Friday, January 11, 2013

The Thrust and Parry of Dueling Diagnosis and the Cognitive Circus

English: Autopsy specimen from the frontal lob...
English: Autopsy specimen from the frontal lobe of patient with rapid cognitive decline, myoclonic seizures, elevated 14-3-3 protein showing vacolated neuropil, compatible with diagnosis of Creutzfeldt-Jakob-Disease (HE stain, x100 magnification) (Photo credit: Wikipedia)
Medical Professionals:  On Garde!  This round of investigating my higher order functions seems to  be a bit of thrust and parry among professionals.   As my Gentle Readers are well aware, I have accumulated a big pile of paperwork from my various assessments as I journeyed through my cortex!

So, the next round is go  to see a cognitive neurologist at a big University medical center.  After waiting and waiting... like forEVER!!!  It takes FOREVER to get into a BUMC (Big University Medical Center).

A cognitive neurologist has more of a medical background than a neuropsychologist and will focus more on the medical side of cognition than a neuropsych does.  I was told to go investigate organic causes of my neurological problems so I needed someone with more of a medical background in cognition. 

At the doctor's office, I took a Mindstreams assessment given by a medical technician.  Mindstreams tests the following skills:
  • Memory
  • Executive Function
  • Attention
  • Visual Spatial Perception
  • Verbal Function
  • Information Processing Motor Skills
  • Motor Skills 
 Many of the tests were similar to the exercises that I have done in my different therapies such as Captain's Log, Brain Fitness, Brain Safari, and Vision Therapy; some, in fact, were the same. 

Then a nurse practitioner took my medical history.  I am good at giving medical histories now!

Then, I saw the doctor who ran me through a number of exercises and gave me the results of Mindstream.  Surprise, Surprise!   I am above average for my age and, in fact, I am one standard deviation above normal in one measure. 

How can this be?  I feel as though I still have significant problems, although not as bad as when I started my journey.  I am sure some of my therapies have remediated some of the worst of my problems but I do wonder about some of this testing.  I did do the AWMA (assessment of working memory before I did Cellfield) and it showed some significant problems in some areas with working memory.   My original neuropsych testing showed some problems with So, how could I go from one test showing problems to another test showing that I am above average?

Or, have I just become a trained cognitive monkey?   You know, trained to perform the cognitive equivalent of handstands, trapeze tricks, juggling or breakdancing as I hope for the cognitive banana reward?  Some of these therapies have definitely carried over to everyday life as I do feel that my memory and decision making skills have certainly improved. But I am not sure about how much testing of my ability to do tricks like repeating numbers backwards, recalling words that I was told to remember, clicking on colored boxes which may or may not match the color of a word,  will get to the bottom of my problems especially after being retrained to do these things. 

At any rate, based on my good scores and physical exam, the cognitive neurologists really doesn't think he has much to go on.  He will continue screening with an MRI, an EEG and a plethora of blood work.

So we began fencing.  Politely (I really don't believe in pissing off medical professionals),  I took out my sabre and lunged at him a little bit by saying real life is not matching his test results and he needs to look further.  He beat back my blade and said that he doesn't want to go on fishing expeditions.  I parried and pointed to the stack of unread medical reports on his desk and told him to read them, told him that I have passed many standard screenings before 2009 without incident, and that my neuropsychologist wants a complete medical workup as the inconsistencies in my reports seem to indicate an underlying medical condition.  He reiterated his lack of desire to engage in piscatory adventures but added a few more tests after I told him that I would get a consult between himself and my neuropsych.    After all, it was she who wished to look at organic causes.   Point, Set, Match.

Upon ending our discussion, the good doctor gave me a worksheet with some thoughts as to healthy cognitive lifestyle activities that was pretty useful.  These activities included:

  • Aerobic Exercise for 30 minutes 3x week until sweating and out of breath.  Getting oxygen to the brain is a big deal.
  • Mindfulness Based Meditation -- suggested doing it with a major medical facility as apparently there can be a certain amount of woo in the field.  But, there is clinical evidence for improved cognition through meditation
  • Massage -- done with major medical facility as there is a bit of woo in the field as well
  • Healthy Diet -- lots of fruits and vegetables, no carbs and processed foods
  • OT and PT -- gave some referrals for therapists who will come to my home
So, the upshot is this:  I will throw my neuropsychologist at him and let the two of them sort out their differences.  I am not so sure about this thought about running through a canned screening and then saying that if nothing turns up then a medical practitioner will do nothing for you.  I am definitely on tail end of the bell curve statistically and am not sure that only following an evidence based medicine approach will serve me properly.  An evidence based approach seems a bit, well, lazy.  The good thing is that a clinician won't miss the big things; the bad thing is that a patient may not have his/her needs met.

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