Msday -

No worries, it's really something that's quite capitivating, as you can't imagine how much time I've logged on PubMed over the last month.

But the good news is this: we know what it's not. And that is small vessel ischemic white matter disease that is atheroscleratic in origin. The "TIA" standing alone could be many things, including a "Panic Attack": a defined term having nothing to do with perceived anxiety and everything to do with the release of stuff from the subconcious. Which in fact once happened to me on a beautific early January day ("Rose Bowl Weather") in 2007, on retreat in Santa Barbara, only it felt like a heart attack, and I wondered in retrospect whether I had received a visit from the legendary "Armies of Mara."

Until I saw the neurologist on Tuesday and we kicked this around, I had been bummed that this had popped up between late January, 2007, when a couple of weeks after the retreat I keeled over one morning (again) out if the blue and a brain MRI (w/ and w/o constrast) showed only a single very small area of focus, and August of this year, at a time when I was already on the primary drugs used in treatment: Plavix and statins. Then just after we had gone over the fact that those drugs are used because, in the great majority of cases, the problem is atheroscleratic in origin, a fasting lipid test report from last week was faxed over from the lab, and it was absolutely normal! So whatever it is, can't be atheroscleratic in origin.

Bottom line, if something is actually going on, we're not going to waste time treating the wrong disease. And I say if, because, as luck has it, the 2007 study was read by one of the best neuroradiologists in town. So, on Wednesday morning I will be delivering to his office CDs of the 2 studies I've had over the last six weeks, and independent of the reports of the other radiologists, he can read the images side by side an offer an opinion as to the precise extent of the changes and how "normal" the situation is for a 56 year old man. If it's normal, then the perceived cognitive changes including increases in both disorganization and the time it takes me to get a sentence out (either verbally or on a keyboard) can be chalked up to medications. And even if that's not how it goes, at least we know how not to treat it.

Meanwhile, I'm in for a good read. So no worries.

Mike