Hello and welcome to Checking the Vitals, a podcast powered by SpecialtyCare. I’m Todd Schlosser and today my guest is Dr. Mohamad Khaled, a neurosurgeon at Hartford HealthCare. In this conversation, we discuss his path to becoming a doctor that literally took him around the globe. We also discuss deep brain stimulation, exactly how it works, and some of the amazing innovations that are coming to that space. Enjoy the conversation.
Todd Schlosser: Dr.Khaled, thank you so much for joining us today.
Dr.Khaled: Thank you for having me.
Todd Schlosser: I appreciate it. I’d like to start off a very similar way I start off most of the podcasts, and that’s simply, what was it that made you want to pursue a career in healthcare to begin with?
Dr.Khaled: Just looking at, when I was in high school, I was looking at different careers obviously and trying to decide what am I going to do with my life. I really felt that the thing that comes to me the most natural way, is helping people, and being there and being selfless. I think medicine was the career that mostly embodied those principles and values that came to me naturally.
Todd Schlosser: Yeah. Was there someone in your life that sort of looked for you, or sort of guided you to pursue medicine, or was it just you were-
Dr.Khaled: My father was a very strong influence. He’s a diplomat.
Todd Schlosser: Oh, okay.
Dr.Khaled: But there were no physicians in the family.
Todd Schlosser: Yeah.
Dr.Khaled: I was his oldest son, and he encouraged me in that direction.
Todd Schlosser: Awesome.
Dr.Khaled: Yeah.
Todd Schlosser: You sort of had an interesting upbringing, maybe not interesting to you because you lived it, but interesting to me, someone who grew up in the States, you grew up in Egypt, I believe.
Dr.Khaled: Yeah. I’m Egyptian, but I grew up in a lot of different countries given the fact that my father was a diplomat.
Todd Schlosser: He was a diplomat, yeah.
Dr.Khaled: My childhood, I actually spent it in Zimbabwe.
Todd Schlosser: Oh wow.
Dr.Khaled: Then my teenage years I was in Bangladesh.
Todd Schlosser: Okay.
Dr.Khaled: I was in British schools throughout that time.
Todd Schlosser: Okay.
Dr.Khaled: It was an interesting way of learning English with a British accent at school, and a mix of middle Eastern accent at home, and African accent in Zimbabwe, and Indian accent in Bangladesh.
Todd Schlosser: Sure.
Dr.Khaled: I don’t know what kind of accent I have now.
Todd Schlosser: Sort of a hodgepodge, but yeah, it makes it work. You went to a med school, I believe, in Cairo.
Dr.Khaled: Yes, I went to med school in Cairo, Egypt, yes.
Todd Schlosser: Was the family there and you just applied to schools there or did you seek that out?
Dr.Khaled: Yeah, so the way it works in Egypt is there is no pre-med, you just take the national high school test.
Todd Schlosser: Okay.
Dr.Khaled: Then if you rank within the top five percentile, than you can choose to go to medicine.
Todd Schlosser: Oh, okay.
Dr.Khaled: Which is what I did.
Todd Schlosser: Sure.
Dr.Khaled: Med school there is six years rather than four years.
Todd Schlosser: Okay, so it’s a more arduous program perhaps because it’s sort of bridging the gap between, I guess the pre-req’s you would do-
Dr.Khaled: Exactly.
Todd Schlosser: – and regular sort of master’s of science degrees.
Dr.Khaled: Exactly.
Todd Schlosser: Yeah. Okay. Because you did come to the States for your residency, correct?
Dr.Khaled: I finished my med school in Egypt in 2000, and then I did my internship and neurosurgery residency there.
Todd Schlosser: Oh okay.
Dr.Khaled: I completed my neurosurgery at Ain Shams University in Cairo Egypt.
Todd Schlosser: Okay.
Dr.Khaled: Finished that in 2005.
Todd Schlosser: Okay.
Dr.Khaled: Then I came to the United States in 2005 and did a couple of years of fellowship at the Cleveland Clinic.
Todd Schlosser: Oh okay. You actually did your residency in Cairo as well, and then came here for a fellowship?
Dr.Khaled: Yes.
Todd Schlosser: Okay.
Dr.Khaled: That’s kind of the backdoor of entering a neurosurgery residency for foreign medical graduates like myself. You have to prove yourself-
Todd Schlosser: Sure.
Dr.Khaled: – in research or fellowship or something of that sorts before you apply for residency again, to become board certified in the United States in neurosurgery You have to do your full residency here.
Todd Schlosser: Okay.
Dr.Khaled: Regardless of how much training or how much practice you’ve had elsewhere-
Todd Schlosser: Right.
Dr.Khaled: – it only counts for a few months.
Todd Schlosser: Oh wow.
Dr.Khaled: So you have to have ave full training here.
Todd Schlosser: Is that process difficult? I mean clearly it’s a time commitment.
Dr.Khaled: Yes.
Todd Schlosser: But is the process of like applying to come over, is that difficult?
Dr.Khaled: Yes, there’s lots of steps, and there’s a lot of competition, so you have to prove yourself.
Todd Schlosser: Yeah.
Dr.Khaled: So after doing a year of pediatric neurosurgery fellowship with the Cleveland Clinic, and then an epilepsy surgery fellowship, I was in the process applying for residency. In terms of going backwards because fellowship is afterwards.
Todd Schlosser: Sure, normally it is, yeah.
Dr.Khaled: I got into residency at University of Virginia.
Todd Schlosser: Okay.
Dr.Khaled: I spent six years there, then I did a year off informal fellowship at the Somerset Kentucky, at the Lake Cumberland neurosurgical clinic there with doctors [inaudible 00:04:32], and then I did my chief year at the Detroit Medical Center.
Todd Schlosser: Okay.
Dr.Khaled: My training spanned from 2001 to 2015, so 15 years of training after med school.
Todd Schlosser: Yeah, yeah. Clearly all doctors go through a lot of training, but that’s a lot for doctors.
Dr.Khaled: Yes.
Todd Schlosser: Yeah.
Dr.Khaled: Then from a neurosurgical perspective, to become board certified, you still have to start practicing for a few years, getting some cases, and then submit the cases to the board.
Todd Schlosser: Okay.
Dr.Khaled: They review the cases, and then you take your oral board exam.
Todd Schlosser: Right.
Dr.Khaled: From the time I started my neurosurgical training in 2001 until I became board certified in 2019, it was a 19 year process.
Todd Schlosser: Oh wow. Yeah.
Dr.Khaled: Around a hundred thousand hours of work and studying.
Todd Schlosser: Wow, and they say it takes about 10,000 hours to become great at something.
Dr.Khaled: Yes.
Todd Schlosser: You’ve done 10 times that, so congratulations.
Dr.Khaled: Thank you.
Todd Schlosser: I would like to back it up a little bit and ask you, what it was that drew you to neurosurgery originally, because being a doctor, it could be any number of things.
Dr.Khaled: Yes.
Todd Schlosser: Being focused in on neurosurgery.
Dr.Khaled: Yes. In the beginning I knew it was going to be a surgical specialty, not a medical specialty.
Todd Schlosser: Okay.
Dr.Khaled: I like to do things with my hands.
Todd Schlosser: Sure.
Dr.Khaled: I want to see the results. Then it was a choice for me, interestingly, between obstetrics, gynecology on one hand and neurosurgery on the other hand.
Todd Schlosser: Oh wow.
Dr.Khaled: Two completely unrelated-
Todd Schlosser: Yeah.
Dr.Khaled: – specialties, but that’s how it was for me, and just.
Todd Schlosser: the potential in neurosurgery was much higher and that’s what drew me to it. When you say the potential for it, do you mean innovation-
Dr.Khaled: Innovation.
Todd Schlosser: – as far as technology and techniques?
Dr.Khaled: Our understanding of how the brain functions, and what we can do with that techniques, innovation in terms of technology, that that was clearly more promising in neurosurgery than any other surgical specialties.
Todd Schlosser: You sort of did two residencies.
Dr.Khaled: That is correct.
Todd Schlosser: One in Egypt.
Dr.Khaled: Yes.
Todd Schlosser: And one here.
Dr.Khaled: Yes.
Todd Schlosser: When you went through your fellowship here, and then had to reapply to residency and go through that again, was that a strange process to be a day one resident year one, with all the training you already had?
Dr.Khaled: Every training and every place I go to I learn something different. I was looking at it from that perspective, is that I’ve learned the basics, but there’s a lot more to learn.
Todd Schlosser: Sure.
Dr.Khaled: Having had a little over 30 mentors throughout my career until this point, taught me that there’s always something new to learn, there’s always a different way of doing things.
Todd Schlosser: Yeah.
Dr.Khaled: And the more I learned, the more broad experience I have, the better experience I can give for my patients. One of the things that I always take into account when I’m making a decision for one of my patients is a few things. One of them is that a patient is not just a medical condition, they are a human being who had a social life, who has a background that I have to take into account when I’m making a decision for them.
Todd Schlosser: Mm-hmm (affirmative).
Dr.Khaled: Maybe their ideal option would be an a major surgery, but their social situation would not allow for that. What can I do to fit that patients special condition or situation as a human being who has a social life into his medical decision making process, so I don’t rubber stamp decisions?
Todd Schlosser: Sure.
Dr.Khaled: Or because it says that this should be done that way, that it has to be done for everyone. I tried to personalize, basically the care I give to my patients, and having a broad range of experience and having learned different ways of doing things really helps make me do that in an easier way, and provide that service to my patients.
Todd Schlosser: Absolutely. Yeah, and I think it’s telling us sort of your nature as a person, that you embrace that going only through residency again as just a way to learn more, and a way to get better and hone your skills.
Dr.Khaled: Definitely, and even after residency, I still continue to learn to teach myself.
Todd Schlosser: Absolutely, yeah.
Dr.Khaled: Actually I was talking to one of the neurosurgeons who is one of the big names in the country, and of course he was telling us that currently in his practice, he is applying 0% of what he learned during residency, and all what he’s doing now is what he taught himself and learned after that.
Todd Schlosser: Sure.
Dr.Khaled: So it goes to say that learning and improving oneself, and improving one’s skills is a continuous process of those that does not end with residency or fellowship.
Todd Schlosser: Sure, absolutely.
Dr.Khaled: It’s something that one has to continuously pursue throughout your career until you stop practicing.
Todd Schlosser: Yeah, I think anyone in any field, in order to be successful has to be a lifelong learner.
Dr.Khaled: Yes.
Todd Schlosser: They sort of rest on their laurels as it is.
Dr.Khaled: Yeah.
Todd Schlosser: They have to continue to push forward and move forward and just better their skills at whatever they’re doing.
Dr.Khaled: Yes.
Todd Schlosser: Clearly you’ve done that, taking almost 20 years to sort of transition from one country to another. I’ve talked to a perfusionist that did sort of the same thing.
Dr.Khaled: Okay.
Todd Schlosser: He went from India to Toronto to New Orleans.
Dr.Khaled: Okay.
Todd Schlosser: And he had to go through school again.
Dr.Khaled: Yes.
Todd Schlosser: And he, like you, looked at it the same way. It’s an opportunity to learn more and be better.
Dr.Khaled: Yes.
Todd Schlosser: I think that’s the right way and the best way to look at it. I heard you mentioned that you went to the Cleveland Clinic for one of your fellowships.
Dr.Khaled: Two of them, yes.
Todd Schlosser: Both of them were there?
Dr.Khaled: Yes.
Todd Schlosser: Okay. How many years were you at the Cleveland Clinic?
Dr.Khaled: Two years.
Todd Schlosser: Okay. They are normally a year, but residency’s can vary, that’s right.
Dr.Khaled: Yes. The residency now, it’s officially seven years. It used to be some programs were six, and some more seven.
Todd Schlosser: Oh yeah.
Dr.Khaled: It’s now seven years.
Todd Schlosser: Yeah. Does that include a research year?
Dr.Khaled: Yeah, it does include.
Todd Schlosser: Okay.
Dr.Khaled: While I was at the University of Virginia, I did research focus ultrasound.
Todd Schlosser: Okay.
Dr.Khaled: I was involved in that, and that’s a noninvasive way of making lesions in the brain for the treatment off different conditions, currently it’s FDA approved for lesioning for essential tremors, and tremor dominant Parkinson’s disease.
Todd Schlosser: Okay.
Dr.Khaled: But there’s a lot of research looking at it for lesioning for tumors, lesioning of blood clots, and so forth, and breaking down the blood brain barrier for drug delivery and so forth. There’s a lot of promise for that technology to kind of perform a a surgery without a knife basically.
Todd Schlosser: Yeah, absolutely. Because when you’re going in, especially on the brain, introducing a knife to that situation can be very dangerous.
Dr.Khaled: If you know what you’re doing, it’s okay.
Todd Schlosser: Well, no, but you wouldn’t want me doing it. I’d rather have you, because you had so much training doing it. But yeah, absolutely. So anytime you can reduce the risk of a bad outcome-
Dr.Khaled: yes.
Todd Schlosser: – you want to be able to do that.
Dr.Khaled: The less invasive generally speaking, I can’t say that applies for everything, but the less invasive the safer, generally speaking.
Todd Schlosser: Yeah.
Dr.Khaled: But there are situations where you have to be more invasive than others, otherwise you’ll be compromising the care.
Todd Schlosser: Absolutely.
Dr.Khaled: At least given the state of technology and skills that we have at this point.
Todd Schlosser: Yeah, so you did two fellowships at the Cleveland Clinic?
Dr.Khaled: Yes.
Todd Schlosser: Now when I think Cleveland Clinic, I think Toby Cosgrove-
Dr.Khaled: Yes.
Todd Schlosser: – and cardiology.
Dr.Khaled: Yes, he was the CEO when I was there.
Todd Schlosser: Okay.
Dr.Khaled: Yes.
Todd Schlosser: So you’re familiar with Toby?
Dr.Khaled: Yes.
Todd Schlosser: Yeah. I had the chance to see him speak once, and I’ve always been very impressed with Toby Cosgrove.
Dr.Khaled: Yes.
Todd Schlosser: But one of his points in his speech was that when he went from sort of surgeon to CEO, he was not at all prepared for that. I found that very interesting, that sometimes we just jump into things that we’re not necessarily prepared for-
Dr.Khaled: Yes.
Todd Schlosser: – and we just immerse ourselves in them and we can get through it.
Dr.Khaled: Yeah.
Todd Schlosser: I wonder if your fellowship at the Cleveland Clinic was at all like that? And you did two fellowships there?
Dr.Khaled: Yes.
Todd Schlosser: What was the first one focusing on?
Dr.Khaled: It was pediatrics.
Todd Schlosser: Okay.
Dr.Khaled: It was treating children with neurosurgical conditions.
Todd Schlosser: Right.
Dr.Khaled: My mentor was Dr.Mark Luciano, and there was a lot to learn there.
Todd Schlosser: I’m sure.
Dr.Khaled: Then the following year I moved onto epilepsy surgery with Dr.Bill Bingaman, and there was a whole different things to learn from that standpoint-
Todd Schlosser: I’m sure.
Dr.Khaled: – given that they had one of the biggest epilepsy surgery programs in the country, in the world.
Todd Schlosser: Oh wow, yeah.
Dr.Khaled: That was a very, very good experience for me.
Todd Schlosser: Absolutely. I’ve heard that when you’re doing, well anything really, you want to get as many repetitions as possible.
Dr.Khaled: That is correct.
Todd Schlosser: It being one of the higher volume centers, you probably got an opportunity to sit in or lead quite a few surgeries.
Dr.Khaled: That is correct.
Todd Schlosser: It was the epilepsy.
Dr.Khaled: Epilepsy surgery.
Todd Schlosser: Yeah.
Dr.Khaled: Yes. That’s one of the reasons I was hired here at Hartford Hospital, is the epilepsy surgery program was greatly expanding and we are turning it into a level four epilepsy center.
Todd Schlosser: Okay.
Dr.Khaled: I was hired for that purpose, in addition to deep brain stimulation, which is my other sub specialty.
Todd Schlosser: yeah.
Dr.Khaled: I still continue to do everything in neurosurgery from brain tumors, spine tumors, degenerative disc disease, spine deformity and so forth, but in addition to that, I am sub-specialized in deep brain stimulation in epilepsy surgery.
Todd Schlosser: When you leave your fellowship, where did you decide to start practicing? Was it private practice? Was it more of a hospital group?
Dr.Khaled: I finished my chief year residency at Detroit Medical Center in 2015, and during that year, what I was looking to is not join an established functional neurosurgery program.
Todd Schlosser: Okay.
Dr.Khaled: Which functional stands for deep brain stimulation, epilepsy surgery and pain treatment.
Todd Schlosser: Okay.
Dr.Khaled: But I wanted to establish my own program somewhere where they wanted to build it from the ground up.
Todd Schlosser: Okay.
Dr.Khaled: Hence, I took my job at Baystate Hospital in Springfield, Massachusetts.
Todd Schlosser: Yeah.
Dr.Khaled: Because they did not have a functional program there yet, and were looking to establish one.
Todd Schlosser: Right. You introduced deep brain stimulation there. Is that correct?
Dr.Khaled: That is correct.
Todd Schlosser: Yeah.
Dr.Khaled: Before I went there, there was no deep brain simulation done at that hospital, and I was trained on using something called a frame, a frame based deep brain stimulation.
Todd Schlosser: Okay.
Dr.Khaled: And I was given a zero budget to start that program over there.
Todd Schlosser: It’s always that way.
Dr.Khaled: I had to figure it out for myself.
Todd Schlosser: Sure.
Dr.Khaled: I called one of my mentors in Kentucky and asked him, what should I do at this point? He guided me, and I sought out a company based in Maine-
Todd Schlosser: Mm-hmm (affirmative).
Dr.Khaled: – that does frameless DBS. I went to the factory, saw how they manufactured their equipment and what it was based on. I taught myself how to do frameless deep brain stimulation.
Todd Schlosser: Can I ask what the distinction is between frame and no frame?
Dr.Khaled: The frame, basically a frame base, the frame is mounted on the patient’s head the morning of the surgery-
Todd Schlosser: okay.
Dr.Khaled: – and they undergo a scan with the frame on board, and then they undergo a CT scan, and then that CT scan is fused with a priorly done MRI, and then the surgeon plans where the target is going to be and where the entry point is and hence the trajectory.
Todd Schlosser: Right.
Dr.Khaled: To avoid hitting any of the major structures and so forth.
Todd Schlosser: Sure.
Dr.Khaled: Once that plan is made, then the coordinates are dialed into the arc that is attached to the frame, and hence the targeting is done.
Todd Schlosser: It’s probably a lot more accurate.
Dr.Khaled: It is very accurate. It is with millimeter to sub-millimeter accuracy.
Todd Schlosser: Wow, okay.
Dr.Khaled: The frameless system that I use, I implant small screws in the patient’s head in the office, very tiny incisions, screws are like five millimeters long-
Todd Schlosser: Very short.
Dr.Khaled: Very tiny. Then the patient gets the CT scan and then goes home.
Todd Schlosser: Oh, okay.
Dr.Khaled: For nine days or so.
Todd Schlosser: Okay.
Dr.Khaled: Nine to 10 days. Then I take that scan and fuse it with the MRI, and then make my plan, and then I send that plan to the company, which 3D prints that platform.
Todd Schlosser: Oh okay.
Dr.Khaled: And then it ships it over to us at the hospital, and then the patient comes in for the surgery. Instead of the patient having the frame fixed to their heads, getting the scan, waiting for the plan to be done by the surgeon, and then starting the surgery-
Todd Schlosser: Having the frame on their head the whole time.
Dr.Khaled: Exactly.
Todd Schlosser: Oh, I didn’t realize they kept it on.
Dr.Khaled: They kept an eye on it throughout the surgery too.
Todd Schlosser: Oh wow.
Dr.Khaled: I divided into two steps so that way the patient doesn’t have to wait for me.
Todd Schlosser: Sure.
Dr.Khaled: The patient is at home, I’m doing the plan at my own time too.
Todd Schlosser: Right.
Dr.Khaled: If it’s a little bit of a more complicated anatomy, I’m not rushed through it.
Todd Schlosser: Sure.
Dr.Khaled: I take my time doing that, and then the day of the surgery it shortens the surgery a lot, because the patient comes in, we’re already done with the planning, we’re already done with the targeting, we’re already done with all of this. All we have to do is start the surgery.
Todd Schlosser: Right.
Dr.Khaled: I’ve taught myself how to do this, and and since then I’m not going back to frame based. It’s just easier for the patient.
Todd Schlosser: It sounds like a better work-life balance for you, but also a patient balance of not having to have the frame on their head.
Dr.Khaled: Yes. The frame base of patients is fixed to the operating table at all times and it’s an awake surgery, so not very comfortable, not very comfortable feeling. The frameless, The patient can move their head.
Todd Schlosser: Yeah.
Dr.Khaled: They can tell me, hey, I want to move my head now, so I stop what I’m doing, they can adjust their neck or head, and it’s a plastic, very light platform that they don’t feel versus a metal frame that is fixed to the bed.
Todd Schlosser: Probably pretty heavy, yeah.
Dr.Khaled: Yes.
Todd Schlosser: These surgeries can be sometimes pretty long, correct?
Dr.Khaled: For a deep brain stimulation, I keep my surgeries, if I’m doing both sides, under four hours usually.
Todd Schlosser: Oh okay.
Dr.Khaled: I’ve done them in two, two and a half hours at times. I don’t rush through surgery. I tell all my patients, this is not a race.
Todd Schlosser: Yeah.
Dr.Khaled: I never give a certain set amount of time. I give her a range, and I tell them if it takes longer, then it needs to take longer, than I’m going to take longer to do it.
Todd Schlosser: Yeah.
Dr.Khaled: The main goal is to do it right and do it safely.
Todd Schlosser: Absolutely.
Dr.Khaled: I’m not in a race, but generally speaking, the shorter the surgery, the safer it is in terms of the less chance of an infection.
Todd Schlosser: Right.
Dr.Khaled: Less chance of bleeding and so forth.
Todd Schlosser: Right.
Dr.Khaled: But definitely I’m not in a race.
Todd Schlosser: Yeah. When you went to start that program, you specifically sought out a program that you could build.
Dr.Khaled: Yes.
Todd Schlosser: Right. Does that come from many sort of place of you wanting to build something that you can put your name on, or is it more just you, you like the entrepreneurial nature of building something from the ground up? What was it that made you seek that out?
Dr.Khaled: I had a vision that I wanted to enact myself.
Todd Schlosser: Okay.
Dr.Khaled: And having trained under a lot of different mentors taught me there are a lot of different ways of doing things.
Todd Schlosser: I’m sure that’s true.
Dr.Khaled: I wanted to use that experience and expertise, build something unique, something that I see I will use what I’ve learned, instead of walking into a program that’s already established where they’re doing things a certain way.
Todd Schlosser: They already have their policy in procedures.
Dr.Khaled: Where I know it can be done a little bit differently.
Todd Schlosser: Right, right.
Dr.Khaled: That’s where I was coming from.
Todd Schlosser: Yeah, absolutely. Obviously you saw the benefits of deep brain stimulation early on.
Dr.Khaled: Yes.
Todd Schlosser: DO you mind if I have you run through what some of those benefits are, and what sort of patients can benefit from them?
Dr.Khaled: Yes, so currently there are uses for deep brain stimulation that are FDA approved, and there are so many others that are still under trials and not FDA approved, although in Europe they are used way more frequently than they are in the United States. As in the United States you have to get the FDA approval.
Todd Schlosser: Sure.
Dr.Khaled: In Europe they have a little bit of a different process that is more lenient than here.
Todd Schlosser: Okay.
Dr.Khaled: The FDA approved uses of deep brain stimulation include Parkinson’s disease, essential tremors, which is another disease which is another movement disorder, it’s not as famous as Parkinson’s disease-
Todd Schlosser: Sure.
Dr.Khaled: – because more famous people have had Parkinson’s disease, but actually it is twice as common as Parkinson’s disease.
Todd Schlosser: Oh wow, really?
Dr.Khaled: It’s just not many famous people have had it.
Todd Schlosser: Yeah, I hadn’t heard of it until I started talking to some neurosurgeons.
Dr.Khaled: Yes.
Todd Schlosser: I’d never heard of it.
Dr.Khaled: No essential tremor is twice as common as Parkinson’s disease.
Todd Schlosser: Wow, okay.
Dr.Khaled: There is also dystonia, which is much more rare. There is something called humanitarian device exemption, which is kind of a little bit of a special use of it, that’s also FDA approved for obsessive compulsive disorder.
Todd Schlosser: Mm-hmm (affirmative).
Dr.Khaled: And we’re in the process of doing our first patient here at Hartford, DBS for OCD. These are the ones that are currently FDA approved in the United States. There are other uses of deep brain stimulation that have been done in trials and have shown kind of mixed results, where some success and some failure, including deep brain stimulation for chronic pain, different types of things and syndromes.
Todd Schlosser: Oh wow, yeah.
Dr.Khaled: Like thalamic pain syndrome. There is also a deep brain stimulation for depression. Actually there are some YouTube videos by CNN that show patients in surgery having deep brain stimulation for depression, where they turn from someone who had been depressed for many, many years, have not smiled or laughed in years, smile and laugh in surgery when you turn on the simulation.
Todd Schlosser: Yeah.
Dr.Khaled: There’s also looking at it from a schizophrenia aspect, is it going to work for that, anxiety? Many, many different possibilities.
Todd Schlosser: Absolutely.
Dr.Khaled: Obesity.
Todd Schlosser: Oh really? Wow.
Dr.Khaled: It depends. I mean we can reach anywhere in the brain with the electrode that we implant, and all it takes is for us to know what the circuitry is, what are the different areas of the brain that form the circuitry, so there are certain different circuitries in the brain. There are circuitries for movement.
Todd Schlosser: Sure.
Dr.Khaled: If you have a problem with that than you develop one of the movement disorders.
Todd Schlosser: Right.
Dr.Khaled: Circuitry formed from memory, if you develop a problem with that and you develop something like Alzheimer’s disease.
Todd Schlosser: Yes.
Dr.Khaled: There is also deep brain simulation for that in trials.
Todd Schlosser: Absolutely.
Dr.Khaled: If you have a problem with the circuitry responsible for mood, then you develop depression and so forth. What we do is with deep brain stimulation we target different parts of the circuitry, and either stimulate that area to function more or [inaudible] that would suppress the extra signals that are being sent in that specific target or nucleus.
Todd Schlosser: Yep.
Dr.Khaled: We can kind of correct the firing and the overall output of that circuit to correct the function.
Todd Schlosser: Yeah.
Dr.Khaled: We’re not necessarily treating the disease itself, but we are electrically changing the signals.
Todd Schlosser: Yeah.
Dr.Khaled: One of the other uses for DBS that has been recently approved by the FDA is deep brain stimulation for epilepsy, which is another tool that we can use to treat patients with intractable epilepsy.
Todd Schlosser: You were in residency, and you were training for a very long time, and you’ve been practicing for a few years now.
Dr.Khaled: Yes.
Todd Schlosser: Outside of that, and just in that maybe not quite 20 year process, I’d imagine a lot of that stuff was happening while you were training.
Dr.Khaled: Yes.
Todd Schlosser: I mean I remember when I was a kid, and I’m talking about brain mapping, so like finding out, oh the frontal cortex controls this and all that stuff-
Dr.Khaled: Yes.
Todd Schlosser: – and now we’re talking about going in there and changing, maybe this isn’t the right terminology, but changing the wiring of that movement cortex so that you don’t shake anymore.
Dr.Khaled: Yes.
Todd Schlosser: That to me, is amazing, that in that 20 year period, or perhaps less, that that much innovation has happened, are there any other innovations that has stood out to you?
Dr.Khaled: The role of focus ultrasound is more the lesioning prospective, or a lesion is basically you create a lesion, is that you kill that area that is causing that problem. Or if you’re wanting a lesion, like burn a tumor or something, so you can do the lesion with different different ways, using radiofrequency, using gamma knife which is radiation, using ultrasound, among other things. Now focus ultrasound has the potential to be used to modulate the function. Focus ultrasound, what it does is that it heats up the tissues, but there’s a way where if you don’t go all the way up with the energy, and if you vary the frequency a little bit, then you can change how that ultrasound affects the tissue function without actually causing a permanent lesion. That is another thing that it’s being looked at-
Todd Schlosser: Wow.
Dr.Khaled: – in focus ultrasound is how to modulate different functions. We’ve seen experiments where a certain amount of ultrasound, energy and frequency, the specific area of the brain, you could get a mouse to move its tail, basically. Is that going to be the future for controlling brain function using ultrasound waves from outside? There’s also the looking at magnetic simulation, transcranial magnetic stimulation to alter the different signals, because we know that electric waves have a magnetic field.
Todd Schlosser: Right.
Dr.Khaled: Right. If you change the magnetic field, will you be able to alter the electric waves and hence ultimate the function.
Todd Schlosser: Right.
Dr.Khaled: That’s all in the infancy, in its infancy, and the potential is huge to be able to do this without surgery, basically from outside the skull.
Todd Schlosser: That’s amazing, because if you look back at medicine even 50 years ago, it looks a little like, wow, we used to do that.
Dr.Khaled: Yes.
Todd Schlosser: I just wonder what new things will happen in 20 years. When we’ll look back at this time period and be like, wow, we used to go in there and burn things off.
Dr.Khaled: Yes.
Todd Schlosser: I mean, don’t get me wrong, where we are now is amazing.
Dr.Khaled: Yes.
Todd Schlosser: I wouldn’t trade 2000s healthcare for what we have now.
Dr.Khaled: That is correct.
Todd Schlosser: But that sort of stuff is amazing to me.
Dr.Khaled: That’s correct. We’ll look at it from, for example, psychosurgery. Psychosurgery is banned, I think in two States, in California, and I think in Oregon, I’m not sure, but it’s banned in at least two States, because of what happened in the 1950s and 60s, where they were going around and doing [inaudible] and so forth.
Todd Schlosser: Yeah.
Dr.Khaled: Now we’ve come a long way from that.
Todd Schlosser: Yeah.
Dr.Khaled: Now we can do deep brain stimulation, which is a reversible, very minimally invasive, and turn it off, you can actually take it out and do psychosurgery in a very safe and ethical way-
Todd Schlosser: Sure.
Dr.Khaled: – as opposed to how it was done 60 years ago.
Todd Schlosser: Yeah. We’re not talking lobotomies here.
Dr.Khaled: Yes, right.
Todd Schlosser: Right, right. That’s amazing. You’ve mentioned you had somewhere close to 30 mentors.
Dr.Khaled: Yes.
Todd Schlosser: I’d imagine that you, having been a part of so many people’s lives and then helping shape your life, that you sort of love giving back?
Dr.Khaled: Yes.
Todd Schlosser: And helping mentor those people who are coming up behind you.
Dr.Khaled: Yes.
Todd Schlosser: I’d like to close with the question of what advice do you have for those who are coming up behind you? In those mentor mentee relationships.
Dr.Khaled: Yes. I’m certainly passionate about education and teaching, and one of the main reasons I took the job here at Hartford Hospital is that we’re starting our own neurosurgery residency in a few months.
Todd Schlosser: Okay.
Dr.Khaled: That’s definitely a part of the passion that I have that’s included with helping other people is teaching. It’s a principle that I tell my patients is that I don’t treat images, I don’t treat the MRI or the CT scan.
Todd Schlosser: Sure.
Dr.Khaled: I don’t treat the lab results, I treat you as a patient. I’d like to spend more time with my patients, listening to them, hearing what they have to say, spend more time examining them, trying to get the full picture.
Todd Schlosser: Sure.
Dr.Khaled: Of what is really bothering this patient, not what is wrong with the MRI.
Todd Schlosser: Right.
Dr.Khaled: The goals of the treatment have to be centered around the patients expectations, the patient’s background, the patient’s life, and the clinical skills that come with that is not necessarily what is interpreted on an MRI or a CT scan, it’s actually digging deeper, and personalizing the care for every patient.
Todd Schlosser: Right.
Dr.Khaled: I think that way you can impact your patients’ lives in a much better way, rather than rubber stamping a certain treatment for everyone or for subset of patients.
Todd Schlosser: Sure.
Dr.Khaled: The other thing that I like to tell people who are thinking about getting into medicine, please don’t get into medicine for money, because no one can pay you enough to do what you’re doing.
Todd Schlosser: Yeah.
Dr.Khaled: The risks that we take, and the stress that comes with it, it’s not worth it if that’s what you’re doing it for.
Todd Schlosser: Right.
Dr.Khaled: There are much easier ways to make money than this. This is the most stupid way to make money if that’s why you want to do.
Todd Schlosser: Sure.
Dr.Khaled: Definitely do this because you want to help people.
Todd Schlosser: Right.
Dr.Khaled: Definitely do this because you’re passionate about that specialty that you’re choosing.
Todd Schlosser: Well, Dr.Khaled, thank you so much for joining us here on the podcast. We really appreciate it.
Dr.Khaled: My pleasure, thank you for having me.
Todd Schlosser: Thank you so much.