By Jane Ehrhardt
With the arrival of neurologist Muhammad Siddiqi, MD, on staff, Cullman Regional Medical Center has taken the first step toward creating their own neuroscience department. A daunting goal, neuroscience programs are among the most complex to create, partially due to the host of clinical conditions that call for an array of subspecialties.
The foundation of a solid neuroscience department relies on access to those subspecialists. UAB Medicine lists 78 neurologists who cover specialties from neuromuscular issues, memory and cognitive disorders, neuropathology to vascular neurology, sleep medicine, and neuro-oncology. Ten neurologists listed epilepsy as their specialty.
“We have to bring in more neurologists with subspecialty training. That is our future plan,” Siddiqi says. “As we see the patient influx and see what type patients we are getting, that will be our priority.” Cullman Regional has been gathering patient data since Siddiqi arrived two months ago. Prior to that, an outside neurology practice provided services, leaving no hospital-focused data.
“My job is to slowly see where we are busy and where we need to grow based on patient population and the types of disease we are facing,” Siddiqi says, who spent years as part of a team building a neuroscience department at a large hospital in Tallahassee, Florida. At this early point, he sees stroke topping the list of needs for Cullman.
Right now, the hospital can medicate patients after diagnosis in hopes of dissolving the clot as quickly as possible to save brain tissue. But without a neurosurgeon trained in neurovascular procedures on staff, Cullman must transfer patients with large clots to UAB to perform those procedures. “They can go through the leg to remove the clot from the brain,” Siddiqi says. “That’s why you need a neurosurgeon on board.”
In time, the hospital aims to acquire the staff and resources to attain accreditation from the Joint Commission as a primary stroke center, and ultimately a comprehensive stroke center. Those designations confirm that a facility provides the critical elements for long-term success in improved outcomes for stroke patients.
Other units Siddiqi puts at the top of their neuroscience department goals include seizures, headaches, multiple sclerosis, and dementia. In his personal specialty, he has seen numerous misdiagnoses so far of headaches as migraines. “There are 24 types of headache,” he says. “If you treat those types of headaches with migraine medicine, it’s not going to work. You need a nerve block. You need a different type of medicine to treat those headaches.”
Memory issues can also be easily misdiagnosed. “The number one cause of loss of memory is depression. It’s called pseudodementia or false dementia,” Siddiqi says. “So memory medications are not going to help these patients.” Siddiqi has recently seen a 32-year-old man prescribed medication for dementia for memory loss when the cause actually lay in his anxiety and depression.
All of these goals require patience and a vast financial investment well beyond the staff costs. “Building a neuroscience department requires millions of dollars,” Siddiqi says. In equipment, a neurosurgical catheter lab for procedures such as removing clots, inserting stents, and preventing bulging aneurysms from bursting, runs around $3 million. CT brain scanners to detect viable tissue in the penumbra following a stroke cost $2 million. “It takes a lot of manpower and resources to build a department,” he says. “But when you grow, you are seeing more patients, so it eventually pays for itself.”
Cullman Regional already pulls in patients from in-between communities closer to Huntsville, including Madison County, and has experience drawing in patients all the way from Birmingham. One of their orthopedic surgeons still sees a group of patients he had when practicing in Birmingham. All older patients who are also friends, they ask for appointments to be scheduled on the same day so they can ride together
“They’re following the quality care,” Siddiqi says. “Distance doesn’t matter when you find a good doctor.” With the Birmingham neurology market getting oversaturated and patients waiting months to get an appointment with a neurologist, he expects to welcome that overflow in Cullman. “You will go to the doctor who listens to you and treats you, even 45 minutes away.”