MY NEW LOCAL NEUROLOGIST - EXPLAINS MY MIGRAINES

Dr. Patrick J. Madden of Sarasota, Fl is my new neurologist, closer to home.  He is very informed about IHCP and Celiac Disease, which made me feel comfortable. Our appointment was over 2 hours.  He read my tumor biopsy with us and explained some information we had not understood before.  While reading he paused a moment and said, "This is not only rare, but very very rare."  Okay...I have never been known to do anything "half baked", guess this fits!

During my physical check, he noted that I had a migraine.  Really?  I had no idea.  I thought you had to have a very painful headache.  So, I learned something new:

Migraine^[1]

This common condition manifests itself in a number of ways, most of which involve some degree of ophthalmological problem.

• Visual aura - occurs in 99% of migraines with aura (typical and prolonged) as well as in retinal migraines which are characterised by recurrent monocular visual disturbance ± various types of scotoma. Visual disturbances are also the hallmark of ocular migraines or acephalic migraines (those without headaches).
• Diplopia - transient paralysis of III, IV or VI may occur during ophthalmoplegic migraines and may go on for days or weeks. These are rare and recovery is full.

I have vertical double vision. When tested at the Mayo Clinic by an opthamologist, he stated it is called monocular.  So, now I get it. One huge advantage to seeing double is, instead of seeing one star, I get to see two! 

When Dr. Madden had me perform the walk test, I got "dizzy".  He asked me if I felt the room was dizzy or if I was...I was.  He then said this is a type of vertigo and had me stop the test.  He asked me about my exercise program, and I told him I just use the cycle, so I will not fall if dizzy.  He liked that answer.

We talked about my speech issues.  At first he was not understanding what was causing my halting speech, and he said he guessed that is one reason my speech pathologist had me meet him.  We are still working on this.

So, about my flying in a plane.  Dr. Madden said, the cabin pressure could possibly cause a migraine.  The natural alleviation would include non-milk chocolate and coffee.  Need I say how much I love this type of prescription!

To assist my autoimmune issues with my speech, he has recommended Ginger tablets and Vitamin B6.  Also, I am to eat tuna twice a week for the Omega 3 build up.  I love natural dispenses, makes life much easier than all of the prescription drug side effects.  Besides, being a Celiac, I am accustomed to changing my diet appropriately.

Dr. Madden also sent me home with several "use at home" help sheets.  These include subjects, like Migrane 101, Sleep Sheets, and many on-line tools to use for Research.  Here are a couple:

www.achenet.org
www.headaches.org


I have lots to read up on!!

This is a very good place to be and I am so thankful.  I really miss not having Dr. Hanel and his nurse.  I know that Kim would have loved being a part of this with me too.

APHASIA....DYSPHASIA

Thinking back to when all of this started...September 24,2013, the words dysphasia and aphasia have been  the explanation of my speech and memory issues.  There were some episodic occurrances before the "big" one that day, but I resigned them with a reasonable disregard.  This disregard is the same many face in today's busy world, along with added stress

Now, having my expert Speech Pathologist, Mary, helping me, aphasia is more understandable.  There are so many types and they contain similar differences.

THE LONG DEFINITION OF APHASIA:  (Dysphasia has been used as an alternate name.)

What is aphasia?

Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals. But brain injuries resulting in aphasia may also arise from head trauma, from brain tumors, or from infections.

Aphasia can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect mainly a single aspect of language use, such as the ability to retrieve the names of objects, or the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some channels remain accessible for a limited exchange of information. It is the job of the professional to determine the amount of function available in each of the channels for the comprehension of language, and to assess the possibility that treatment might enhance the use of the channels that are available.

Varieties and special features of aphasia

Over a century of experience with the study of aphasia has taught us that particular components of language may be particularly damaged in some individuals. We have also learned to recognize different types or patterns of aphasia that correspond to the location of the brain injury in the individual case. Some of the common varieties of aphasia are:

Global aphasia 
This is the most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Persons with Global Aphasia can neither read nor write. Global aphasia may often be seen immediately after the patient has suffered a stroke and it may rapidly improve if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result.

Broca's aphasia ('non-fluent aphasia') 
In this form of aphasia, speech output is severely reduced and is limited mainly to short utterances of less than four words. Vocabulary access is limited and the formation of sounds by persons with Broca's aphasia is often laborious and clumsy. The person mayunderstand speech relatively well and be able to read, but be limited in writing. Broca's aphasia is often referred to as a 'non fluent aphasia' because of the halting and effortful quality of speech.

Mixed non-fluent aphasia
This term is applied to patients who have sparse and effortful speech, resembling severe Broca's aphasia. However, unlike persons with Broca's aphasia, they remain limited in their comprehension of speech and do not read or write beyond an elementary level.

Wernicke's aphasia ('fluent aphasia')
In this form of aphasia the ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected. Therefore Wernicke's aphasia is referred to as a 'fluent aphasia.' However, speech is far from normal. Sentences do not hang together and irrelevant words intrude-sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired.

Anomic aphasia
This term is applied to persons who are left with a persistent inability to supply the words for the very things they want to talk about-particularly the significant nouns and verbs. As a result their speech, while fluent in grammatical form and output is full of vague circumlocutions and expressions of frustration. They understand speech well, and in most cases, read adequately. Difficulty finding words is as evident in writing as in speech.

Other varieties of aphasia
In addition to the foregoing syndromes that are seen repeatedly by speech clinicians, there are many other possible combinations of deficits that do not exactly fit into these categories. Some of the components of a complex aphasia syndrome may also occur in isolation. This may be the case for disorders of reading (alexia) or disorders affecting both reading and writing (alexia and agraphia), following a stroke. Severe impairments of calculation often accompany aphasia, yet in some instances patients retain excellent calculation in spite of the loss of language.

So, where am I in all of this???   To be specific, it would seem that I fall under the Broca Aphasia because my speech can be "broken and halting" at times.  However, I believe part of the Broca problem is due to the Anomic aphasia because I have difficulty in finding words.  It is laughable because sometimes, I just give up searching for the words I want to use, and say "it starts with a "(letter)".  Other times, with added fun, my family, friends, and I play a very old game called, "Charades"!

The Ipad has been so helpful in dealing with aphasia.  Not only do I have the good and helpful APPS, but I created a list of my most difficult words that I continue to search for.  Of course the internet helps me in writing, I just look up synonyms of what word that is needed.  I also play a word game with a friend.  She has been helping me since the first week after my surgery with this game.  

Mary, my Speech Pathologist, gives me a good 80% rating.  I am so grateful for all of her understanding and help.  We have discussed that I may or may not ever really achieve 100% back to normal.  That is okay with me, I am so grateful for my ability to speak at all, to hear as well as I do, and to read and write.  

Because this disease is determined to be "chronic", the indication is that in time, my physical and mental ability can alter. I look at that possibility no differently than I do to "aging".  Who does not change in one way or another as they age?  Perhaps that is the reason I am going through this now.  Everyone I know is aging, no one gets to stay "forever young".  I am hoping that my learning experiences in all of this will be helpful to others, especially my family.

Aphasia, another name for blessings we share and the purpose He has given us.

A LETTER FROM MAYO CLINIC...MY DR. RICARDO HANEL IS LEAVING...

"Be Thou My Vision" by Nathan Greene

I received a letter from the Mayo Clinic dated January 27, 2014...however, I received it, Friday, February 28, 2014.  It states:

Dear Mrs. Pfeiffer,
This letter is to let you know of a change in our health care team in the Department of Neurosurgery at Mayo Clinic in Jacksonville, Fl.

Dr. Ricardo Hanel, will be leaving Mayo Clinic to join another healthcare facility in Jacksonville, Florida and no longer providing care to patients at Mayo, effective March 14, 2014.

.....the remainder of the letter is to assure me that they will identify the most appropriate Neurosurgeon for my future care.

This past week through  ARC (Aphasia Recovery Connection), my friends and professionals discussed this topic....dealing with "stress" and how it affects our aphasia.  Is it allowable to be stressed as a Christian?  (It does show a lack of trust in God, but we are human, and He knows our hearts.) Dear Lord, forgive me...because when I received this letter.... I cried.  

IN HONOR OF THE "LIGHT" 
DR. RICARDO HANEL CARRIES 

Matthew 5:14-16

New International Version (NIV)

¹⁴ “You are the light of the world. A town built on a hill cannot be hidden. ¹⁵ Neither do people light a lamp and put it under a bowl. Instead they put it on its stand, and it gives light to everyone in the house. ¹⁶ In the same way, let your light shine before others,that they may see your good deeds and glorify your Father in heaven.

"By Dr. James E. Brenneman"

"You are the light of the world! There’s something about knowing who we are as declared so by Christ himself that can become one of the most liberating truths guiding our destinies wherever they take us. One of the great goals of almost any developmental theory, psychological quest, or religious aim begins with the discovery of knowing who we are, knowing our own identities. Who am I? Closely followed by “what is my mission, my purpose, my calling in life.”
.........................

I love the image that Jesus paints for his disciples back then and paints for us today. “You are the light of the world.” Period. Let’s not kill a great metaphor with a thousand qualifications; all the ways we know we are not “lights” or “couldn’t ever be lights” or “lesser lights in a relative bright context” and so on and so forth.

There are enough darkened and shadowed and sorrowful and hurting places in the world, and within each and every one of us, to know that the world needs you, the world needs us. We need more light among us. "

The wording above explains , "Jesus' gift of light"!  This is the vision God gave me of Dr. Hanel.  When he first held my hand and knew my pain...and wanted to use his God given "calling in life" to help me.  I am so humbled and thankful....God's amazing gift of a man who prayed with me..... before opening my brain....

There are so many people in this world who need Dr. Hanel.  I know that God is placing him where his "light" is needed the most.  I have and will continue to pray for this man's journey.  

On my last appointment with him, Dr. Hanel found out that I spoke some French, so his last question to me was "Tres bien?" and I replied smiling, "Oui!"  And we laughed!

Believing! The Lord brought Dr. Hanel to my life when needed...He will do it again...as needed.  

Philippians 4:6-7 

Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. (NIV)