Dr. Trey Lee Monitors Multiple Surgeries to Help Avoid Nerve Damage

SHARON H. FITZGERALD

Dr. Trey Lee Monitors Multiple Surgeries to Help Avoid Nerve Damage

Dr. Trey Lee with his two sons, Gardner and Camden.
Imagine trying to keep up with six football games at once, with statistics for all the games popping up simultaneously on your computer monitor. Welcome to Dr. George “Trey” Lee’s professional life, only Lee doesn’t monitor gridiron games this way. He monitors surgeries.

“I have them all up on a screen, and they’re all going at the same time right in front of me, and I can easily work with each technologist on each case. Not every moment in the surgery is critical, though; there’s a lot of downtime,” Lee said.

A neurophysiologist, Lee specializes in intraoperative neuromonitoring, keeping a close eye on one reading or even several readings to help ensure a surgeon avoids damage to the nervous system during delicate procedures such as brain, spinal-cord, vascular or peripheral-nerve surgery. Thanks to today’s remote technology, Lee can monitor from his Hendersonville office as many as six operations at the same time happening in six different hospitals. Lee works for NVMS (Nursing Visioned Medical Services) LLC, which was launched in 2000 to offer both intraoperative neuromonitoring and autologous blood component therapy.

A native of Rome, Ga., Lee earned his bachelor’s in biology and history at Emory University and his master’s in neurobiology at Georgia State University. Then he returned to Emory’s School of Medicine for research work before moving on to the Medical College of Georgia in Augusta to earn his MD. After a year at the University of Alabama in internal medicine, Lee was Nashville-bound for his residency in neurology, followed by two years as a Vanderbilt clinical and research fellow in neurophysiology, concentrating on epilepsy and intraoperative neuromonitoring. After training in neurophysiologic intraoperative monitoring at New York-Presbyterian Hospital, affiliated with Columbia University, Lee took the position of NVMS medical director. “It was difficult to leave Vanderbilt, but I am staying on as an adjunct professor and lecture from time to time,” said Lee, who met wife wife, Amy, a Nashville native, while at Emory.

Lee joined NVMS in 2005 “to take it to the next level, and that was to have real-time intraoperative monitoring where there’s real-time communication and viewing of data during the surgery so that immediate responses can be given or made. … The neuromonitoring provides an early warning system for damage to the brain or the spinal cord.”

Lee monitors brain-wave activity using an electroencephalogram, muscles through electromyography, the sensory pathway using somatosensory-evoked potentials (electrical waves generated by the response of sensory neurons to stimulation) and motor pathways using motor-evoked potentials.

“Even though the surgeon is well-trained to identify anatomy, the anatomy can be obscured by scar tissue or a tumor that has infiltrated the area, and it’s hard to know what’s what without identifying it,” he explained. “The electrical activity has certain wave forms and signature morphology that I can follow. Given the sheer volume of patients and the variety of anatomy as demonstrated by different patients, you’re going to have from time to time neurologic problems – a patient wakes up not able to move lower extremities or the left side of the face, for example. We’re trying to avoid these things. We can’t 100 percent cut them out, but we can at least reduce drastically the incidence of neurologic complications during surgery.”

Lee said intraoperative neuromonitoring is replacing the wake-up test, the safeguard method used for decades. During the wake-up test, the anesthesia is reversed, and the patient awakens enough to follow commands to speak or move an extremity. “As you would imagine, there are many problems with that,” he said. “So the technology we’re using now allows us to assess the integrity of the nervous system without waking the patient up. We do continuous analysis of spontaneous electrical activity from the brain or even specific muscles, and we can also stimulate certain areas to elicit sensory or motor pathway activity, and we can measure the response repeatedly throughout the surgery.”

Once Lee detects a problem, he notifies the physician, the anesthesiologist or the neuromonitoring technologist so the surgeon can then alter his or her approach and avert any damage. “We can help guide the surgeon. It gives the surgeon a gauge to know how aggressive he or she can be,” he said.

During vascular surgery, blood flow to the brain could be compromised, either intentionally or unintentionally. “We can pick up these changes, and we sometimes can also get an idea of how long the surgeon can continue, which is helpful,” he said. “They can either speed up, change their approach, and a lot of times it can dramatically alter the surgeon’s strategy.”

Along with working with Vanderbilt physicians, Lee is working to establish a bachelor’s-level program in Nashville for electroneurodiagnostic technicians, who must be specially trained to set up the sophisticated machinery, apply the electrodes to the patient and maintain communication between the operating room and the neurophysiologist monitoring the procedure. There isn’t a training program in Tennessee or any of its contiguous states, he said.

Lee is also proactive when it comes to his involvement in organized medicine advocacy and policy-making. “I always felt like a physician is responsible for shaping and improving healthcare, so I felt like it’s been my responsibility to get involved,” he said. Lee is the young physician representative on the Tennessee Medical Association Board of Trustees; on the board of directors for the Tennessee Medical Political Action Committee, the Tennessee Medical Education Fund and the national Committee on Accreditation for Education in Electroneurodiagnostic Technology; and on the steering committee for the Tennessee Physician Leadership College.

Lee and his wife have two sons, Gardner, nine, and Camden, eight.



November 2007