9/29/24

September 29, 2024

1916 American oil tycoon John D. Rockefeller became the world's first billionaire

923 The British Empire reached its geographical peak, covering a quarter of the globe's land (nearly fourteen million square miles), with the Palestine Mandate coming into force under British control

1941 Nazi massacre at Babi Yar ravine Ukraine began, 33,771 Jews were  murdered

1983 US Congress authorized President Reagan to keep 1,600 US Marines in Lebanon

1990 US Secretary of State James Baker met with Vietnam's foreign minister

In bed at 9 and up at 4:15.     

Prednisone, day 138, 7.5 mg., day 17/28.   Prednisone at 5:00 and morning meds at 5:50.  Pumpkin bread for breakfast.

Obituary, psychological assessment.  In this morning's NYTimes, there is an op-ed by Kelly McMasters, "Why I Write My Obituary Every Year."  She got into this unusual habit when her mother started working at a hospice and was required to write her own obituary as a part of her job, or rather as an imaginative exercise in preparation for work with terminally ill patients.  The column reminded me that I have composed my own obituary as part of my 'death dossier,' a collection of documents I keep in a three-ring binder on the credenza behind my desk in the basement.  The dossier contains important or not-so-important documents and information I gathered for Geri to be used when I die in an attempt to make my 'last arrangements' as unburdensome as possible.  This morning's op-ed is a reminder to bring the binder upstairs to my bedroom desk and to see what, if anything, needs updating.  In searching my laptop for the draft obituary, I came upon the VA report of my long neuropsychological examination on July 24, 2028.  How interesting, if somewhat spooky, to read about one's self as a "subject" which would seem more accurately phrased as an "object."  Excerpts:

DATE OF NOTE: JUL 24, 2018@10:29 AUTHOR: LARSON,ERIC READ 

Mr. Charles Clausen is a 76-year-old left-handed Caucasian man who was seen for evaluation of his cognitive and emotional status to assist with differential diagnosis and treatment planning. He was referred by his Primary Care Physician . . .Clinical interview by psychologist: 60 minutes . . .Neuropsychological testing by technician: 240 minutes.  Computerized neuropsychological testing by technician: 60 minutes Integration of findings with medical record by psychologist: 60 minutes

Behavioral observations: The veteran ambulated slowly and assisted by a walking stick. He was appropriately dressed and well groomed. He was pleasant and cooperative with the examiner. Speech was fluent and articulate, normal in tone and rhythm; however, rate was moderately slow. Thought content was logical and goal oriented, although he was somewhat verbose upon interview. No language errors were noted. Insight into his condition was adequate. His affect was mildly restricted and his mood appeared mildly depressed. He denied current suicidal ideation. There was no evidence for any symptoms of psychosis. Eye contact was somewhat low upon interview, but appeared to improve over time during testing. Vision appeared adequate for testing. Hearing difficulties reported by the veteran were evident upon testing, requiring occasional repetitions; however, hearing generally appeared adequate for testing. He exhibited long response latencies between items during list recall, and was frequently able to provide additional appropriate information with more time. . . . On a timed task requiring visual construction and problem solving, the veteran was able to compose the correct designs with additional time. A generally slow speed of processing was noticed throughout testing. 

Results: Performance on measures of verbal knowledge and concept formation was in the very superior range, while visuo-constructional problem solving abilities were average. Auditory learning and memory for stories and word lists was high average to superior, with no decline in performance apparent after a delay.  While visual memory for geometric designs after a delay was high average, learning over trials as well as ability to discriminate learned designs following a delay were average. Language measures including word reading, confrontational naming and comprehension of verbal commands were performed in the average to superior range. Visual scanning abilities were measured as average; however, the addition of set-shifting demands resulted in reduced performance in the low average range. Letter and category fluency were performedin the low average range. The veteran's ability to determine rules and flexibly shift mental set based on feedback was average to superior. Visuospatial perception for judgement of line orientation was high average. Ability to rapidly process visual symbol to number associations was low average for both written and oral modalities. The veteran endorsed mild symptoms of depression with suicidal ideation on self-report measures, as well as mild elevations on scales indicative of alcohol use concerns, post-traumatic stress, social withdrawal, and preoccupation with physical complaints. Of note, the veteran has endured significant health problems including chronic pain.

Summary and impression: Mr. Clausen is a 76-year-old left-handed Caucasian man with a history of suicidal ideation and plan without attempt; vascular risk factors such as diabetes and diabetic retinopathy, hypertension, obstructive sleep apnea; and chronic pain, referred for memory concerns. Results of testing indicated broadly intact learning and memory, language, executive functioning, and visual perception; however, subtle difficulties were evident on tests requiring efficient processing speed, such as on timed measures of mental flexibility and non-verbal problem solving. Mood was characterized as mildly depressed on self-report, consistent with the veteran's report upon interview.  Self-report measures were noteworthy for clinical elevations of suicidal ideation, and mild elevations of alcohol use concerns, post-traumatic stress, social withdrawal, and physical complaints. . . .

This is a mildly abnormal neuropsychological profile with mild difficulties on tests requiring efficient processing speed. These findings are consistent with mild subcortical dysfunction and likely represent the effects of cerebrovascular pathology, given his elevated risk factors, but mood symptoms might be playing a role as well. The most appropriate diagnosis is likely mild vascular neurocognitive disorder.

I have no idea where the reference to PTSD comes from.  My weight in the summer of 2018 was 239 so I have lost 40 pounds since then.  That was also the year I received steroid & lidocaine injections for bilateral hip pain.   The photo is a distortion giving me a big head; it seemed appropriate to accompany the text about my session with the headshrinker.