S02-Ep03_Dr_Heron_Werner

Disabled Lives Matter

Season 02, Episode 03
Co-Hosts: Nadine Vogel & Norma Stanley
Guest: Dr. Heron Werner

Intro: [Music playing in background] Disabled Lives Matter... here we go!

Voiceover: Hello and welcome to this week's episode of the Disabled Lives Matter Podcast. Let's welcome co-hosts Nadine Vogel and Norma Stanley!

Nadine Vogel: Hello everyone, this is nadine vogel and I want to welcome you as co-host of disabled lives matter we are more than just a podcast we are a movement, and today I am joined by the fabulous norma stanley.

NORMA STANLEY: Hello everyone.

Nadine Vogel: My co host in crime partner in crime.

[laughter.]

Nadine Vogel: And we are just delighted today to bring you Dr Werner Dr Werner is a specialist in fetal medicine ultrasound obstet obstetrics and gynecology not that easy to say.

Nadine Vogel: Dr Werner welcome.

Heron Werner: Thank you i'm very happy to be with you.

Nadine Vogel: Thank you so tell our audience where you're practicing today primarily.

Heron Werner: Yes, I live in Rio de Janeiro Brazil so i'm physician here work more with the fetal imaging ultrasound and also Magnetic Resonance Imaging. In special case.

Heron Werner: I I had been here in Rio for. 30 years.

NORMA STANLEY: oh wow.

Nadine Vogel: So thank you, I you know it's interesting because when when we heard about you and your work and your background we were just so excited to speak with you. um.

Nadine Vogel: And I think our audience is going to be really surprised I didn't even know these things existed, but you came up with an idea an invention to make 3D models. Of fetuses.

Nadine Vogel: but so if that's not amazing enough right i've heard a 3D lots of things, but not of fetuses, but you decided to do specifically for your patients who are blind so, can you tell me first, tell our audience just how did that idea even come to you.

Heron Werner: Yeah. um. I love very much human fetal imaging and I remember.

Heron Werner: When I was in my first practice I lived in France for three years and I remember there we received one time a patient a blind patient.

Heron Werner: And in that time we didn't have a 3D ultrasound 3D images for diagnosis, so we, I saw something very interesting because we did the profile of the fetus in the ultrasound.

Heron Werner: And with a scissor we cut the profile to the patient to feel the profile of the fetus, so I saw that it's very interesting.

Heron Werner: So the years past in the 90s, we start to have the 3D ultrasound there in the beginning, if 3D ultrasound was not very powerful it was difficult to prepare the images, the quality of the images were not.

Heron Werner: Very good, it was not very good.

Heron Werner: But in at the end of 90s, the ultrasound start to be the 3D ultrasound we start to be powerful and then we can improve a lot, the quality of the images so my experience it will increase it with the 3D ultrasound and.

Heron Werner: In the beginning of the year 2000.

Heron Werner: I received the clinical proposal.

Heron Werner: From the people from the National Museum in Rio de Janeiro.

Heron Werner: To to work with them with the fossils.

Heron Werner: Within computed tomography.

Heron Werner: What they would like.

Heron Werner: to do is to prepare the the rocks they have the rocks.

Heron Werner: With the fossils inside with do the CT scan and then by.

Heron Werner: Using 3D printers you can print, what do you see inside.

Heron Werner: The rocks.

Heron Werner: It was a very, very.

Heron Werner: Good experience, so we start to work together and we have the four we we did a group of four institutions here in Rio de Janeiro, which is Gávea university, Catholic University of Rio de Janeiro, the National Institute of Technology and also the National Museum of Rio.

Nadine Vogel: Wow.

Heron Werner: So, and this was the first project, so our first this experience in 3D I have my experience in 3D ultrasound.

Nadine Vogel: Right.

Heron Werner: But the experience of 3D printing what we start in this time at this time we so we use the non invasive technology in paleontology.

Heron Werner: Where we're different blocks of material containing fossilized the vertebrates from the museum, we can extract the rocks in do the 3D printing of the fossils so they they weren't very excited with these in they asked why not.

Heron Werner: They asked us in the clinic, why not we continue this with the Egyptian collection, because we have Egyptian collection in the museum, so we did the also the the.

Heron Werner: Egyptian collection use the mummified the human bodies in also animals, so, if I can see the.

Heron Werner: The bones of the vertebrates inside the rocks if I can see the mummies inside the coffin, why not again not I can produce the 3D the print of the fetus inside the the womb so then we start to do the we start our third project was with to call the Fetus 3D project and.

Heron Werner: The problem in that time was around.

Heron Werner: 2005 the quality of ultrasound to do all of this kind of 3D printing was very, very bad So the first experiences we started to study with the fetus with bones more malformations that we used to do a CT scan at the end of the pregnancy with low dose dose of.

Heron Werner: Radiation very low dose.

Heron Werner: to study the complex mal malformation bones more malformations and that with this we could do the 3D printing of the bones and help the specialists to identify the pathologies.

Nadine Vogel: Wow, that's amazing.

Heron Werner: So ah. Yeah.

Heron Werner: Then we we started to talk with the the company's of ultrasound and M-R-I, because when you feed babies is ultrasound.

Heron Werner: To diagnose to start to prepare the protocols for use these in 3D printing so we got it in ultrasound and MRI Magnetic Resonance Imaging.

Heron Werner: In the initial idea was of reconstruction, the 3D printing of the fetus from ultrasound or MRI to assist medical students in the study of complex malformations in university.

Heron Werner: And also these models could also facilitate a multidisciplinary magical discussion, for example, involved with Neonatologist, geneticists, pediatric.

Heron Werner: resurgence in also radiologists did all of them discuss in those kind in this kind of images the diagnosis incoming complex pathologies, including pre and postnatal surgical planning.

Heron Werner: For the fetus or post natal in the babies.

Nadine Vogel: Wow, that's amazing.

Heron Werner: So the quality, year after year is start to be better and better and then you think I remember the case, we did in France when I cut the fetus of the profile of the fetus and we say.

Heron Werner: Why, we cannot use also for prenatal care in in blind patients, yes, so I close to my house here in Rio, I have the Institute for blind people.

Heron Werner: it's a big institute here in Rio went there with my friends and I say so, we like to to start and then another experience in see how the patients feel the pregnant patients blind patients feel during the ultrasound if they can touch the fetus.

Nadine Vogel. Yeah,

Heron Werner: So.

Heron Werner: Then they.

Heron Werner: They say it's a good idea I wait to four weeks, months and more than one year, but one day a patient call.

Heron Werner: from there.

Heron Werner: and say i'm pregnant.

Heron Werner: They talk about to you, I like to have this experience and then we did the ultrasound and it work and that time was difficult to work with the images, because it takes the the the quality of the software to prepare the human.

Nadine Vogel: was not.

Heron Werner: Good so usually we take more than 10 hours to prepare the. images.

Nadine Vogel: Oh my God.

Heron Werner: But we did that in the day, the first experience was wonderful very, very.

Nadine Vogel: So what I find so interesting and normal you know as I'm listening to this right, then.

NORMA STANLEY: Yeah.

Nadine Vogel: So we have a doctor who specializes in fetal medicine that starts out by looking at and doing this in rocks.

NORMA STANLEY: Right.

Nadine Vogel: We have a doctor working with a museum and i'm thinking okay that that's a little odd right we go from rocks to but the journey, I guess, I would say that you have taken.

Nadine Vogel: You know, talk about out of the box talk about not necessarily connecting those dots but then when you talk about that last stage before you went to do this for for women who are blind.

Nadine Vogel: But about diagnosing and preparing you know my daughter was born significantly contracted all over her body, and you know, had we had that kind of imaging before.

Nadine Vogel: yeah we had those 3D models and I think that a number of things could have been.

Nadine Vogel: We could have prepared better.

NORMA STANLEY: yeah.

Nadine Vogel: And and procedures and so forth, so you know i'm taking this from a very personal note, as well, but but to hear you know.

Nadine Vogel: i'm just smiling because I can just imagine there's someone who can't see their baby right and can't look at that screen to be able to feel that and get a sense I I just that has to be just mind blowing.

Heron Werner: But it's incredible when I saw the first time they become up from the 3D printer I say it's unbelieveable when I showed them.

Heron Werner: In the Congress and the people saw in the first time that's incredible.

Nadine Vogel: Wow.

Heron Werner: It was. very funny to see the the face of the doctors.

Heron Werner: watching that.

Nadine Vogel: Right. right. and to just because if you think about it, how else would a woman who is blind.

Nadine Vogel: Have any idea of how that baby is forming or you know even just through description, obviously, but, but I just love this, so this is fascinating, but we need to take a very short break and then, when we come back Dr Werner, Norma and I have all kinds of questions for you.

Heron Werner: All right

Nadine Vogel: So any to our listeners don't go anywhere, we will be back in just a minute with Dr. Werner moving from.

Nadine Vogel: rocks to babies.

Nadine Vogel: All right, we'll be right.

Voiceover: And now it's time for a commercial break.

[COMMERCIAL]
Have you attended a springboard Consulting event? Well, you should, we have the best events and our 2022 events are just under way. Firstly is the Brg Summit happening on Tuesday, April 26th, and then following that is Disability Matters. North America Conference and Awards that's happening Wednesday and Thursday, April, 27 and 28. Both events are being delivered by a live stream. If interested in attending, please visit www.consultspringboard.com for more information.

Voiceover: And now back to our show.

Nadine Vogel: Well Hello everybody, this is nadine vogel joined by my co host norma stanley of the podcast disabled lives matter.

NORMA STANLEY: Well hello.

Nadine Vogel: And today we're talking to a doctor Werner this incredible emotional story, but it's not just a story it's it's real life and it's Dr Werner it's you creating these 3D models of.

Nadine Vogel: women's fetuses and when they're blind that's, the only way they can get a sense of right and and see but I, you know, I have to tell you.

Nadine Vogel: You know, for our listeners on break Dr Werner was showing us a sample of a baby's face a 3D image and you know, I was thinking, even though Norma you and I can look at the ultrasound right and.

NORMA STANLEY: Right.

Nadine Vogel: right but i'm sitting here thinking Oh, but that's so much more powerful.

Nadine Vogel: Then seeing on a flat screen right.

NORMA STANLEY: Yes.

Nadine Vogel: Wow. So let me ask you this, Dr. Werner how many how many patients, how many patients, you know, pregnant women who are blind have benefited so far.

Heron Werner: So a to now 23 blind pregnant women.

Heron Werner: 18 of them, their husband was also blind they meet each other in the school they told me, and most of many of them to work together and.

Heron Werner: So we have one in one case the woman was Okay, but the father was blind and the other case the husband was blind.

Heron Werner: One case.

Heron Werner: In the other case just a woman blind.

Nadine Vogel: And in what is the cost and you said 23 women that that's the only just since 2017 I think right so it's only really in a fairly short period of time that you're doing this, but are there is there a financial cost to these to these couples.

Heron Werner: No, no, there is no financial cost.

Nadine Vogel: Really.

Heron Werner: Because we have a program here, we pay for, for we we have a lab in which we talked that this must be free for them, so if the the the couple if they are in Rio de Janeiro area, we were you, we are based.

Heron Werner: There is no cost.

Heron Werner: Even the ultrasound so the ultrasound examinations free and also the 3D printed model is free.

Heron Werner: But if they live far from Rio.

Heron Werner: In another state or if they are outside of the country, so I asked them to send me the file from the ultrasound.

Nadine Vogel: Okay.

Heron Werner: Sometimes the doctors they're called me to to.

Heron Werner: To explain them how should they manage the block the 3D file sent to me, and you sent to the patient without cost any cost so it's a program it's it's free yeah.

Nadine Vogel: Now is this free outside of your country like you know, is it first of all, I guess, I should ask the question are there other institutions doing this in other countries around the world, one and then two if they are, are they also providing it for free.

Heron Werner: i'm not sure.

Heron Werner: I don't think so yeah we you here is free, but I think around the world they they they pay I think.

Nadine Vogel: yeah I would I would imagine if you did this in the states.

Nadine Vogel: We definitely pay.

Heron Werner: Yeah, yeah.

Nadine Vogel: i'm sure we pay a lot for it, and so, how many of these images in 3D images does a couple receive throughout that nine month period.

Heron Werner: We will do the ultrasound so the ultrasound we describe they all the images with talk too much with the patient talk a lot describing how is the fetus the position, and then we choose the best image and then we print. the best.

Nadine Vogel: And how many times do you like how many images will they end up having over the course of the pregnancy.

Heron Werner: How many exams so usually here we have three exams during pregnancy, first, second and third.

Heron Werner: trimester in the first trimester is around 12 week of gestation, the second trimester between 20 to 22 weeks, and the third trimester between 28 to 32 weeks of gestation.

Nadine Vogel: now let me ask you this, because obviously this program is funded for women who are blind or husbands, who are blind.

Nadine Vogel: But what happens if you're conducting an ultrasound and you can see, there is something wrong with the fetus right there's there's some clinical issues um would you then also do still use the 3D images for that.

Heron Werner: Yeah. This is this same one one important point in 3D images in 3D printed images in specially for blind patients, if you find them in some kind of malformation especially out external malformation like. cleft lip for example.

Nadine Vogel: Yeah.

Heron Werner: We can explain better the couple.

Heron Werner: What what is the malformation.

Heron Werner: You know, because the people who can see you can explain the TV in the monitor the machine, but for the blind, when they have to visualize.

Nadine Vogel: Yeah.

Heron Werner: They have what's the problem, even when they touch the problem in we have we had one case with problem.

Heron Werner: All of out of these.

Heron Werner: 20-23 patients and we have one case we.

Nadine Vogel: face malform malformation.

Heron Werner: We can describe we can discuss and explain better when you have the 3D model.

Nadine Vogel: When I would think to if there is an anomaly, that is, that great even from someone who can see it on screen.

Heron Werner: Yeah.

Nadine Vogel: Sometimes it's it's it's still very difficult to imagine what that really looks like or what that means and i'm just thinking from a very personal perspective, so I I appreciate this is very much on how long after the exam does the do the couple get the copy of the of the image.

Heron Werner: If they are based in Rio what we do, we do the ultrasound in special case we do MRI but.

Heron Werner: We do the ultrasound we explain everything some some most of the time it takes around five to seven hours to prepare the model.

Heron Werner: So I asked the patients go back home and I asked them to come back the next day or 48 hours, depends of the schedule and then we would do the ultrasound again explaining and then they can touch the image.

Nadine Vogel: i'm just saying in awe. norma do you have some questions I'm.

NORMA STANLEY: I was wondering, is it is this a service that.

NORMA STANLEY: can be offered to typical parents too, or is it specifically for you knoq, because I think that they would be. interested.

Heron Werner: Yeah we use a for free here just for blind patients, but we use a lot these for.

Heron Werner: For for the specialists to discuss complex malformations I think it's easier when you have a 3D model.

Heron Werner: very clear image and discuss the pathology.

NORMA STANLEY: Right.

Heron Werner: With this those kind of file.

Heron Werner: Because years ago we used we used to have neonatologist surgeons are all of them inside the room in discussing in 2d images, the problem is sometimes they were geologists know very well the images, but the surgeon they don't so discussion it's improved with.

Heron Werner: A lot when you have a very clear image 3D image.

NORMA STANLEY: Up to what age they do the imaging how old the fetuses when they're doing is it is it all the way.

Heron Werner: I like first trimester 12 weeks because you can see the whole fetus body in ultrasound and I like.

Heron Werner: The second, the end of second trimester around 22 weeks or 24 weeks when you can see the fetal face by ultrasound, but if you want to see the whole fetus.

Heron Werner: In the his body very well developed at the end of the pregnancy, then you have to do to do the MRI, because MRI has a very big field of view.

Heron Werner: And then you can catch the whole fetus, for example, our nine month fetus inside one image and, then you can bring the fetus in the the real size.

Heron Werner: In ultrasound you cannot do it so in ultrasound I like first trimester and.

Heron Werner: Beginning of third trimester to see the face.

NORMA STANLEY: Yeah.

Heron Werner: In MRI I like.

Heron Werner: The third trimester after 30 weeks.

Nadine Vogel: So I mean what's racing through my mind norma is just you know how many other applications.

NORMA STANLEY: absolutely.

Nadine Vogel: Right, there are for this so Dr. Werner you know i'm sure you've already thought about that we already moved from rocks to people.

Nadine Vogel: What what other applications are you, you know thinking, this could be used for.

Heron Werner: We use a lot here we just published a paper.

Heron Werner: In in conjoined twins.

Heron Werner: To planify the surgery, because when you see, we have our case now the the twins link it with the brain.

Heron Werner: And the discussion, how you sit there, how you separate them is starting prenatal so we start to prepare the 3D models and the surgeons start to talk with the patient.

Heron Werner: How they will procedure after the labor you know and and the patients in the beginning, are very anxious about that.

NORMA STANLEY: Right.

Heron Werner: And when you have the surgeons discussing this. What do you do in postnatal the anxiety of the patients is is getting down, you know.

Heron Werner: So used to prepare the patients and to explain them what What do you do after.

Heron Werner: The labor.

Nadine Vogel: Wow. norma i'm like speechless.

NORMA STANLEY: I know.

Nadine Vogel: My brain is racing right.

NORMA STANLEY: I know I mean I would think, for you know families like ours, who you know who are expecting this might be something that can bring.

NORMA STANLEY: Like you said you'd know what to expect and how to handle it when the baby comes up in the morning and then finding out what you need you know just start planning for the future, so. yeah.

Nadine Vogel: But you're right Dr. Werner. you know I can think when when my daughter was born and she spent three months, in NIC-U and I remember the team.

Nadine Vogel: All the specialist would gather together in the conference room and there was be all these pow-wows, and you know, everybody in that case was sighted, but that doesn't mean that clinically they were sighted right.

Nadine Vogel: In terms of really understanding each of these issues with just made us feel even you know even further away.

Heron Werner: In another point interesting that's when you see all of these 3D images, which is not only 3D printed images but to also have the virtual body.

Nadine Vogel: Yes.

Heron Werner: That can use for the others purpose, for example, I can put the 3D glasses V-R glasses, and I can navigate inside the the womb.

Heron Werner: I can go inside the fetus and I can see, for example, fetus with a tumor in the neck, I can see the relation between the tumor and the airway path.

Nadine Vogel: Wow.

Heron Werner: So many possibilities, you can have with the 3D models so you can print the models so they can see the models virtually.

Nadine Vogel: Yes.

Heron Werner: Now what the sides cursed with the surgeons, for example, we are based in in the lab in the university the surgeons based in the hospital they send me we prepare the file in nowadays they can virtually.

Nadine Vogel: Right.

Heron Werner: You know we're.

Heron Werner: We can discuss virtually the 3D models that.

Nadine Vogel: What a long way, this has come.

Heron Werner: Like metaverse was like you know we be together with their avatars discussing the 3D virtual model.

Heron Werner: In a think soon we can touch also the virtual model, because if you have we have nowadays, we have the technology.

Heron Werner: And we did this experience we published this experience, we can have the virtual model, and it can put a glove, with sensors in the glove and you can go virtually in have the feeling of the virtual.

NORMA STANLEY: Wow.

Nadine Vogel: Ah.

Heron Werner: So it's many we have many possibilities, you know, of course, the future more possibilities to facilitate this. virtual.

Heron Werner: discussion between the specialists and also with the patients.

Nadine Vogel: Well, you know I had to I have to say, as you know, hosting a podcast The last thing I should be is speechless.

[laughter.]

Nadine Vogel: But I'm kind-of speechless, aren't you norma.

NORMA STANLEY: I love it it's just so amazing what technology can do.

NORMA STANLEY: These day, but it's a game changer.

Nadine Vogel: And for good right because you know.

NORMA STANLEY: Absolutely.

Nadine Vogel: You hear, often in the news, you know, yes, we have capabilities from a technological standpoint but are they all being used for good, this is not just being used for good, this is being used for good better best I don't know this is this is truly. game changing.

NORMA STANLEY: Absolutely.

Nadine Vogel: I just I can't believe that we're out of time, I feel like I could spend another half, I just want to listen to more stories.

NORMA STANLEY: Yeah, that was pretty awesome.

Nadine Vogel: So, Dr Werner. Thank you so much for joining us today, I hope we can come back to you and hear a little bit more. About the developments.

Nadine Vogel: Please let us know, you know as there are major.

Nadine Vogel: Developments coming out, let us know bring you right back in and.

Nadine Vogel: and talk to our audience, but this was fascinating so I just want to thank you very, very much.

Heron Werner: It was a very good pleasure to me to be with you.

Nadine Vogel: Oh well thank you.

Heron Werner: I hope to be with you together another day.

Nadine Vogel: Absolutely. Maybe in person. Who knows.

Heron Werner: I know right.

Nadine Vogel: And to our listeners, i'm sure it is fascinating for you as it as it was for us, and this is nadine vogel and norma stanley.

NORMA STANLEY: Norma Stanley.

Nadine Vogel: Co host of disabled lives matter we are more than a podcast we are a movement, and we look forward to having you join us next time on the podcast, see you soon everybody bye bye.

NORMA STANLEY: Be blessed.

Heron Werner: Bye bye. Thank you.

Nadine Vogel: Thank you.

Closing comment: [Music playing in background.] Thank you for listening to this week's episode of disabled lives matter. We look forward to seeing you next Thursday. Have a great week!

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