Brain Games

Yesterday (August 18) was my return to Vanderbilt. To say that I was extremely nervous about these appointments is probably the understatement of the year. I don't know why I was so nervous, but I was and it showed in probably everything I did in the days before going.

My first appointment was with the neuropsychologist. I had no idea what to expect (although they did try to prepare me with a "what to expect" letter in the mail). My appointment with this doctor was at 8am, which meant Mom and I had to leave Knoxville at 6:15am, which meant I had to get up at 5:15am. Of course it was pouring down rain when I got to Mom and Dad's house. Mom drove my car. She thought I might nap; I knew I wouldn't! There were times along the way that I thought we were going to be late, but then it looked like we might be around 15 minutes early. I was super excited about this, until we hit Nashville. Traffic was horrible!!!!! I don't know if it's like that every day or what, but we were actually 10 minutes late for the appointment. The doctor wasn't fazed by it in the least bit. He said he had come to realize that patients with the 8am appointment were bound to be late. :) He took me and Mom back to an exam room where we met Kendra who was a PhD candidate and would be the one actually administering the tests.

I got to know Dr. W. (the neuropsychologist) and he got to know me. He was incredibly personable and friendly and put me right at ease. He did say though that they had designed the tests that I was going to be taking to push me to the limit. I wasn't sure what he meant by that, but it was a little intimidating! After about a half an hour of speaking with him, it was time to start the tests. He had Mom leave the room and he did as well. It was just me and Kendra and the tests. Oh.My.Gosh. Like I said, I had no idea what to expect and the tests turned out to be intense. They started out easy enough, but got harder and harder. There were tests like: "identify the object drawn on this card". I did OK on that test until I got to the clothes pin. I knew what it did, but for the life of me I could not remember the words "clothes pin". So frustrating!!!!

Then there was a test where I had to name as many words as I could think of in 60 seconds that started with the letter "F". I couldn't use names or months though. I started out OK, and then quickly faded. I joked with Kendra that I was not ready for her to give me the letter "F". I was thinking more along the lines of an easier letter like "A". To my surprise she said, "Actually, that's the next letter I want you to use." Let me tell you, "A" was no easier than "F"!!

Then there was a test where Kendra gave me (around) 10 words (it could have been more, could of been less) and she wanted me to repeat back to her as many as I could. I thought this test would easy - WRONG! She tested me three times on this and every time, I messed up. By this time, I was regretting the fact that Mom and I had told both Dr. W. and Kendra that I had an excellent memory!!!

Then, Kendra said she was going to tell me a story and she wanted me to repeat it back to her and try to use the same language she did. I thought, "Oh great, this isn't going to be any better than the words I was supposed to remember and say back to her." But, (surprisingly to me) I remembered everything about the story. I can still tell you today what it was: On May 4 in Cleveland, Ohio there was a three alarm fire. By the time that the firemen got there, two hotels and a restaurant were destroyed." But ask me what those 10 (or more) words were from yesterday and today, the only word I can remember is "elbow" (and surprisingly enough that was one of the words I couldn't remember on all three tests yesterday). But when Kendra asked me to identify from words she said out loud which words were in the group she asked my to memorize and which ones weren't, I nailed that test!

Then there was a test where the words "red", "blue" and "green" were written and I had to identify the color that they were written in (like the word "red" was written, but the color it was written in was blue, so the correct answer is blue.) Again, I thought that this would be easy. Ha! It was not. I struggled and was not fast at all in answering.

Then there was a test where an object was at the top of a sheet of paper and then there were 4 objects below it and one of those 4 was identical to the image on the top of the page. I did well on that test, however I didn't do so well on the test where there were right angles and other shapes and I had to see which shapes matched them in a picture with many lines and shapes all jumbled together. I thought I had done well on this, but it turns out, later when given the results, I did not do well at all!

After an hour and half of this testing, it was done. I got a 30 minute break while they scored my tests. Yay! My brain hurt!

Then the interesting part happened. Dr. W. went over all the results and literally read my mind. I was amazed at how the tests I took revealed to him exactly what I was already experiencing. He said my language skills were normal. He said that I don't have any signs of dementia (praise the Lord!), but I have trouble retrieving words, which is why I had such a hard time remembering the 10 words or so and why I couldn't think of the word "clothes pin". He said this is a direct result of the dystonia. I had no idea. I thought dystonia only effected my motor skills! He said that I do know the words and recognize things, I'm just not as automatic in retrieving those words as I should be. It's like a hitch in my brain in what should be automatic. However, I do remember things when presented in a story like fashion, hence my acing the remembering the story test. He said that my resolve conflict is slower than normal for my age which contributes to my falls. It's like a hitch in what should be automatic to me. My motor execution is not automatic, but my cognitive function in fine. He said that I was in the 81-82 percentile in cognitive function which he said was great. He said my spacial judgment was a little off. When I asked him what percentile I was in for the spacial judgment, he said I was in the 5th percentile, to which I exclaimed, "that's not a little off, that's way off!!" He said that I had to take it all in context because I was so high in cognitive function that kind of levels off the spacial judgment function. When I told him that I can walk with no assistance necessary on sand, he was impressed. He said that sand is the absolute hardest surface for anyone to walk on. My being able to walk on that surface with no assistance told him that walking on it challenges my brain to engage. The other surfaces that I walk on are supposed to be automatic and it's not in me, so I'm not challenging my brain to engage in it. When I told him that different seasons also effect the way I walk (hot weather is the absolute best for me, cold weather makes me feel like I can't move.), he said that that thermoregulation is definitely a factor in neurological diseases.

Then Dr. W. showed Mom and I the place in the brain where all of these hiccups were occurring. It is deep with in the brain (hence the name for deep brain stimulation surgery!) but so very tiny. Like a pea. Maybe a little bit bigger, but I couldn't believe that this little place within the brain could cause so much havoc!! He demonstrated how the surgery would be done. It's a thin wire that would go into this place and it has 4 settings on it. The neurosurgeons would gage which setting is the best for me. This is why I have to be awake during this part of the surgery. And yes, I said "this part" because the surgery is actually done in three steps. The first is to insert bone marker screws into the brain (for this, I'm under general anesthesia.) Then a week later they would attach a frame to those screws that will hold the robotic arms. They then would drill 2 holes into my skull and lower the wires in. Then they would wake me up and do the testing and then they would plug the holes up and tuck the wires underneath my skin. The 3rd surgery would be a week later where they insert the battery pack in under my collarbone and attach all the wires to it.

I was stunned, amazed, and completely fascinated and enthralled at how much all of these neuropsychological tests can allow the neuropsychologist to be able to literally read my brain! When God made the brain, He did so with such intricate beauty and precision. I am in awe.

Next up was the motor skills test. This was fascinating to me as well. First, the physical therapist video taped everything I did. She had me stand for 30 seconds. Just stand, to see what, if anything my body did. My foot didn't disappoint. But what I found fascinating was that after she stopped the recording she asked if I meant to do "all of that" with my neck. I had no idea I was doing anything with my neck!! So, obviously she saw something. Then I did neurological tests like touching my finger to my nose and then to her finger. She made me sit on the floor and recorded how I got up. Then I had to brush my teeth (yes, actually brush my teeth - she gave me the toothbrush as a souvenir.). I had to make a sandwich (she didn't make me eat it as she said the bread wasn't stale, but it wasn't fresh either!). To make the sandwich, I had to toast the bread and unwrap a piece of cheese to go on the bread. Then I had to clean a counter. I had to brush my hair. I had to get out of bed (for this I had to get under a cover on the exam table and then get up.). I had to walk for her and I actually did this without the walker or the cane, but I had a wall if I needed to hold onto something. Then I had to walk with the walker and carry a Wal-Mart bag with me that had items in it. All the while the physical therapist was video taping me. This lasted about 90 minutes.

A few of the things Jennifer (the physical therapist that was giving me the test) observed: She commented that I rarely use my left hand. This is true! It's mostly there for show :) OK, not really. She noticed that I only used it when I absolutely had no other choice. I have definitely noticed this. I have trained my right hand to do just about everything. I told her that I can get a gallon of milk out of the refrigerator with my right hand, but if I try it with my left, my hand just goes limp. I told her that when I type, I use mostly my right hand. My left will contribute every once in awhile, but somehow, I have learned to type pretty fast using just my right hand. She also commented on the fact that I don't walk like a "normal" dystonia patient. She didn't elaborate and I didn't have a chance to ask her what she meant by that. When I told her that I can walk in sand without any assistance, I think I blew her mind. She actually said that I'm off the charts in the other direction. She said that no dystonia patient can do that. She said (echoing Dr. W.) that sand is the absolute hardest surface to walk on for anyone. She couldn't believe I could do it.

On the drive home (Mom was driving), I commented to Mom that I was absolutely drained. And she said that she wasn't surprised by that. The thing was, I was surprised by it! I went in thinking these tests would be a breeze and I came out knowing my brain was completely drained. I gave it my all. I finally knew what Dr. W. meant when he said he was going to stretch my brain to its absolute limit! He did and I was spent. I tried napping on the way home and did a little, but it wasn't until I actually got home that I realized the depth of how drained I was. I went to bed at 9pm.

The next step is for all the neurologists, neurosurgeons, neuropsychologists, physical therapists and probably more people that I don't even have on my radar now to meet on September 4. My case will be brought up and discussed and everyone has to agree that I'm a good candidate for deep brain stimulation surgery. So, September 4 is D-day (decision day). I'll either be moving forward (deciding if I actually want to go through with the surgery, getting insurance approval, meeting with the neurosurgeon, getting a surgery date set...) or will find out if I'm not a candidate. Either Patricia (my patient coordinator) or Dr. T. will call me that day and let me know of the outcome. Until then, I wait and I pray and I wait some more and I pray some more!

I truly believe that everything is in God's hands. He'll let me know the decision soon enough! Until then it's wait and pray and then repeat. :)