FAMILY DOCTOR: Fearing outcome of further testing
Thursday, September 14, 2006 FAMILY DOCTOR PETER GOTT, M.D. UNITED MEDIA


Q: I have been reading and benefiting from your column for many years. You seem always to cut through all the medical-establishment bias and self-interest and make sense of it all with your long years of experience and open-minded, common-sense attitude.

I am writing about a crisis in my own life. I am 71 years old, and, until very recently, I would have considered myself to be in excellent health — very active, exercise, eat right, etc.

About nine months ago, I experienced what I thought might be a minor stroke, only affecting me with slightly slurred speech and a tendency to lose my balance and fall. After several tests, which included an MRI of my brain, the neurologist concluded that there was no evidence of stroke. He now wants to perform a battery of tests to determine if I have ALS.

I have researched this disease, and I am overwhelmed by the utter hopelessness. I am now being urged by family members to go ahead with these tests, but I am reluctant to receive such a hopeless diagnosis.

What purpose can be served by knowing my motor neurons will slowly wither away, leaving me a helpless husk, then to finally suffocate when the muscles for breathing become too weak?

Since nothing can be done to significantly alter the course of this disease, then why not just make the best of it and avoid thousands of dollars worth of tests and the certainty of my agonizing final episodes in life?

What other diseases might possibly cause my symptoms, which, by the way, are not growing worse (yet)? I have learned from my research that little can be done to alter the course of any motor-neuron disease.

A: For many people, knowing a diagnosis — even if an illness is incurable — goes a long way toward helping them cope.

Also, some treatable ailments may resemble incurable conditions. For example, your description of significant but brief neurological symptoms is typical of transient ischemic attacks (“mini” strokes), which anticoagulant medication and other drugs may prevent at little cost and inconvenience.

TIAs are, as stated, transient. They rarely show up on a brain scan, so I believe the normal MRI you had is consistent with TIA, and this should be addressed.

Of course, you have the privilege of refusing further testing, but, in my opinion, a diagnosis is what you need most — not a premature death warrant.

My advice is, bite the bullet. Ask your primary care physician to refer you to another neurologist for a second opinion that I hope will be more likely to provide good news rather than bad.

Write to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.
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