The Surgical Dementia

Don’t say, ‘forget it!’ when you repeatedly forget. It demands brain imaging and some lab tests to see what’s messing with your memory—blood collection, tumour, thyroid or simple B12 deficiency 

A septuagenarian couple was seated in my consulting room. The wife started to talk as soon as she caught her breath. “He’s been forgetting a lot of things these days,” she complained. “He doesn’t remember what he’s eaten this morning or how much money he withdrew from the bank the other day.” She sounded a tad exasperated of taking care of him.

“Does he remember past events like which school he went to, his wedding date?” I questioned, hoping to give him some brownie points. “March 31, 1975,” he shot back, putting a gentle smile on her tired face. “He fumbles a little in his speech as well, I’ve been noticing.”

I asked him to close his eyes and stretch his arms out straight in front of him, parallel to each other with palms facing the ceiling as I demonstrated the action myself. After a few seconds, I noticed his right arm drift downwards while his left was able to resist gravity. I explained to them that this was probably owing to something pressing down on the left side of his brain.

“Do you drink?” I questioned innocently to postulate a diagnosis in my head. Husband and wife looked at each other and then at me. He shook his head sideways and she, up and down. “A few pegs a week doesn’t classify as drinking,” he reasoned.

I asked them to get a CT scan done right away on the ground floor, and within the hour they were back at the clinic. “It shows exactly what I expected,” I said with slight cocky arrogance, even though most of the time that I order a scan for forgetfulness, it usually comes back normal. “You’ve got  a chronic subdural hematoma,” I stated, describing it as collection of blood between the bone and brain and probably responsible for his symptoms. “You must have bumped your head somewhere without realising it,” I continued, explaining that this can happen in the elderly even without any definite trauma. The brain atrophies with age and if a tiny vein between the brain and its covering (the dura) snaps, it can cause blood to accumulate over time and cause this symptom. “It needs to come out,” I concluded, even before they could ask how we should go about it.

The next morning with zealous quickness, we made two small incisions on his scalp and drilled two holes into the skull, a few inches apart, following it up with a cut into the dura. Dark altered blood emanated under high pressure. Although this is technically the easiest operation in our field and I must have done several hundred by now, I’m excited every single time I cut into the dura. With the delectation of a child, I’m eager to see what comes out. Each time the colour of the blood has a varied hue of red, it jets out at a force that’s different every time, and the underlying brain is at disparate distances from the bone. I often joke with my dextrous orthopaedic colleague that this is one neurosurgical operation I can teach him to perform, because all it involves is drilling a hole into the bone.

After ensuring that all the blood was out, we closed in the usual fashion. The next morning, his absentmindedness was gone, and at dinner, he was crisply responsive about what he had eaten for breakfast and lunch.

Dementia is a collective term used to describe various symptoms of cognitive decline. Forgetfulness is a symptom that plagues all of us at all stages of our life. As physicians, we need to discern which patient needs an MRI, or more importantly, in which cases can this condition be reversed. As the French philosopher Montaigne pointed out, you can be knowledgeable with another man’s knowledge, but you can’t be wise with another person’s wisdom. Surgical wisdom is just as hard to attain as the spiritual one.

In my opinion, any elderly patient who has a recent onset of forgetfulness should have their brain imaged. While blood accumulation is not uncommon, on occasion, I have also found tumours in the frontal lobe—the area that aids in planning, execution, processing feelings, and memories. I’ve also picked up an extra accumulation of fluid in the ventricles, which, when drained, reverses these symptoms. More importantly, forgetfulness is commonly seen in those having deficiencies of Vitamin B12 and low thyroid levels and can be easily reversed by supplementing them. So, before we start prescribing pills for dementia, let’s try and take a look at what’s going on inside; also because there’s a high chance your patient won’t remember taking the pills!

“How do I keep my brain sharp?” a lot of people ask me. “Clean living and keep moving” is my standard response. There is really no rocket science here. Exercising, healthy eating, a bedtime routine, sound sleep, yoga, meditation, and expressing gratitude is what every single self-help book will tell you.

The other day, three lovely old ladies came to take the vaccine at my hospital. They were in their 80s and I had made arrangements for them to be taken care of, as one of them needed a wheelchair. I came down to visit them in the waiting area where they relaxed for the mandatory 30 minutes once they took the jab. “Hi!” I said, happy to see them dressed in nice floral skirts, their faces powdered in the characteristic way that elderly Parsi women step out in the afternoons. “Can you give me some medication for my memory, please?” the one in the centre said. “I’m forgetting a lot these days.”

“And she fumbles with her words too,” her friend added.

“This COVID is driving us insane,” the first justified. “It’s so depressing. Plus, we live alone. What if we get it? There are no vibrators available anymore!”

There was a delightful silence. I know she meant ventilators, but I didn’t have the heart to correct her, I wanted to enjoy the moment. Also, I don’t judge.

27 Comments on “The Surgical Dementia
  • Chanda says:

    Hahaha! Such a delightful way to start a Sunday amidst all the miserable news around you. This is another sixer batted on the last ball thus winning the game again. Can’t help but pass on this writeup further to friends and relatives with a footnote ‘Read the end, its hilarious ‘
    Thank you Dr. Turel for a delightful Sunday

    Reply
  • Supriya Correa says:

    The best old ladies ever! Bet they know a thing or two that we don’t!

    Reply
  • Anuradha karnik says:

    What a delightful article on such a serious condition such as dementia! Crisp, informative and laced with the typical Mazda sense of humour. Keep giving us more such gems of knowledge to enable us to cope with our forgetfulness!!

    Reply
  • Vipul shah says:

    Hello Dear Dr Mazda………..

    As usual the topic of dementia explained so nicely with easy to understand explanation for layman…….

    Your every piece is delightful & humorous…

    We Gujjus likes Jalabi & Gathia on Sunday morning & your Article goes very well with our favorite breakfast…….rather more sweeter ……👍

    God bless ..

    Reply
  • Mrs Sunaina N Saraf says:

    Hello sir
    Wow very innovative & inspiring 👍
    Keep doing the good job

    Regards,
    Mrs Saraf

    Reply
  • Rita singh says:

    Thanx for the write up.It’s knowledgeable n entertaining as well.As I am also getting older I may have this problem of forgetfulness.

    Reply
  • Pilloo aga says:

    Your wonderful cheery article slways puts a smile on my face as you make each op so simple and patient gets well soon which gives both patient and you soo much joy!!

    Reply
  • Mahashweta Biswas says:

    Excellent article Mazda explained so well about dementia & forgetfulness. The 3 ladies were cute.

    Cheers

    Reply
  • Debashree Turel says:

    🤍

    Reply
  • Dr Salim lad says:

    Very well written article.
    I always look forward to reading your articles.
    They are shared by my friend Dr Ghate.
    Insightful and beautifully worded.

    Reply
  • Theo Emanuel says:

    Hi Dr Turel,
    I’m Joel’s Dad. He sent me the link to this post of yours. I must say you have a wonderful and easygoing style of writing- so different from what one would expect from a doctor and especially one so qualified and skilled a neurosurgeon as you. Looking forward to seeing you here in Botswana sometime soon. Keep well.

    Reply
  • Burzin Panthaki says:

    Lovely article.
    I never forget to read your articles.
    Reading your article makes one forget about the daily miseries
    God bless and keep writing doc

    Reply
  • Zarine Pastakia says:

    This fab gem rang close to home as a few years ago i had strange memory lapses that frightened me .. As my dad at 90 was dealing with dementia in Melbourne (runs a lot in the family ) an insidious doubt then fear anaconda-ed my being. . . Blood tests revealed Vit B12 and D deficiencies (throw in hypothyroidism for good measure) .. long story short .. with supplements i was on great terms again with my ol familiar pal Memory.

    But enough about me … thanks Doctor MArvellouZDA for yet another
    informative
    inspirational (you make us want to be better humans and linguists😀)
    and VIBRANTLY entertaining read to render our serene Sabbath suffused with such ebullient scintillating VIBES!

    Need Of The Hour … EVERY hour .. more delectable vibrators/ventilators like your-humorous-humble-meticulously-caring-self !!

    Your writing style and content .. unsurpassed!

    Yeh dil maange more Dr Mazda!

    Love light laughter gratitude galore n blessings always😀

    Reply
  • Rustom says:

    Science with humor, that is Dr. Mazda Turel interestingly 5 of the first 6 appreciative comments comes from ladies

    Reply
  • Havovi Noshir Kapadia says:

    Great article Mazda! You’ve explained causes for dementia so lucidly. The humour in the finale calls for an encore. Well done!

    Reply
  • Amanda Marufu says:

    Nice and informative read. Keep it up Doctor Mazda!

    Reply
  • L G says:

    ” you must have bumped your head somewhere”-is quite thought provoking. We all do and quite a many times! Should that be taken seriously?
    You made it sound easy , the prevention as well as remedy.
    Keep writing mazda, its better to have educated and aware patients just as its better to have an educated client in business.

    Reply
  • Ralecha Mmatli says:

    Dr Mazda, I like the way you demystify these high sounding neuro surgery concepts by making them appear so simple. You have your unique way of making them simpler to comprehend. Also it looks like they have everything to do with brain connection..

    Reply
  • Marzin R Shroff says:

    Hilarious! So we’ll written as always.I’ve also noticed the number of comments going up with every post. Means you’ll have as many fans for your writing as for your medical prowess
    Cheers

    Reply
  • Shilpa Mhapankar says:

    Nice, informative article. The word dementia which normally scares us, well explained. We do forget sometimes. Remembering something, I go to the kitchen but don’t remember y I went there. Is it normal or not?

    Reply
  • Gloria Msampha says:

    “Vibrators”- wow, priceless and so cute for someone of her generation to know about vibrators! Growing old is so hard. Wish there was a way to slow down the process. Glad you were able to sort out the gentleman’s problems and he is now ok.

    Reply
  • Rumy Ghoga says:

    Your articles are a perfect combination of knowledge packed with humour. Keep writing Dr mazda God bless

    Reply
  • Aban (Gandevia) Commissariat says:

    It brought a smile to my face when the perceptions of the husband and wife differed! True to life. Hilarious at the end! Freudian slip? Cute though! Coming from the mouth of an 80 year old woman! Hey she was once young too!
    Your writing skills and surgical skills are amazing and your innate ability to simplify this mysterious organ, the brain is awesome. Looking forward to more of your writing. Sahebji!

    Reply
  • Di says:

    Kudos to u for another well written article! Informative, funny and entertaining.. found ur interaction with the old couple and the three old ladies so cute.. i was smiling while reading those parts.. u have a great flair for writing.. looking forward to ur next article
    And oh happy happy parsi wala birthday!!! Thank you for being awesome and saving countless lives!

    Reply
  • Gladys T K Kokorwe says:

    A powerful message. I will share it with my friend whose husband has dementia. Stay blessed.

    Reply
  • Lucky Yashvant Singh says:

    Fabulous article, 🤠
    First of all grt sense of humour sir I really enjoy when ever I read it… combination of science nd humour fantastic ..keep going sir…nd keep writing such lovely things ..
    Thank uh😁

    Reply
  • George Koshy says:

    👍well written..no vibrators available any more..😂

    Reply

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