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Faculty Spotlight: Natalia Gonzalez, MD

Thursday, August 22, 2019

Our newest faculty member in the Division of Neuromuscular Disease, Natalia Gonzalez, MD divides her time working in our Early Phase Research Unit, diagnosing and treating veterans at the Durham VAMC, and working on ways to improve the management of neuromuscular diseases. In this week’s “Spotlight” interview, Gonzalez talks to us about each of these positions, what she learned as a neuromuscular disease fellow last year, and how she uses problem-solving in her new hobby of rock climbing.

What are your current responsibilities within the Department? What does a typical day for you look like?
I am currently doing a two year Duke/UNC/UCB pharmaceuticals drug development fellowship. This year, I split my time at Duke working in the Duke Early Phase Research Unit and neuromuscular division, at the VA performing EMGs, and at UCB. I will be taking classes through the Clinical Research Training Program as well. Next year, I will spend most of my time at UCB taking an active role in phase II and III studies.

How and when did you first become interested in neurology and in neuromuscular disease in particular?
My interest in neurology began during my time on the stroke service in my third year of medical school. I then spent time in the neuromuscular clinic, and ALS clinic, in particular, left a lasting impression. In residency, I really enjoyed my time in the EMG lab. I also found the neuromuscular faculty to be thoughtful, curious, and particularly skilled in physical examination, which made them good general neurologists as well. 

What kind of patients do you typically see at the Durham VA? What kinds of neuromuscular conditions are most common among the veteran population?
Overall, the most common neuromuscular conditions for which I see veterans are common in the general population as well (e.g. radiculopathies, focal neuropathies, and polyneuropathies). However, one of the most common issues veterans face is a higher rate of post-traumatic stress disorder and other mental health illnesses which result in some unique challenges. Some veterans may be hesitant to undergo EMG testing based on a prior traumatic experience, so sometimes we have to be very judicious with what testing we perform and interpret the best we can with limited data. 

Mental health illness can also affect compliance and follow-up, and my impression is that there are more cases of patients presenting for the first time late in their illness than in the general population. I really enjoyed my time in the Pittsburgh VA during residency and found taking care of veterans rewarding, so I was happy to continue to do so here in Durham.

What do you enjoy most about your work? What’s the hardest part of your job?
I think the best part of my work is being surrounded by people who are passionate about what they do and are willing to work a little harder to do what is right for the patient. The hardest part of my job is when having to make the diagnosis of a progressive, disabling disease without an existing treatment. However, it is exciting to see what potential therapeutics are on the horizon and that is my motivation to seek out additional training in drug development.

You recently completed your neuromuscular fellowship within the Neurology Department. What’s one memory or experience that stands out for you?
When I learned to perform needle EMG of the genioglossus muscle, I learned there were two methods, one by direct approach, and the other from under the chin. The indirect approach was almost universally accepted, at least by fellows, as it was much less intimidating to the examiner and the patient. I immediately decided that was the way I was going to do it as well since sticking a needle in someone's tongue seemed like it would never go well. Towards the end of my fellowship, however, I mentioned to Dr. Massey the frustration I had with inability to get recording from this muscle in a relaxed state, and she suggested I try the direct approach. I doubted it would help significantly but decided to give it a try. I have done it that way ever since. I have been able to get much better data in much less time and with less discomfort to the patient. I remember being in awe of how understanding and trusting patients were as long as I was confident and explained what I needed to do. It was also a reminder to stay open to trying new techniques or ideas rather than sticking with what is comfortable.

What other passions or hobbies do you have outside of the Department?
I spend most of my time with my husband and our beloved dog, Alba. We adopted her as a very high-energy six month old puppy so it has been quite the adventure training her through her "teenage years". Rock climbing has become a recent passion after being introduced to it a couple of years ago while in residency, and I now climb regularly at a local gym. I love that it requires problem-solving, technique, and balance just as much as strength. I also enjoy running and occasionally painting.

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Gonzalez and her husband visit Canada's Banff National Park.