Yesterday

JF was here first yesterday. She is doing so great. She came to me about six months ago, I think. She had very severe pain. She was truly upset and very anxious. She was calling me neally every day. She was on pain medicin (narcotics) and xanax and high dose anti-depressants. She has a very strange variant of trigeminal neuralgia. I got her somewhat better with an anti-convulsant. I was trying to wean her off the xanax with great difficulty. I got her off the narcotics. One of the psychiatrists who is amazing saw her and told her to just stop the xanax. She did, and she was great. Then, she had a reaction to the anti-convulsant so we had to change that to another one. Now, she is doing even better. It was a great joy to see her improvement. She is truly a "new person". That was my first patient yesterday.

DT came second. She was told by Dr. M that she shouldn't drive due to cognitive problems. She went for a driving evaluation with an OT who specializes in this and said that she shouldn't drive. So she came here. She is here only so that I will let her drive. I did a thinking test which shows decreased attention and information processing speed. The OT who said she couldn't drive said she lacked attention, especially with divided attention (requires speed). DT may have Alzheimer's because her MRI shows some hipoccampal atrophy. However, the thinking test is still pretty good. I told her that she needs to come of two medications: Paxil and Ambien which could be contributing to her decreased attention levels. Then, we can re-evaluate her thinking test and if the attention and speed scores increase, we could repeat her driving evaluation. I thought that was great. She didn't. She just wants to drive. She doesn't really care about anything other than the fact that she feels she is capable of driving. I asked her if she thought that both Dr. M and the OT were incompetent. She thought they were just wrong. So I asked her how we know that she's not wrong. She just repeated that she just thinks she can drive. She doesn't really want to answer the question about how much certainty we need to have in order to have her drive. She didn't want to answer what she would do if she killed someone after the question of her capacity was raised. In this town, when you can't drive it really ruins your life. The public transportation exists, but that's really about all I can say for it.

LD was here. He's worried about the economy.

I saw a new patint, DF. I have no idea what he has. It's some kind of really unusual sleep problem. He is truly fascinating. I e-mailed a friend of mine who specializes in Sleep medicine. I don't think he's ever heard of anything like this either. It's exciting to see something that no one has really described before. Maybe I'll be able to make him feel better.

BS came. He is 96. He goes to the YMCA to work out four times a week. He lives alone in his house independently. He isn't happy.

RK came. He has been a patient for about a year. He told me that his sister was burned to death. He thinks that her husband killed her, but that was never proven. He raised his two neices. It's surprising what happens to people.

LL was a new patient. He is a retired accountant. He worked as an auditor. He doesn't think very highly of some of his colleagues.

I got very behind on paper work yesterday. I ended up staying at the office too late.