Friday, March 20, 2015

My Health, According to Hoyel

The phrase "according to Hoyle" refers to Edmund Hoyle, 1672-1769, an Englishman who made a name for himself compiling into book form the rules for various card games—gambling games in particular. In colloquial terms, the phrase has come to mean "the proper rules or protocol for doing a thing."

I bring this bit of arcana into play because I enjoy word play, I enjoy gaming, and yesterday I had a productive visit with my personal physician, Neil Hoyel, who operates out of a clinic in Memphis, our country seat. While I don't see Dr Hoyel that often, I like his down-to-earth nature and clear explanations very much. Though I never play games with my doctor, it amuses me that my straight shooting physician's last name is a simple anagram of Edmund's homophonic surname from three centuries ago (I just love how life randomly deals out such divertissements from time to time).

In any event, I went to see Dr Hoyel yesterday morning and here’s the report.

1. Cognitive Degradation
Back in January Ma'ikwe expressed concern that I might be losing cognitive ability. It relates to my habit of talking to myself (which I've done since I was a young child) and her sense both that the frequency of my doing it has increased and that I am not remembering what I'm saying to myself.

Here's an overview of the incident that caused her to voice her concern. We had been working together professionally and came to a friction point about how to proceed at the end of a long day. After deciding how to handle the moment with the client, we retired to our apartment. While we both knew we needed to discuss the tension that had just occurred, we didn't get to that right away and in the interim I was processing the experience, as I am wont to, by having a conversation with myself. 

A few minutes later, when I was discussing the awkward dynamic with Ma'ikwe, she confronted me with a phrase she overheard me use while I was subvocalizing—something that was critical of her—and I reported that I had no relation to having said that. Mind you, I wasn't denying that I had said it (because I rarely have a clear memory of all that I say when talking with myself); I was only saying that I didn't relate to having said it. For Ma'ikwe this was evidence of cognitive loss. She was clear that I'd said it (and only moments before), so how could I possibly not access it? This scared her.

While I didn't like hearing that I might be losing cognitive ability, I also didn't trust that I would notice if I was, so it made sense to me to look into it (which idea was reinforced by our couples counselor when we shared the story with her). Because of my travel schedule, yesterday was my first opportunity to broach this subject with my physician.

Hoyel said the kind of test he could administer was aimed at people with clear signs of dementia which he could tell wasn’t what was going on with me after only a couple minutes of talking. There are, he went on to report, much deeper, more subtle tests available (the kind of things that take a couple days to conduct), but he said I’d be looking at around $2500 for those tests, which was more money than I was willing to spend (at least at this point).

I explained about my talking to myself, and he reported that it’s entirely possible for a person to subvocalize something that they’re not consciously aware of, and he thus didn’t take Ma’ikwe's experience of me not recalling what she’d just heard me say as necessarily meaning anything—all the more so in that I wasn’t getting any other data (so far!) regarding my dropping balls.

To be sure, this does not prove anything, and he understood my concern about not putting myself forward as a professional facilitator if I’m losing my ability to track well. However, he made the point that if the shift is so subtle that it’s hard to detect, then why worry about it, and that there’s not much I can do about advancing dementia anyway (if that’s what’s happening). Thus, he recommended keeping an open mind about watching for symptoms, because it will start getting more obvious if that’s what’s going on, or else it’s not happening—in which case there’s nothing to do.

That was good enough for me.

2. Sore Ribs
I explained my recent journey with back pain, going all the way back to Oct. When I got to the part about responding poorly to a recent chiropractic adjustment, followed by sore ribs near the top of my sternum, he felt my front ribs and it was clear to him that they were out of position (and therefore it was no wonder that they were painful). Knowing that I was tender, he tried a gentle technique to pop them back into position, but it didn’t work (rats!). He said he could have me to lie on my stomach while he “pounded them” back into place but I declined (I couldn’t imagine the pain).

Instead he gave me an exercise I could do myself (on hands and knees) to try to slide the ribs back in and recommended that I to do this 2-3 times daily until the ribs repositioned themselves. This at least I can do myself, limiting the pain to what I can handle. I realize that I have been walking somewhat hunched over because pushing my ribs out is somewhat painful, but now I know I should be breathing deeply and working more deliberately on good posture. (Having an idea what’s going on is so helpful.)

In any event, the rib pain has diminished and is less acute (whew). I can cook and tend the fire, but no roller skating or break dancing.

3. Cramping Feet
I’ve been noticing this on and off for months and it was on my mind to mention because I experienced it in both feet the night before the appointment. Hoyel recommended an OTC magnesium supplement so I picked up some 500 mg tablets on the way home and I had no cramping last night. So this may be a relatively simple fix. (Whoopee!)

4. Arthritis on my Spine
When Hoyel looked at the CT scan on my abdomen (done in early Dec when doctors were looking for kidney stones) he noticed that I have considerable arthritis on my spine. Uh oh. Although I am not aware of any symptoms relating to that, it’s certainly something to keep in mind. For one thing, I’m glad to have lost 30 pounds since Oct (less to pack around and less strain on my back, as well as my heart).

It looks like I'll need to be paying particular attention to range of motion exercises (needed anyway because of my prolonged inactivity since Oct), emphasizing good posture (do you detect a theme here?), knee-to-chest stretching, gentle spinal twisting, and cow-cat rotation of the pelvic girdle. I'm thankful that I've gotten the heads up about this from Hoyel, instead of from my back.

So that’s me as of yesterday. Now I'm ready to spring ahead. Merry Equinox everyone!

1 comment:

Anonymous said...

Re: foot cramps--I get them at night, too. I make sure I am well hydrated before sleep and also have a homeopathic cramp medicine that has quinine in it. Tonic water may also work. A metaphorical pain in the ass.