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A moveable cough | page 1, 2
Put yourself in a theater. You become antsy -- suddenly you can feel every crease in your pants. Your collar is too tight. Your glasses don't fit properly. All of these sensations were present before you got antsy, but you didn't notice them. Your mind filtered out the irrelevant. But when anxiety takes away that filter, you become hyperaware of ordinary bodily sensations. My first question would be: Are your symptoms neurological or do they stem from "hyperawareness," particularly in someone who is quite familiar with the expected symptoms of brain damage? Post-concussion syndrome is a strange bird. On the one hand, each year hundreds of thousands of athletes experience true concussions (loss or alteration of consciousness with associated period of amnesia) yet have only transient symptoms that resolve within a couple of weeks. On the other, we have patients with minor head injuries who have complaints that linger for years. Let's exclude those associated with litigation or other obvious ulterior motives. In the healthy individual who has smacked his/her head, it is often extremely difficult to determine whether the symptoms arise from a subtle brain injury or from mere worry that you might have a brain injury. The symptoms are similar, and invariably the standard tests -- neurological exam, MRI or CAT scan, or EEG -- are normal or reveal no definite specific pathology. Immediately you are up against the dilemma of psychological vs. neurological -- if I can be allowed such a simple-minded, Cartesian distinction. It is the old mind vs. body problem. Of course, as the generator of the symptoms, you cannot tell, nor do you have appropriate wetware/software/programming (whatever you call the ability of the mind to diagnosis itself). You have the sensation but not the ability to categorize it. We must also keep in mind that the sensations of anxiety are as real as the symptoms of any brain lesion. As patients, we notice what we are trained to notice. If we expect to be well in a couple of weeks (as athletes do), we tend to be well in a couple weeks. If we expect lingering symptoms, we are less likely to have a prompt recovery. You have a choice. You can go to Internet support groups and read about the worst-case scenarios or you can draw upon your own common-sense experience. But the latter will be affected by your working with brain-injured patients. It is no wonder that "medical student syndrome" no longer occurs just with medical students. Ask Dr. Bob Dr. Robert Burton, who is a neurologist and novelist, answers health questions every Monday in Salon Health & Body. Please e-mail your queries to him at AskDrBob@ As we went through med school, we developed a fair percentage of the diseases we studied. Amazingly, they tended to resolve on their own, only to be replaced by new conditions. (You would think that our experience would give us some degree of empathy, but human nature doesn't work that way. I think we doctors get embarrassed by all our imaginary infirmities and project our personal disappointments onto our patients. Perhaps this is also why so many seek junk science explanations for the clearly psychological.) On a practical note: Consider your observation on possible neglect. (Neglect is a condition secondary to parietal lobe damage in which a patient becomes unaware of one side of his body -- usually the left side. He may actually ignore the left half of his visual field or fail to dress his left side.) You are not describing neglect, but its converse. You are not neglecting your left side; you are hyperaware of it, are drawing attention to it. I cannot count the times that I have worn different shoes. But because I wasn't concerned about parietal lobe disease, I concluded that I was absent-minded, but not necessarily brain-damaged. Try to listen to the syntax, the actual vocabulary of your complaints. They are a clue. You say, "I am doing odd things that are typical of brain-injury patients." You have jumped from observation to probable diagnosis. Try to learn how you are biased about your own complaints. They often give you a clue to the treatment. In this case it is apparent that you believe your symptoms are synonymous with brain damage. If that belief persists, it is difficult to get rid of the associated anxiety that probably drives the symptoms. You think: Well, maybe I should get another scan. But you already know that the chance of it being diagnostically abnormal is quite small. You want reassurance, which you recognize as being the best treatment. A major stumbling block for a doctor is how to reassure without excessive testing, and without overwhelming the patient with literature that might help, or might actually aggravate the problem. Ask yourself, "What would reassure me?" If all you need is a doctor saying that such symptoms seldom represent permanent damage from the injury you describe, then you have my reassurance (but not my guarantee). Another sore point: In this world of litigation and accusation and finger pointing, no one in medicine wants to stick his neck out and give the final absolute word. We couch everything in generalities, none of which are reassuring to anyone but the doctor and his personal attorney. You must learn to read between the lines. Trust your own common experience; realize that you are constantly bombarded with misinformation, medical salesmanship disguised as scare tactics and support groups beating their own drums of victimization. These are tough times to be a patient but, from what you describe, I think you will be just fine.
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