Otto Appenzeller

As a practicing neurologist for many decades, I closely observed each patient, searching for signs of improvement or recovery. Each step in the healing process required time and effort, which could become exhausting, and I have always balanced hope and anxiety anticipating recovery for my patients. But successful outcomes were deeply rewarding. Now that I am 98, the tables are turned, and my daily challenge is to diagnose and treat myself, closely monitoring my own state of mind and the condition of my aging body. As I advised so many patients to do over my career, I adjust my diet, exercise habits, and outlook to sustain my health and my mood.

A 97-year old man is largely healthy, but his respiration is altered. He breathes normally and effortlessly while sleeping or sitting. But if he stands, walks, or engages in other activities that require him to concentrate on coordination and balance, breathing becomes a conscious effort. He stops breathing and grows faint if he does not remember to breathe. This condition compounds other challenges of aging, but he is determined not to allow it to limit his activities. He speculates that his condition results from age related deterioration in the autonomic nervous system, most likely the breathing centers in the brainstem.

My neighbor, who is a talkative character, lives in a gated community, with a gate that can be opened by a code. He often accosts me in the street to tell me his stories. His house has windows that stick out into the street, allowing him to see the passersby while sitting at his kitchen table. He amuses himself by observing his neighbors and their dogs. He confesses he has become a stickybeak—a term from Australia, where he once lived, for an overly inquisitive person. He told me his neighbors are few, but that to his trained eye—he is a retired physician--an amazing variety of ailments unfold daily. 

Decades ago, technology was primitive in medicine. Tests were limited to blood work, and x-rays were our most sophisticated imaging. Lacking machines to diagnose our patients, we relied heavily on a physical examination. Hospital care now begins with tests, and until all test results are in no treatments take place. In the meantime, the patient languishes, often unattended, his condition unknown. Few doctors bother with a physical examination, that is the “laying on of hands” [1] where the patient is subjected a physical examination. No one takes the patient’s clinical history, asking about his past health and that of his relatives. What illnesses lurk in his family history remain a mystery. The effect of these kinds of omissions is that no one ever evaluates the entire patient, their physical state, their interacting ailments, their hereditary risks. 

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ABSTRACT Migraine auras have some visual components. They lasted for the author usually 3 minutes but with exercise they continued for 11 minutes. In this self-experiment the author ensured an adequate supply of blood to his heart by the release of CGRP to ensure coronary vasodilation sustained for the duration of the exercise. Migraine auras can occur any time. They often but not always have some visual component such as zig-zag lines, or blind spots which may precede or follow the headache and may last anything from minutes to hours1. (See the figure) Keywords: Migraine auras, zig-zag lines, Blind spots