This week’s meet a mom is Alice Rusk, MD, mom to three boys and Chief of Neurology at Greenwich Hospital! We spoke to her about her love for her job, Greenwich Hospital, and our town, plus all that her department has to offer (from Greenwich youngest to oldest residents). Plus, how her practice is coping with Covid-19 restrictions and needs.

Can you please share how long you’ve been practicing and your specialty? 
I came (back) to Greenwich in 1996, after my fellowship at Columbia Presbyterian Medical Center and residency at New York Hospital – Cornell Medical Center. I have been here ever since.

So you grew up in Greenwich? What neighborhood do you live in now? 
Yes, I grew up by Burning Tree Country Club. Now I live in Byram near the water—it’s beautiful. I have three kids, all boys. My eldest is 22 and graduating from Tufts, then I have a 21-year-old at Rensselear Polytechnic Institute and a 19-year-old at Lafayette College.  They’re all very busy but home right now due to Covid-19 closures.

Speaking of Covid-19—is your practice adapting to new restrictions? 
We’re talking to people on the phone and also seeing patients over telemedicine, which is wonderful, but can also be somewhat challenging for elderly people who might not be as comfortable on a computer or smartphone. We’re spending time helping people get acclimated so they can visit us virtually.

Was this telemedicine capability new with Covid-19? 
It’s been around in the background for the past year or two. There has been talk about implementing it, but when the [Yale New Haven] ]\system realized what was happening with Covid-19,  a task force was set up to do this for all of Greenwich and Yale New Haven Hospital.

That’s amazing. How does it work?
Patients connect through MyChart App and we connect with them through their chart on an iPhone. I think it’s going to revolutionize what we do after the crisis. There are so many patients who are limited in their ability to come in because of their neurological conditions and now for something simple—for instance if they want to ask about a new medicine they saw on the news—they don’t have to come in. Of course, we’ll still see people in person if there is an urgent need, but we’re screening people carefully for COVID-19 symptoms.

Your appointments are usually hard to come by. Has this made it easier to get in to see you? 
Yes, the number of appointments dropped way down so our capacity to absorb patients has increased. Depending if it is an existing patient, we can see them by telemedicine and convert to a regular appointment in the future.

What makes the neurology department at Greenwich Hospital stand out? 
Well, this area of the state has a lot of excellent medical care. I think we stand out though, because we supply excellence in multiple specialties, but with a great deal of compassion and with a higher level of attention to each individual and to detail. We are smaller and communicate well as a department, and that helps us provide better care from nursing staff to doctors. We really want our patients to achieve their best outcome whatever their condition.

What are some new additions to your department in terms of technology/infrastructure? 
In our neurophysiology department we are now providing increased access and excellence in  electromyography (EMG) testing, which is important in diagnosing neuromuscular diseases. We’ve added the capability for continuous 24 hour electroencephalogram (EEG) testing, which screens for seizures. This allows us to monitor and screen patients in the hospital who may be having seizures which cannot be detected by visual observation. The patient is connected to the EEG machine in Greenwich and then those brain wave recordings are sent to Yale.  They are interpreted there and sent back to our neurologists so proper treatment can be implemented.

We’ve always had excellent stroke care in Greenwich, but now when we have an unusual case we can connect directly to Yale, in real time via telemedicine, for consultation with a stroke expert to assist with treatment decisions. In addition, we now have the availability for a procedure called thrombectomy. If we have a case of stroke caused by a large blood clot in a major artery of the brain, a neurosurgeon at Greenwich Hospital can retrieve the clot through a catheter and restore blood flow to the brain often reversing the stroke before it permanently damages the brain. Before we were sending these patients in an ambulance to Yale, a long and dangerous trip for a critically ill patient, but now we’re capable of providing that procedure right at Greenwich Hospital with an excellent neurosurgeon. As we say, time is brain.

Fantastic. Any news you’d like to share in terms of common conditions like migraine, Parkinson’s and Alzheimer’s?
In the last year to two years we’ve had the most exciting addition to our treatment options for migraine. We now have several new medications called CGRP inhibitors. We can safely use these in the acute treatment of migraine, as well as in an injectable form given monthly for migraine prevention. This provides an alternative to older medications like sumatriptan that cannot be used safely in patients with hypertension and heart issues.

For Parkinson’s Disease we have several new medications to treat long term complications for patients with advanced disease.  there are two medications currently available to slow progression of disease as well. Physical exercise is clearly well recognized as preventative in progression of PD.  To help patients capitalize on this benefit Greenwich Hospital has added additional physical therapy services for a specialized therapy program for PD called LSVT BIG.

For our memory patients who may have Alzheimer’s or other cognitive disorders we have added, an on-site neuropsychologist to allow increased access to testing. This will aid in earlier and more accurate diagnosis of these disorders.

Concussions are top of mind for so many moms with kids in contact sports. What should we really be concerned about? Football gets a lot of the bad press…
Certainly football, but also hockey, and soccer can be high risks—soccer is underrepresented as a cause. Rugby, bicycle, and horseback riding, as well. The main symptoms parents should be on the lookout for are headache, nausea, vomiting, dizziness, difficulty concentrating, and confusion.  Always seek emergency care if a child (or adult) loses consciousness. Limit the exposure of young children to high risk sports and always wear a helmet for those sports.

How has neurology changed since you started practicing? 
Advances in the technology such as using e-charts has been a major shift in the way doctors practice. Electronic charts allow the doctor and patients to connect directly with health care information from other doctors immediately. This limits waste and improves safety for patients by avoiding duplication of testing and potential medication interactions. It also gives the patients easy access to their own medical information.

How have your patients been impacted by COVID-19?
We have yet to learn all of the neurological effects of the virus, but will continue to be there on the front lines to help our patients needing neurological attention in the hospital and after discharge.

What is your favorite part of working at Greenwich Hospital? 
I love working at Greenwich Hospital because we have many dedicated professionals who all have the same goal of providing excellent care for our community. We work together as a close knit team and because we are connected and communicate well our patients benefit as a result. We are lucky to serve a wonderful town full of many patients who are very invested in their own care and that makes our mission much easier. Doctors and patients who work together achieve better outcomes and forge strong relationships, which after all is the greatest benefit of being a physician in a town like Greenwich.

‘Neuroscience,’ along with Pediatrics and Women’s Health, was an intended beneficiary of the Greenwich Hospital Benefit on May 15, 2020. This event will be postponed until 2021, when the hospital and community will come together to celebrate the doctors, nurses, clinicians, staff and volunteers who have worked tirelessly during the COVID-19 crisis to care for everyone.

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