Deep Brain Surgery - Cognitive Testing

A sight to remember  -  Port Angeles, WA.  11/14

After an early morning drive down to Seattle amongst heavy traffic, Carolyn and I sat together in the neurology waiting area patiently listening for my name to be called.  Ahead were 4 hours or so of both cognitive and memory testing intended as part of the selection process for deep brain surgery. Cognitive functions include much of our thinking capabilities.  This means long term memory, working memory or executive memory, creativity, judgement and much more. 

I once regarded this testing as a small step in the path that could lead to deep brain surgery(DBS)but now it seems to be much more.  If the test shows evidence of cognitive decline and memory loss it likely would mean disappointing results from the surgery and probably a worsening of cognitive function.  It also may mean a tough time dealing with and cooperating with "awake" surgery.  It may also mean difficulty dealing with the complexity of the process of deep brain surgery period.

It always feels good to be in Seattle regardless of what brings us down here.  I lived here for a short while in the 70's and it was here that I met Carolyn.  We enjoyed the perfection of physical health and youthful minds that were ours for that short period of our lives. Now I recognize that at least some of that is slipping away but I will always remember that Seattle was our city for a short while.  Lucky me.  The girl I love still sits by my side.

Tucked in my briefcase are 3 sets of paperwork.  The first set of paperwork included questions for me to answer and were intended to obtain an up to date medical history.  The other two sets of questions were identical.  One for me and one for Carolyn.  These sets included questions that were geared to finding out what we both had observed about my current mental status.

The questions included things like:

     Am I still able to manage our finances?

     How many items can I remember to get at the grocery without needing a list?

     Am I still able to drive?

     Do I have trouble remembering details of recent conversations?

     Have you ever used mind altering drugs?
     Do you consume alcohol?

      And so it goes.

My name was called well before my scheduled 8:30 appointment and both Carolyn and I were taken back to a small exam room.  We waited for a few minutes and two attractive women  entered.  The older, in charge of the test, introduced herself and was a doctor.  She also asked permission for the younger, who was a student, to sit in and help with the testing.  I gave her permission to stay.

The doctor sat down in front of a computer terminal and pulled up my medical record for reference.  She then went through the observed mental status questions Carolyn and I had both filled out previously and separately. Her intent appeared to be, to fully understand what was behind our answers and to reconcile any differences.

I think that over the past several years I have noticed more frequent lapses in at least some of the areas questioned. I am not certain what this means.  The brain itself is so complex and is likely influenced by many things currently shaping my life.  Is it Parkinson's?  What about aging or even lack of sleep?  Is it some sinister side effects of the medications that I take?  Each of the drugs I take for Parkinson's is targeted at the brain or central nervous system and probably have some effect. How can these things be sorted out?  Do they need to be sorted out?

After the questions were reconciled and the interviewer believed that she understood the answers we had given, she turned the actual testing portion over to the student.  The Doctor and Carolyn both exited.  

The student began by reading me a list of 7 words and then asked that I repeat them back.  No problem.  She then asked another question or two and then surprised me by asking me to recite what I could remember of the original 7.  Whoops, I must have missed the bit that said I would be asked to repeat those 7 words later.  I had made no mental notes and could not remember even one of the words.  Alas the student giving the test genuinely seemed to like me and was delighted when I was successful and appeared disappointed when I was not. So she gave me a second chance and we  repeated the process with a different list and I once again was asked to repeat what I could remember of the list later. I did better this time around but still found it difficult. 

As the test went on she asked questions to verify that I was oriented to time and place.  I did pretty well but occasionally got hung up a bit.  I did fine with President Barack Obama but could not come up with Joe Biden's last name.  Poor Joe his last name on the tip of my tongue but would not come.  Also I could not think of our Governor's last name either.  What does that mean?  Maybe nothing, I think it is compatible with my age to come up with name blocks. What I think may not matter and so the testing went on. I was shown patterns of geometrical objects and then asked to pick out similar patterns among different objects.  I drew stick diagrams from memory of stick diagrams I had previously seen.  I counted numbers backwards by differing increments.

Things went on and we finished up about lunch time.  The doctor in charge returned and said that it may be a month or so for the results to be ready.  So what then?  There may or may not be a decision for myself and Carolyn to make about deep brain surgery.  They either will pass or fail me to move on toward surgery based on the test results.  For now I am perfectly happy to simply wait.

Shaky in Coupeville

Catching The Frisbees of Life

....Should we accept only good things from the hand of God and never anything bad?...
From Job 2

I launched the Frisbee with a quick backhanded toss from my right hand.  At first the Frisbee flew a flat and somewhat rising trajectory to my right.  Juney eagerly retrieved it with typical Lab enthusiasm.  I tossed it many times but I could not get it to hold a level  flight long enough for Juney to catch up with it in the air.  Juney is our middle daughter and family’s black lab who has stayed with us this past week.  She is a lovely dog and is a people pleaser.  I am reconciling my advancing age with declining ability physically to throw a Frisbee.

Advancing age or not it is still a delight to throw a Frisbee to a Labrador after more than 40 years. Then it was with my brother’s black Lab, Tuco, who lived with myself and my brother in the Fall of 1970.  We were going too school at Washington State and lived together in a small basement apartment adjacent to Mcgee Park in Pullman, Washington.  I was young, Tuco was young and my brother was a young veteran of the Vietnam war.  My brother had lived through great pain by way of this terrifying curve called Vietnam. No such hard curves for me,  God was spinning perfectly thrown Frisbees my way.  I thought that was the way things would always be.

If my life was a picture book I would flip through pages and remind myself of all of the good things that have been sent my way.  I might come first to a picture of my wife.  At this I would pause for a while and think about what a miracle it was that I even met this wonderful girl from upstate New York: 

You know how it is: you’re twenty-one or twenty-two and you make some decisions; then whisssh! you’re seventy: you’ve been a lawyer for fifty years, and that white-haired lady at your side has eaten over fifty thousand meals with you.
From Our Town by Thornton Wilder

From our marriage came the most wonderful pieces of my life, three children.  Two girls and a boy, they are still young, married and are working hard to make their way in this world.  And yet they are no longer here most of the time and my wife and I have only smaller roles in their lives. 

There are no free passes in life and if I ever had one, it was revoked when the neurologist at the University of Washington told me I had Parkinson’s disease.  I had no clear idea of what living with a chronic degenerative disease would be like. Even less clear were what changes  mentally and physically that would come to roost and never leave.

I was about to learn what it is like to take prescription drugs daily for a long time.  I was about feel what it is like personally to balance intended drug effects with unintended effects or side effects.  I was about understand what all of my pharmacy customers already understood.  Taking drugs on the long term is an arduous, and difficult task that requires much effort and expense.

And yet there is reason to hope, given the scientific advances with Parkinson’s. The list of medications available to treat PD since I entered pharmacy in the 1970’s has risen sharply and is worth noting. Startling success has been achieved with DBS or deep brain surgery.  A story came across the internet this past week about a young woman with early onset Parkinson's who has recently ran a full marathon after receiving the surgery.  Not a cure but a procedure that can provide relief for many and often for a long time.  Still it is not a procedure to be taken lightly and does not cure while it apparently does a very good job of treating some of the symptoms.

In that Fall of 1970 I would rush back to our tiny apartment somewhere between my early classes.  I unlocked the door and Tuco would come bounding out bursting with Labrador strength.  With Frisbee in hand I stepped out to the park and dog and I would start our game.  With a quick flip of my wrist I could send a Frisbee straight and true halfway across the park.  It finished with a hover and was plucked from the air in perfect timing by a leaping 2 year old Lab. a crowd of students soon gathered and clapped and cheered every catch. Those days were a true gift followed by many more.  Now, long after Tuco has gone. It is my turn to retrieve the Frisbees thrown my way by God.  Both the good and bad.