Brief Answer:
Receiving solid care

Detailed Answer:
Good morning.

Thank you for sharing the details of your condition. I am going to start out by asking you a question.

Please clarify for me what "solid care based on my symptoms." refers to since you've seemingly detailed much more having to do with medication lists that have been prescribed as opposed to the actual MEDICAL CARE been offered to date.

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Brief Answer:
Medications will always "seem" in line with conditions---

Detailed Answer:
Good morning.

Thank you for your clarification to my question and here is my response.

I am the type of doctor who believes much less in medications as "treatment" for ailments than some doctors for sure. I almost consciously resist prescribing drugs anymore for my patients when I believe there are more "beneficial" ways to control conditions than dropping chemicals into the body.

Having said that though I am also one who believes that patients must take the lion's share of responsibility when it comes to RECOGNIZING AND IMPLEMENTING such alternative methods when it comes to improving their health.

In other words, a physician can do all the pointing out to BETTER ways to accomplish goals by not using pills, drugs, devices, etc. but it becomes a matter of implementation by the patient for any of those "great ideas" to even have a chance at working.

In your particular case (as it once was with me) I believe that a large part of your multiple medical problems that no doctor will ever be able to solve is related to your BMI and additional weight. Proof of that statement would come in the answer to the following question. At the point in your past (at whatever age you may have been) when your BMI would've been 22-25...did you have cognitive dysfunction? Poor kidney function? Poorly controlled diabetes and renal disease? diastolic dysfunction? Poor stamina? Constant fatigue? OSA? Sleep apnea? I believe the answer to that question will be a likely "no"....perhaps there was the depression, anxiety, and those sorts of things since unfortunately, all human beings are born into situations where plenty of psychological stress can be present from birth making the rest of the journey an uphill battle.

I don't have an answer as to what to do with that issue except that one must cross their fingers and hope that such individuals end up having the strength and fortitude to somehow climb those barriers during their early years not allowing all the rest of the physical/mental ailments such as weight gain, disorganized functioning,work problems, school problems, family problems, etc. etc. to follow them and get a foothold on things before they fall into "ways of living" which become extremely difficult to change.

In my case all I can say is that I did suffer from a very high BMI for my age and height which developed over a long period of time. I ignored it simply because I couldn't believe that it could happen to me and I had all sorts of very legitimate reasons (as judged by myself) that things got so out of control. I also always believed that because of my prior athletic status in college that I was only "a workout or 2 away" from getting back into the pink of shape and health. Other things soon started to follow in terms of blood pressures that were up, cholesterol, stamina, just feeling "mediocre" most of the time as opposed to "fully primed and rearing to go" as I always had been....and to boot I still wanted to believe that not much was wrong and that one day I would fix it. I never did take medications for anything nor did I need to at that time...nor do I now....but in my opinion, all the negative things that took over 15 years to develop did so on the basis of one thing alone....weight gain which remained uncontrolled and eventually caused the rest of the body to start to breakdown. 10 years ago my wife really seriously pointed things out to me in a XXXXXXX and unabashed way and I was lucky enough to have been listening to her on those conversations since I couldn't listen to myself and nobody else was telling me anything I didn't want to hear.....and I went on a mission to do one thing and one thing alone.....LOSE THE WEIGHT but to do it without drugs, no pills, no devices.... I just decided to reverse all the bad habits I'd allowed myself to fall into for the past 15 years before, making no further excuses for getting back into the gym, or the basement, or the garage, or wherever I had to do daily exercises, calisthenics, running, lifting, and everything else that I had promised myself I'd be doing, and make sure that every day was filled with REAL PROGRESS in the areas of diet and exercise. Nothing else mattered aside from going to work and keeping the cash flow going to pay the bills and support the family....that was it....that was going to be my new life.....if I wanted to have any chance at regaining my old life back.

It took nearly 8 months of the hardest work I've ever done to regain my physical fitness, change every bit of focus I had around to give up habits that I had grown quite happy with and just keep my eye on the prize....I returned to an assistant coaching position with the varsity wrestling squad at my university where I once wrestled before going to medical school and now 10 years later continue to lock horns with these kids (I'm 55), enter into competitive tournaments at the OPEN LEVEL...none of this Master's crap....give me those 20 year olds! And I have to continue battling against the old habits....they are always gnawing away at my heels....you'd think that my body would finally get the message to "get used" to living well.....but it's a daily battle still to keep all of that weight off....our society just keeps tempting me at every gas station, fast food restaurant, too much GOOD STUFF out there...it just keeps beckoning and it'll likely never go away.

So, are your meds in line with your conditions? Yes they are....I question why do you really NEED so many different medications for cholesterol and triglyceride control? Why do you need so many drugs for blood pressure control?

Just why does your body and mind need so many drugs to survive? Answer? It just does you say...but what are the results? Are you improved? Really improved with all those medications? I mean REALLY IMPROVED...are you CURED? Isn't that the goal of a medicine? To cure your body or your mind of some ailment? Which problem has been cured by which drug? Please list for me the diseases or conditions that you've successfully cured using any of the above medications....

You used the word "controlled..." I might even wish to challenge that terminology....I want a list of things you've CURED with the medications you're taking.

So YES again, I reiterate all the medications you've been prescribed are certainly in line with all the disease entities that you apparently possess which would be refractory hypertension, difficult to control diabetes, refractory hyperlipidemia, severe sleep apnea of the obstructive type due to morbid obesity, chronic depression and anxiety, Carpal Tunnel Syndrome....

By the way, I see no evidence on VIRTUAL PAPER....of Alzheimer's/dementia at this point....but I wouldn't be a bit surprised if dropping the telephone from your hand comes from a combination of too many medications, too much chronic fatigue, and too much lack of concentration and attention SECONDARY TO everything just mentioned beforehand.

I hope gastric bypass turns out to be the solution for you....but my understanding on something like that is that you must FIRST drop a significant amount of weight on your own before getting into the program or being accepted. So if that's the case and you are successful at losing let's say 50, 75, or even 100 lbs. without anything but sheer discipline and the will to be successful...then, why do you need to go under the knife for the rest of it? I don't know of very many surgeons who would feel comfortable taking you in for that type of procedure with a GFR of 39.....you couldn't even get an MRI with gadolinium contrast at most places with that kind of GFR let alone major surgery.

So in conclusion, I hope you don't take anything I've said as chiding you but rather as inspiration that I believe that in all likelihood you have the machinery STILL...even at age 50 and even as much of a "train wreck" that you think you are to turn things around....I've seen it happen in myself and in many others....no damn reason you can't be one of them.....IF YOU WANT TO....it's not going to come from your doctors, certainly not from any of the pills, I don't believe gastric bypass is going to be a long term solution because it simply doesn't make sense to do when there are better alternatives.

I was in a crossfit competition this past weekend....took 3rd out of a field of about 40....(I sucked on the run! LOL).....and I saw the coolest T-shirt.

It said, "Being in great shape is not being able to beat someone else in anything...it's YOU being better today than you were YESTERDAY!"

Now, isn't that the coolest thing? I'm taking that back with me to the wrestling room with the guys and make sure I drum that into them the rest of this preseason as I keep banging heads with them on the mats.....HA!

By the way, you do understand that by my saying that I don't believe you are demonstrating signs of Alzheimers disease in these few brief lines of writing you are CLEAR ON THE FACT that I am certainly not making a DIAGNOSIS of any sort because that can only be done after extensive batteries of neuropsychological tests and other things....but rather what I'm saying is that you've got so many other "fuzzy factors" in front of you as you've already mentioned that need correcting that until that occurs....it's not possible to say anything else.

First, get rid of the medications, get that weight down (preferably without surgery), get these crazy issues of REFRACTORY this that and the other under control, start getting physically active...even if it's 10 minutes a day....you've got to start somewhere, and then, when that's all under our belts and on our way....come back and ask about whether or not you have early dementia and we'll be able to answer that question.

Good luck on putting the ball in the play......KEEP YOUR EYE ON THE PRIZE MAN!

I hope I've satisfactorily addressed your questions. If so, may I ask your favor of a high star rating with some written feedback?

Please send me more comments or inquiries in the future by going to my web address at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively. Please keep me informed as to your decisions and commitments on things.

This query has required a total of 90 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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