Re: What happened to Joel Eichen?



Mark & Steven Bornfeld wrote:
> clintonz@xxxxxxxxxxx wrote:
> > Steven Bornfeld wrote:
> >
> >>clintonz@xxxxxxxxxxx wrote:
> >
> >
> >
Clinton--
>
> I know you have had difficulties with a particular dentist, and I'm not
> looking to pick a fight with you.
> There are clearly situations where dentists should be ruled incompetent
> to practice. I am not equipped to argue the merits of privacy for HIV

I realize that. However I think other people on the list may
be interested to know, because it came as a surprise to me, that
there is a specific condition associated with Aids called
AIDs dementia complex. (ADC). Here is a link on it.

http://hivinsite.ucsf.edu/InSite?page=kb-04-01-03#S5X

Clinical Presentation of (ADC)

Although the severity and relative prominence of some symptoms and
signs compared to others may vary among individual patients, the
general character of ADC involves three functional categories:
cognition, motor performance, and behavior.(5) Table 2 provides an
outline of some of the early and late manifestations. Of the three
categories, cognitive and motor dysfunction are the most helpful in
characterizing patients and in defining diagnosis; it is for this
reason that they provide the basis of ADC Staging, which omits
behavioral criteria. When approaching diagnosis, it is useful to
separately consider milder and more severe affliction.


Stage 0.5 and 1 ADC

Cognitive impairment usually underlies patients' earliest symptoms.
Mildly afflicted patients most often have difficulty attending to more
complex tasks at work or at home. They need to make lists, sometimes
very detailed, of the day's activities. They lose track of actions
(e.g., leave the water boiling, get up to go to another room and then
forget why they did so) or of conversations in mid-sentence ("What was
I saying?"). Processing unrelated or complex thoughts becomes slower
and less facile. While similar lapses can trouble many normal people
especially in the face of fatigue or generalized illness, lapses in ADC
patients intrude on daily function to a greater degree. Multi-staged
tasks become difficult; e.g., the waiter can no longer keep verbal
orders straight when he arrives at the kitchen or the avid reader needs
to reread paragraphs or pages. When such dysfunction is mild, it may be
difficult to substantiate the basis for these complaints by bedside
examination, and it is important to apply tests that are sensitive to
these abnormalities, including particularly tests requiring
concentration, change of sets, and timed performance. Because it was
constructed for other conditions, the standard Mini-Mental Status(22)
may not be sufficiently sensitive at this point; however, when ADC
patients do perform abnormally, it is usually on reversals (reversing a
five-letter word like "world," or subtracting from 100 by 7's), complex
sequential tasks (placing the right thumb on the left ear and sticking
out the tongue), or remembering three objects.

Although motor symptoms are far less common during this early phase,
individuals relying on rapid or fine coordination may note a change.
For example, the guitarist may no longer be able to keep up with a
difficult piece or the athlete may be slowed to below a competitive
level. An inquiring history may discover a change in handwriting or,
less commonly, clumsiness in tying shoes or buttoning a shirt.
Moreover, even in those without overt symptoms, motor signs may be
detected on examination, including slowing of attempts at rapid
opposition of the thumb and forefinger, rotation of the wrist, or
tapping of the toe. While the gait may be generally steady, it is often
slow, and rapid turns may be interrupted by an extra step or performed
hesitantly. Reflexes are also often abnormal. The deep tendon stretch
reflexes, including importantly the jaw jerk, are frequently
hyperactive, although the ankle jerks may be relatively less active
when there is concomitant polyneuropathy. Babinski signs may be present
and other "pathologic" release signs may also be detected; of these,
the snout response is relatively frequent and particularly helpful when
present in young patients.

The time course and onset of milder ADC is variable. It may begin
insidiously or abruptly and progress more rapidly to a higher stage, or
it may continue to evolve slowly or even remain static for some period.
In patients with mild ADC, missed diagnosis usually results from
overlooking the important aspects of the history. Functional
difficulties may erroneously be considered as a "normal" part of
systemic illness by patients and their caregivers despite the fact that
most AIDS patients without neurologic conditions perform quite
normally, even in the late stage of HIV-1 infection. Particularly
important is the distinction of ADC from clinical depression, which can
produce similar complaints but carries distinct therapeutic
implications (see Chapter 5.15). Hypochondriasis and anxiety in those
understandably worried about body function may also lead to similar
complaints.

............

Interestingly , they say that it can be difficult to diagnose
in early stages and preceeds decline in motor function and probably
overall health, although fine motor function and complex motor tasking,
such as used in dentistry and undoubteldy required for a good amalgam
product and surgical outcome, can decline substantially without overall
motor symptoms obviously declining. So for some subset of Aids
patients, an early and substantial decline in work
performance/abilities do occur. Very interesting indeed.

.

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