Tag Archives: GP

Doctor #WotW #PoCoLo

So I had two doctor’s appointments this week. First, like I said last Monday, I was seeing my GP on Wednesday regarding my mild motor skills impairments. A little explanation is in order. I have always had fine and gross motor skills impairments. Since they are so mild, they have always seemed practically non-existent in the face of the major disability of my blindness. As a child, I held my parents’ hand till I was at least twelve. This was however seen as a lack of self-confidence. I did use my white cane when prompted, but since I had trouble accepting my deterioratng vision, I apparently chose dependence on others over the white cane. When I did use it though, I often used it as a walking stick.

Now I’m no longer ashamed of the white cane. I in fact prefer to have it with me even if I walk sighted guide, because then at least people will see I’m blind. Still, despite having had countless orientation and mobility training sessions, I still cannot seem to use the white cane in its proper way. Even so, I feel very unsteady when walking independently. I would love to learn to improve, because, even though there is no route in our village I’d like to learn to walk without anyone accompanying me, I’d love to be able to walk without holding onto someone’s arm. That would enable me to go to events on my own by accessible transportation, which I now avoid due to not wanting to ask strangers to be my guide.

As for my fine motor skills impairments, I cannot eat neatly no matter how hard I try. I find this terribly embarrassing. I also struggle with preparing my own breakfast, pouring myself drinks and other skills that require the use of both hands. I can perform tasks that require just my right hand just fine and I can use my left hand for support, but activities that require coordinating both hands, just don’t work without adaptations. I’m curious to know whether such adaptations exist.

My GP looked up what seemed to have been a letter written by my previous GP in the institution. It said that I was born prematurely (correct), had a stroke as a baby (not correct, it was a brain bleed) and developed hydrocephalus as a result (correct). The resulting impairments are diagnosable as acquired brain injury. I seem to have read that when a person sustains a brain injury before age one year (or three in some countries), it’s not diagnosed as an ABI. The correct diagnosis, well, I don’t know. Motor impairments are, or so Dr. Google tells me, often diagnosed as cerebral palsy, but then they have to be severe enough, which I doubt mine are. I didn’t question the doctor though, although the confusing diagnosis did frustrate me more than I’d hoped it would. After all, my intention was to ask about treatment options.

The doctor told me that, if I’ve been stable for over two years, there’s no hope for neurological improvement. This timeframe is longer in children, but since I’m now 31, I’ll pretty much have to learn to live with my impairments. Still, I might benefit from occupational therapy and possibly a little physical therapy to help me learn to use adaptations and learn compensatory strategies. The doctor is going to contact the nearest rehabilitation center to ask whether an occupational therapist can take me on. My blindness may be an issue though, in which case I’ll need to see an occupational therapist at the blindness agency. They don’t often know acquired brain injury though. Seeing both is not an option insurance-wise.

I also saw the mental health agency’s general doctor on Thursday. The physical health screening with the nurse and all the things I didn’t know about my childhood conditions, were what had prompted me to see my GP. I discussed the GP visit for a bit. Then we went over the lab work the doctor had ordered. Everything was within the normal range except for one thing, creatinine, which was a little high. The most likely reason for this is that I don’t drink enough water.

With these two appointments and my having been having them on my mind all week, my word of the week is going to be “doctor”.

The Reading Residence
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G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.

Gender

There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.

Genetics

When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.

Geriatrics

Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.

GP

Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

Medical #WotW

It’s been a tough week, so I haven’t written much. I’ve had countless plans and ideas in my mind, among which restarting my Dutch blog (yes, again!), but my brain and body won’t fully cooperate. I did restart the Dutch blog, but I only republished an old post. Because I can’t really get my mind to work towards creating an original blog post, I’m just going with #WotW and share my word for the week. I’m a bit late, but I checked and the linky is still open.

My word of the week, not quite surprisingly, is: medical. I’ve had quite the week with medical visits, after all. On Monday, I had to be screened by an endoscopy nurse in preparation for the upper GI endoscopy, which was Friday. The screening was relatively easy-going. The only hurdle was that the nurse hadn’t gotten a referral letter, so he had no idea why I was supposed to get an endoscopy. I explained that i had heartburn and pain up my esophagus. “Ah, you have reflux.” I happen to know the term in English but had hardly heard of it in Dutch and thought it’s the same as heartburn. I got the idea that the nurse felt the endoscopy wasn’t necessary, but he didn’t say so. Not that it’s his job to decide on such matters anyway. The nurse did say that my being short of breath while lying down but not (too badly) during slight exertion could be due to the reflux.

On Friday I got the actual procedure. It was a breeze too. A nurse from the institution came with me since my husband was at work. She wasn’t allowed in the room when I got the endoscopy but that wasn’t a big problem. I was sedated under twilight anesthesia, where you’re conscious but not quite aware of what happens. I can’t remember a thing about the procedure itself, though I do remember being brought to recovery. In the bed next to me was a man who got the news that he might have cancer. That gave me a bit of anxiety, because I still wasn’t so sure nothing would be found on my endoscopy. As it turned out, the doctor was finished telling me the results within less than half a minute. Nothing was found and he’d send a letter to my GP. I’m glad that nothing was found, although it would’ve been better if something with an easy, targeted treatment had been found.

On Tuesday, I went to my GP again because I’ve been having terrible fatigue and what I have gotten to believe is some sort of brain fog. I didn’t mention the term brain fog but did describe what it’s like. The doctor sent me for bloodwork and is going to give me a physical examination next week. Even though I’ve been a little less exhausted over the past few days, I do hope something easily treatable will be found. As the doctor explained, fatigue usually has more than one cause. It could be I’m having some case of the winter blues, because I’ve been feeling more depressed lately too. Fatigue for me gets better and then worse but it’s never fully gone though. I have had vitamin and iron deficiencies in the past, so we’lll see whether these are acting up again.

The Reading Residence