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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