OCD Ruled Moksha Patel’s Life Until A Rare Surgery Changed Everything
Moksha Patel, MD, is a busy man. He recently completed a fellowship in the Division of Hospital Medicine at the University of Colorado School of Medicine, where he is now a senior instructor. He was appointed as a senior informatics physician for the Institute for Healthcare Quality, Safety, and Efficiency at CU Anschutz and is working on an MBA at CU Denver.
Patel, a caring person with lots of friends and a busy life, is thriving professionally. He’s also making up for lost time — when he was a prisoner of his own mind, shackled by severe obsessive-compulsive disorder (OCD), a brain disorder in which unwanted, intrusive, and repetitive thoughts cause significant distress and obsessive behavior.
People with OCD attempt to alleviate the anxiety, fear, or disgust caused by these obsessions by performing mental or physical rituals, or compulsions.
For Patel, who has suffered from the disease since he was a child, the obsessions remain. But after undergoing rare deep brain stimulation surgery for OCD at the University of Colorado’s UCHealth Hospital on the Anschutz Medical Campus, a procedure most often used to treat Parkinson’s disease, her symptoms dramatically improved. decreases. And he is slowly coming back to life.
Moksha Patel, MD
It’s not gone but, it’s so much better under control. I almost felt like I was choking on my own thoughts and then the compulsions took over,” Patel said. “They still come but they are quieter and less frequent.”
His disorder is manifested by germaphobia and fear of contamination, mainly by public toilets. He took long showers and scrubbed his raw skin, sometimes using harsh chemicals to feel clean. These rituals consumed most of his waking hours when he was not working.
“The physical toll of my cleansing rituals was unbearable,” he said. “It would burn my skin and take hours out of my day, every day.”
And then there are the emotional, social and mental consequences. Patel hasn’t visited his grandmother in England for years. Dating was difficult and relations with family members were strained. Everything from hanging out with friends to choosing college had been disrupted by his OCD. He tried all the standard therapies and medications, but whatever small relief they provided was minimal and fleeting.
“I look very successful and very successful,” Patel said. “It’s isolating. People don’t understand me. There’s a discord between my appearance and this real struggle every time I’m out in public.
Find support and care
When Patel came to CU Anschutz, his supervisor noticed his struggle and put him in touch with Rachel Davis, MD, associate professor of psychiatry at CU School of Medicine and medical director of the OCD program. Davis is also co-director, with Steven Ojemann, MD, of the OCD Surgical Program, a collaborative venture with the Departments of Psychiatry and Neurosurgery and the University of Colorado’s UCHealth Hospital. This program is one of the few in the country to offer deep brain stimulation (DBS) as a treatment for refractory OCD.
During the procedure, electrodes are implanted into the deep structures of the brain and connected to generators in the chest that deliver small electrical currents to the brain, similar to pacemakers. When DBS is successful, the low current of continuous stimulation reduces the intensity and frequency of obsessions and compulsions, allowing previously ineffective therapies to have another chance to work.
Davis recognized Patel as a candidate.
Rachel Davis, MD
“When I first met him, I had no idea how severe his symptoms were. He functioned so well at work and he wanted to present himself that way too,” Davis said. “But I quickly understood how handicapped he was by his symptoms. He had tried many medications in the past that were of little or no help. He had participated in intensive exposure and response prevention therapy, and met other criteria for DBS.
Roots of a rare procedure
DBS for OCD is rare. It was first used to control Parkinson’s tremors in the late 1980s. In 1999 it was used experimentally to successfully manage OCD and received FDA approval through a humanitarian device exemption in 2009. It is rare today, in part because of the stigma surrounding the use of invasive surgical procedures for mental illnesses, stemming from an era of inaccurate and destructive brains. surgeries such as lobotomies in the 1950s and 1960s.
“There was no good regulatory oversight, oversight, or ethical guidelines at the time, in addition to a virtual absence of other effective treatments for mental illness,” Davis said. “The type of brain surgery people underwent for mental illness was often devastating and ineffective. There are now established ethical guidelines and criteria backed by literature and expert consensus, but there is still reluctance, particularly when the symptoms are invisible or “mental”, as in OCD.
“We use DBS much more often in patients with Parkinson’s disease, which is also a disease of the brain, but manifests physically.”
Despite the stigma, the results of the DBS study are promising. Research conducted by Davis shows that the procedure often brings relief to patients with debilitating OCD, both by reducing OCD symptoms and improving overall mood.
Fewer than 300 patients worldwide have received deep brain stimulation therapy for OCD. At UCHealth, Moksha Patel was patient number eight.
“His ability to tolerate surgery and recover so quickly is in part due to what he’s had to endure every day of his life – he’s used to tolerating the tough stuff and still functioning.”
A year of preparation
Prior to DBS, the most serious procedure Patel underwent was the extraction of his wisdom teeth. Brain surgery is something else.
“I will probably take two weeks off afterwards, I have a lot to do,” he said in the months leading up to the procedure. He waited anxiously for a year for his claim to make the rounds of insurance. Due to the rarity of the procedure, the process was like a wild goose chase.
Rejected. Called. Rejected. Called. Finally, with the support of CU Anschutz leadership and so many of his peers and experts in the medical field, the coverage was approved.
Patel’s surgery was performed last September by Ojemann at UCHealth. The recovery was tough. The invasive nature of the brain surgery and the accompanying scarring caused a great deal of discomfort. Progress was also slow at first, but as pacemaker programming intensified with Davis and the UC Department of Psychiatry, relief began to set in.
“At first, as I was trying to work through my pacemaker settings, I went from dizzy to sad. It was a real rollercoaster,” Patel said. “On the first day, I was sent home in a framework and I felt slight progress. In a second session later in the week, I left with another frame and felt even better.
In the months following the operation, Patel continued to work with Davis and the psychiatric ward, not only to schedule her DBS, but also to re-engage in intensive exposure therapy. Some sessions were spent sitting on the floor of public restrooms, moving closer and closer to the restroom, while monitoring his brainwaves.
Now, only three months after activating the stimulation, he has seen a noticeable improvement.
“I feel like I have more control over him, rather than having control over me,” he said.
Patel’s resilience in treatment and recovery stems from the extraordinary hardships he faced throughout his life.
“What strikes me about Moksha is that he didn’t have to take time off work for this – no disability, he didn’t quit his job,” Davis said. “His ability to tolerate surgery and recover so quickly is in part due to what he’s had to endure every day of his life – he’s used to tolerating the tough stuff and still functioning.”
“But I want to let others know that there is hope and that they are not alone. Treatments and care are changing. There is something out there that can help you.
Engage in life
Patel returned to work shortly after the procedure and continues to adjust to life with a calmer mind. He proactively referred himself to a physician oversight program through the Colorado Physician Health Program prior to his surgery. They had and have no concerns about his ability to practice safely.
He recently visited Disney World with his sister. Traveling is now easier, as is being away from home for hours or days at a time.
“I’m much happier and able to appreciate things,” he said. “Day to day, I still need to break habits that have been built for 25 years, but it weighs on me much less mentally.”
He started dating and made an effort to be more social. He also takes on more professional responsibilities.
“I’m more engaged in life now,” he said. “Not stuck in my head.”
Patel also wanted to share her story publicly to fight the stigma around OCD and its treatments. He wants to give hope, he says, to the millions of people like him who are struggling with something others don’t understand.
“We talk openly about other illnesses and their treatments. There are a lot of illnesses that people grapple with and struggle with, but because OCD is behavioral, it seems like a choice. People are more understanding these days and are willing to open up about it,” he said. “But I want to let others know that there is hope and that they are not alone. Treatments and care are changing. There is something out there that can help you.