“Do you ever get in a car and get lost?”
The doctor stares at me from across the desk.
“Apart from being forgetful — and everybody’s forgetful — do you have any transient episodes where your brain’s not working and it scares the heck out of you?
“How do you sleep?
“Do you feel energetic when you wake up in the morning, or do you feel like it’s a chore to get out of bed?
“How fatigued are you during the day? Let’s say you go for an appointment and you’ve got to wait for somebody because they’re late, and you’re sitting in a comfortable chair. Do you nod off to sleep?
“Have you ever suffered from depression?
“Have you ever suffered from anxiety or panic attacks?
“Do you ever wake up at night with cramps in your legs or weird sensations in your legs where it keeps you awake?”
This is the Mini Mental Status Examination, created to see how sharp your “cognition” skills are, and Dr. Joseph Abramowitz, anesthesiologist, internist, tribal physician, prison doctor, rebel, thinks that, as a form of Alzheimer’s triage, it is garbage.
Not only that, but he also thinks he may have discovered a way to pull people in the earliest stages of the incurable disease back from the brink.
Not that the medical establishment has sat up and embraced him or his ideas. Medical journals reject his submissions. Specialists don’t seem to appreciate him bringing his ideas to “their” field.
Abramowitz is not at all surprised by this. “I have no friends in medicine who I call colleagues. I have friends who are doctors. I’m a loner. Because if I wasn’t I’d have to buy into their crap.”
Abramowitz, who comes from a distinguished medical family in South Africa, has had a colorful medical career that has stemmed from half-million-dollar positions as internist and anesthesiologist, to medical director of the Southern Indian Health Council in Alpine and urgent care clinics. He also has his own private practice in Chula Vista.
But all through, he has privately pursued the onrushing tidal wave of Alzheimer’s and early-onset dementia that seems to be turning into the AIDS epidemic of the 21st Century.
I first came across Dr. Abramowitz when he sent this letter. “I am a physician in San Diego who conducts clinical research in Alzheimer’s disease. I have made an interesting discovery which I feel certain is very relevant. I am not claiming to have cracked the case, but I have discovered something very significant which has been ignored by mainstream medicine.... I cannot get anyone to take me seriously....”
I didn’t know it would end with me being put in the hot seat to see if I had any symptoms. I can’t tell you how scary that scenario is.
It began with a meeting on the jungle-like deck of Krakatoa eatery in Golden Hill. He was still in his green hospital scrubs. He had flown down like that from a stint at an urgent-care clinic up north.
He was just as I expected a doctor to be who is claiming to have a handle on the medical world’s biggest mystery. Spikey, with the quick eyes and the lightning intellect of an anti-establishment fighter, capable of drowning you in medicalia and then suddenly swerving off into wild and crazy impersonations.
“NOBODY expects the Spanish Inquisition! Our weapons are surprise. Surprise and fear. Surprise, fear, and ruthless efficiency. Surprise, fear, ruthless efficiency, and an almost fanatical devotion...”
He has Monty Python totally down. He inherited the British-style humor from his South African upbringing.
“I had a very privileged childhood as a second-class white, because being Jewish was not accepted amongst [the white establishment]. My father was an obstetrician and gynecologist who did part of his training in England. My mother’s father was the youngest of 11 children from Russia. About half of them were pharmacists. His brother made a fortune by developing a combination of aspirin and [what was known as] phenacetin, which is now no longer used, and it’s Tylenol and codeine. And the product was called ‘Grandpa’s Headache Powders.’ About 1957, he sold out to Beechams, and they paid royalties to him and his successors for 50 years.
“So, I had no thought about looking at [dementia, Alzheimer’s disease, and thyroid causes], and in my book Patienthood the first case report is about a patient whom I interviewed as a medical student, who had a thyroid so big that he could have turned it around and used it as a pillow in a plane. And I didn’t see it. I looked straight at him for 45 minutes and I didn’t see it. He had a toxic diffused goiter. He had an over-active thyroid. Most goiters are related to under-active thyroid. Hypo. Yet I had looked straight at it for 45 minutes and I had missed it.
“That, I’m afraid, is called training. Or rather lack thereof. That is why people have to train for such a long period of time, when there are so many other things in medicine far more subtle, which have to be recognized intuitively.
“During my fourth year in medical school were the Soweto riots. Up till then I had always had an ongoing dilemma about what I would do when I graduated. Whether I would stay and train in South Africa or whether I would leave. And once the Soweto riots came, it was clear what I had to do. Get out. So, I graduated in 1978, and I did an internship at the Grootschuur Hospital in Cape Town and left for London.
“I was only really turned on to this thyroid stuff in the last five years or so. My friend S.K. is one of the top diabetes researchers in the country. He’s up at the Puget Sound V.A. And he doesn’t know squat about the thyroid. He’s so sub-specialized in diabetes. And as an endocrinologist he’s supposed to know almost as much about the thyroid and thyroid issues as he does about diabetes. Because the thyroid is an endocrine gland, just like the pancreas.