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  • Karl Thunemann

After the Diagnosis, a Prolonged Sidebar

I didn’t know what to make of this diagnosis: mild cognitive impairment. I was grieving--angry, sad, rueful—and doubly angry that the time of bargaining had passed. I felt as if the advice was vague: the gerontologist recommended the Mind Diet, poles apart from the ketogenic diet I had found in the provocative book, The End of Alzheimer’s. I didn’t know what to do.

Worst, I found it almost impossible to set aside the ominous sense of doom attached to “mild cognitive impairment” when viewed as a precursor to Alzheimer’s—far better it should be called pre-Alzheimer’s, as it was by a doctor whose patient lived in our coop. The doctor came to tell us about it. (I was away and missed the program; had I been there, maybe I could have received my own diagnosis in a different frame of mind).

And there was so much the doctors didn’t tell me—things I should have known intuitively, given my life’s experience. It’s not just a matter of shutting off Alzheimer’s … it is just one kind of dementia.

I haunted the internet, finding encouragement only on the website of Brigham and Women’s Hospital. It made vascular disease sound a bit mysterious: The condition could get better, it could get worse, it could stay the same. The site did not list actions and interventions that influence these alternatives. The hospital promised treatment. But I was not about to move to Massachusetts to become a patient at B&WH. Nor was I ready to move to Ohio to be treated at the Cleveland Clinic, which seems to be another cutting-edge place.

And there was so much the doctors didn’t tell me—things I should have known intuitively, given my life’s experience. It’s not just a matter of shutting off Alzheimer’s and being free of dementia. Alzheimer’s is just one kind of dementia. Sure, it is far out in front as the leading cause of dementia. But there are numerous other types, and vascular dementia is in a strong second place. You can even have a dual diagnosis. At one time I thought my mother might have vascular dementia, because of her plethora of transient ischemic attacks, or mini strokes. (It’s like having a guerrilla war with your own circulation system.) I even ordered a brain autopsy after she died, but there was nothing to see but Alzheimer’s. And here in the present I sometimes must remember that so far what I have is vascular disease, not vascular dementia. Such a vast difference.

So in the face of my own diagnosis I started devising meditations that I hoped would be relevant. I pictured the blood vessels running to and through my brain as relaxed, unblocked and in a recuperative mode. I imagined taking a promenade with my Lord Ganesha around the Circle of Willis—an obscure network of five arteries in the brain. We hobnob with the beings we meet there, exchange our experience of gratitude, and sing the praises of redundancy. The circle is now—400 years after its naming—believed to be redundant; half of all people have irregularities in their Circles of Willis. When it comes to fomenting change, the circle seems a fine place to start. And it goes on: My wellness meditations must include at least two dozen internal stopping points where I ask for change, as specifically as I can.

It’s odd—I feel I have run through this very catalogue in another epistle quite some time ago, though I have no idea which one. Well, can it hurt to work it through again? Do you mind? Anyway, I have no idea whether chatting with organs and other features of my body can really bring about change. Maybe it serves only to make me think things are better. Can I really ask that the plasticity of my brain be maximized (plasticity being one of the brain’s most celebrated features) and that the production of white matter (the bane of memory!) be minimized? Well, no harm in asking. And I sense a variability in my well-being that may respond to these queries, and to my taking my supplements regularly and getting enough sleep. I can sense it day-to-day, hour-to-hour, even minute-by-minute. Sometimes, while playing solitaire Scrabble at my computer, I can revel in my capacity to discover complex, high-scoring plays. And just moments later, this facility will disappear. I study the board and see only the simplest of plays, even knowing that once I have made my play and checked to see what I could have played—they will have been there all along.

The key to all this seems to lie in my capacity to go back to the sidebar—not a conversation in the judge’s chambers, but a discussion among my various internal constituents. I may ask whether my essential self is still present, despite all the distractions and setbacks, and usually it is possible to get to yes, or at least to discern a path in that direction. If I can just be patient! (Assuming that exclamation marks are compatible with patience!) Okay, I think this sidebar has lingered long enough. Let’s go find out what’s going on with memory.


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