Neurologists and physicians writing on KevinMD about the brain: dementia and Alzheimer's disease and the biomarkers that now find it early, stroke and what recovery really allows, autism, Parkinson's disease, gait and balance as vital signs, and caring for a spouse or parent with a neurological illness. Three maintained records draw on this archive: Aging and dementia: what physicians say, in their own words, Heart disease: what physicians say, in their own words, and Mental health: what psychiatrists and physicians say, in their own words.
The most persistent problem I encounter is not nerve pain or slipped discs. It’s the tenacious misconception that someone can be “too old” for spine surgery when it’s truly needed.
Many years ago, it was true that age played a significant factor in a person’s ability to tolerate and recover from surgery. Surgeries were once highly invasive, and recovery could take months. But over the decades, spinal surgery techniques have improved …
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The most common misconception about spine surgery
Stuttering is a speech disorder characterized by the involuntary disruption of verbal fluency. It is relatively common, with an estimated 55 million people affected by the condition worldwide. For some, the condition can be relatively mild and is barely noticeable unless one is feeling especially anxious. In more severe cases, the disorder can be virtually debilitating. Stuttering not only impairs communication, it can also have a …
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Stuttering: Understanding the neurobiology, psychology, and treatment options
Every time I visit my great grandmother, Tata, Atul Gawande’s Being Mortal floods my thoughts. Tata is 101 and developed severe dementia within the past two years. In 2019, she fell and fractured her hip. In the hospital, she recovered poorly. The physicians on her team offered hospice. My grandfather (her only son), declined fervently. Instead, he insisted on moving her back home to my aunt’s house, where my great …
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Let’s talk about dying
I knew it was the end of the world. I was about ten years old and returning home just as it was becoming dark. The sky began to be shot full of incredible colors coming from one direction. They became larger and brighter. Having been raised in a strict Catholic household, I had been well prepared for the end of the world – it was here! I raced home at …
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Every patient makes me a better doctor
“Have you ever been on a cruise?” Betty asks.
It’s a strange question in the age of COVID-19, where thousands of people have been stranded on large ships over the past few months. I’m a wound physician who rounds at nursing homes, and my gloved hand holds her warm, wrinkled foot. I’m looking at a wound on her ankle that is almost healed.
“I went on a cruise before, but it was …
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When COVID hits memory care
It was the morning after Thanksgiving, 2012. My parents and I were sharing a suite at the Four Seasons Hotel in Beverly Hills, where we were camped out after the holiday dinner. We were not here because it was a family tradition or even because we wanted to notch it up this year. My family loved our paper plate style event, the air thick with the scent of turkey baking …
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A physician’s story: “Please come quickly. My brain is bleeding.”
As the COVID-19 pandemic quickly moved across the nation this spring, state governments and health systems rushed to create or revise their crisis standards of care that contain medical rationing guidelines. In light of the crisis, how can we distribute health care resources equitably and without discrimination or bias when they are in short supply?
During a podcast interview, Kim …
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Medical rationing in the age of COVID-19
Since the arrival of COVID-19 in America, most health care systems have adopted a policy delaying non-essential or non-urgent procedures and appointments in the hopes of preserving PPE and minimizing interpersonal exposure. Despite resultant furloughs, frustrations, and massive financial losses, the practice remains relatively non-controversial as the safest course for patients and staff. Numerous professional societies have subsequently released guidelines defining what kinds of conditions can and should be deferred. …
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What is routine? Preventative care in the age of COVID.
In neurology, we all crave to “localize the lesion,” taking pride in our well-refined and meticulous physical examination skills – an aspect of my identity that was temporarily stolen from me in the era of COVID-19.
As I walked into the hospital that day, I felt bare without the typical hammer, tuning fork, and ophthalmoscope weighing down my white coat. I was welcomed by an infrared thermometer check, and my smile …
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A neurologist is redeployed and is a better physician for it
I am hiding out in our lovely spacious house in the woods with my husband, hoping that COVID-19 will not find us. Both of us are in the “at-risk” category as we are both in our 70s. We are both New Yorkers, but we are upstate because our 50-year-old daughter lives in a community here.
Our daughter has a rare genetic condition that has severely limited her …
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Persons with intellectual disabilities forgotten in the COVID-19 pandemic
It’s common knowledge that a good night’s sleep prepares us for a successful day, but I like to think of it the other way around: Good planning for sleep during the day can ensure successful sleep at night.
As a neurologist who specializes in sleep, I tell my patients that what they eat during the day, how often they exercise, how they manage stress, and how much screen time they get …
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Treat your sleep like the vacation it is
Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy in which the body’s immune system attacks peripheral nerves. Clinical and epidemiological evidence seems to indicate that most cases are preceded by an infection such as Campylobacter jejuni enteritis, but in many cases, no cause is identified.
GBS is characterized by symmetrical muscle weakness that begins in the legs and ascends. The degree of weakness can vary from mild difficulty with ambulation …
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Learn about Guillain-Barré syndrome with a Medcomic rap
The need for a refreshed perspective on life and practice, a renewed sense of the concerns of our patients, and an appreciation for the subject matter: This is what so many of us need while in residency training. There are rare moments in the midst of it all when a renewing of sorts takes place, is noticed, and makes a small difference. Let me share one of those moments with …
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Renewal is what we need during residency training
Recently, revelations indicated that the Iran missile strike on the U.S. base in Iraq actually did cause head injuries. So why did the U.S. initially claim no “casualties”? From the limited reports available, it appears that most of the soldiers’ symptoms were consistent with concussions. Let’s define terms: In the wars of the 20th century, our soldiers would have been labeled with “shell shock.” In the past, diagnosing concussion required …
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The casualties of the Iran missile attack: not your father’s concussion
I know you want to. I know you would rather have anything other than dementia—even cancer. I know you are happy with your life and want it to continue as it is. If it has to change, I bet you’d like to slowly become more frail until one night you just die in your sleep. You do not want to slowly become more confused. You don’t want to live …
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When your doctor says you have dementia, don’t argue with her
The chances that you or someone you love will be diagnosed with dementia are shockingly high. By age 65, your chances are already at 9 percent. Make it to age 85, and the chances go up to 33 percent. Of course, if you’re diagnosed with dementia, it will be a struggle for you to think clearly about your diagnosis. So, today, while all of your faculties are still intact, I’d …
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Dementia is worse when coupled with inadequate preparation
As a relatively healthy Medicare patient, I do not visit doctors often.
I have had digestive issues most of my life — probably from too many antibiotics when I was a child with recurring strep throat, or so I’m told.
My husband and I had just returned from living out of state for two months while he was treated with proton therapy for cancer.
My stress levels were high.
I was not resting well …
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A health care headache from a patient’s perspective
“Let’s take a look together,” was the start of a virtual clinical assessment that led to a primary care provider and a neurologist diagnosing a patient with Parkinson’s Disease. As the neurologist in that conversation, I had the opportunity to play a meaningful role in delivering my expertise and, most importantly, making sure the patient received the highest level of appropriate care. With telemedicine’s support, both providers – and the …
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Why specialty health care should go virtual
