Today is the day I finally get to see the Neurologist with VCU. One thing about VCU that is always fantastic, is you typically don’t have to wait long to be seen. They are very punctual, and this is so appreciated.
The nurse brought me back and took my vitals and let me know that the Neurologist that I am seeing today would have a student with her and wanted to ensure that I was okay with her being in the room during my appointment. I told her I didn’t mind at all, and she said they would be right in.
There was a knock on the door and in walked in Dr. Kerstin Bettermann and her Med. Student.
Dr. Bettermann asked me to walk her through everything of what happened on the day of June 9th. She wanted as much information as possible and proceeded to let me talk without interrupting me. This was a huge difference from the TPMG Neurologist.
Once we finished going over the episode of what happened, Dr. Betternmann proceeded with my Neurological Exam.
Neurological Exam
- Mental Status: Patient is alert and fully oriented, no aphasia or dysarthria, normal attention and concentration span, intact short-term and long-term memory function, good fund of knowledge, appropriate affect.
- Cranial Nerves: Full visual fields to confrontation, pupils are 4-5 mm BL and round with normal reaction to light and accommodation, full extraocular eye movements, normal facial sensation and strength, face is symmetric, hearing is intact, uvula and palate rise symmetrically, tongue is midline, full shoulder shrug bilaterally.
- Motor examination: Normal muscle bulk and tone,full strength 5/5 throughout, no drift, intact fine motor skills.
- Reflexes 2 and symmetric, plantar flexor responses.
- Sensation: Intact to light touch, pin-prick. No paresthesias.
- Coordination testing: Normal symmetric rapid alternating movements in upper and lower extremities. Romberg test negative.
- Gait: Stable. Normal tandem gait.
ASSESSMENT AND PLAN:
- Nicole J Freeland is a 36 y.o. lady with multiple vascular risk factors including HLD, cardiac shunt of unclear type and at the time use of OCDs.
- Her cardiac shunt was described as either a PFO or ASD and she will need further evaluation by interventional cardiology for possible shunt closure.
- 1. Obtain recent discharge summary and neuroimaging studies from outside hospital.
- 2. Stroke prevention-Continue ASA and patient. Check ASA function assay.
- 3. Referral to cardiology to review echos and to discuss possible shunt closure.I asked patient to bring her TEE and TTE studies on a disc for review by cardiology.
- 4. Order LE dopplers to r/o DVT.
- 5. HLD-Continue statin, regular FLP with PCP.
- 6. Migaine: We have discusedd the concept of rebound headache on Fioricet. Due to her h/o stroke patient can only take limited types of abortive medications. I have prescribed Nurtec for severe break through headaches. Will continue Amitriptyline for HA prevention.
- 7. Detailed stroke education has been provided by our stroke nurse educator.
- Follow up in about 3 months (around 1/24/2024).
I had a fantastic experience with Dr. Bettermann and it was nice to have someone who listed and actually seemed to care. She didn’t dismiss the stroke because I was “too young”. She also said that more and more younger people are having strokes and that more and more symptoms are now related to strokes.
Once she left the room, I had another Neurologist that come in and asked if I would be willing to participate in a study on the signs and symptoms of strokes and how likely I would be to notice the symptoms or dismiss them. I was very happy to participate in this study. If it could even contribute to saving 1 life, it would be making a difference.
Once I concluded the study, in came a stroke nurse educator. This nurse went over all the different signs and symptoms and a stroke and how to recognize them. She also gave me a list of support groups for people who have had strokes and different programs that I can join.
All of the additional care I received made a huge impact. I didn’t feel dismissed with this appointment, and I felt like the team truly cared about my health.
Nic of Time - Travel 