My Latest Neuro Appointment: Fun, Pets, Screenings, and Some Thoughts on EMRs vs. Paper Records
September 19th, 2017 - 12:45 p.m.
Here are a few takeaways from my four-month neuro appointment.
“Ugh!” my neurologist groaned as she clicked some keys on her laptop. “The system went away again. I’ll just have to write down some notes and enter the data later on.” This is how my appointment started. Being in an excellent, energetic, jovial place, I took it and ran.
A return to paper
“I just read an article announcing a return to paper,” I joked, punctuating the claim with laughter.
“I hope so!” she said, and went on to lament the loss of paper medical records, explaining how she could better commit to memory the changes in our test results by taking the paper reports and physically placing them in a circle around the older report that occupied the center. But she simply gets lost in EMR apps drill downs. My neuro is about ten years my junior but still of a microgeneration that went to med school before the invention of the personal computer. The visual-tactile relationship with paper still haunts the dreams of we older, fartier souls.
Considering the recent Equifax breach, my facetious overthrow of electronic files by paper is a perfectly rational idea. Ever since the electronic file coup of the last 20 years, I’ve not had an expectation of privacy. As a writer, I’m tempted to advise fellow souls that if you want your work to be lost or stolen, do store it on your hard drive and in the cloud. If you want to give it a better chance at protection, write it on paper and stow it in your file cabinet. But the best way to protect your literary masterpiece is to not file it anywhere. There is one surefire solution that fills the bill.
Commit it to memory
Ray Bradbury had the right idea in FAHRENHEIT 451: Commit it to memory. That way no one can know that you have it unless you recite it out loud. Same goes for diaries and personal journals. If you don’t want to risk having some personal thoughts discovered by prying eyes then don’t write it down. I never keep a personal journal. Everything I write is for public consumption. If it’s private, I keep it in my head. But since I can’t trust my memory anymore and it’s too sensitive to write down, I tell it to a close, trusted ally who has a better memory than I do. Then I can forget it without anxiety. Mostly.
Score one for electronic medical records
Meanwhile, back at the neuro appointment, doc’s computer now revived, she reviewed my medications and caught something. I take an anticholinergic (Vesicare) and a potassium supplement in solid form. A drug interaction popped up on the screen. Apparently, mixing the two can cause delayed gastric emptying and stomach ulcers. “But you’re safe taking the liquid form of potassium,” she offered. I thanked her for catching that and called my PCP as soon as I got home to request a change from capsules to liquid. Score one for electronic medical records.
Next we reviewed earlier MRI results. I remembered that the lesion load remained unchanged but a cervical disc herniation had worsened. My pain hadn’t worsened, however, and I told her my trigger is poor posture, which I know how to avoid. I also sleep with a memory foam contour pillow and that ensures I’ll wake up pain-free every morning. She reminded me that if that stopped working then physical rehab would be the next treatment, and if that didn’t work, cortisone shots would be next, and if that failed, then surgery.
Reviewing family medical history
Next she performed a physical exam, first listening to my carotid artery. I told her that recently my brother had suffered a mild stroke and the blockage was in that very artery. His PCP had missed it during an exam just weeks before the stroke despite it being a rather serious (85%) occlusion. We reviewed my family history. Mom died of lung cancer and dad died of heart disease. "And now you can add stroke to your history," she said. So now, the top age-related diseases: cancer, heart disease and stroke--are all represented in my family history. And here is where my doc made a fascinating recommendation.
An affordable screening
She encouraged me to get the screenings as advertised by Life Line Screening, a mobile service that charges reasonable fees for health screenings designed for your personal risk profile. These screenings are not covered by insurance. I have Medicare, and experience has shown me that it will only pay for tests that they deem medically necessary. Hospitals charge the uninsured lots more for such screenings. So I researched Life Line Screening and answered a simple questionnaire. It recommended a screening bundle for $149 tailored to my family history. Totally affordable, and if I wait for it to come to my home town, I'll pay nothing for transportation.
A positive appointment
Last on the agenda was to clock my walking speed since it was time to renew Ampyra, and I did well. My doc had been bringing her dog, Heidi to the office, a friendly little Scottie who served as the welcoming committee while I was ushered back to the examining room. Now Heidi wanted to race me as I limped down the hallway, but my doc corralled her in an empty room. With my competitive nature, I might have walked even faster if Heidi had been allowed to run alongside me. It would have been fun, anyway. My appointment was so positive that we decided the next one could be six months instead of four. “If I have a problem before that, I’ll call,” I promised my doc.
On a final note, I lost a piece of clothing between leaving the office and arriving home. My fitness fleece jacket, something I wear to death and refuse to throw away, somehow left my hand and is nowhere to be found, not in the car and not in my apartment. Next I’ll call the doc’s office. It must be there, right?
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