It is a bright sunny winter morning in Bangalore at half-past ten. Mr. Mathias, a retired colonel, is sitting with his son Derrick in the waiting hall of a busy OPD in Synapse institute. Derrick had to cancel a meeting to accompany his father for consultation. Derrick was continuously texting on his smartphone, his father was only gazing at a picture on the wall without saying a word and sometimes even trying to use a softball with his left hand gifted by his granddaughter Samantha. They finally get called in after waiting for an hour.
“Hi, Good Morning” Please have a seat, Says Dr.Mirza, a young neurologist as Mr. Mathias walks slowly with a cane in his right hand.
“Hi, doctor” replies Derrick and helps Mr. Mathias sit on a cushioned chair and also takes a seat along with all the documents including fancy black and white films appropriately placed in a white file in chronological order.
Dr. Mirza leans forward on his table filled with neurological tools and looks inquisitively at Mr. Mathias. “Hello there,” says Dr. Mirza. “Good morning Doc,” says Mr. Mathias with a very heavy voice without much interest.
How are you doing today? Questions Dr. Mirza
“Not bad,” says the colonel
“Did you have breakfast colonel?” Asks the Doctor quickly as soon as Mr. Mathias finishes.
“Yes, with the struggle” replies looking down.
“Why do you say so sir?” asks Doctor
Mr. Mathias thinks for a while and looks at Dr. Mirza. “Since that incident, I am unable to chew properly especially my toast, It keeps coming out from the left side of my mouth. It's a little better than before though. Doctors also told me to restrict pancakes which I loved so much. So I eat something pathetic without even able to eat it properly.
Oh! May I know about the incident? Dr. Mirza sensing the likely diagnosis.
“Six months ago, It was late in the evening, I was with an old friend of mine at my house. I suddenly felt like my left hand was becoming numb and within half an hour, I could not speak clearly and could not walk and needed support. Two weeks later I started to walk on my own but people say I can’t smile well and my left hand seems like it has given up on me.”
“That’s the really disappointing colonel. Anything else you would like to say?“
“Hmm. That’s pretty much it Doc”. replied Mr. Mathias.
“Shall I talk to your son about your health? “ Dr. Mirza asks politely
“You can,” replies Mr. Mathias.
Good Morning!. wishes warmly looking at Derrick.
“Hello Doctor, Myself Derrick. Son of Mr. Mathias.” Derrick says with pride.
“I did get some hint of his problems. Anything else would you like to add? “ questions Dr. Mirza
Derrick thinks for a while and speaks with little anxiety. “Incident six months was an eye-opener for us. Doctors told us he had a minor stroke which would improve gradually. Along with the diagnosis of stroke came uncontrolled diabetes and hypertension. Though he had diabetes and hypertension for a decade now, he never bothered to keep it in check, neither he controlled on what he ate nor he quit smoking but he took medication regularly. Thanks to forces for discipline! Anyways, I am grateful to God that it is only a minor stroke, probably because he has been very active physically throughout as long as I remember.”
Dr. Mirza leans back on the chair after listening to Derrick and nods. Mr. Mathias keeps looking down and stares at Dr. Mirza once in a while.
“Ok. Is he on medications for all these?” asks a Neurologist.
“Yes,” replies Derrick and opens the file to show the medication.
“I shall go through the documents later Derrick”. Dr. Mirza politely.
“How do I check sugar and hypertension off late?” questions Doctor.
“It's been better since the last two months as he has been put on a diet and has quit smoking.” says with relief.
“That's wonderful” replies the doctor and leans forward.
“I see that he is recovering from a stroke and has a decent lifestyle now plus he is on all medication. Then what brings you to a neurologist?” Doubting there is more to history.
“Doc I have been told by our family physician to meet a neurologist,” says Derrick.
Ok. Why is that? Asks inquisitively Dr. Mirza
“He was suspecting some kind of dementia and suggested to meet you for an opinion and advice.''Derrick looks at Dr. Mirza with hope.
“Is it? Let me have a look”. Dr. Mirza straightens up.
Dr. Mirza looks towards the colonel and requests “ Sir, Shall I ask you a few questions? “
“Please Doc” replies Mr. Mathias with a low voice.
Do you think you forget stuff? Asks the doctor.
“No, but small things such as the place I kept my specs. That is the only thing I remember as of now”.
“Ok. Do you like to indulge in family activities? I mean spending time with your children? “asks Dr. Mirza.
“I don't know, nothing interests me off late, maybe because of stroke. I wish to stay in my room most of the time gazing at Martha’s photograph” replies as Mr. Mathias looks down at his cane again.
Dr. Mirza tries to cheer up colonel and asks “what Pan Cakes do you like colonel?”
“Colonel looks up at the doctor and replies. “Pineapple pancake served with THAT syrup at Koshy’s.” replies with a smile.
Which Syrup? asks Dr. Mirza
The colonel looks at his son. ”The syrup which has a name of a leaf. What s that called?”
Derrick replies with doubt. “Maple???”
“Yes that's the one doc” concludes the colonel with content.
Derrick interferes here.” Doc, he has been having difficulty in finding words recently. We need to suggest. Sometimes it’s as if we are playing TOM, DICK and HARRY”
“That's about it Mr. Mathias, “ tells doc and looks at Derrick and asks. “Anything you would like to tell Derrick?”
“Dad has been emotionally strong ever since i know but since last few months, there were tears in his eyes looking at my mother’s photo occasionally. He used to love my daughter Samantha and would play with her but off late he is mostly up to himself and does not seem to be interested”.
“Ok. I understand” Dr Mirza empathises with Derrick.
“Does my father have dementia doc?” asks Derrick with anxiety.
“There are a few hints about it. Let me examine him first” says Dr Mirza and instructs Mr Mathias to sit on the examination table.
After a neurological examination, Mr Mathias assisted by Derrick and Dr.Mirza sit back in their chairs.
Dr Mirza asks for documents and looks at the fancy black and white films on the view box.
“There are few signs of dementia which needs to be monitored. On the other hand, The good thing is he is recovering from the stroke. He is on the right medication for preventing another one. He is also following all the suggestions appropriately. We are on right track right now. I think he will recover faster if physiotherapy is continued regularly. Importantly, family need to indulge him in activities which he liked or make him meet people whom he likes.” Dr Mirza counsels Derrick.
Dr Mirza gives a second or two of silence and adds. “I am open to any questions. Anything you would like to ask?
“Ok, I understand. It’s great that he is improving, Dementia, as I know, progresses right. Will he forget us also in future.? Is it Alzheimer’s disease Doc? asks Derrick Anxiously.
“Dementia in Mr Mathias is due to small strokes happening in the brain because of the long duration of uncontrolled diabetes and hypertension which may be evident after one large stroke which occurred six months ago. It is not Alzheimer’s disease. It can be controlled provided Diabetes and hypertension are take care of” Speaks Dr Mirza.
Derrick takes a sigh of relief and asks “Ok. I understand. Any medication to be given for this condition?
I am going to write for a few tests and I shall start a new medication for him. Replies Dr Mirza
Dr Mirza explains regarding the medication and side effects
Finally, Derrick Says, “It’s been nice meeting you doc. We shall get back with reports next month”.
Dr Mirza says. “My pleasure” looks at the colonel and adds “ I shall try the pineapple pancake at Koshy’s in meantime and give you feedback next month”
Colonel and Derrick leave the room with the smile and Dr Mirza remembers playing TOM, DICK and HARRY with his sisters during childhood and smiles.
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