Friday, November 30, 2012

The New Neurologist

Mom and Lyn visited with the new neurologist earlier this week.  The appointment went very well.

When he walked into the room he greeted Lyn first and introduced himself using his first name, successfully putting Lyn at ease.  He didn't talk down to either Lyn or Mom and addressed them both directly, using terms which were easily understandable.  When he had a question, he directed it to Lyn and only looked at Mom if Lyn was unable to answer.

Lyn was having a particularly good day.  She was working very hard to pay attention to the doctor and gave her best attempts to answer his questions.  She exceeded herself.  She was able to name the city, state and county.  She named the day of the week and the year.  She did not know the specific date, however.  The doctor gave her three words to remember.  When he asked her for the words about 5 minutes later, she was able to give two back.  When asked to draw two overlapping polygons, she drew two triangles.  One was inside the other.  They did not overlap.  When he asked her to draw a clock, he first asked if she could write her numbers.  She placed the 12 in the proper position and then filled in numbers 1 to 11 in proper sequence.  They were bunched together and the 11 ended up in the 9's position.  At that point, she got confused because she knew there were no more numbers needed on the clock but also knew there was an open space.  Both the doctor and Mom were very surprised at her level of lucidity.

Mom was a bit concerned about how the doctor would react to Lyn given how "with it" she was during the appointment.  Unfortunately, many are dismissive of early on-set Alzheimer's and more don't realize that an Alzheimer's patient can have a really good day.  She was quickly put to ease because the doctor did not dismiss Lyn, the reports or the early on-set Alzheimer's diagnosis.

He did a very thorough exam including verbal responses and a physical in addition to the Alzheimer's quick tests described above.  He had already had an opportunity to review her case file which is on record with the TEASC committed and includes all previous evaluations and labs.  He also discussed her history of seizures and the family medical history.

The doctor usually sees elderly patients.  He has a few patients who are younger.  They have Downs Syndrome.  He commented that he has no specific information that would apply to Lyn as nothing is known about the prevalence of Alzheimer's within the population of those with intellectual disabilities that are not related to Downs Syndrome.  He was also puzzled about the apparent lack of familial early on-set Alzheimer's in the family.

When he got to the topic of medications, Lyn started to draw within herself.  He promised to send Mom more information "in lay terms" so Mom and Lyn can evaluate it and make an informed decision about potentially adding it to her care.  He noted that the meds have been used on the elderly but there is no information on the effectiveness or impact on a younger patient.  When Mom and Lyn left, she was morose and said she didn't want to take medicine.

Mom asked about the agoraphobia diagnosis from the TEASC committee.  He agreed it didn't make sense and suggested she question it with the committee, particularly the psychologist who participated in the evaluation.  He supported listing Sundowner's and agreed that Lyn's Sundowner's was atypical.  The funny thing is that her Sundowning symptoms follow the pattern described as atypical.  It is described as atypical because it is not the normal progression of symptoms.  However, this progression is known to Alzheimer's specialists.

Despite Lyn's reaction at the end, the visit as a whole was very good.


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