A New Diagnosis

Mom finally saw the neurologist today. When I told her about the appointment last night, she asked “What’s the purpose for seeing this new doctor?” I didn’t want to talk about dementia, so I said the first thing that came to mind – that her regular doctor was concerned about her balance issues, as evidenced by the recent falls, and had referred her to a neurologist. I hoped I wouldn’t look like a liar when her falls weren’t the focus of the doctor visit, but I figured she probably wouldn’t remember by then anyway.

It was a long appointment for an office visit, but Mom was a trooper. First the nurse gave her one of those mini memory tests, where they ask basic questions like “what day of the week is it?” and “what year is it?” and “do you know what state you are in?” and then ask you to write a sentence and draw a diagram. She ACED that test in December, getting only one question wrong. I was slightly concerned that if she did too well on it this time, they would dismiss my concerns about her dementia. I needn’t have worried. She flunked this one good and proper. She thought she was in Arizona but couldn’t name the city, had no idea what day of the week or year it was, but was fairly confident that today was sometime in November. For the writing sample, the nurse told her to write a sentence – any sentence you want. I jokingly asked if anyone had ever written “This test is stupid” as their sentence. The nurse chuckled and said no, not that she could recall. When she collected the test paper from my mom, the nurse read her sentence out loud: “This is fun.”

Then a young man whose name tag identified him as Sam, a medical student from USC, came in and asked Mom several of the same questions. This time she answered that the month “must be July” and gave the year as 2018. Interestingly, though, she knew that it was winter – less than a minute after saying that it must be July. Both of those are understandable, I think, considering that this is her first Southern California winter and it was 80 degrees today. But where the hell did 2018 come from? Sam the med student also did some tests of reflexes and muscle strength (“You’re strong!” he told her with a grin), asked me a bunch of questions about her medical history, and had her walk across the exam room and back without her walker, noting her shuffling gait. I liked Sam. He was friendly and kind, listened attentively, and had taken time to read the notes I’d faxed over the day before documenting her symptoms and their progression over the last year.

Finally, Dr. O, the neurologist, came in. She started off with some of the same basic questions. Mom again gave the year as 2018, thought she was in a hospital (not a doctor’s office), but this time she correctly identified the current month as February. Dr. O asked her “What kind of doctor do you think I am? Am I a heart doctor? A foot doctor? Or what kind?” Mom looked thoughtful and answered “I don’t know, but I know I don’t need a heart doctor.” I think I saw Sam the med student smile at that, and it was all I could do not to laugh, considering that we’d just had a five-minute discussion about her heart conditions and medications.

And here’s the irony: her falls and balance issues did turn out to be one of the focuses of the visit. After observing her shuffling walk and the slight tremors of her hands (which is a brand new symptom I’ve only noticed in the last couple of weeks) and hearing about her falls, the doctor’s preliminary diagnosis (pending CT scan) was age-related Parkinsonism. My mom’s younger brother, my uncle Tom, had Parkinson’s Disease. Dominic at her assisted living community also has it. Parkinsonism, Dr. O explained to me, is not the same thing as Parkinson’s Disease but it has some of the same symptoms including gait and balance issues, postural instability and tremors. Memory loss and disorientation can accompany it, but Dr. O said those symptoms usually show up much later than the physical symptoms. Since Mom’s memory issues started at least a couple years before we noticed any of the Parkinsonism symptoms, she suspects there is another neurological disease (she turned away from Mom and mouthed “dementia” to me) at work here. I guess the CT scan will help identify what kind of dementia. The “A” word (Alzheimer’s) was never mentioned.

We left with orders for blood work and a CT scan and two prescriptions – something commonly prescribed for Parkinson’s patients to help the balance issues and Namenda, commonly prescribed to Alzheimer’s patients for memory loss. Dr. O wants to see her again in two months, which seems to me a long time to wait to go over the results of the CT scan and blood work. But I’m hoping, between the new meds and the physical therapy that is supposed to start this week, that we’ll be able to report some improvement in her mobility by then.

As a reward for being such a good sport about the 90-minute doctor visit, I took Mom out to dinner and we shared some warm apple pie a la mode for dessert.

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3 thoughts on “A New Diagnosis

  1. Thanks for sharing , interesting my Mom is nearly at the same point as yours , tho my Mom went through some real hurdles prior to .
    I as well don’t feel the need to go into detail with Mom ,she gets confused n thinks the worst.
    My Mom has had the mini tests ,she does well at times n others not so much … she can get through it until shes asked about The Hospital or Donating Organs … her set delusion is that there are body part thieves n this is why shes in this mess !! ( no other delusions )

  2. The visit was pretty informative if somewhat discouraging. But it’s good to know what you’re up against. Tom’s neurologist always said to introduce one new medicine at a time so that if one caused trouble you would know which one. Did your neurologist mention that approach also? Good job, Lira!

    • No, she started them both together – but they’re to treat different symptoms and don’t seem to have the same side effects. She told me what side effects to watch for and report to her if they occur, and I passed that along to the staff who will dispense the meds.

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