Know About Motor Neurone Disease
My mother has motor neurone disease. Can you explain this condition for me?
This is one of the nastier diseases that can attack humans. We do not know its cause, and there is no cure; but doctors do know what happens inside the body, and to the patient.
Nerves occur in two main types—sensory and motor. The sensory nerves detect heat, cold, pain and touch. The motor nerves send messages from the brain to make every muscle in the body move as we want it to. In motor neurone disease, these motor nerves slowly degenerate, often in a random pattern around the body, causing weakness in the arms and legs, poor posture, difficulty in speech, and eventually difficulty in breathing. It may get better spontaneously for a few weeks or months, but eventually the disease progresses to the point where the body cannot function adequately.
It is a tragedy to see these people deteriorate, particularly as they maintain
their normal mental state and intelligence. Active physiotherapy, good nursing care, medications to relieve muscle spasm and infections, and lots of T.L.C. are the main forms of treatment.
I was astonished to read in your column your advice that an orthopaedic surgeon would perform an operation to do a carpal tunnel repair. My operation was done by a neurosurgeon. You should know better?
Some of the less polite and wildly scrawled letters bring up some of the most interesting subjects.
I can assure readers that the column is written by a doctor, in fact by a general practitioner in private practice. There are no set rules about which doctors may perform which procedures, but by training, certain surgeons tend to perform operations on certain areas. Legally, there is no law restricting me as a GP from performing routine brain surgery, but it would be ethically wrong, and no reputable hospital would allow me to perform such surgery, as I have not been trained to perform this work.
Once a doctor has a surgical fellowship (and all surgeons have the same qualifications, but with emphasis in their training in a certain area), it is very difficult to delineate certain areas of the body to a particular type of surgeon. The simple operation on your wrist could have been equally well performed by an orthopaedic surgeon, neurosurgeon, general surgeon or a general practitioner with only moderate surgical skills (eg. in a rural area). Most are performed by orthopaedic surgeons.
Many other areas of overlap occur, particularly in the head and neck where otorhinolaryngologists (ear, nose and throat surgeons), plastic surgeons, general surgeons and even dental surgeons all may be involved.
Geographic location is another factor, and in major cities, more highly specialised surgeons are available. The emergency of a burst blood vessel in the brain would be dealt with by a neurosurgeon in the city, by a general surgeon in a major country town and by a general practitioner in a small country town.