Shadowing Practice: A man hiked in the woods. Every brain cell got cooked. - Learn English Speaking with Video
Creating lesson...
1
K.A is a 49-year-old man presenting to the emergency room with fever, headache, and confusion.
2
His speech was garbled, his vision was blurry.
3
Something was wrong with his brain.
4
An MRI of his head showed that something was abnormal, but it didn't give any clues as to what was happening.
5
The brain and the spinal cord are surrounded by a liquid that cushions and protects it called the cerebrospinal fluid .
6
Doctors stick a needle into K.A.'s back to draw some of that fluid to send to a laboratory to test, so that they can get some more information.
7
When they looked at it, it was yellow and cloudy.
8
It's not supposed to look like that.
9
And when the lab results returned, it shows that there's a huge amount of white blood cells in it.
10
These aren't supposed to be in the CSF.
11
And this gives doctors some clues as to what's happening to him.
12
Five years earlier, KA wasn't feeling well.
13
He'd wake up every day and feel bloated.
14
At first his wife thought it was funny, and she started calling him sausage fingers.
15
He noticed that he was gaining weight disproportionately to how little he was eating every day.
16
And every time he'd use the bathroom, he'd notice a mass of foamy bubbles in the toilet.
17
At a doctor's visit, his wife realized this wasn't funny anymore.
18
KA had gained 40 pounds, but almost all of this was water.
19
When the doctor squeezed his leg, it was like squeezing memory foam.
20
This isn't supposed to happen.
21
This kind of fluid overload is seen when someone's organs are failing.
22
A blood test reveals two things.
23
First, KA's kidneys have shut down.
24
They're not filtering his blood anymore.
25
The bubbles in his urine are proteins that are just bypassing the kidneys, and his edema, the fluid buildup, is because his kidneys aren't removing wastes from his body anymore.
26
The second is that Ka's immune system is attacking his kidneys, that's why they're shutting down.
27
The blood test finds that his white blood cells have created antibodies that specifically target his kidneys for destruction.
28
If this keeps up, the damage done will be permanent.
29
This is called membranous nephropathy, nephro referring to kidney, opathy referring to disease,
30
and membranous describing how the kidney looks under a microscope when the immune system is attacking it like this.
31
Medicines can fix this.
32
KA was given two.
33
The first is a steroid.
34
This is a general anti-inflammatory.
35
It blunts the immune system.
36
But it's not enough by itself.
37
The second medicine goes into the white blood cells.
38
It tells their genes to stop producing signal chemicals.
39
This makes it so that the immune system can't communicate amongst itself.
40
Both of these together should stop KA's immune system from attacking his kidneys, allowing them to heal and enabling Ka to live his normal life again.
41
And things seemed to be okay.
42
But three years later, there was more protein in his urine than ever before.
43
His fluid overload is so severe now that his blood pressure is always high.
44
Now it's severely impacting his heart.
45
His kidney damage was getting worse.
46
His immune system was still destroying his kidneys.
47
Two more medicines were given.
48
One stops white blood cells from growing, stops them from functioning, and it forces them to destroy themselves.
49
The second medicine gets into the DNA of white blood cells and inserts chemical parts that completely invalidate the entire cell.
50
Doctors aren't shutting down the production of signal chemicals anymore, they're depleting the white blood cells in his body.
51
This is the last resort to save what's left of Ka's kidneys.
52
He received a few doses of these medicines over 18 months, and his kidney function held steady.
53
All of this was working, but something was still wrong.
54
Hey, have a quick question.
55
Have you learned a few things in this video so far?
56
If you have, I'd really appreciate it if you aren't subscribed yet to subscribe
57
and come back to see the video that I post next month too.
58
I make these videos for fun, and I do them because I genuinely like to.
59
It's always one of the highlights of my day.
60
I've published on average one a month every month since 2017, and I do these to teach how we think in medicine by telling stories of patient cases.
61
I'm very thankful to have the opportunity to make these for you.
62
Appreciate you.
63
20 months after treatment, which is 4 months before he's presenting to the emergency room, K.A went on a hiking trip with his wife.
64
In the evenings, after they were done, he'd notice welts all over his arms and legs.
65
They were itchy, sometimes painful.
66
The trip was like this every day, but he was totally fine when he got home.
67
A few weeks later, he started seeing flashing lights.
68
He thought maybe he hadn't gotten enough sleep, but then a horrible pain emerged on the left side of his forehead.
69
At the hospital, doctors did a brain MRI.
70
Nothing was found.
71
Everything was normal.
72
His kidneys were healing, but blood tests suggested that he was dehydrated.
73
They gave him IV water.
74
Two days pass, and he got better.
75
They sent him on his way, but very clearly dehydration wasn't his problem.
76
A week later, Ka was back in the hospital because his speech was nonsensical.
77
He was confused.
78
He didn't know where he was.
79
One kind of stroke is when a blood clot gets lodged into a blood vessel of the brain.
80
This chokes off blood flow and starves that part of the brain of oxygen.
81
There's just minutes before permanent damage settles in.
82
When doctors did imaging of Ka's brain, It kind of looked like he was having a stroke, but it wasn't clear, it was borderline.
83
But there was no time to wait.
84
Medicine, that immediately breaks blood clots by thinning the blood, were given.
85
It seemed to work.
86
KA got a little bit better.
87
But he appeared to still have problems.
88
It was hard for him to find the right words to say, and he was still confused.
89
But by that hospital administration's metrics, he was good enough to go home.
90
No more immediately completely life-threatening problems, so let's schedule you an appointment for follow-up." And he was on his way.
91
As the weeks passed, KA started seeing floaters on his left side.
92
He had to lay down in bed with an eye mask
93
because light would make him feel like a hammer was smashing his skull.
94
He had to wear earplugs because all sound would amplify an echo.
95
At the ophthalmology eye doctor's office, KA was found to have eye inflammation.
96
The left was worse than the right.
97
The pattern and where the inflammation was inside the eye were very specific.
98
And this was concerning.
99
KA had a history of his immune system attacking his kidneys.
100
If his eyes have inflammation, this could mean that it's attacking his eyes now.
101
KA was given steroid eye drops.
102
A mixed sedative, Tylenol, and caffeine combination pill were given for his headache.
103
This calms down the brain, reduces inflammation, and constricts blood vessels going to the brain to limit excess blood flow that could cause headache.
104
In over two weeks, KA's pain went away.
105
His vision improved, he didn't need to wear the eye mask anymore.
106
But a week later, KA suddenly felt weak on the right side of his body, and the right side of his face was drooping.
107
He could only slur his words.
108
At the hospital, again.
109
Clinically, it looked like he was having a stroke again, but brain imaging returned normal, no stroke.
110
Two days in the hospital passed, KA could speak normally again, so he was sent home.
111
Nothing wrong was found.
112
But over the next week, KA's wife noticed that he would have staring spells.
113
Things would last just for a minute, but he would stop moving.
114
His eyes would be wide open, he wouldn't blink, he wouldn't respond to anything, and after a minute, he'd snap out of it, and he couldn't remember anything that had happened over the last hour.
115
He started having a fever, and his episodes of slurred words would return every few hours.
116
At the hospital, again.
117
Brain imaging was normal, blood test results were normal.
118
Nothing looked wrong, but very clearly, something was wrong.
119
KA had gone to the same hospital seven times in the last four months.
120
The doctor this time remembered him from a previous visit.
121
When he looked at the medical record, he realized that no one here ever found out why any of these things were happening to KA.
122
This doctor pulled KA's wife aside and told her, there might be a better hospital, maybe you could say, more adequately equipped, to figure out what's wrong.
123
It's just on the other side of the city, and she agreed to the transfer, and he's brought to the emergency room, where we are now.
124
In this emergency room at the second hospital, doctors re-evaluated KA.
125
All of his vitals were normal.
126
He didn't look well.
127
in his face had wasted away, indicating malnutrition.
128
A mental status exam found that he couldn't name the days of the week backwards.
129
He named a month, and then said the days forward.
130
When he was asked to remember three words, he could only remember one after five minutes.
131
He said that nine quarters was $4.25.
132
His vision was blurry, and he had trouble moving his eyes, but he knew where he was.
133
He could say the word hospital sometimes.
134
Other times, he'd stare off into the void as if he were trying to speak, but couldn't.
135
tests were normal, urine and serum toxicology negative.
136
A brain MRI showed subtle changes, but it's not clear what any of this means.
137
Given this information, and KA's past medical history, the overactive immune system attacking his kidneys, and the four immune suppressing medicines that he was given,
138
there's a few things that doctors want to do immediately.
139
A lumbar puncture found lymphocytic pleocytosis, pleo from Greek referring to a very large quantity, phyto meaning cell and osis meaning a disorder,
140
and lymphocyte being a particular type of white blood cell, a large quantity of white blood cells causing a disorder.
141
This means that his immune system is trying to respond to something.
142
Regardless of the fact that it was nuked by those four medicines, it looks like it's still responding potentially to an infection of his.
143
His CSF was yellow and cloudy.
144
It's not supposed to look like that.
145
The problem is, there's no telltale signs of which infection this is.
146
It could be a virus, it could be bacteria, it could be both, it could be something different.
147
Doctors come up with an early plan.
148
Give KA an antiviral medicine, give him three antibiotics and B vitamins just in case of neurodegeneration from that malnutrition.
149
And then watch him in the hospital.
150
Do this now, because the infection can and will get worse in the coming days.
151
In the meantime, they draw blood and order many different tests.
152
Some of these tests will take days to return.
153
An ophthalmologist examines his eyes.
154
They saw that fluid was swelling into his optic nerves, connecting his brain to his eyes.
155
The next day, doctors noticed that KA's speech was slurred.
156
None of his words made any sense.
157
He would scream and cover his eyes until the lights were turned off
158
and the window blinds were closed because he was so sensitive to light.
159
On the second night at the hospital, KA was finally able to get a good night's sleep.
160
And this is where the medical team was totally thrown off.
161
The next day, hospital day three, KA opened his eyes.
162
He stood up, he stretched, and then he started walking around like nothing was wrong, like nothing had happened.
163
He was calm and collected.
164
Doctors asked him questions.
165
He responded in full clarity, no problems.
166
He could remember the three words after five minutes.
167
He could name the days of the week backwards.
168
Nine quarters is $2.25.
169
And when they asked him what was going on through his mind the last few days, he said that he knew he was in the hospital because he wasn't feeling well,
170
but he couldn't remember that doctors had asked him to do any of those things that he just did.
171
One thing that he wanted doctors to know was
172
that his vision started getting weird after he spent a lot of time outdoors, hiking with his wife, hunting with his colleagues.
173
Every time he'd come back from these, he'd notice welts all over his arms and legs.
174
He thought these may have been bug bites, but he wasn't sure.
175
He had asked the other hospital about this, but they never found anything definitively.
176
But what is definitive is that KA appeared healthy suddenly, but his vision was still blurry.
177
The studied eye exam the following day found that only his left optic nerve was swollen, and that the inside of his eyes looked markedly different, a big improvement from two days prior.
178
And around this time, the blood tests and CSF lab tests had returned, and this screwed everything up.
179
When he presented to the emergency room, he had meningoencephalitis.
180
Meningo referring to the meninges, the membrane protecting the brain and the spinal cord, Encephal, referring to the brain,
181
both his brain and the membrane surrounding it were inflamed.
182
And words matter.
183
Meningitis, the inflammation of the meninges, usually presents with headache, stiff neck, fever.
184
But brain function is totally normal.
185
Ka's brain wasn't normal at presentation.
186
Meningoencephalitis is meningitis with a brain that can't function,
187
can't talk, can't think, can't respond appropriately and visual changes with swollen nerves means that the brain and nervous tissue are inflamed,
188
and this is what he had at presentation.
189
And his condition rapidly improved once he came to this hospital and was started on antiviral medicine, three antibiotics, and B vitamins.
190
Doctors had written a problem list to match his symptoms, and they need to rule each one out in order to find out what's happening.
191
The blood and CSF test results give them some direction.
192
First, Ka had an autoimmune problem, and this means two things.
193
The first is that his immune system could be attacking more than just his kidneys.
194
It could be attacking the blood vessels in his brain.
195
That can cause problems that look like a stroke, which he had at the hospital a few weeks earlier.
196
A blood test can find this, but that test was negative.
197
So whatever it was that caused that stroke was something else.
198
So this wasn't his problem.
199
The second issue from autoimmunity stems from the latter two medicines that he was given for membranous nephropathy.
200
When these shut down the immune system, it puts him at risk for rare infections.
201
So if Ka got better after being given one antiviral, three antibiotics, and B vitamins,
202
and if he was predisposed to infection because of a prior illness, then this means that his meningioencephalitis is because of infection.
203
But which infection?
204
These medicines have side effects, you can't keep them indefinitely on all five.
205
And if you stop the right medicine too early, then you'll grow a medicine-resistant strain of the pathogen without knowing what caused this problem in the first place.
206
But here's a big problem.
207
When doctors tried to grow bacteria from his blood in CSF, nothing appeared.
208
This could mean that his problem isn't bacteria, but it could also mean that it's a secret bacteria that can't be grown in a petri dish.
209
Meningoencephalitis pathogens are only found at best 30-60% of the time.
210
there's an actual chance that they're not going to be able to find what's wrong, but doctors still need to reason out what Ka doesn't have.
211
Bug bites give the clue.
212
Viruses.
213
West Nile from mosquitoes.
214
Ka's in the northeastern United States.
215
Lots of mosquitoes there.
216
This can cause his problems, but antibodies in the CSF and viral RNA in the blood were negative, so he doesn't have this.
217
All other mosquito-borne and tick-borne viruses local to the northeast were tested for.
218
They can cause similar neuroinvasive viral encephalitis, but all of these were negative.
219
Shingles and herpes viruses can cause similar-looking illness involving eye and brain, but his brain MRI didn't have characteristic features of any of these.
220
Blood and CSF tests for these sometimes aren't accurate.
221
The inflammation in his eyes don't look like the patterns usually associated with these illnesses, and it's unlikely that the particular antiviral medicine
222
that he got would have had an improvement this profound in such a short amount of time.
223
While a viral illness is not completely off the table, doctors look at all the possible bacterial species that could be the problem.
224
Hospital labs can't grow every bacteria from blood and CSF samples.
225
Some that cause problems aren't easy to grow.
226
When they did try, they weren't able to grow any species from his samples.
227
Reasoning out which bacteria it wouldn't be, mycobacteria, which can cause tuberculosis, can cause optic nerve edema and uveitis,
228
but they also cause movement disorders and issues moving the eyes.
229
And the antibiotics that were given to him don't really destroy this kind of bacteria.
230
There's a spiral shaped bacteria called a spirochete, one species is well known that causes syphilis, named Treponema pallidum.
231
This causes uveitis, and late stage disease can cause neurologic signs and symptoms.
232
But this is easily tested for, and it was done, and it was negative.
233
Finally, the last test.
234
Borrelia burgdorferi, the spirochete that causes Lyme disease.
235
This is a disease that comes from bacteria transmitted by ticks.
236
KA is in the region of the country where Lyme Connecticut is, where the name of the disease is from.
237
KA's problem started after he went on hiking trips with his wife and hunting trips with his colleagues,
238
all activities outdoors in places where there's ticks.
239
This was KA's most likely problem.
240
It causes uveitis and optic neuropathy.
241
Lyme disease can cause lymphocytic pleocytosis.
242
It can cause facial nerve problems looking like a stroke.
243
It can inflame the meninges, all signs and symptoms that he had been suffering from over the last several months.
244
One of the antibiotics that he was given acts directly on Borrelia, and this explains how he suddenly became better after he got it.
245
But when they tested him for Lyme disease, they didn't find any antibodies to Borrelia burgdorferi.
246
He also didn't report the kind of rash that you often, but not always, see with Lyme disease.
247
But maybe that's okay.
248
One of the immunosuppressants that he received for his membranous nephropathy can delay the body's antibody formation against Borrelia burgdorferi.
249
The problem is, when they did imaging of his head and his spine, none of the pictures looked like what you would get when one has Lyme disease.
250
And over the days, they kept repeating the blood test, only for it to keep coming out negative for Lyme disease,
251
meaning that their entire problem list was totally crossed out, and this advanced hospital couldn't figure out what was wrong.
252
What could this be?
253
If this isn't Lyme disease, but it has similar features, but just slightly different, then is it possible that it's another species of Borrelia?
254
Special research laboratory testing was ordered.
255
gene sequences of particular known bacteria were done on Ka's blood and CSF.
256
These are bacteria that have only been described in a handful of human cases.
257
No standard clinical lab tests exist.
258
In truth, only a high-powered academic institution with labs willing to look deeper would be able to do this.
259
But when the results returned, they found out what it was.
260
One angle of being healthy is eating well, appropriate portion size, and fresh nutritious And CookUnity is a great option for getting started on the right track for food choices.
261
They're the sponsor of this video.
262
They don't have anything to do with me saying anything about any infectious disease.
263
CookUnity is a chef collective that gets you restaurant-quality meals by award-winning chefs delivered fresh to your door.
264
Every week, I choose a couple of meals.
265
The system knows what I've really enjoyed and can make informed decisions for me.
266
And delivered to my door is a whole week's worth of lunch for me, and this helps me stay on track with what I eat.
267
These meals are amazing, and there's a huge variety.
268
Let me show you some of my favorites.
269
Roasted chicken with Peruvian sauce by Chef Nelson Brizuela.
270
The chicken is juicy and the sauce with the rice is amazing.
271
The flavors are incredibly unique.
272
It's nutritionally very good, too.
273
And take for example this Mexican Philly cheesesteak bowl with smoky Baja sauce, also by Chef Nelson.
274
It's such a rich, cheesy flavor brought together by Rice and Juicy Steak.
275
Cook Unity is offering everyone watching this video 50% off their first order.
276
Click the link in the description below and use my code CHUBBY50 to try it out.
277
Link in the description with code CHUBBY50.
278
I highly recommend it.
279
In 1995, Japan, a group of researchers were investigating the tick Ixodes persilcatus.
280
This is one that carries Borrelia burgdorferi.
281
You can get bit by this one, and you can get Lyme disease.
282
Spirochetes have a body part that helps them twist through their environment called an endoflagellum.
283
When the scientists looked further at a sample of Ixodes ticks,
284
they found that there were these remnants of endoflagella that were distinctly different than what's found in Borrelia burgdorferi.
285
This is like finding the bone of an animal in a human burial site.
286
When they looked at genetic samples, they found distinct parts of genes that were not related to any known Borrelia species at that time.
287
However, other parts of the genes show that whatever it was that had these endoflagella remnants was related to Borrelia.
288
The study demonstrated that there exists a previously unknown Borrelia species inside the Ixodes persilcatus tick,
289
but not much more was heard about this until 2009.
290
Eastern Russia, a place well known to have tick-borne disease, 46 patients had come in to a regional hospital with fever,
291
headache, chills, fatigue, vomiting, and muscle aches after known tick exposure.
292
By this time, doctors and scientists in the area were well aware that local Ixodes ticks harbored many different bacterial species.
293
When the Russian Central Research Institute of Epidemiology conducted the study
294
in conjunction with another tick familiar academic hospital in the northeastern United States,
295
they formally reported the first human cases of this particular bacteria that was discovered in Japan 14 years earlier.
296
Its name is Borrelia Miyamotoi.
297
Borrelia Miyamotoi illness was first reported in humans in 2009.
298
The bacteria was first described in 1995.
299
Just because we named it and documented human cases, doesn't mean that it didn't exist before then.
300
It's just that we hadn't found it yet, and we didn't have the awareness, the techniques, and the technology to describe it and define it.
301
And just a couple of years later, in 2012, the first described Borrelia miyamatoi case in the United States was published,
302
happening in the Northeast, just a few states away from KA.
303
And interestingly enough, this patient had so many striking similarities with KA, they had taken the same immunosuppressant medicine,
304
suffered the same subacute meningoencephalitis, and had a lymphocytic pleocytosis in the CSF that both suddenly improved when antibiotics were given,
305
and the blood test revealed that that KA had had this infection for several months.
306
And now that doctors found the exact causative agent, they have an idea of which antibiotics were doing the work, and they know how to proceed with KA's treatment.
307
The reason this case is important is because disease-carrying ticks have been migrating both inside the US and across continents.
308
Incidence and prevalence of Lyme disease is increasing, and if we know that these ticks have many different kinds of bacteria inside,
309
then it really is important for you to take precautions to prevent tick bites on you.
310
If you live in an endemic area, use insect repellent, wear long sleeve shirts and pants, check your body, clothes, gear and pets for ticks after being outside,
311
and it could be outside that's just even in your backyard.
312
And remove attached ticks as soon as you see them, don't wait for someone else to do it.
313
If we operate under the assumption that you could get bacteria
314
that may not be detectable when you see your doctor because it's not something that's easy to test for, which could then go untreated, just like in KA's case,
315
then protecting yourself and preventing this becomes the most important thing that you can do.
316
I'm not here to scare you about this.
317
You can still do something about this for yourself.
318
KA's case brings up a couple different issues that people today are likely very familiar with.
319
The first is that this was not an easy diagnosis.
320
The hospital that happened to figure out Borrelia Miyamotoi happened to be one of the top research hospitals in the entire world.
321
That's linked to one of the top medical schools in the entire world, meaning they had access to the most advanced labs in the entire world.
322
And most importantly, they had people who were willing to look deeper.
323
And even then, there was a window of time where it looked like they were going to miss this diagnosis.
324
There's no standard clinical test for Borrelia miyamatoi, at least at the time that this patient was diagnosed.
325
Now, I've been alive long enough and doing this long enough to have the hypothesis
326
that if this man went to any hospital in this part of the country, there's a 95 to 100% chance that Borrelia miyamatoi would have never been found in him.
327
There's still a chance
328
that he would have gotten the right antibiotics for the right amount of time fixing all of his problems, and that's where that 5% comes from.
329
And so this brings us to the second issue.
330
There's people who feel that they have something wrong.
331
They know that they have something wrong with them, but no one has been able to give them a definitive answer.
332
Now despite being in medicine, I experienced this myself once.
333
And I've talked about this before, this video on my second channel, but long story short, I had a self-inflicted problem that I wasn't thinking of.
334
It's not malicious, it was an accident that I wasn't paying attention to.
335
And it led to me having the worst insomnia I've ever had for almost two years.
336
And I was given the runaround, even at a major city academic hospital specialist center.
337
Now, I was lucky I found it and fixed it myself.
338
It was a vitamin deficiency, but many people aren't as fortunate and aren't able to do that.
339
Now, inside this topic of people having problems and not getting the right help, there's two things.
340
The first is in context of Lyme disease.
341
The diagnosis isn't simple, and this is where issues come from.
342
People need to have both the risk of exposure to ticks carrying Lyme disease
343
and the clinical symptoms and clinical manifestations of Lyme disease.
344
Sometimes that bull's eye rash doesn't show up.
345
Sometimes you're bitten by a tick.
346
That's not the species that carries Borrelia.
347
And if you are bitten by that tick, if it's not on you for long enough, which is around 24 hours, it's not known to transmit the bacteria in saliva.
348
And sometimes you're bitten by that tick and it doesn't even have Borrelia in it.
349
Now the added factor to this is that the blood test for Lyme disease isn't always accurate, so some people might have gotten a false positive rather than a true positive,
350
meaning that they didn't actually have Lyme disease, even though the blood tests said that they did.
351
They received antibiotics.
352
But because it wasn't the problem, they got antibiotics they didn't need, and then they're still sick.
353
So they think they have chronic Lyme disease.
354
There's a post-treatment Lyme disease syndrome in some people who really
355
did have Lyme disease where the Borrelia bacteria fragments induce an autoimmune reaction.
356
The communication from doctors a lot of times isn't very good about this.
357
And I think people might be familiar with the, Oh, but did you really get Lyme disease?
358
Question that one might get.
359
The second issue is when someone like KA genuinely has a problem, but it's so rare
360
that it takes an ultra specialist at an elite institution that's
361
in a location where the associated disease is endemic to find it.
362
An average Ixodes tick has many different bacteria inside, including many different species of Borrelia,
363
and they will have multiple variants of each species too.
364
There's one thing that we use in medicine, and it's this idea that many of a patient's problems can be explained by a simple, single diagnosis.
365
This helps prioritize decision making, especially in the most common setting, where you're not the only patient that we're seeing.
366
The problem list that the doctors came up with, 4KA, demonstrated this.
367
And it's true, patients can have more than one problem, but human bodies are robust.
368
Our natural facilities can handle many things to maintain homeostasis.
369
I think in the context of chronic diseases, there can be a communication issue, and there are some doctors who are absolutely the right person for you as a patient,
370
and there's definitely some who are definitely not the right person for you.
371
And I do hope that you're able to find the absolute right person, just like how KA was able to in this case.
372
The last thing I want you to be aware of is
373
that there are people who will try to sell you false hope on the internet through supplements and all of those.
374
You have to have your own due diligence to be able to see through all of those.
375
The antibiotic doing the work was one that was used to treat Lyme disease.
376
KA was sent home with this antibiotic to be given intravenously, but he started getting a rash on his face, so they switched to a different one.
377
Three weeks after discharge, at the follow-up, all of his symptoms had resolved, except his vision was still blurry.
378
But three months after that, his vision had slowly begun to improve as he was able to make a full recovery.
379
Thanks so much for watching.
380
Take care of yourself and be well.
About This Lesson
You're practicing English with "A man hiked in the woods. Every brain cell got cooked." using the Shadowing technique — a method originally developed for professional interpreter training.
Focus on sounding like the speaker — not just repeating words. With 15–30 minutes of daily practice, you'll build real-world speaking confidence.
What is the Shadowing Technique?
Shadowing is a science-backed language learning technique originally developed for professional interpreter training and popularized by polyglot Dr. Alexander Arguelles. The method is simple but powerful: you listen to native English audio and immediately repeat it out loud — like a shadow following the speaker with just a 1–2 second delay. Unlike passive listening or grammar drills, shadowing forces your brain and mouth muscles to simultaneously process and reproduce real speech patterns. Research shows it significantly improves pronunciation accuracy, intonation, rhythm, connected speech, listening comprehension, and speaking fluency — making it one of the most effective methods for IELTS Speaking preparation and real-world English communication.