July 26/27, AD and Cancer doctor check ins

Marcia’s appointments with her neurologist in NYC have become a full day off for me.  We used to take later appointments so I didn’t have to take a full day off, but we’ve learned that we need to take the first available appointment unless we’re comfortable spending time in the waiting room.  Today I ran a few errands in the morning.  Things Marcia used to do.  Took one of our cars in for oil change and wheel alignment and dropped off Ryan’s medical forms at the middle school so he can play on the school soccer and/or lacrosse team.  Marcia and I then went to the YMCA to get in a workout before the trip to NY.

Today was a little different than most appointments, as two med school students sat in to observe.  Both spoke highly of Dr. Honig (“learning from the best”).  Dr. Honig did the usual tests; all of them are distasteful to Marcia and always hard for me to watch.  He asked her to look at three diagrams/shapes and draw them next to those on the page.  One was a circle with a rectangle next to it.  This Marcia did fairly well.  The second was a three dimensional box.  This she couldn’t do at all, though she spent several minutes trying.

Then we both get asked a series of questions about how she’s doing.  “How’s your memory?”, “any issues dressing yourself?” and other questions I suspect are typical questions of Alzheimer’s patients.

Next came a physical review including height, weight, looking in eyes, ears, etc….  Marcia is in unbelievable shape for her age and this part of the evaluation always goes well….. until Dr Honig asks more questions….. “Can you spell ‘world’?”  She could not.  “Can you say ‘no ifs, ands or buts’?”  She tried, but could not.  “Do you know what day today is?”  She did.  She also knew the month, and date (but she doesn’t say 26^th, she says “two-six”).  The year she also indicates by saying the individual numbers.  Most of us say two thousand and twelve.  Marcia says “Two – oh – one – two”.   Many more questions, but one seems to occur every time.  While the words change, the drill is the same.  Dr Honig says three words and asks Marcia to repeat them.  Plum, table and penny.  Marcia repeats Plum, table and plum.  About a minute later he asks if she remembers the three words.  This time Marcia can only remember “plum”.

All in all, he believes her memory to be largely unchanged since April, but her speech is noticeably different.  We discussed her recent mammogram results, in hopes that there would be a clinical trial exception for her.  Very doubtful for at least another 4 years (most require participants to be cancer-free for five years), and her speech difficulties might further challenge her eligibility.

Over the last 6 months, Marcia has seen with increasing frequency occasional “twitches”.  When these twitches occur, she will drop anything she’s holding (juice, cereal).  Learned today these are called “Myoclonus”, which is a brief, involuntary twitching of a muscle or a group of muscles. Brief twitches are perfectly normal. The myoclonic twitches are usually caused by sudden muscle contractions; they also can result from brief lapses of contraction. The most common time for people to encounter them is while falling asleep (hypnic jerk), but myoclonic jerks are also a sign of a number of neurological disorders.  Myoclonus is one of several signs in a wide variety of nervous system disorders such as multiple sclerosis, Parkinson's disease, Alzheimer's disease, and several others.

Dr Honig talked about the latest in clinical trial drug development.  One very promising drug, I don’t remember the name, recently failed.  Discouraging news in the Alzheimer’s community for sure.  But there is a lot of activity and a lot of hope for something to breakthrough soon.

Last thing we did was ask about Marcia’s driving results for the April test.  Bottom line is she failed the reaction time and a few other important parts of the evaluation.  A little scary was that the final recommendation was that she should only be “restricted”.  Thankfully Marcia has said “I’m done driving”. 

Friday, July 27^th, we met with Marcia’s breast cancer surgeon.  Great news here!  No sign of cancer and no apparent side effects from the Timoxifin, which she has to take for another four years.  Next visit is in six months.