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Saturday, April 24

Irony

Oh I am so thankful that my bed awaits me in just a few moments. Once I upload my final case study, I will be heading into the land of ZZZZZZZZZZZZZZZ. My mother had a very difficult day today, probably the worse that I have seen. It started with a trip to the obgyn. What a great doctor. This was our first visit to her-she actually can in for us (she had today off for her daughter's b-day). Anyway, mom was very confused and continuously asked what she was doing. She had difficulty with opening the doors, holding things, talking, understanding, everything. When we arrived at the doctors, she was very confused and did not want to do it. However, as soon as she found out that the doctor was a Christain, she was very happy. In fact the entire staff was. She was called back and talked to the nurse for over 15 minutes about God. The nurse was very patient and very sweet. She let mom rattle on about tongues and her experience with God. When the nurse left, mom got very upset because she was embarrassed by how much she talked. She started pacing and wanted to leave. Then she wanted to find the girl to tell her about tongues (so she would not think mom was crazy) She could not let it go and finally I asked the ladies at the front if they could send the nurse back in when she had some time. Mom kept repeating that tongues is in the Bible but only for God and her. Anyway, the Dr. came in and reviewed her file. Mom got extremely angry when she asked about depression and anxiety. As soon as the doctor left the room for her to undress, mom started to cuss me out saying that I did it, I told them about her problems in some ugly ways. She was ready to walk out of the room and luckily, I calmed her down and got her to undress. Dr found three lumps on her left breast and two on her right. Her last mammogram was in Dec. and was negative (no lumps) So this new set of lumps grew to the size of grapes since December. The emotions that she had were so extreme.


It has been a few days and quite a weekend. I will resume where I left off. My mother is having an extremely difficult time grasping the possibility of breast cancer. Whether it is because of the stress or not, we are seeing her short term memory beginning to go. She will repeat herself often, ask the same questions, confuse the facts...She will also forget something I told her just a few minutes earlier.


Here is the letter I had sent to Social security. Please review it and let me know what you think.


We are here today to present information regarding Audrey and her condition. White it is not argued that she demonstrates a disability, the issue is when the disability affected her life significantly enough to impair her ability to work. Due to the nature of the disease, it took many years of tests, visits, medical procedures, and scans to derive at the conclusion of Early Onset Alzheimer's Disease. According to Dr. Kenneth Langa, associate professor of internal medicine at UM in Ann Arbor, said it is not unusual for a relatively young person to have many tests before receiving a diagnosis of early onset Alzheimer's
"You'd want more evidence that that's what inf act is going on given the rarity of Alzheimer's disease in someone that you," Langa said. "On average, they would have more tests, and more expensive test, and more elaborate testing than an older patient."
Unlike the traditional form of Alzheimer's ,which occurs in the elderly, the early onset type first produces symptoms prior to the age 65. Estimates indicate that only 1 out of 10 percent of Alzheimer's' patients have the early onset form and because it is relatively rare, there is often a delay in making the diagnosis, said Erin Heintz a spoke person for the Alzheimer's Association. Audrey had received the diagnosis of menopause, anxiety, depression, brain aneurysm, asthma, muscle spasms, angina, night terrors, and stress. She underwent multiple MRI's Cat Scans, Pet Scans, Ultrasounds, catherization, which a conclusion of minimal findings. It was not until 2008 that Audrey received her diagnosis, fiver years after he symptoms manifested themselves enough to cause significant difficulties.
"Imagine slowly forgetting everything you learned in life? Imagine not knowing what day, year or season it is. Imagine being angry, afraid, tormented, confused, sad and frustrated most days? Imagine being afraid to do simple tasks like taking a shower, imagine forgetting how to dress, brush your teeth, use your fork, swallow, laugh, and even talk. Imagine staying awake a night even when you are exhausted because your brain won't rest. Image forgetting everyone that was important in your life.. everyone that you ever loved. This is the world of Alzheimer's as seen through one patient. Now imagine being 51 when all this started. This is the world of Early Onset Alzheimer's.
As we discuss her case, I hope you gain an understanding of this disease and the history of Audrey, It is my hope that you will see her years of dedicated work and agree that she should be awarded this aid.
Audrey has worked her entire life; she worked as a secretary in the school systems, a paraprofessional, transcriber, and real estate agent. She received high recommendations and praise in all her jobs for her efficiency and organizational skills. She was employed from 1988-1004 as a Secretary, became a paraprofessional from 1996-2000. She worked as a real estate agent from 1997-1999 as returned to in during 2003. During the one break in her working career, she requested time off from her job in order to care for her mother. During 2000-2002, Audrey opened her home up to her mother who was diagnosed with Alzheimer's.She hired no help and worked 24 hours a day providing everything her mother needed. While it was not a paying job, it was more demanding, more exhausting, and more draining than any of the previous jobs that Audrey had obtained. It was because of her caring for her mother that she is unable to receive her benefits now. The unforeseeable result was that Audrey bestowed to her mother the last two years she would have been able to function in the work place. Upon her mother's death, Audrey tried to procure a job. She returned as a real estate agent, but realized that she could not complete the work needed. She had difficulties with the paperwork and understanding contracts. She decided to return to the school systems and applied at multiple job listings. She interviewed and did not receive a job due to her inability to control emotions and her lack of social skills.


As you examine her medical record, you see a change in Dr's notes regarding Audrey. Prior to 2002, her Drs. never mention her mental status or behaviors. In fact during 20-00-2002, which were years of extremely high stress, not once is she considered depressed, anxious, neurotic, etc. Is is not until 0003 and 2004 that her behaviors started to impede her life in all areas.


Alzheimer's is a progressive brain disorder where nerve cells in the brain start degenerating and die. A person suffering from Alzheimer's has problems with memory, judgement, and thinking. As a result, they cannot perform day to day activities which affect their social life and family life. In the rare cases of Early Onset, it is quite common to see the EOAD accompanied by mood problems. Other symptoms include confusion, restlessness, change in personality, and decreased judgment. A normal happy persons may become irritable, irrational, and possibly aggressive with very sudden mood swings. paranoia, jealousy, fear, and delusions are common. Another symptom is called myoclonus, which causes muscles twitching and spasms. This is more common in people with Early Onset than those Who develop the disease later in life. Often these illnesses are not diagnosed for a while due to their age and is often mistaken form depression.The younger the patient, the more progressive the disease and the more fraught with complications. Most people believe that Alzheimer's s displayed by memory issues and that the damage is to short term and long term memory. That is true in most cases; however, damage is done in many areas and affects many aspects of mental function, meaning the difficult cognitive abilities are damaged unevenly. As demonstrated on the PET scan, Audrey's are of damage are in the Left and Right parietal Lobes, and the frontal left lob. Impairment to these areas in the brain result in ability to plan a sequence of steps, loss of spontaneity in interacting with others, loss of flexibility in thinking, persistence of a single thought, inability to focus on a task, change in social behavior, inability to name objects,difficult with left and right, loss of awareness in surround space, difficulty with eye and hand coordination, difficult with drawing objects, and difficulty with visual attention.
Prior to 2002, Audrey exhibited no major health issues or difficulties. Starting in July of 2002, she mentioned having night terrors. She would wake up screaming and would be in a state of horror. She was very tense and upon wakening, was extremely confused. From September2003 until December 2003, she underwent an MRI of the Brain and lumbar/spine, ultrasounds of the pelvic/abdomen, EEG, and nerve tests (sensory and motor) to find out what was ailing her. Her family Doctor ordered an MRI on September 11, 2003 due to a change in mental status. He again addresses it ion the 23rd of September. This is the first indication that something greater was going on. There was something affecting her memory. Nothing presented itself from her testing. She also complained of severe headaches and pain. During 2004, Audrey complained of heart problems, trouble focusing, sleeping, weird sensation in her ears, balance and coordination issues, and having a hard time doing things. She was diagnosed with asthma, but there is a debate on whether it was asthma or anxiety. She also complained of tightness in her chest. In August of 2004, she mentions that her night terrors were worsening. she had trouble focusing, severe fatigue and found her husband to be like a stranger. She continues to complain of chest pain, dizziness, and shortness of breath. her family doctor diagnosed it to be depression and anxiety. Audrey denied it and was referred for psychiatric evaluation. She underwent catherizations, EKG, Ct of the brain, and again there was very little found.
In 2005, Audrey demonstrates stiffness in joints, dizziness, chest tightening, muscle aches, fatigue, muscle spasms (myoclonua), anxiety, trouble focusing, sleep issues, fainting, disorientation, and vertigo. Her family doctor again diagnosis anxiety and depressions. Another doctor diagnosed anxiety and also referred her for evaluation. The doctor described and episode in which Audrey pretend to faint and became very distraught and confused. Yet another Doctor describes Audrey as a neurotic lady. Audrey again mentioned in a vi st to her family doctor that she is very disorganized, loses items, has difficulty with attention, extreme mood swings, accented emotions, disorganized speech, scribbles, worse memory, and issues with spelling. Although all the testing came back negative, it is now apparent to both her family and doctors that she had all the symptoms for EOAD. The fine motor deterioration, behavioral issues, social issues, judgment issues, and processing issues now make sense. IT is hard to determine at what stage she was in, but it is evident that she was impaired mentally and behaviorally. Even if she could have procured a job, it is unlikely that during the 2004-2005 year, she would have maintained the position for any significant time.

1 comments:

Sandy Kessler said...

The letter is outstanding one suggestion from experience. Right from papragraph one start with dates and be explicit and matching in all your dates.. That is the way it is most expedient. Be vague nowhere. Be right ontop dates,so that they can back up a paper trail..Begin with the dates even if it too a lot to predetermine.paragraph 1 start and stay with it..

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