Neurological problems can perplex
Dear Dr. Gott: My brother and an unrelated friend in Alabama suffer from a brain disorder that affects their speech and the muscular control of their extremities. My brother has been to clinics in Florida, Alabama and Georgia. The specialists could not arrive at a diagnosis and concluded that nothing can be done.
Is there hope for these two? Where can they seek further help?
Dear Reader: This question is way beyond my capabilities because I cannot determine, from your brief note, the cause of the neurological abnormalities. In fact, these puzzling cases seem to have challenged specialists in several cities. In my experience with patients who have troublesome diagnoses, I’ve often found resolution if they are examined and tested in tertiary medical centers where super-specialists abound and sophisticated equipment is readily available.
Therefore, with a profound apology for saying, “I don’t know,” I suggest that the patients investigate the possibility of seeking help in a medical school atmosphere. Which one is a decision I’ll leave to your brother’s primary care physician. Please let me know how this works out.
Also, while difficult diagnoses are a welcome challenge to most doctors, difficult diagnoses can be a frustration beyond belief. Despite the marvels achieved by medical science, we don’t have all the answers and our limitations are no more evident than in the vignette you supplied. Clearly, your brother and his friend must be frightened and confused about their lack of diagnosis. This is the reason that I am suggesting further, expert analysis, instead of being content with inconclusiveness.
To give you related information, I am sending you a copy of my Health Report “Medical Specialists.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.
Dear Dr. Gott: When I go to my doctor for a 6-month checkup (because I have hypertension under treatment), he instructs his nurse to forego measuring my pulse rate and temperature. Also, do I need to have a digital rectal exam every year? I am 68 and had my prostate removed 11 years ago. My PSA is zero.
Dear Reader: Most doctors (or their assistants) check the “vital signs” (pulse, blood pressure and respiratory rate) as part of a routine office visit. Temperature is usually not necessary, but the pulse certainly is, especially if the patient is being treated for high blood pressure.
In my opinion, a rectal prostate exam is not required if you have a low PSA, have had normal prostate exams since your surgery, are over 55, and have no compelling reason to do so. Ask your urologist about this and how often he would like you to have repeat exams.