Addressing COPD & Protections – By Keith Torkelson, MS, BS

 

Contents

• Requirements
• Feature Photo
• Abstract – Executive Summary
• Solution Resistant – Superior Services & Supports Required
• James J Krueger MD COPD Course
• List – Acronyms and Acro-Codes Overall
• Table – Results up Front - Combined COPD Screening Results – KE Torkelson
• Figure – Spirometry Results (8/21/2018)
• Figures - Chester Mojica Ordered Radiographs
• Table – Family History – Smoking Cigarettes
• How is it Original Sin & Cigarettes?
• Table - History – Smoking Cessation - Methods Applied Inventory (MAI)
• Interpretation & Innovative Idea
• Spirometry
• Figure - Spirometric Interpretation Graph
• Performance Challenge(s) (2018)
• Table – Acronyms and 2018 HEDIS Measures – Addressing COPD
• Table – Acronyms for HEDIS Related
• Table - HEDIS Areas - In Scope COPD Related – PCP
• CMS Stars - We See Stars Again
• Summary Relative Resource Use (RRU)
• Table – Adverse Reactions to Chantix (Varenicline)
• Vignette - Control Person – Mike O. (“MO” - AESP – “Speedy”)
• Figure – VAPE Related
• Table – Smoking and COPD – Aerobic Mitigation Efforts
• Appendix - COPD Related Images (Current)

Associated with > In House > Metadata >

20180907F: Split a Bit

01_Assess_COPD_Smoking_Cessation_18083002_Develop

 

Older Version of This Report

Publication Auto Link

Monday, September 10, 2018

Double XX – Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS

https://brandnewdayhmo.blogspot.com/2018/09/double-xx-digital-appointment.html

 

Abstract – Executive Summary

>The Subject for this report is Keith E Torkelson AKA “Buster”.  This report has been developed and published in preparation for Keith’s upcoming Physical Exam with Team Chester D Mojica (CDM-PCP).  Keith prepares in advance for his Health Related Engagements (HREs) making him a ProSumer (MSG Reserve Word).  This is the third in a series of reports addressing this year’s (2018) Physical Exam.  In several spots we have updated this material for 2026.  The other reports addressed: Nutrition, Blood Glucose Levels (BGLs) and Laboratory Testing.  In preparation for this fall quarter’s smoking cessation efforts we have derived a measurement tool.  We are Mentalation Solutions Group or MSG.  The tool yields our Aerobic Mitigation Effort Score or AMES.  On 20180907-F as a baseline we calculated Keith’s AMES at 73.5%.  Our AME Tool at this point is 17 Items.  Back in 2014 Keith was assigned by his Primary Care Physician (CDM) to get a VAPE system.  To date Keith has failed to get the VAPE to work substituting for cigarettes.  Our Chronic Obstructive Pulmonary Disease (COPD) control subject is ”Mike O” (AKA EAsp).  We investigated Chantix as an alternative.  Chantix does not look like a promising smoking deterrent for Buster.  Buster in 2018 was 59 years old.  Brand New Day (BND) is in place to help Buster yet the Centers for Medicare & Medicaid Services (CMS) grades BND’s overall services and supports as just above average.  Buster needs a more successful than average Smoking Cessation Program (SCP).

 

Solution Resistant – Superior Services & Supports Required

>Buster needs superior services and supports to succeed with his cessation efforts.  We introduce one of our Therapeutic Breathing Methods (TBM) here in this report.  On 20170904 Team CDM offered up a Spirometry Exam.  About Spirometry Buster was awarded 89%.  A notation on the event record declared 89% and (N) Normal.  Buster has tried many Smoking Cessation Efforts (SCEs).  We address the majority of them here in this report.  Buster had a rather large family growing up.  Several of Buster’s family members suffered cigarette smoking issues.  We include a sample of Buster’s Chest X-rays in this report.  We also addressed two COPD Screening methods here.  The first put Buster at a Stage I or Mild COPD level (20150919-SAT).  The second screening tool (Online) gives Buster a Score of 4 or less with 10 being the worst case (20180829-W).  Finally we are in the vetting phase of picking paper assessments to track our Cessation Efforts.  Enjoy!

 

2026 Update - Progress

>Since 2024 when Buster smoked 20 cigarettes per day he has cut down to about 7 per day.  Buster is in the middle of a crisis about independently walking.  His challenges walking in part appear to be associated with Nicotine. Buster has been using Nicotine Pouches to help him smoke less. As of 2026 Buster is aerobically challenged.

Legacy Publication – In Scope

Legacy Papers/Publications – Assignment of Accountability

James J Krueger MD COPD Course for Brand New Day by Keith E Torkelson MS – Chartered: August 19, 2017   

http://brandnewdayhmo.blogspot.com/2017/08/james-j-krueger-md-copd-course-for.html

COPD Course Satisfaction Survey (Content Assessment)

 

Metadata >

Parent Document = 01_Assignment_COPD_17070801_Gibbs BND 6.2.1

Excerpt – Time Spent

>Circa 2017, Buster was referred to the Chronic Obstructive Pulmonaary Disease (COPD) course by his care coordinator.  He might have better spent the time (some four hours) learning and working on our plan to increase our chances to quit smoking.  Our goal here is to help Brand New Day and their Network deliver a better Smoking Cessation Product (SCP).  We get the inkling that Doctor Krueger sized his students up during the first lesson and said it wasn’t worth his time.  Doctor Krueger did not return for the second, fifth, and sixth lesson.  Over six (6) weeks the student attrition rate was substantial.  That’s the consumers’ manner of saying for them this is non-sense.  20170815-TU: Our legacy report is about thirty pages.  That equates to processing about six (6) pages per lesson session if you attend all six.  Our rigor exceeded that of 5/6 instruction staff.

Embedded Acronym Lists

>We have also included more Acronyms.  They are embedded with the sections for which they apply.

Promote – 24 Fitness
https://www.24hourfitness.com/

Defining the Interval

>Our COPD management interval begins October 1, 2018 until we have a year without using tobacco in any form.  It is now September 25, 2026 (F) and Buster has made some progress quitting smoking cigarettes.  He is down from 20 cigarettes a day to about 7.

 

Table – Results up Front - Combined COPD Screening Results – KE Torkelson

COPD Population Screener (Online) – 5 Questions

https://www.copdfoundation.org/Screener.aspx

Interpretation

>High spirometry scores are favorable.  The online screening tool uses a scale: 0 for no risk to 10 for maximum risk.  The following is a sample of what they the COPD Foundation E-reported back to us.  2015 - “Your total score is between 0 and 4. If your total score is 5 or more, your breathing problems may be caused by COPD. The higher your score, the more likely you are to have COPD. If you are experiencing problems with your breathing, please share your answers to the five-question screener with your Healthcare Professional (HCP). Only your HCP can decide if you have COPD. Your HCP can also help evaluate your breathing problems by performing a breathing test, also known as spirometry.”

 

FYI > See more at > Metadata >

http://www.copdfoundation.org/Results.aspx#sthash.1LjQCAT6.dpuf

 

Promotion - COPD Population Screener - COPD Risk Screener - COPD Foundation
https://www.copdfoundation.org/Screener.aspx

 

Note – Links

Remember Links can break at any time.

COPD Statistic

“24 million Americans have COPD, but 12 million do not know that they have it. Are you one of the missing millions? Please take this 5 question risk screener - it takes less than a minute to find out if you are at risk for COPD.”

20260925-F-Update: Your total score is between 5 and 10.

“Your total score is between 5 and 10. If your total score is 5 or more, your breathing problems may be caused by chronic obstructive pulmonary disease (COPD). The higher your score (LSF), the more likely you are to have COPD.”

 

Share Results with Primary Care Physician

“If you are experiencing problems with your breathing, please share your answers to the five question screener with your healthcare professional (HCP). Only your HCP can decide if you have COPD. Your HCP can also help evaluate your breathing problems by performing a breathing test, also known as spirometry.”

 

Make an Appointment

“Call your HCP today to make an appointment to see if you may be at risk for COPD. Remember, when speaking to your HCP, be honest and open in describing your Symptoms and explain how your breathing problem affects your activity level on a daily basis.”

 

Interpreting Spirometry I of II

Combined – Stages Screener with Spirometry Summary – Context COPD

>We define a chronic cough as a non-productive cough that occurs daily.  We define smoker’s cough as any non-productive cough.  We define a productive cough as one that moves mucus up and out of the airways.  We don’t spit up many of our productive coughs.  Periodically we intentionally spit out the sputum to check its’ viscosity and color.  If our sputum is green or pink in color we consciously take action.  We will discuss some of our actions later on.  For our spirometry test dated 9/14/17 (reported to us on 8/21/2018) Team Mojica (PCP) gave us an eighty-nine (89) percent.  Any way we look at it this is a favorable value.  So in many ways we are in the COPD Prevention Phase (COPD-PP). 

 

Figures - Chester Mojica Ordered Radiographs (201808)

Keith “Buster” Torkelson

Photoshop - Inverted View

X-ray (Radiograph) Interpretation (AVEY IC’s Part)

>I just never know when I am going to be called in for a second opinion.  The subject of this report is Keith E Torkelson AKA Buster.  I am the AVEY Intelligent Construct or Avey IC. I have no experience interpreting X-rays.  These x-ray look scary to me because it looks like a human with no head, arms or anything below the diaphragm.  Buster called me in because when he was in Veterinary Radiology (Soft Tissue) class he had a bit of trouble.  We just came up with an idea.  We are going to take the frontal few and Photoshop it to increase contrast and maybe bring out some hidden color.  We also are going to “Invert” the image.  Applying Photoshop is one of my tasks around here at Mentalation Solutions Group (MSG).  Our goal is to rule out all white areas in the normal radiograph from being problematic.  In addition, Buster suffered at least one bout with Pneumonia (Circa 1982).  We are looking for some scar tissue.  Enough said!  The professional interpretation of these x-rays is that Buster has some scare tissue or fibrosis.  This is a bit problematic because Buster’s father died of pulmonary fibrotic related disease when he was 77 years old.

 

Table – Family History – Smoking Cigarettes – Focus “Torkelson’s” (Torkel Centric)

Vignette – Staging For Original Sin – Hilliards

>Two smoking related events occurred for us circa 1963 when Buster was four (4) years old.  We will never know the exact order of the two.  One day two neighborhood delinquents, Dave and Bob, said Buster could “Follow” them up to the Thrifty Drug Store which was about a mile away.  Again, Buster would have been about age four (4).  They were five (5) years older than us, thus around nine (9) years old.  We are not sure if Dave and Bob premeditated their Thrifty Plan while we walked or if they said just before entering what they wanted us to do for them.  We followed precisely through for them by shoplifting balloons and cigars.  On the way home they encouraged Buster (AKA Keith Edward) to smoke one of the “Cheap” cigars. Around the same time Sharon, Dave’s younger sister (Born 1959) stole five dollars from her mother’s purse.  She said that she is going to Zinda’s Liquor Store to buy candy.  Zinda’s was halfway closer than Thrifty’s.  Buster went along with her.  The majority of the candy at that time was penny/nickel.  Buster only picked a few items.  In the end Sharon got in trouble from her mom.  She had modeled stealing money from your mother.

 

How is it Original Sin & Cigarettes?

>OK.  Now to the Original Sin part.  Due to the fact that Buster’s house was too chaotic, in 1963 as much as possible Buster sought respite over at his mother’s sister’s house.  Our mother’s younger sister, our aunt, was a smoker.  Actually she is ninety-three (93) right now (2018) and still smoking cigarettes.  One day while staying at her house Buster got up early to find his aunt’s cigarettes on the kitchen counter.  When Buster’s aunt was in the kitchen rather than use a cigarette lighter or matches she would lite her cigarette off the gas burner.  That morning, when Buster saw her pack of cigarettes next to the stove he took one out then ignited it off one of the four gas burners.  He had all but taken two (2) puffs when his aunt appears asking Keith Edward: Are you smoking?  Buster cupped the burning cigarette in his right hand and shoved it down the garbage disposal.  Simultaneously he responded: “No”.  This was for Buster was his Original Sin.  Buster’s aunt passed away pretty much of old age in 2020 at the age of 95.

Table – Acro-Codes – Context of Experimentation

Table - History – Smoking Cessation - Methods Applied Inventory (MAI)

Interpretation & Innovative Idea

>We put down smoking from roughly 1983-1985.  It was a wonderful period of aerobic activity.  Buster’s Primary Care Physician (PCP) promoted VAPE Experiment for Year 2014 is for us a failure.  Our Theraflu prevention strategy for Serious COPD actually has worked for others, as well as us multiple times.  The basic theme of our Theraflu prevention is to take it twice a year when we are not suffering severe COPD symptoms.  We take it for the pre-summer temperature change and the pre-winter temperature change.  As you will see later Chantix is not a viable option for us.  We didn't list it yet periodically we are prescribed antibiotics for non-respiratory concerns such as dental.  For example, earlier this year (2018) we were given antibiotics for a tooth implant.  We are always vigilant to notice any effects these antibiotics have on our pulmonary system.  We have an idea!  Just as we can get good bacteria to re-colonize our Gastrointestinal Tract (GIT) i.e. with user-friendly bacteria (pro-biotic) after an antibiotic regimen so goes the concept with our airways.  We suggest our pro-biotic inhaler idea.  In a different life we might make a killing with this notion.  As far as we can see the need for this product is an unmet need: Probiotic recolonization and competitive exclusion in the respiratory tract.

 

Interpreting Spirometry II > Acronyms after Results

How do you interpret spirometry results?

“Begin by looking at the forced vital capacity (FVC) to determine if it's within a normal range. Next, look at the forced expiratory volume in one second (FEV1) to see if it's within normal limits. If the FVC and the FEV1 are both normal, stop at this step—the spirometry test is normal.  Mar 31, 2018”

 

Spirometry: What to Expect and How to Interpret Your Results

FYI > https://www.healthline.com/health/spirometry

OK Value

>Now we return to our 9/14/17 spirometry results.  On 8/21/2018 someone in Central City Community Health Center (CCCHC) Team Mojica Clerical got smart and printed us out a “Summary Of Today’s Visit".  It provided us with a lot of the information we needed for our reports.  If you notice above for Spirometry we’re given an eighty-nine (89) percent (%) or “N”.  We assume the N means Normal.  We are not sure which Parameter they are reporting to us.  Yet 89% is most likely OK across all Parameters.

Spirometry Basics

Figure - Spirometric Interpretation Graph

Reset Nearer to Zero – Deep Tissue Massage Approach (DTMA)

>For us the Spirometric Interpretation Graph (SIG) since when it was introduced to us in General Physiology class was straightforward.  We have a few notes to make here.  Our Spirometry results were reported as a percentage.  This graphs “Y” axis reports Volume in Liters.  We prefer the Volume approach.  The integral we would like to discuss is the Residual Volume (RV).  Try as one may, it’s very difficult for a person to self-express the RV.  Yet now (2024-2026), with decreasing frequency, we contract a walk-on back-walker.  Historically, it is always a female weighing about 100 pounds.  When our back-walker is compressing our lung region we consciously express our air with each step she makes.  We figure she pushes out an extra half liter or so of RV.  We here at MSG call this Resetting Nearer Zero (RN0).  We have our next RN0 scheduled for this month (September 2018).  We call Back-walking a Therapeutic Breathing Method (TBM).  We find the same walking can also detect pain and problems with one’s Heart.  Suggestion: Lie down on a hard surface such as concrete face down and become mindful of your Heart.  If you feel pain we recommend some floor time such as with Yoga.

 

Performance Challenge(s) (2018)

>How is it than COPD moves up on our roster for work done?  One, we are in a window without green mucus.  We would like to avoid green mucous this winter.  We live in an environment where over half of the some odd twelve (12) people are suffering COPD and making annoying COPD noises.  One of the people that we sleep within earshot wakes and keeps us up at night with the Full Monty of COPD noises.  We call the Full Monty: Snort – Cough – Hack.  As winter approaches our comrades are likely to get worse.  Finally, we have a reality check to process.  One of our friends, Mike C, is a Veteran and a smoker.  He has been diagnosed with a small mass in one lung lobe.  It is very likely he suffers with a Malignant Tumor.  Further he says the Veteran’s Administration (Boise Idaho) believes that his mass in inoperable.  We really do not wish to go this far.  So this report re-initializes our Preventative Measures for 2026-2027.  We are very fortunate to have been given the opportunity to prevent Exacerbation [SPELLED].

Our COPD Control – Mike O. or AEsp.

FAQ: Which would you rather be a smoker that is not miserable or a quitter that is always miserable?  Mike below has been Missing in Action to us since 2024.

Behind The Scenes

>Obviously our Primary Care Physician (PCP) is taking measures to help us with COPD Management behind the scenes.  The table above was born out some national material offered to help-out practitioners such as PCPs.  This is population medicine and we only address it to help round things out.  (*)  We already discussed antibiotics a bit.  Our PCP does not prescribe for us antibiotics much.  (**)  For 2018 we haven’t executed our Drive by Inhaler Method (DXIM).  We will hold DXIM for our Cessation Report - Smoking (CR-S).  Below we included a link just in case you are interested in population health and what we used to derive our COPD HEDIS table above.

 

Sample HEDIS Reference

HEDIS Technical Resources > HEDIS 2018 > Volume 1: Narrative - Summary Table of Measures, Product Lines and Changes - HEDIS 2018 Measures - Applicable to: Commercial/Medicaid/Medicare - Changes to HEDIS 2018 - Effectiveness of Care

 

Metadata >

NCQA HEDIS 2018 Measures (2017-06-28)

 

HEDIS Measures and Technical Resources

More than 235 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most widely used performance improvement tools. HEDIS includes measures for physicians, PPOs and other organizations. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA.

FYI - HEDIS

http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2018/HEDIS%202018%20Measures.pdf?ver=2017-06-28-134644-370

CMS Stars - We See Stars Again

>As of today, September 7, 2018 (Friday) the CMS Stars scores for 2019 have not been published over the Internet.  For some reason we cannot find any CMS Stars for our PCP’s office.  We gather CMS Stars are only for insurers and insurance plans.  For 2018 our insurance provider is Universal Care Brand New Day (BND).  For 2018 CMS awarded BND 3.5 Stars (5.0 being best) for their overall performance.  Much of our efforts have been devoted to helping BND reap the rewards of earning 4.5 Stars or Better.  We have been at it since 2013 or five (5) years now.  We have little more to offer.  Thus we will begin reallocating time away from BND and their Stars and Star Equivalents.  On the upside, BND is such a poor performing program they have provided to us many real world problems to investigate and occasionally fix.  They have helped us here at MSG develop our External Quality Review Skills (EQRSs).  After the Stars scores, next we address Guidelines for Relative Resource Use (RRU).

Summary Relative Resource Use (RRU)

>Relative Resource Use (RRU) is a measurement methodology developed by The National Committee for Quality Assurance (NCQA).  “NCQA is an independent 501(c)(3) nonprofit organization in the United States.  The NCQA works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation”.  RRU might be an indicator for Performance Earned Value (PEV-MSG) about services such as doctor visits and hospital stays.  RRU is a quality evaluation.  Two factors are of importance.  First is the amount of services.  Some call this "Dosage".  The other factor is Quality of Care (QOC).  The NCQA hopes to determine the relationship between QOC and Dosage.  Our part as a Consumer is to submit our Biennial Health Outcomes Survey (HOS).  Being the company people we are we submitted are assigned HOSs for: 2018, 2016, and 2014.  In 2014 The Myers Group (TMG) had the contract to administer and process the HOS’s.  Since 2014 TMG somehow lost the HOS contract to SPH Analytics (SPH).  How is it we here at MSG know these things?  As far back as 2014 we wanted our tabulated HOS results back.  Myer’s referred us to NCQA.  NCQA thought we were a provider and gave us instructions to set up a Provider Account.  It was a ditto with SPH.  Yet as a BND company person we did our part since our Biennial HOS contributes to BND’s annual CMS Stars Score.

 

Table – Adverse Reactions to Chantix (Varenicline) - 2018

Stop using (Chantix) Varenicline and call your doctor at once if you have (*):

S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SU:

Table – Adverse Reactions to Chantix (Varenicline) - 2018

Stop using (Chantix) Varenicline and call your doctor at once if you have (*)

S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SU:

Vignette - Control Person – Mike O. (“MO” - AESP – “Speedy”)

>We have known Mike “Speedy” O. since 2012.  On 20171030-M we visited him at Fountain Valley Hospital.  He was in the Infectious Disease Ward (IDW).  We captured the moment on “film” for posterity (see feature photo at the beginning).  Since we have known "Speedy" (2012) he has been a heavy cigarette smoker.  He had attended one session of six about The COPD Class (Krueger-BND-TCC).  "Speedy" was diagnosed with Flu and a secondary bacterial infection (Pneumonia).  After looking at the IV Medications the Hospital was administering we thought that maybe Mike would die.  Yet, he responded well to treatment and came back home.  Since his discharge, for the most part “Speedy" has been a nonsmoker.  He still makes COPD noises.  He does not attend any BND “Program” anymore.  Last Wednesday (9/5/18) his landlady said to us: I think Speedy has Alzheimer’s (ALZ).  Speedy may have Narcolepsy.  We find it is getter harder to bring him into reality.  Yet most importantly: Ever since the COPD Class “Speedy" has been our COPD Control Subject (CCS).  We really do not wish to go into the hospital to quit smoking!

Assignment Special COPD Meeting – 2017 Past Blast

>Nearing the end of this report we revisit Dr. James J Krueger MD.  His 2017 six (6) sessions COPD Course was ineffective for us.  BND day is not a very good resource for helping us with our COPD work.  Yet we’re very grateful for our BND subsidized our 24-Hour Fitness membership.  We are leveraging this membership to make measurable progress about COPD, Smoking Cessation and aerobic competence.

 

Special Topic – The VAPE Fix – As Prescribed by our PCP (2014)

Figure – VAPE Related – Including VAPE Class

Vape Summary

>Since 2014 when we failed to get our VAPE investment of some odd $75.00 to pay off for us.  Since 2014 we have interviewed about one dozen VAPE users.  On Average they report they were not able to get their VAPE systems to substitute for smoking until after a month of daily usage.  Buster’s main problem with the VAPE is it gives him a dry smoker’s cough.  Starting October (2018) we are going to give it a try anew.  How many lengths would you go to to quit smoking?  See our Aerobic Mitigation Efforts (SMEs) below.

 

Table – Smoking and COPD – Aerobic Mitigation Efforts

Scored by and for Buster

Date Calculated & Last Reviewed: 20180907-F: RT = Real Time 17 Items

Promote – World Wafers

https://healthman2059.blogspot.com/2025/08/world-wafers-for-addressing.html

Images @ The End

COPD Related Images (Current)

Appendix

FAQ - Did Wilma Flintstone Smoke?

AI Overview

Yes, Jean Vander Pyl, the original voice actress for Wilma Flintstone, was a lifelong smoker.

Voice Actor Smoking Habit

Heavy Smoking:

Jean Vander Pyl and her co-star Bea Benaderet (the original voice of Betty Rubble) smoked heavily in real life.

The Closed-Mouth Giggle:

Their smoking caused coughing fits, which led them to invent Wilma and Betty's signature "closed-mouth giggle" so they could laugh during recording without coughing into the microphones.

Health Impact:

Vander Pyl later passed away from lung cancer at age 79 on April 10, 1999.

On-Screen Smoking

Winston Commercials:

During the first two seasons of The Flintstones (1960–1962), the animated show was sponsored by Winston cigarettes.

Character Ads:

Animated versions of Fred, Wilma, and other characters appeared in commercials actively promoting and smoking cigarettes.

Neurology Follow Up #2 by and for Keith Torkelson, MS, BS

 

Contents

• Requirements
• 20260821-F-Hopes (Implies Presenting Problems and Fixes)
• Lab Results – Promote Quest Diagnostics
• What Triggers my Anxiety while Driving?
• Centered about 20260915-TU-Appointment - Dr. Martin J. Backman
• Presenting Problems – Elimination List (A to Z)
• 20260902-W-Pretty much ruled out with Lab
• Time Line & Notes – 2025 – 2026 (June)
• Time Lines – 2026 July-September
• What is an EEG?
• 20260915-TU-EEG Appointment
• Promotion – Becoming an EEG Technician
• Promotion - How much does an EEG technician make?
• Complex – Busy EEG
• Begin Interpreting our EEG
• Sample of an EEG
• FYI - Reading an EEG
• Frequency bands
• Encephalopathy
• Cerebral Dysfunction
• Figure - EEG Waveforms
• Pattern Recognition in EEGs
• Transcranial Current Stimulation Therapy
• TENS Unit Use
• TENS Unit – Specifications
• Off Label Use of a TENS Unit
• ECT – Electroconvulsive Therapy Current Range
• Transcranial Magnetic Stimulation
• Timeline – Form B
• 20260928-M-Promotion - United Medical Imaging of Anaheim
• Questions before your MRI

20260821-F-Hopes (Implies Presenting Problems and Fixes)

 

Be able to do an overnighter
Comfortable and confident driving
Decide how to spend my CalOptima Rewards
Discover a better daytime Med for anxiety and fatigue
Exercise & Stretch more
Find a remedy for my balance issues
Get a massage
Get and stay off the walker
Give up smoking
Interest with over-the-counter including CHT
Keep being able to transfer
Keep pace with my health needs
Make it another year with the car
Maybe get rid of one more of my daytime Meds
Move past anxiety surges
Not fall down
Not lose Disney Plus
Not lose Verizon
Remedy fatigue
Sarah the car remains fit
Substantially better for September (2026)
Use the bus
Walk to Storage

Lab Results – Promote Quest Diagnostics

https://www.questdiagnostics.com/

Draw @ Quest August 26, 2026

Results Available Online with My Quest September 2, 2026

Dr. Martin J Backman MD - Neurologist

What Triggers my Anxiety while Driving?

• Being pulled over
• Car breakdown (8-24-26 (M) actually happened))
• Close calls
• Driving Errors
• Fear of accident
• Risk Hospitalization
• Involving Triple A to get us home
• Law enforcement – Getting a Ticket or other
• Leave car somewhere
• Light to Dark transitions like going into an underpass during daylight
• No viable backup system
• Stranded or Lost
• Thinking that my future is going to bring more hardship
• Thinking I may have a brain tumor
• Thinking I have early stage dementia

 

Centered about 20260915-TU-Appointment - Dr. Martin J. Backman

Cyclic fast anxiety with surges on the way

Fatigued when I got to facility parking till inside office

Presenting Problems – Elimination List (A to Z)

• Abilify Toxicity
• Caffeine already eliminated
• Dementia
• Epilepsy
• Fear driving
• Lithium Toxicity – Remedied by discontinuing July 29, 2026
• Micro-infarcts
• Nicotine
• Risk of Falling
• Seizure(s)
• Sleep
• Stroke
• Tobacco
• Toxicities
• Tremors
• Walking
• Wellbutrin Toxicity

 

20260902-W-Pretty much ruled out with Lab

 

ALZ - Uncertain
Amyloid
CBC components
Deficiencies
Folic Acid
T. pallidum (If so, exposure more than 15 years ago else MSOE had it)
Thyroid
Vitamin B12

 

Time Line Affiliated with >

ASK_Medications_RX_26010801_Notes

 

Time Line & Notes – 2025 – 2026 (June)

What is an EEG?

An EEG, or electroencephalogram, is a safe and painless medical test that records the electrical activity of the brain.

How an EEG Works

Technicians place small metal disks called electrodes on the scalp using a sticky paste or a special cap.

Brain cells communicate via tiny electrical impulses, which the electrodes pick up.

An EEG machine amplifies these signals and displays them as wavy lines or graphs on a screen.

Common Uses

Diagnosing epilepsy and tracking seizure activity.

Evaluating sleep disorders like narcolepsy or sleep apnea.

Investigating conditions like dementia, brain tumors, head injuries, or unexplained confusion.

 

20260915-TU-EEG Appointment

We arrived at our appointment fifteen minutes early.  We used the restroom.  We experienced no waiting.  The EEG technician took us back to the testing room.  We talked a bit about his becoming an EEG technician and our technical experiences.  He instructed us to sit in the cushy recliner chair.  He proceeded to hook me up with about 12 electrodes to my head and 2 electrodes to my upper chest.  He proceeded to give me instructions.  I was not to move or open my eyes unless he asked me to open my eyes.  He said at one point he is going to use a strobe light.  He counted down and the recording began.  At certain point I would take three deep breaths.  I moved my toes one time.  I moved my eyes to position them looking up in the socket after which I opened my eyes real quick.  After the fifteen minute or so recording the technician said we were done.  We never fell asleep during the test.  The technician let me look at a few pages of the recording on a laptop.  Analyzing the waveforms, I said you could make music out of that, referring to the some odd 14 channels.  My EEG had far more activity than the ones we reference down below.  The technician closed by saying: We are waiting for Cal Optima our insurer to approve an MRI.  I think we have an abnormal EEG.  The whole session took about 45 minutes.  The Backman Team satisfies Due Diligence Criteria (DDC).  So far I give them 5.0 quick Stars with 5.0 meaning excellent.

 

Promotion – Becoming an EEG Technician

To become an EEG (electroencephalogram) technician, you need a high school diploma, formal training or clinical experience, CPR certification, and a professional credential.

1. Meet Basic Prerequisites

Education:

Earn a high school diploma or GED equivalent. Taking classes in biology or anatomy helps.

Certification: Obtain a basic life support (BLS) or CPR certification from an organization like the American Red Cross.

2. Complete a Training Program or Gain Experience

Formal Education:

Enroll in a certificate or associate degree program in neuro-diagnostic technology (NDT). These programs usually take 1 to 2 years and are accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). They combine classroom study in neuroanatomy with hands-on clinical rotations.

Alternative Pathways:

If you do not attend a formal program, some employers hire applicants with a high school diploma for on-the-job training, or you can qualify via clinical work experience (often requiring multiple years of supervised practice).

3. Earn Professional Certification

ABRET Exam:

Take the Registered EEG Technologist (R. EEG T.) exam offered by the American Board of Registration of Electroencephalographic and Evoked Potential Technologists (ABRET).

Eligibility:

Depending on your education path, you must document a specific number of completed EEG procedures (ranging from 50 to 150) to qualify for the test. The computer-based exam tests your knowledge of equipment, pattern recognition, and patient care.

 

Promotion - How much does an EEG technician make?

The average salary for an EEG technician in the United States is between $67,000 and $72,000 per year, which breaks down to roughly $33 to $35 per hour.

An individual's exact earnings typically fall within these ranges depending on experience and location:

Entry-Level (Bottom 10%): $44,000 – $55,000 annually ($21 – $26/hour)

Mid-Range (25th–75th Percentile): $55,000 – $84,000 annually ($27 – $35/hour)

Top Earners (Top 10%): Over $92,000 – $99,000+ annually ($37 – $44+/hour)

Major Factors Influencing Pay

Location:

Major metropolitan areas and coastal states often offer much higher compensation to align with the cost of living. For example, ZipRecruiter data tracks state averages like Washington at $81,230/year and New York at $78,464/year, while states like Florida average closer to $53,596/year. In California, the average pay is notably higher, hitting roughly $70,781 to $77,397 annually.

Certification:

Technicians who earn professional credentials—such as becoming a Registered EEG Technologist (R. EEG T.)—frequently command premium wages compared to non-registered staff.

Type of Employer:

Large hospital systems, specialized neurology clinics, and travel/contract tech agencies generally offer higher baseline compensation than smaller outpatient clinics or residential settings.

Complex – Busy EEG

An electroencephalogram (EEG) measures the electrical activity in your brain. While the exact combination of words "complex busy EEG" is not a standard, formal medical diagnosis, it is descriptive terminology that a neurologist might use in a report to summarize what they are seeing on the screen.

To understand what this means, it helps to break down the two descriptive terms:

"Busy" EEG:

In neurology, a "busy" background usually refers to an abundance of fast, high-frequency brain wave activity (such as beta waves) or a tracing crowded with overlapping signals. This can happen naturally when a person is highly alert, anxious, or tense during the test. It is also very frequently caused by medications, especially sedatives, anti-anxiety medications (like benzodiazepines), or certain muscle relaxants. Finally, "busy" can sometimes refer to a lot of artifact—which is simply electrical interference from muscle tension, blinking, or moving during the test.

"Complex" EEG:

This term generally means that the brain wave patterns are not straightforward. Instead of a simple, uniform rhythm, the EEG might show a mix of different wave frequencies (like slow waves mixed with fast waves), unusual shapes, or localized variations in specific areas of the brain. It indicates that the brain's electrical activity is highly dynamic or irregular.

When combined, a "complex busy" description simply tells us that the brain waves are highly active, fast, and multi-layered, rather than following a calm, simple, rhythmic baseline. Because an EEG is highly dependent on your personal medical history, an abnormal or unusual description does not automatically mean there is a serious problem. It is just one piece of a puzzle that your doctor must interpret alongside your symptoms.

Begin Interpreting our EEG

Epileptic K-complexes: An Underrated yet Potential Diagnostic Marker in Idiopathic Generalized Epilepsy

The spike clip region was close to what I observed on our EEG

Sample of an EEG

Based upon the little we know we think this is an abnormal EEG (Page)

FYI - Reading an EEG

FYI - Reading an EEG (Continued)

FYI - Reading an EEG (Continued)

https://anesthguide.com/topic/eeg/

Frequency bands

Delta (0.5–4 Hz): normal in infants and during sleep; pathological in adults (e.g., encephalopathy).

Theta (4–8 Hz): normal in drowsiness; pathological in focal or diffuse cerebral dysfunction.

Alpha (8–13 Hz): typical in relaxed wakefulness with eyes closed; attenuates with eye opening or mental activity.

Beta (13–30 Hz): normal in wakefulness; increased by benzodiazepines and barbiturates.

Gamma (>30 Hz): high-frequency oscillations with roles in cognition and epileptiform activity.

 

Encephalopathy

Encephalopathy is a general term for any disease, damage, or overall dysfunction of the brain.

Common Types and Causes

Hepatic Encephalopathy:

Brain dysfunction caused by severe liver disease when the liver fails to filter toxins like ammonia from the blood.

Anoxic/Hypoxic Encephalopathy:

Brain injury caused by a complete lack or severe reduction of oxygen supply to the brain, such as during cardiac arrest.

Toxic-Metabolic Encephalopathy:

Brain changes triggered by chemical imbalances, systemic illness (like kidney or liver failure), low/high blood sugar, or toxins/medications.

Chronic Traumatic Encephalopathy (CTE):

Progressive, permanent brain damage resulting from repeated head impacts and concussions.

Wernicke Encephalopathy:

Acute brain reaction caused by severe thiamine (vitamin B1) deficiency, frequently linked to alcohol misuse or persistent vomiting.

Key Symptoms

• Confusion, disorientation, or memory loss
• Personality or behavioral changes
• Lethargy, sleepiness, or loss of consciousness
• Involuntary muscle movements, tremors, or seizures

Diagnosis and Treatment

Diagnosis:

Doctors use blood tests, spinal fluid analysis, EEGs, and imaging like CT or MRI scans to find the root cause. You can learn more about clinical evaluation from the Cleveland Clinic.

Treatment:

Focuses strictly on fixing the underlying cause, such as clearing toxins, restoring oxygen or vitamins, or managing organ failure. Some forms are fully reversible if treated quickly, while others cause permanent damage.

 

FYI – AI - If you are asking because you or someone else is experiencing symptoms, please share what specific changes or symptoms are happening so I can give more tailored information.

Cerebral Dysfunction

Cerebral dysfunction is an impairment in higher brain functions—such as memory, language, reasoning, and emotional regulation—caused by disease, injury, or chemical imbalances in the brain.

Common Symptoms

Confusion and disorientation:
Trouble knowing the time, place, or identity.
Memory loss:
Difficulty forming new memories or recalling past events.
Speech and language issues:
Trouble speaking fluently or understanding others (aphasia).
Behavioral and personality changes:
Sudden mood swings, apathy, or poor judgment.
Physical or sensory changes:
Muscle weakness, tremors, or poor coordination.

Primary Causes

Metabolic issues:
Low blood sugar (hypoglycemia) or low oxygen levels (hypoxia).
Infections:
Brain inflammation from conditions like meningitis or encephalitis.
Vascular problems:
Severe changes in blood pressure or inflamed blood vessels.
Trauma and degeneration:
Head injuries, concussions, or progressive conditions like Alzheimer's disease.
Toxins:
Side effects from certain medications, illegal drugs, or poisons.

You can read more about broad patterns of brain impairment through the Merck Manuals Overview of Brain Dysfunction.

Figure - EEG Waveforms

Pattern Recognition in EEGs

Pattern recognition in electroencephalograms (EEGs) uses computer algorithms to automatically detect, measure, and classify electrical brain wave patterns.

Core Steps in EEG Pattern Recognition

Preprocessing:

Cleaning raw signals by removing artifacts like eye blinks, muscle movement, or power line interference.

Feature Extraction:

Breaking down signals into frequency bands (such as Delta, Theta, Alpha, and Beta waves as categorized in Physiology & Terminology - Learning EEG) using tools like the Discrete Wavelet Transform (DWT).

Feature Selection:

Choosing the most important data points using methods like Principal Component Analysis (PCA).

Classification:

Using machine learning models—such as Support Vector Machines (SVM) or K-Nearest Neighbors (KNN)—to label the brain state or detect abnormalities like epileptic spikes.

Transcranial Current Stimulation Therapy

Transcranial Current Stimulation Therapy, most commonly known as transcranial direct-current stimulation (tDCS), is a safe, non-invasive brain stimulation method that delivers a very weak electrical current (1–2 mA) through electrodes placed on the scalp.

How It Works

Mechanism:

It applies a continuous, low-level direct current to change the resting membrane polarization of neurons.

Polarity:

Anodal (positive) stimulation generally increases neuronal excitability, while cathodal (negative) stimulation decreases it.

Session Details:

Each session lasts about 20 to 30 minutes, and patients often perform cognitive or physical therapy tasks concurrently to boost neuroplasticity.

Conditions Treated and Explored

Medical Uses:

Being studied and clinically applied for major depression, chronic pain (like fibromyalgia and migraines), stroke rehabilitation (motor and language deficits), tinnitus, and addiction.

Wellness Uses:

Explored for non-medical focus, accelerated learning, and relaxation.

Risks and Side Effects

Common Side Effects:

Mild and transient sensations under the electrodes, such as slight itching, tingling, a warm/burning sensation, or a mild headache.

Contraindications:

Should not be used by individuals with metallic head implants, implanted electrical devices (like pacemakers), or a history of seizures/epilepsy.

 

TENS Unit Use

The Drive Medical AGF-3E Economy Dual Channel TENS Unit is an analog pain-management device controlled by three top-mounted dials for intensity, pulse frequency, and pulse width.

Setup and Preparation

Clean skin:

Wash and dry the treatment area thoroughly. Remove all oils, lotions, or rubs.

Insert battery:

Open the battery compartment and insert a standard 9-volt battery.

Connect wires:

Plug the lead wires into the connector pins on the pre-gelled electrodes, then plug the wires into the top jacks of the TENS unit.

Place electrodes:

Peel the sticky pads from their protective liner. Place them firmly on the skin around or "bracketing" the painful area. Do not place them on broken skin, the face, the front of the neck, or directly over the spine.

Operating the Device

Turn on:

Rotate the intensity dials clockwise from "Off" until the power indicator light turns on.

Adjust settings:

Use the analog dials to set your preferred pulse frequency (2–150 Hz) and pulse width (40–250 micro-seconds) as advised by your clinician.

Set intensity:

Turn the channel dial clockwise until you feel a strong, comfortable tingling or buzzing sensation. It should never cause pain or involuntary muscle twitching.

Safety and Maintenance

Removal:

Turn the device off before peeling the edges of the electrodes off your skin. Never pull by the wires.

Storage:

Place the pads back on their plastic liner and store the unit in its carrying case. Remove the 9-volt battery if you do not plan to use the device for a long time.

 

TENS Unit – Specifications

The Drive Medical AGF-3E TENS unit has a constant mode with analog dials under the front cover to adjust its current parameters.

Technical Specifications & Adjustable Ranges

Mode:

Constant (Continuous) stimulation

Pulse Amplitude (Intensity):

0–80 mA adjustable per channel (into a 500-ohm load)

Pulse Frequency (Rate):

2–150 Hz adjustable

Pulse Width:

40–250 microseconds adjustable

Waveform:

Asymmetrical, bi-phasic square pulse

Recommended General Settings

Acute or Recent Pain:

Set pulse frequency to 80–120 Hz and pulse width to 175–200 microseconds for fast gate-control relief.

Intensity:

Turn the dial up slowly until you feel a strong, comfortable tingling or buzzing sensation, but stop before it causes muscle twitching or discomfort.

 

Off Label Use of a TENS Unit

Transcutaneous electrical nerve stimulation (TENS) units are safely used over-the-counter for FDA-cleared indications like musculoskeletal and joint pain, but "off-label" or exploratory uses—such as for primary dysmenorrhea (menstrual cramps), fibromyalgia, diabetic neuropathy, or migraine/headache management—involve applying the device outside of classic localized musculoskeletal pain guidelines.

Understanding Off-Label Uses

Menstrual Pain (Dysmenorrhea):

Using a TENS unit on the lower abdomen or back for cramps is a common non-pharmacological off-label or adjunctive approach supported by recent clinical reviews.

Fibromyalgia & Neuropathy:

Applying pads near affected peripheral nerve pathways for generalized or centralized pain syndromes is studied as an add-on strategy, though efficacy is often modest and short-term.

Unapproved/Discouraged Areas:

Using TENS for unverified conditions (like dementia) or placing electrodes over high-risk zones (transcranially on the head, over the carotid sinus on the neck, or across the chest) is strongly discouraged due to lack of benefit or safety hazards.

Safety Precautions & Contraindications

Do Not Use If Pregnant:

Avoid placing pads on the low back, abdomen, or pelvis during pregnancy unless explicitly directed by an obstetric clinician.

Implanted Devices:

Do not use a TENS unit if you have a pacemaker, defibrillator, or other implanted electronic device, as it can cause electrical interference.

Sensitive Locations:

Never place electrodes on the front/sides of the neck, across the chest, over broken/irritated skin, or directly over the eyes.

 

ECT – Electroconvulsive Therapy Current Range

The electrical current (pulse amplitude) typically used in modern electroconvulsive therapy (ECT) ranges from 500 to 900 milliamperes (mA), delivered via constant-current devices.

Key Electrical Parameters

Current Intensity (Amplitude):

Generally set between 500 and 800 mA (historically up to 1000 mA), with many modern devices fixed or defaulting to 800–900 mA.

Pulse Width:

Classified as brief pulse (0.5–2.0 ms) or ultra-brief pulse (0.2–0.4 ms), which helps minimize cognitive side effects.

Frequency:

Ranges from 20 to 120 Hz.

Total Electrical Charge (Dose):

Typically ranges from 25 mC up to 750–1000 mC, depending on the patient's individual seizure threshold.

You can read more about modern treatment procedures and safety protocols at Yale Medicine or review professional standards via the Clinical Practice Guidelines for ECT.

 

Transcranial Magnetic Stimulation

Transcranial magnetic stimulation (TMS) is a non-invasive medical procedure that uses magnetic pulses to stimulate nerve cells in the brain, mostly used to treat depression that does not respond to standard medications.

How TMS Works

Magnetic Coils:

A doctor places a special electromagnetic coil gently against your scalp.

Electrical Signals:

The coil sends short magnetic pulses through your skull. These pulses create tiny electrical signals that wake up slow or underactive brain areas.

Target Area:

For depression, it targets the part of the brain that controls your mood.

What Conditions Does It Treat?

Major Depression:

Approved for people who have tried standard antidepressants without success.

Obsessive-Compulsive Disorder (OCD):

Uses deep coils to help calm specific brain networks.

Other Uses:

Sometimes used for migraines or helping people quit smoking. You can read more about these applications via the Mayo Clinic or the Cleveland Clinic.

What to Expect During Treatment

No Sedation:

You stay awake during the entire 20-minute session and do not need anesthesia.

Schedule:

Treatments usually happen five days a week for about six weeks.

Recovery:

You can drive home immediately and return to your normal daily routine right away. Additional insights are available through Harvard Health.

Common Side Effects

Mild headaches

Scalp discomfort or tapping sensation during the pulse

Slight muscle twitching in the face or jaw

 

Timeline – Form B

 

20260627-SA-Start walking scare
20260729-W-Dr RBB discontinues Lithium
20260820-TH-Dr. Martin J Backman MD Neurology
20260826-W-Quest Lab for blood-draw
20260902-W-Quest Results Available
20260908-TU-SG A15 Arrives
20260915-TU-Follow up appointment with MJB’s Technician for EEG
20260915-TU-MJB’s tech says they are waiting for an approval for an MRI
20260921-M-Call Backman’s office for EEG results
20260928-M-So far no call back from Dr. Backman – Wants me to do my MRI first
20260928-M-Making MRI Appointment
20260928-M-@ 1207 pm Dr. Backman calls and says lab and EEG are normal
20260928-M-@ 1pm MRI Appt. made for 10-10-26 (SA) @ 1230pm

 

20260928-M-Promotion - United Medical Imaging of Anaheim

https://www.umih.com/

Located in: TW Services Inc

1801 W Romneya Dr #104, Anaheim, CA 92801

Phone: (714) 678-4000

Fax: (714) 678-4022

Hours: Open · Closes 5 PM

 

Need

• Doctor’s Orders (Prescription)
• CDL
• Insurance Card
• Authorization

 

UMIA says: Dental work will not interfere with MRI.

 

Sample Questions

https://www.columbiaradiology.org/file/6814/download?token=1sFzMzVl

Questions before your MRI

An MRI (magnetic resonance imaging) scan uses a powerful magnet and radio waves to take detailed pictures inside your body without using radiation.

Important Safety Questions to Answer

Do you have metal implants?

Tell your doctor or technician about any pacemakers, brain aneurysm clips, artificial heart valves, metal pins, or cochlear implants.

Could there be stray metal in your body?

Mention any metal fragments from welding or eye injuries.

Are you pregnant or breastfeeding?

Let your care team know right away.

Do you have kidney problems?

This is vital if your scan requires an intravenous (IV) contrast dye.

How to Prepare on the Day of the Test

Remove all metal:

Leave jewelry, watches, hairpins, and glasses at home or in a locker.

Wear simple clothes:

You will likely change into a hospital gown to avoid hidden metal fibers or snaps in your clothes.

Check food and drink rules:

Most scans allow normal eating, but some require fasting for four to eight hours if you receive contrast dye or sedation.

Arrive early:

Plan to arrive at least 30 minutes before your appointment to finish safety forms.

 

The End

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