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Scars Don't Stretch

Scars Don't Stretch

The weather started to change a few days ago. I remember the cool crisp morning air as I sat outside and had my coffee after my morning chores. The weather shifted back to hot and humid quickly. On one of our busiest days, a man in his sixties came from Texas to be evaluated for a change in his mental status. He was the last patient scheduled for that day. I think he was given that appointment time because his wife wanted to spend an hour describing his medical condition. We conference called his daughter in Dallas at the same time so she could have input and participate in the conversation.

In March of 2014, I performed my first evaluation on this gentleman in his late sixties. He was a bit forgetful then as well as his weight had increased profoundly. He was a type two diabetic with very poor dietary understandings. He craved sweets. He was the founder of a small business and employed forty people or more. He lived in a small town in Texas with his wife of forty years or more. She was a delightful woman, full of energy and optimism about that initial evaluation. They came for consultation because an aunt of his wife had come to see me and my prescribed pulse dose therapy of four different antibiotics cleared her of a chronic atypical mycobacterium infection of her lungs.

On that day in March, he was oriented to everything and everybody around him. At that time, his blood work had gotten really screwed up prior to his visit. Our business manager at that time arranged the visit and she had no idea what she was doing. I remember being very upset that this couple came from Texas and our usual new patient blood work was improperly ordered. That episode in his care greatly influenced our administrative structure since I terminated the business manager within a month of their visit.

Not only was he a president of a small business, he was a creative genius. He designed and created unique pieces of jewelry. One of a kind masterpieces adorn his wife that day: rings, broaches and necklaces. He had a creative fire that was very unique and he talked about his jewelry making more than anything. He did it because it fascinated him. He was one of those rare individuals who lived out of both sides of his brain. I admire those people who have depth of Spirit. He clearly had it.

He was committed to changing his life style to reduce the complications of his diabetes. He was being cared for by local small town physicians who were well meaning in their approach but not very helpful when it came to health related topics. Their worldview was simple: eat whatever you like, we'll prescribe medicines to offset the untoward side effects of food on your diabetes and overall health. He was on a number of diabetic drugs, of which none of them controlled his blood sugars or weight. He was frustrated and so was his wife. He was mentally sharp and understood all of the hormonal interactions I showed him that were being affected by his medications, uncontrolled eating and use of daily insulin shots. He left that day with a new plan. And it worked for him.

Months after our visit, he started having abrupt changes in his cognitive function. He had lost weight, reduced the numbers and doses of his medications, reduced his insulin use and felt much better overall when the stroke like attacks occurred. He was seen twice in local emergency departments for acute onset of slurred speech, disorientation and inability to form words. He was unable to communicate. The emergency physicians administered a clot busting drug (tPa) intravenously on two occasions. There was no immediate relief of his symptoms. There was no mention of whether his blood sugars levels had dropped precipitously or not. Each time his condition totally reversed itself over an hour or two. He seemed to recover to his pre-morbid self, although there was no question that he had significant change in his cognitive function after the second episode.

One of this man's fears was claustrophobia. And he had it bad. He needed to be sedated for his CT scans of his brain. No evidence of brain damage was identified, but each time he had an episode, the physicians would sedate him with intravenous medications so they could perform a CT scan of his head. He had a general physician and neurologist at the same time, both of whom were not exactly sure why he was having these brain attacks. They both agreed that he was not having stroke events, but they could not identify the true nature of his change. So they decided he was either having "silent migraines or petit mal seizures."

I was pretty much kept out of the loop concerning his declining health and subsequent treatments. His neurologist tried a number of migraine medications as well as statins and antidepressants. No real improvement was observed. So the neurologist demanded an MRI of the head in order to get a more precise anatomical picture of his head. The neurologist felt the two or more CT scans were not adequate examinations. Remember, the patient had claustrophobia so he would not agree to the MRI unless he was knocked out. So the neurologist enlisted an anesthesiologist to administer general anesthesia before, during and after the MRI. Our patient was induced into coma and given the same treatment as if he were undergoing a major intra-abdominal surgery. After the MRI, he was taken off the ventilator and transferred to the post-op recovery room.

When he awoke, he was in a state of dementia not witnessed by his family before. He had profound post anesthesia cognitive decline. His MRI result was essentially normal for a man in his late sixties or early seventies. No new information was gleaned from the testing, but his mental state had declined to the point that his wife must dress him and help him with his hygienic practices daily. He went from an independent forgetful person with a mysterious condition to a man who smiles to hide his true demented self. His physicians tell them that he will return to normal in a few weeks. At our recent visit, it had been six weeks and he was still exhibiting severe dementia like cognitive function. He was a shadow of the man I examined in March 2014. I felt sad.

Although the family requested to have him knocked out so they could perform the MRI, they never were informed about the dangers of post anesthesia cognitive decline. They were absolutely ignorant about the detrimental effects of general anesthesia on a patient over sixty years of age. More disturbing to me is that the physicians have given up on trying to find some successful treatments to his current condition. There is no medicine to reverse his anesthesia induced cognitive decline, but getting his blood sugar under control, making sure that any of the medications he is on would not create more cognitive disturbances and changing his food plan might go a long way in enhancing his ability to heal from their aggressive decision to get an MRI under general anesthesia.

The message in all of this is simple; do not be absolutely ignorant of your medical care and let physicians cavalierly administer potentially life changing treatment unless you understand the risks. If you or a loved one has a serious medical problem that is undiagnosed or under treated, it should be clear that the physicians are either baffled by the disease and/or they do not know what they are doing. Contrary to popular belief, physicians have a relatively finite data set that they pull from mentally to diagnose and treat disease. Many of them overstate the benefits of a medical procedure and understate the true risks or complications that could happen as a result of the procedure. The rule I go by related to general anesthesia; one does not administer general anesthesia to a patient who has had a stroke or stroke like event for at least a year after the stroke or stroke like event had occurred, unless the patient has a need for life saving surgical intervention, especially in a man or woman over the age of sixty years of age.

The prognosis for the man from Texas is not good. But if I can get him to remove himself from the medical politics of his small town, change his food plan and try a different approach medically to stop the progression of his abrupt and significant health decline, maybe he will improve enough to wash and dress himself, keep up with his small business and enjoy his first and only grandchild due in the next two weeks. On the other hand, the family might decided that the best course of action would be to shop around the country looking for the most sophisticated neurologist to render an enlightened diagnosis and prescribe a cure to reverse his dementia thereby avoiding the difficult task of rebuilding him from the bottom up and not the top down. The time delays in getting back to a proper course of action will leave deep scars in his cognitive function.

I hope his wife and daughter understand that his ability to regain mental awareness is time sensitive and more important than a pasta dish, a cookie, a piece of cake, a piece of bread, a statin drug, subcutaneous insulin injections or an antidepressant. The madness needs to stop.

Truth be told, scars don't stretch. And neither will his mind.



Doc
Posted by Amanda Sanders at 10:59 AM
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