillary Clinton has PD. Dr. Noel has cherry picked various signs without fitting them into a logical context or natural history of PD. I do not believe Hillary Clinton suffers from PD based on current evidence.

Whether she has another neurological disorder cannot be discerned from the limited medical information available. Medical records and examinations are needed.

Dr. Lisa R. Bardack, Hillary Clinton’s Internal Medicine physician, has released limited information on Hillary Clinton. Clinton has treated hypothyroidism, seasonal allergies, and we know of her recently diagnosed bout of pneumonia for which she was placed on antibiotics.

More concerning was the episode of closed head injury that took her a full five months from which to recover. She apparently developed a blood clot within her head in 2012 believed to have been a transverse sinus thrombosis- a very serious  brain disorder. Almost certainly Clinton would have  been attended by a neurologist or a neurosurgeon or both; however no neurological records have been released of this major medical event. We do not know whether she suffered any permanent brain damage or other complications from this episode.

She also has suffered episodes in 1998 and 2009 of deep vein thrombosis (DVTs) in her legs and takes an anticoagulant, Coumadin for prevention of future blood clots.

As an aside, Hillary Clinton’s falls or risk for falls while on Coumadin, demands caution, especially when climbing stairs or at risk for falls or cuts.

Very little medical information has been released for either Hillary Clinton or Donald Trump despite the rhetoric streaming from their campaigns claiming the opposite. As compared to the medical records released by John McCain and George W. Bush when running for President, the currently released medical information is meager by comparison. This is, in my opinion, very unfortunate.

Whether a candidate is healthy enough to become president and perform the duties of the office should be a condition for running. The people who vote would benefit from health information just as they  benefit from policy statements and fiscal plans. Since both major candidates, Clinton and Trump,  respectively are 68 and 70-years of age, the need for this information takes on even greater importance.

The candidates in my opinion should release their full health records and not just politically sanitized versions or the results of their most recent physical examinations. A list of their medications should also be released and would likely be revealing. Lacking a willingness by the candidates for full medical disclosures, a non-partisan panel of medical experts should review all available medical records and attest to the candidate’s health status and their ability health-wise to meet the demands of the office of President of the United States. Such a course of action would be in the best interest of the American people.

 

TV/Film Rights to Carrying The Black Bag

15998415Felt emotionally uplifted when I recently received an inquiry from L.A. area for the TV/Film rights for my  book, Carrying The Black Bag: A Neurologist’s Bedside Tales. The inquiry asked who to contact and I responded with the contact information for my agent, Don Fehr, at Trident Media in New York City.

Suspect many inquiries are made and few books are acquired. Nevertheless, it’s wonderful to be sounded out. This would give a boost to the book and extend the stories into a new medium. Here’s hoping!

Continue to give talks on my book and have several scheduled over the next month. Have particularly enjoyed the interaction with various book clubs, but also the various women’s clubs and service clubs have been great fun. These are enjoyable experiences, as I always enjoy telling the stories within the book. Trudy has been a great help in this regard.

Remain open to additional invitations to speak. Am willing to travel. Trudy keeps the calendar of events and can be contacted at trudy_hutton@yahoo.com.

Reflections On My West Texas Book Tour

IMG_0363I enjoyed a busy week recently in Lubbock speaking on their NPR station at Texas Tech University, at an event at the Texas Tech University Library, to a private book party entitled “A Celebration and a Conversation” kindly hosted by Judy Wilkins and La Nelle Etheridge, and to the Lubbock Roundtable. Wow, each was a lot of fun. The comments on my book, Carrying The Black Bag, proved very positive and I enjoyed the interaction.
Below I’ve shared a couple of pictures from the library presentation and a very nice video provided by the library. Should you wish a similar talk to your organization, please contact Trudy, my wife, who keeps the schedule (don’t they always). Her email is trudy_hutton@yahoo.com

IMG_0383IMG_0386Here is the link to the presentation at the Texas Tech University Library:

https://youtu.be/yyh241N4zNg

Lubbock Book Tour This Week-Carrying The Black Bag

21122377Looking forward to several book related events this week in Lubbock. Thursday morning I’ll tape a thirty minute program for Dr. Tom McGovern”s radio program that will play on the Texas Tech University NPR station. Dr. McGovern is a fine Ethicist and a wonderful human being whom I always enjoy being around and learn from.

Then on Thursday evening at 7 pm I will be presenting at the Texas Tech University Library on my book, Carrying The Black Bag: A Neurologist’s Bedside Tales. The event is open to the public.

Friday evening my good friends Judy Wilkins and La Nelle Etheridge are having a “Celebration and Conversation” event where I will speak about my book to their invited guests. This is such a generous invitation and one I’m greatly looking forward to.

Then on Saturday morning I will again share stories from my book at the Lubbock Roundtable at 11:00 at the Hillcrest Country Club.

I feel fortunate to have been asked to give numerous book talks since Carrying The Black Bag came out three months ago. These are all fun events. I particularly enjoy gaining feedback from folks whose lives have been impacted meaningfully by my book and from learning their stories. Let me know if you would wish to schedule me for a book talk and Trudy and I will try to make it happen.

If you are in Lubbock this week, hope to see you at the TTU Library Thursday night or as Charles Osgood says, “I’ll see you on the radio.”