Dr. Fatima Issa '23 on child neurology residency at VCU in Virginia

Dr. Fatima Issa, a December 2023 graduate of UMHS, discusses her upcoming residency at Virginia Commonwealth University (VCU) in child neurology in Richmond, VA. The Canadian native is one of the first UMHS graduates to Match in the competitive field of child neurology

Dr. Issa shares her personal experience with a child neurologist as a child when she had a brain tumor and how it inspired her to pursue a career in the field. Dr. Issa said that child neurologists focus on managing brain development and conditions such as ADHD, autism, and epilepsy in children, while adult neurologists focus on conditions such as stroke and dementia in adults. She expresses her interest in conducting research during her residency, particularly in areas such as epilepsy triggers and the impact of environmental factors on brain development. Dr. Issa also discusses the importance of choosing a field that one is passionate about and offers advice to prospective students considering child neurology as a career. She praises UMHS for its caring and supportive environment and acknowledges the need for more child neurologists in the US healthcare system.

UMHS spoke to Dr. Issa shortly after she received the good news about matching at VCU.

UMHS Endeavour: Dr. Issa, I want to welcome you today and could you tell us a little bit about where you're going to be working soon?

Dr. Fatima Issa: Thank you for having me. So I actually got matched into Virginia Commonwealth University, VCU for short. It's a really great hospital university, one of the top in Virginia and also one of the top 50, actually one of the top 30 hospitals for children hospitals in the nation. So it's pretty good.

What made you want to go into child neurology specifically?

When I was younger, I had personal experience with a child neurologist. I remember my first experience with the doctor was with a child neurologist. I had a brain tumor when I was younger. And so she really, really set the tone of what kind of doctor I wanted to be. And she also gave me the thought that I wanted to be a doctor. And so I've always wanted to be a child neurologist since I was younger. And as we went through the match process, I fell in love with it more and more. So here I am.

Dr. Fatima Issa lecturing at the Third Annual Medical Symposium in St. Kitts. Photo courtesy of Dr. Issa.

For current and prospective students who might be unfamiliar with child neurology, could you just briefly explain what a child neurologist does and how does it differ from adult neurology? What are some of the conditions that child neurologists diagnose, evaluate, and treat?

Sure. The difference between child neurology and adult neurology is mainly most children have issues with ADHD, autism and epilepsy as their brains are developing, a lot of errors that occur. And so we want to really focus on managing the patient's brain and its development with proper medication and proper therapy and all of that. The difference between that and adult is more adult neurologists focus on stroke, they do focus on epilepsy and more of dementia. So really adult neurologists focus on end- of-life care and child neurologists focus on the beginning-of-life care and try to manage the patient so that they can go into adulthood properly.

What do you hope to accomplish during your residency?

It’s a five-year residency program. So the program that I'm involved in has different pathways and it depends on what you want to focus on. So I think I would like to focus on a bit of research during my residency and maybe learn a little bit more about triggers that affect epilepsy, triggers that can affect brain tumor morphogenesis and just environmental factors that can affect the patient's brain and how we can alter that in the future. Because lots of research with regard to child neurology and diseases of the brain of the child are minimal. So we need to really focus on advancing that research. So I want to focus on that.

Awesome. And what made you decide to choose UMHS over other med schools when you were looking at med schools to apply?

So, when I was looking to apply, there was a lot of factors in my life that as an undergrad you have a lot of issues going into medicine because it's very restricting and it's very competitive. And when I learned about UMHS, I actually met with one of the owners of UMHS and this was in the beginning of the development of UMHS. And she was so welcoming. She was so beautiful in her approach to how they can help us and what a small class size it is and how the professors are so welcoming towards their students and we're not just a number. I think that was really the main thing that made me want to go into UMHS is the fact that the professors would care for you, the owners would care for you, everybody would care for you. And it's been actually proven through my approach and a lot of my classmates as well, UMHS genuinely cares about their students. So, it was a great experience overall.

That's really great to hear. The Child Neurology Foundation states that the number of child neurologists in the USA is at least 20% below national needs, and this is indicating that this is a specialty in which new doctors are really needed. What would you say to current and prospective students thinking about going into child neurology as a career?

I would tell them don't fear it because I feel like it's such a niche field and there's not a lot of understanding from previous alumni and people really throughout the nation like residents—there's not a lot of information on how to move forward with the Match process with regard to child neurology. So, I would just tell prospective residents don't fear the process. I know the rates when you’re looking through the Match algorithm and all of that, it shows that it's you get one person per each program or two residents per this program and all that. Don't fear that thought because if you are really interested in child neurology, it will show and the right program will come for you. So just go at it full throttle and you'll get what you need.

I think that's really sound advice. And is there anything else that you would like to say to people out there that we haven't covered?

I would just say go for what you love. Being a resident and being a doctor, just going throughout this entire process takes a lot of dedication and sacrifice and we all know how much it takes to get to every step of the way. So, just make sure you choose a field that you genuinely love and that will keep you excited every day and will give you something to look forward to. And yeah, just go for what you love.

Dr. Fatima Issa with a research poster about a study for which she collaborated. Photo courtesy of Dr. Issa.

Born in Canada, raised in Michigan

Did you grow up in Michigan?

Yes, I was actually born in Canada, but I lived in Michigan most of my life. And yeah, I lived in the metro Detroit area.

Where in Canada are you originally from?

Scarborough.

Scarborough, Ontario. That's right outside of Toronto, right? And did you always want to be a doctor?

Yes. So I remember in first grade I think I came up with a thought that I wanted to become a doctor and then really the defining moment was when I met my child neurologist. I knew at that point that's what I'm going to be. And so, I've continued ever since.

Where did you do your undergrad and what was your major?

My undergrad was at Wayne State. My major was biology.

We had talked a little bit earlier off camera about the Academic Affairs Department and I know Jonathan Timen and Patrick McCormick had really good things to say about you. Did you find it was really helpful to work with that department whenever it came time to Match?

Yes. So, I actually was applying to Match last year and I wasn't able to complete my Step 2 in time, but Patrick gave me amazing, amazing insight into focus on your step two, don't rush it, don't rush this process because whatever is meant to be is going to come regardless. And he also was the one that encouraged me to really say my story. I was a bit reluctant to talk about it, but he said, "Use your life to your advantage." And he really just boosted my confidence on how to approach every step of the process.

And even throughout the Match cycle when I was offered second looks and things of that nature, I would call Patrick and say, "Hey, what do I do next? Should I email the program director? What should I do in terms of having the proper connection with the program director so that it's respectable, professional and not overbearing, not crossing any lines?" And so, Patrick was amazing. Then also Jonathan really helped with my MSPE. He was able to write my history and my grades and everything in such a beautiful, eloquent manner. The MSPE is a big indicator of your success as a resident. So he really helped as well.

Just for the lay person out there, can you explain what an MSPE is?

Yeah, so the MSPE is the school's explanation of your history as a med student and as prior to going into med school. So it's like a five to six page paper that the school writes, talking about your history, why you wanted to go into medicine, talking about your basic science experience, talking about your clinical rotations and what your attendings had to say about you. And it really puts you in such a bright light to any program that's looking at you. And so Jonathan really took his time with it and he even would call me and be like, "Hey, I'm going to write this and this and this. I just wanted to let you know." He can't change it because everything is written based off what the attendings and my grades show. But he did it in such an eloquent manner and so he really cared about perfecting it for me.

Dr. Fatima Issa on Match Day, March 17, 2024 in Detroit. Photo courtesy of Dr. Issa.

What conditions a child neurologist diagnoses & treats?

Let’s switch gears a little bit and focus on the field of child neurology. We've talked about the fact that you did have a brain tumor as a child, but what are some of the areas of the specialty that interest you the most? And I know the field covers a wide spectrum from pediatric stroke, epilepsy, neuromuscular disease, but also areas like Tourette's syndrome, ADHD, and then the autism spectrum disorder. What are some of the areas that interest you the most?

So lately, the things that have been interesting me are autism for sure. That field, surprisingly, is growing. There are a lot more autistic patients than there were 5 years ago, 10 years ago or 20 years ago. And again, research on this is very minimal. So I want to focus on autism and I also want to focus on epilepsy as well because epileptic patients have only a few select medication options. And so, some of them—those medications are very tough to handle even as an adult, let alone.

Right.

So, I want to make sure I focus on those types of patients to allow them to receive the best quality of life with their diagnosis. I think that's the most important thing for me is to give these children the best quality despite what they have.

Let's talk a little bit about autism, because you hear a lot now that more and more people are being diagnosed. What exactly is the autism spectrum?

The autism spectrum is really just the cognitive functioning of an autistic patient; is very different than the regular child in terms of they have sensory deficits or they have sensitivity to specific sensory issues. They have no awareness. This is depending on the spectrum and where the patient is on the spectrum, but they sometimes might not have awareness of emotional cues. If somebody is angry with them, they might not understand that hey, they're angry; they do not understand emotional cues, they also have issues with communicating. And there's so many different aspects of a patient's life that is affected from these autistic patients based on where they are on the spectrum.

There are autistic patients that are very much able to cooperate in society and just go to school and live life and progress perfectly. But then there are also autistic patients that aren't able to even leave their room. So we need to help them receive therapy and occupational therapy, physical therapy, all of these things so that they can be incorporated into society as best as we could. So, it's more of a genetic and environmental deficit that occurs in the patient's brain that just affects them in many ways.

A lot of times when people hear the word “autism,” they think that it’s just a child that doesn't communicate, who is maybe just painfully shy; they have real issues with communicating and that sort of thing.

Yes, and just even understanding life. Some autistic patients can't even walk to the grocery store with their mom because it's too much of a sensory over them. So it's a very complex disease and very little is known about it.

You spoke about epilepsy. So, the meds are have a lot of side effects?

Yes. For some epileptic patients, the medications can help them and they can move forward with life with the same dosage until they go into adulthood. A lot of patients actually don't have epilepsy as they move into adulthood. But there are some patients who when they are taking these medications, it causes major side effects for them in terms of cognitive advancements, in terms of functioning throughout life because there's a bit of haziness that comes because the medication is so strong and dulls the nerves because epilepsy is really just nerves firing out of hand. So those medications can really affect a child's development. So I want to be able to help them take the proper dosage for the proper medication that allows them to move forward in life and then hopefully develop past this epileptic stage of life.

That leads into my next question. Are there any new treatments or any groundbreaking research that you know of in child neurology at present that interests you or that you would like to do more research on?

The groundbreaking research that has been going on for the past 15 years has been really the interaction between the gut and the brain. So actually, I did some research when I was in my basic sciences with, I think it was Dr. Jane Harrington; she was the microbiologist.

Yes, I remember her.

Yeah. So I've done a few semesters of research with her with regards to gut flora and how it affects the brain. It can affect a patient's ADHD reactivity, it can affect a patient's depression, anxiety, all of that nature. There's a lot of neurons in the gut that affect the neurons in the brain. So I really want to focus on that as well. I'm trying to hone in my focus definitely, but I feel like that's a major factor in possibly helping a lot of these patients who are having diagnoses that we still don't know much about. I think if we can fix their diet and then fix their gut flora based on fixing their diet, it can help minimize the reactivity of epilepsy and ADHD and even autism, maybe. I don't know much about the autism link with diet, but I know ADHD and epilepsy is very much, can be very much linked to the foods that we eat.

That's interesting that you mentioned it because I know you hear a lot about the keto diet and that's the one that generally people with epilepsy go on.

And it actually stops epileptic occurrences for lots of patients. And this diet isn't for everybody. It's obviously a trend right now, but it genuinely helps lots of epileptic patients. And also, just the diet that you eat can affect gluten intolerance and gluten intolerance causes inflammation in the brain, which can cause reactivity of certain diseases that a developing brain doesn't need to have as it's developing.

Oh, I didn't know that. So, gluten can actually affect the brain, especially if somebody is epileptic. What exactly is the keto diet? I know it's a lot of protein and not a lot of carbs.

So, the gluten diet affects inflammation in the brain. It's not necessarily only for epileptic patients; it's for everybody. Every child who has gluten sensitivity, it can help minimize issues in the brain. But the keto diet is definitely beneficial for epilepsy. But the keto diet is really low carb. They expect you to have less than 50 carbs per day, and that's high protein, high fats, high vegetables that are low in carbohydrates. And it really just helps decrease the neuronal hypersensitivity in the brain. And there's lots of studies that have shown that this is very beneficial to developing brain with a brain that has epilepsy.

Dr. Issa in scrubs with a friend during an OB/GYN clinical rotation at DMC Huron Valley-Sinai Hospital in Michigan. Photo courtesy of Dr. Issa.

Grateful for UMHS

Is there anything that we haven't talked about that you'd like to say that we haven't covered? Anybody you want to give a “shout out” to or any advice that you can give?

So definitely I want to give a “shout out” to the owners of the school. Really, they have done what a lot of people don't have the guts to do in terms of opening a school that is so caring towards their students, so hands-on with their students, especially a Caribbean school. I feel like they have gone above and beyond. And so I really wanted to thank them for that. Also, I wanted to give everybody advice, just go for your passion. Don't let anybody minimize your goals and don't let anybody allow fear to come into your goals because we are very qualified as physicians. Coming from UMHS, most of the students that come from UMHS are above and beyond, I guess they're just very intelligent, very hardworking, very successful people. And so go through the residency match cycle knowing that you are very qualified and you're just up to par with those MDs in the US schools because you really are, if not more. So just go on with confidence and go for what you love.

I'm thankful for the path that I've went on and yeah, it's been a good ride. It's been a long ride, but a good ride.

(Top photo) UMHS 2023 graduate Dr. Fatima Issa. Photo: Courtesy of Dr. Issa.

Email Dr. Fatima Issa at fissa@umhs-sk.net