Interview with Linda Medleau, D.V.M.Professor of Veterinary DermatologyThe University of Georgia JAMPHL: Hello Linda. Thank you for joining us for an interview with JAMPHL. How are you doing today? MEDLEAU: I'm doing fine. JAMPHL: Can you first start by telling us about your profession? MEDLEAU: I am a professor of veterinary dermatology at the University of Georgia (UGA) College of Veterinary Medicine. Briefly, I graduated with a D.V.M. degree from Ohio State University in 1979, then I did a one-year small animal medicine and surgery internship at Michigan State University. After that, I received a M.S. degree from UGA in medical microbiology, and then I was a veterinary dermatology resident at the University of Pennsylvania. After the residency, I joined the faculty at UGA in 1984, and I've been here ever since. In 1986, I successfully passed the board certifying examination to become a diplomat of the American College of Veterinary Dermatology. JAMPHL: Very impressive, Linda! It is such an inspiration to see other individuals with hearing loss set goals and accomplish them. Now, the reason we have chosen you for this issue is because you are legally blind and you have a profound hearing loss caused by Ushers syndrome. Can you tell us about this syndrome? MEDLEAU: I have Usher Syndrome type 3 which is an inherited disorder characterized by both vision and hearing loss. The visual loss is from retinitis pigmentosa, a progressive degeneration of the retinal cells, which begins in the periphery of the retina and works its way centrally - the first thing you lose is your peripheral vision and night vision - developing tunnel vision and then as you lose your central vision you also lose your ability to see depth, read, and see color. I now have about five degrees of vision left and all I can see are vague, grayish shadows. The hearing loss in this type of Usher syndrome is also progressive. My hearing loss was mild during childhood, then became moderate to severe when I was a teenager, and finally profound in college. JAMPHL: So you have always had a hearing loss? MEDLEAU: Yes. It was definitively diagnosed when I was nine years old, but I didn't get my first hearing aid until I was fifteen. JAMPHL: I was under the impression that hearing loss was something that you had dealt with as an adult as not as a child. This makes for a more interesting interview then. Now, you were a former patient of mine when I (Atcherson) was a budding audiology student at the University of Georgia, I remember trying to fit you with the most powerful hearing aids that were available at the time. Can you talk about your frustrations with your incremental loss of hearing during this period? MEDLEAU: That's an interesting question, because at different stages of my life, especially in the early stages, I felt only hearing impaired. Then in my thirties, when my visual loss progressed to the degree that I had to call myself blind, I felt more visually-impaired than hearing-impaired. By the time I met you, when I was in my forties, I was feeling the effects of both impairments. When you met me, my level of hearing loss was profound, and it had been that way for at least twenty years. In spite of that, I was very fortunate because I could hear well on the telephone with the T-coil. And in fairly quiet situations, even noisy ones earlier on, I did well because I was an excellent lip reader. I had had many sessions with speech therapists to develop my lip reading skills during my teenage and college years. But when you met me, my central vision was going and I couldn't lip read anymore, so it seemed like all of the sudden my hearing had drastically worsened, when it really had not. Dark and noisy situations became impossible hearing situations for me, and I felt very isolated at social functions. People did try to communicate with me, but it was really too frustrating for all involved. So I started feeling like I was enclosed in a thick glass-walled cage. And gradually the clear wall began to fog over with a dense gray film so that I not only was in a soundproof enclosure, I couldn't see out of it either. It was hard not to get depressed. JAMPHL: That is a really profound analogy, the thick glass wall. What you describe is more or less the experience that we have all had in social situations, but it sounds like it hit you pretty hard because you could not depend on your ability to read lips. But then you started using assistive technology. Did that help much? MEDLEAU: Absolutely! I had to get used to holding out a microphone for people to talk into, but once I did - and it's funny how people take their cues from you - if I was comfortable with it, so were they. I used it to talk one-on-one in social situations, in restaurants, when teaching classes, and when attending seminars. It had its limitations of course, but it certainly made me more socially accessible. JAMPHL: Do you do any clinical work besides your academic duties? What are they? How had your vision and hearing loss impact these duties? MEDLEAU: I spend six months per year in clinics - teaching and supervising senior veterinary students, interns and residents on the clinical dermatology service where both referred and local clients with dogs and cats who have skin problems are seen. I'm assisted by a technician who does the technological procedures that I can no longer see to do: microscopic exam of ear swabs, skin scrapings, perform skin test for allergies, flush and clean ears, etc. I rely on the input that I get from my technician and my students as to how the skin looks, and I examine the skin with my fingers, using a well-developed sense of touch, and often I find lesions the others have missed because the hair coat has obscured them. I lecture to the second-year veterinary students on small animal dermatology each fall. Another technician assists me with the classroom teaching. She points out the lesions on the projected slides as I describe them (I know what slides are being shown because I have the order of the slides and their descriptions brailled out for my use during lectures). My technician also hands out assignments, and repeats questions asked by the students via my assistive listening device (ALD). In clinics, I hear pretty well (especially now with the cochlear implant), but when my hearing was at its worse, we would find a quiet area to discuss the cases in. In addition to teaching, I give continuing education (CE) courses, do clinical research, and write papers. I had a textbook on small animal dermatology published in 2001-it's currently being translated into Spanish, Portuguese, French, Italian, and Japanese. JAMPHL: Obviously, your vision and hearing loss has not prevented you from doing the things that you love. Now Linda, you mentioned something about having a cochlear implant (CI). About a year ago, I remember how you were contemplating CI surgery. Like most people, there is extreme anxiety about losing residual hearing. But these people were able to fall back lip reading were the surgery unsuccessful. For you, however, you clearly did not have that option. How was the decision-making process like for you and can you tell us some things about how the CI has benefited you? MEDLEAU: Actually, I first thought about getting a CI three years ago. I was evaluated by a CI audiologist in Atlanta (Cindy Gary), by audiologists at the University of Florida, and I attended a Georgia Peach Cochlear Implant Association retreat. I was told at that time that I was an excellent candidate, and at the retreat I was very impressed by what the CI users said about how much the CI had benefited them. But in the back of my mind I wondered how much their success was due to just the CI, and how much was due to the CI and lip reading/ability to see where the sound was coming from. So as you stated, I was very afraid of taking the chance, having the surgery done, and losing the residual hearing I still had left, which, though terrible, did allow me to function okay. So the thought of getting a CI was put on the back burner then. Then last year, in March, I suddenly and acutely lost all the residual hearing I had left in my right ear from Meniere's disease. Now, only my left ear was functional, and believe me, being able to hear with only that ear made communicating almost impossible. People had to talk really loudly into my left ear and even then I usually couldn't understand what they were saying. So I mostly relied on having people print on my palm for communication, a very tedious and frustrating process. It was a terrible time, and I had vertigo too. So, opting for a CI was no longer a risk. I had nothing to lose and everything to gain. And gain I did. I can't even begin to describe how wonderful the CI is. I now hear better than I have in decades, my speech comprehension is about 95%! JAMPHL: That is amazing! You really are an inspiration. Before we conclude with this interview, is there anything at all that you would like to leave our readers with? MEDLEAU: Yes. Please tell your readers that it doesn't matter how you get the job done, as long as you get the job done. It's okay to do things differently, as long as the job gets done. JAMPHL: Thank you so much for being with us today, Linda. MEDLEAU: Thank you for having me! References on Ushers Syndrome http://www.boystownhospital.org/parents/info/genetics/usher.asp http://www.signonsandiego.com/news/reports/unbreakable/index.html
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