March 25, 2025 • 26 mins
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Summary:
What happens when you need a brain MRI—but the results leave you with more questions than answers? In this episode, I take you through my personal journey of facing unexpected MRI findings, the emotional and medical challenges that followed, and the valuable lessons I learned along the way. If you've ever dealt with medical uncertainty, this episode is for you.
Key Topics & Takeaways:
- The Decision to Get an MRI – Why my persistent vertigo symptoms led me to pursue brain imaging.
- The MRI Experience – What to expect, including the impact of claustrophobia and tips for managing anxiety during the scan.
- The Immediate Shock of Results – Understanding what “chronic microhemorrhage” means and how I navigated the initial fear.
- Seeking Answers – The process of finding a neurologist quickly versus waiting for a super-specialist.
- The Power of Medical Conversations – How reviewing my MRI images in detail helped clarify what was truly concerning (and what wasn’t).
- Lessons for Everyone – How to approach unexpected medical findings, manage anxiety, and make informed decisions about your health.
- Practical Next Steps – From tracking symptoms to preparing questions for doctors, how to take control of your health journey.
🔹 Take Action:
- If you've ever faced an unexpected medical result, take a step back, ask the right questions, and seek out the right specialists.
- Interested in the six pillars of longevity and wellness? Download my free eBook "How to Live Long and Well" at DrBobbyLiveLongAndWell.com.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Getting a brain MRI.
What could go wrong?
I needed the scan, but itshowed abnormalities that were
worrisome and I was left withuncertainty and fear.
I learned several lessons frommy life, and perhaps yours,
(00:36):
perhaps yours.
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, apodcast where we will talk about
what you can do to live as longas possible and with as much
energy and figure that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
(00:56):
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to episode 33,brain MRI.
(01:18):
What Could Go Wrong could gowrong?
Well, in past episodes likenumber 12, to test or not to
test we talked about screening,where you might get one of those
hundreds of blood tests or atotal body MRI scan, and the
goal there was to try to find ifthere is any disease really
(01:43):
really early before you getsymptoms and to try to intervene
Now.
This sounded good and I talkedabout it in the podcast, but
there are problems with falsepositives, where a test is
abnormal, and that may lead to alot of anxiety, further testing
(02:03):
and even complications.
Now I have my own story to telland share and I think there's
some lessons for me, and I thinkmaybe some lessons for you,
from what I experienced.
So let's begin with my story.
Now.
This is not about a screeningMRI scan.
(02:25):
This was not something that Iwas like.
Well, maybe I should just dothis to see what might be there.
I woke up a couple months agoand the room was spinning.
Now, I wasn't lightheaded, itwas truly spinning and as I
would get out of bed for about30 seconds, everything would
(02:45):
just be spinning in circles andthen it would go away.
But I had kind of a low-gradeheadache, almost like a hangover
, during the course of the day.
Now, when this comes onsuddenly like this, the most
likely cause it's what's calledbenign paroxysmal positional
(03:07):
vertigo.
It's a long name, but basicallyit has something to do with
what's going on in your innerear and there are little
crystals in there and sometimesthey get into the wrong place
and that can cause the problemand it usually resolves in a few
days or perhaps a few weeks.
Well, several months went onand it was still there and I was
(03:32):
like this isn't normal.
This doesn't seem like thebenign positional vertigo.
I wonder if there's somethingmore I should be aware of.
So I went to my primary caredoctor and he and I thought that
getting an MRI scan made somesense.
Now, as I titled this, whatcould go wrong with an MRI scan?
(03:53):
Well, as I walked in there, thetechnician said well, do you
have any metal in your body,like a foreign object or an
artificial joint or a pacemaker?
And I had this image that if Ihad one of these things with the
magnet in the MRI scan and it'sa huge, powerful magnet all
(04:15):
these things could come flyingout of somebody's body, which,
of course, would be ratherdangerous.
And what I learned was no, Idon't have any metal in my body.
But if I did something likethat, they aren't going to come
flying out of your body, butthey could get dislodged a
little bit, and that wouldn't beideal.
(04:37):
And so, of course, you want totell people at the MRI scan
place about it.
Well, I live in Austin andeverybody and his brother has a
tattoo, and they ask you abouttattoos because I guess some of
the tattoo paint may have somemetal in it.
And no, the tattoos are notgoing to come flying out of your
(04:57):
body.
Again, that was the image I wasthinking, but the tattoos and
some of the metal can distortthe image, and so it's very
important to tell folks aboutthat before you go into the
scanner.
Well, back to my story.
That was just a little bit of adetour.
So I went and did the MRI scanand doing the study was pretty
(05:21):
uneventful.
Now they talk about what arecalled open MRI scans, and this
means that you know the head ofthe scanner and the foot of the
scanner are open, but whenyou're actually doing it, you're
in a tube.
Even though the tube isn'tclosed at one or the other end,
you're in a tube, and for somepeople it can cause some
(05:47):
claustrophobia or feelinguncomfortable.
Now, as we learned in episodefive about mind-body harmony and
meditation and breath work,that's what I did.
I closed my eyes while I was inthe scanner and it took 15-20
minutes.
I closed my eyes while I was inthe scanner and it took 15-20
(06:07):
minutes and was able to meditate, and if I had any anxiety about
being in this narrow tube, thebreathing and the meditation
helped me a lot.
So if you ever need to do anMRI scan, and this is something
you're a little uneasy about.
Maybe try some breath work ormeditation.
Okay, so the results Now.
What was remarkable is that whenyou leave the MRI scanner area,
(06:31):
the technician says, well, thishas to be reviewed by the
radiologist and you'll getresults in the next one to two
days.
And it turns out, at least inTexas.
I don't know if this isabsolutely true everywhere, but
once the radiologist hascompleted the report, in the old
days they would send the reportto your doctor who ordered the
(06:53):
test.
The doctor would review thatand then it would be released to
you, the patient.
But now, apparently, the lawsare at least here that they have
to release the results to me atthe same time as they release
it to the referring doctor.
So before I got to my car, Ilooked at my email and, lo and
(07:19):
behold, there was the report,which was unbelievable that I
got it within probably 10 or 15minutes.
This is all now electronic, sopresumably they sent the MRI
scan to some remote locationwhere the radiologist was just
sitting and available, read thereport and within 10 or 15
minutes I had it, which is quiteremarkable.
(07:42):
Okay, so the good news is thatwhen I read the scan results,
there was no evidence of a tumor.
There was also no evidence thatmight explain the vertigo.
And here's the kicker.
They wrote on the report thefollowing chronic
microhemorrhage in the leftfrontal lobe, white matter.
(08:07):
Now, obviously there's a lot ofgobbledygook here and you
probably don't necessarily needto worry about what exactly it
said.
But chronic microhemorrhage.
It said but chronic microhemorrhage.
Now, that can't be good.
As I was reading this, I'msaying this can't be a normal
(08:31):
thing and I'm not sure I'm happyabout hearing I have a chronic
micro hemorrhage in the frontpart of my brain.
And this also brought to memorymy brother-in-law who at a
young age, had frontal lobedementia, which was quite
devastating on the family, andso this brought to mind could
this lead to something like that?
All right, so now I'm thinkingabout this as I'm driving home
(08:56):
in my car.
Of course, as soon as I get homeI have to start doing my
scientific homework.
What is chronic microhemorrhage?
What does this mean?
And I found review articles andI found primary studies and
reached out quickly to myprimary care doctor and again,
(09:18):
he didn't know definitiveanswers about this either.
So what did I do and this maybe a lesson for you.
I started a list of questionsbecause I knew, ultimately, I
was going to have to see aneurologist, and so this was the
beginning of getting ready forthat visit.
(09:38):
First question what does itmean?
What does it mean to havechronic micro hemorrhage?
Secondly, what causes it?
And I learned that it could behigh blood pressure, and I have
high blood pressure, which hasbeen treated well, but maybe
that caused it.
And then there's something thatworried me more and it's called
amyloid angiopathy.
(10:00):
Now when you hear the wordamyloid, you think maybe
Alzheimer's disease.
So now I'm worried thatpotentially this puts me at
significant risk for Alzheimer'sdisease at a young age.
Now, all of these specificquestions are not ones that are
probably going to apply to you,or hopefully won't apply to you,
(10:23):
but the process of asking thesequestions, and I'm just giving
you these as examples as to whatyou might do if something like
this arises.
So, as I was reading aboutamyloid angiopathy, which is
basically a blood vessel problemdue to the amyloid, I was
(10:44):
asking questions does itincrease my risk of dementia?
The answer is yes, several-foldincrease, it appears.
How common is finding somethinglike this at my age, finding
something like this at my age?
And if there are chronic microhemorrhages, how do I reduce
getting more of them, becauseclearly more of them can't be
(11:05):
good?
I was on low-dose aspirinrelated to my cardiac risk, and
should I stop the low-doseaspirin?
All right?
So these were some of thequestions that I was starting to
wrestle with Now over the nextnumber of days.
There was an emotional impact.
(11:25):
So I'm very healthy.
I follow the six pillars.
Of course I talk about themwith you.
So of course I have to followthem.
And you realize, well, look,bad luck happens even when
you're healthy or appear healthy, and even when you're doing all
the preventive care work thatyou can do.
So maybe this is something thatwas my bad luck.
(11:51):
And then I began to sort ofreflect on well, I'm not going
to die tomorrow from this, butit could mean that dementia
strikes in some number of yearsin the future not 20 or 30 years
, but maybe over the next three,five, seven, nine years.
And what if I only have thosenumber of good years left?
(12:14):
Am I approaching life how Iwould like to?
And I basically felt, yes, thelife I have, running the exotic
animal ranch and the bed andbreakfast and then, of course,
working with you, my audience,with the podcast and with
coaching.
Yes, I think I am living mylife like I would like to.
(12:36):
I love my wife, I love myfamily, I appreciate them.
So that part I felt pretty good.
But then I was like things like, well, you know, I've saved
money over the years.
If I had a more limited numberof future years, would I do
anything different?
And my wife and I have beentalking about going to Europe
(12:57):
and I'm like, yeah, we'redefinitely going business class.
There's no reason to not atthis point in our lives.
Whether I'm destined to havedementia in the near term or not
, let's make that decision, allright.
So these were the questions thatI had queued up.
This is some of the emotionalimpact that I was facing.
(13:17):
What do I do next?
Well, clearly, the next stepwas to see a specialist, in this
case a neurologist.
So this is something that manyof you will face, which is in
many, many cities increasingly,to see a specialist can take a
long time.
(13:38):
Increasingly, to see aspecialist can take a long time.
It can take months to get tosee the specialist you really,
really want to.
So I had a discussion with myprimary care doctor.
Do I wait for the specialneurologist at the academic
center who might be the mostexpert at this issue of chronic
(14:00):
micro hemorrhage, or do I find aneurologist that's more
available?
Maybe not on the you know 10best neurologists list in the
United States, but I wasthinking, you know, this has got
to be a relatively commonquestion that comes up, and any
(14:20):
good neurologist should be ableto help me at least take things
the next step.
So we chose, my primary caredoctor and I, to go to a
neurologist who had availabilityquickly for me, and I was able
to schedule to see him within aweek, which was really quite
(14:41):
remarkable.
On Tuesday I had the MRI scanand, as I said, 15 minutes later
I had the results and thenwithin a week, I would get to
see a neurologist who could helpme begin to understand what the
journey was ahead of me.
Now, if you've listened toepisode 20, do you like your
(15:01):
doctor?
I walk through a whole seriesof things about how you judge
your relationship with yourdoctor and ways that you might
make it better.
By all means, listen to episode20 if you haven't, or if you'd
like to refresh your memory.
And so there were a whole lotof things I was thinking about
as I was going to visit theneurologist and, as it turned
(15:25):
out, he checked off many of theboxes of things that are very
important.
He saw me on time, he took timein the exam room, he answered
questions.
When there were some follow-upquestions, I could email through
the portal and he had referralsthat made sense.
(15:47):
Well, what did I learn Well?
Well, what did I learn?
Well, the good news is I am aphysician, so it was very, very
helpful to walk through the MRIscan together in detail, because
what I got from the radiologydepartment was just a written
report, didn't really give me adetailed sense of what was there
(16:08):
.
So we walked through each sliceof my brain, slicing it top to
bottom, side to side and everyother which way, and it turned
out there was a little microhemorrhage in the location where
they talked about.
It was very small.
And then there was a thing inanother part of the brain that
(16:28):
might have been a microhemorrhage or could have just
been a blood vessel that we werelooking at.
So the first lesson that cameout of this is that looking at
the scan was way moreilluminating with my doctor.
Of course I wouldn't be able tounderstand the scan myself than
the report.
And in hindsight that reportshould have been more precise
(16:52):
about how many micro hemorrhageswere there.
Was this something they commonlysee in doing thousands of these
MRI scans?
That all ideally could havebeen included in the report.
And since these reports go tothe patient right away, even
more important, obviously theradiologist has to be cautious
(17:16):
about what it means.
But there's a few things theycould have said that would have
just clarified things a lot.
So in talking to theneurologist I said look, this is
my scan.
Is this something you seecommonly as folks age?
And he said it's really notuncommon, doesn't mean it's
(17:38):
normal, but what he saw did notworry him.
He said, look, this kind ofthing does pop up.
And he said there's noindication that this little
micro hemorrhage puts me atgreat risk of dementia.
And and this was the good newsbecause you know, as I've talked
(17:58):
about, when you do a screeningtest and again this wasn't a
screening test you want toreassure yourself that there's
no evidence of early disease.
So I took this as anopportunity to say well, I got
the scan and obviously I gotthis abnormality we're not happy
about.
But let's take a look at thebrain more generally.
(18:20):
And what do you think of thebrain?
And he said look, it looksgreat.
There's no evidence of thinningor shrinkage or all the things
that you think about when youlook at an older person's brain
as indicators that maybe there'searly dementia.
And none of that was there.
So that was very reassuring.
(18:41):
And then we got into adiscussion about the level of
blood pressure that would beideal to reduce our risk of
stroke.
And he said well, if you keepit under 135 over 85, that's
really good.
But I said well, myunderstanding of the literature
is that if you can get it downbelow 120, that's even better.
(19:05):
And he said yeah, you're right,that's true.
But for most people, if you tryto lower the blood pressure
that low people will get dizzy.
So although statisticallythat's what you want to do, for
most people, as they get older,their brain needs a higher blood
pressure to keep all the bloodflowing in the brain.
(19:27):
Now, for me, getting below 120doesn't cause symptoms.
Of course, if it drops below 90, I do start to feel a little
dizzy.
So that made me feel good thatI guess my brain was doing well,
that it could tolerate asomewhat lower blood pressure.
So I walked into my neurologyvisit with a lot of fear, a lot
(19:49):
of concern about what this meansand my future, and for me I was
very fortunate that I left theneurology office feeling even
better about my brain thanbefore, because it was clear I
didn't have a brain tumor andnot likely to get one in the
next year or two because theseare often slow growing and that
(20:13):
the brain looked good andhealthy and no early signs that
maybe something's going on Allright.
So now I'm left with the mostlikely diagnosis that I in fact
have that benign positionalvertigo, even though usually
it's gone within days, weeks orup to a month.
Yes, after two months I didhave continuing symptoms, but
(20:38):
the good news is actually,between the two months and three
months it finally did prettymuch go away.
But you have to ask yourself thequestion.
I asked myself the question,but I don't want the vertigo to
come back.
What's the likelihood it will,and this is true for all sorts
of illnesses.
(20:58):
You want to know is it going tocome back?
Well, there's about a 25% rateof reoccurrence in the next year
.
So of course I asked thequestion can I reduce that risk?
So went to the literature and itappears from some studies that
vitamin D can reduce the risk.
Oh, great, so let's takevitamin D supplements.
(21:21):
But and this is why it's soimportant not to get carried
away with studies withoutreading them more carefully the
only time vitamin D helped forthese vertigo patients was if
your vitamin D level was alreadylow.
Well, that kind of makes sense.
If it's low, maybe treating itcould make it better.
(21:42):
Well, in my case, my vitamin Dlevel is just fine, so there's
no reason for me to take vitaminD, and some reasons we can talk
about it at next podcast, aboutwhy you don't necessarily just
want to take vitamin D,especially at higher doses, for
no reason.
And it turns out, if you havethis vertigo problem, there's
(22:05):
some really good physicaltherapy they can do.
Basically, it has to do withlying you down and turning your
head in certain positions, andthe vertigo can be resolved
within one session, maybe twosessions, but generally you can
really do a good job by doingthat, and so, even though I
(22:27):
don't know how to prevent it, Inow know if one of these
episodes pops up, I'm going backto the physical therapist.
Now this is a special physicaltherapist that focuses on
balance and dizziness, that Iknow what to do for the future.
And here's something that Ididn't realize is possible.
Maybe I don't, you know, I havea referral to the physical
(22:50):
therapist and those are good fora year, but I'm like, well,
what if I get this episode again18 months from now?
And what the physical therapistsaid to me is what you can do
on a yearly basis is ask yourdoctor just to put in a referral
, even though you don't need it,and that referral will be good
(23:13):
for the next year.
So if anything happens, I don'thave to reach out to my primary
care doctor, wait for them tomake the referral, the referral,
get to the physical therapyplace.
It can be like a standing orderand it will always be available
to me.
So if you have recurrentepisodes of back pain or
(23:36):
something else, this could besomething you just keep in place
so you're ready if a problemoccurs.
All right, let's sum things up.
This was an episode I wanted toshare with you because there
were lessons learned, lessonslearned by me and maybe lessons
that would be helpful for you.
(23:56):
First lesson even a test thatyou need, in this case the MRI
scan, which was clearlyindicated after several months
of symptoms not going away.
Even a test that's needed cansend you down an anxiety-ridden
rabbit hole, because it may comeup with something that doesn't
(24:20):
explain what's going on butcould lead to worry.
Second lesson when choosing forme when to see the neurologist
and whether to go to the supersuper specialist or somebody who
is more available, sometimesquick answers beats the super
super specialist answer.
(24:42):
So waiting six months wouldhave led to a lot of anxiety, a
lot of uneasiness, and in theend I would have learned from
the super specialists that, yeah, it's not something to worry
about.
So for me, getting that answerwithin a week was really
important.
Now, I could have always seen asecond neurologist from a
(25:07):
tertiary care center after that.
So for me and this is somethingto keep in mind maybe you just
want to find somebody that'srelatively available and then
see how that goes, and if youstill have uncertainties, by all
means then go to the next tierof specialist.
(25:27):
But for me that quick approach,which gave me an excellent set
of answers, really was wonderful, rather than waiting six months
.
So I hope you don't get aworrisome diagnosis as we age.
Probably we will at some point,but perhaps my journey might be
(25:49):
helpful for you and give yousome ideas about how you might
address it.
Let me know your story ifsomething like this has happened
, and maybe I can share thatwith our listeners and help all
of us.
Thanks so much for listening toLive Long and Well with Dr
(26:12):
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
(26:35):
That's Dr.
As in D-R Bobbylivelongandwellcom.
Getting a brain MRI.
What could go wrong?
I needed the scan, but itshowed abnormalities that were
worrisome and I was left withuncertainty and fear.
I learned several lessons frommy life, and perhaps yours,
(00:36):
perhaps yours.
Hi, I'm Dr Bobby Du Bois andwelcome.
To Live Long and Well, apodcast where we will talk about
what you can do to live as longas possible and with as much
energy and figure that you wish.
Together, we will explore whatpractical and evidence-supported
steps you can take.
Come join me on this veryimportant journey and I hope
(00:56):
that you feel empowered alongthe way.
I'm a physician, ironman,triathlete and have published
several hundred scientificstudies.
I'm honored to be your guide.
Welcome everyone to episode 33,brain MRI.
(01:18):
What Could Go Wrong could gowrong?
Well, in past episodes likenumber 12, to test or not to
test we talked about screening,where you might get one of those
hundreds of blood tests or atotal body MRI scan, and the
goal there was to try to find ifthere is any disease really
(01:43):
really early before you getsymptoms and to try to intervene
Now.
This sounded good and I talkedabout it in the podcast, but
there are problems with falsepositives, where a test is
abnormal, and that may lead to alot of anxiety, further testing
(02:03):
and even complications.
Now I have my own story to telland share and I think there's
some lessons for me, and I thinkmaybe some lessons for you,
from what I experienced.
So let's begin with my story.
Now.
This is not about a screeningMRI scan.
(02:25):
This was not something that Iwas like.
Well, maybe I should just dothis to see what might be there.
I woke up a couple months agoand the room was spinning.
Now, I wasn't lightheaded, itwas truly spinning and as I
would get out of bed for about30 seconds, everything would
(02:45):
just be spinning in circles andthen it would go away.
But I had kind of a low-gradeheadache, almost like a hangover
, during the course of the day.
Now, when this comes onsuddenly like this, the most
likely cause it's what's calledbenign paroxysmal positional
(03:07):
vertigo.
It's a long name, but basicallyit has something to do with
what's going on in your innerear and there are little
crystals in there and sometimesthey get into the wrong place
and that can cause the problemand it usually resolves in a few
days or perhaps a few weeks.
Well, several months went onand it was still there and I was
(03:32):
like this isn't normal.
This doesn't seem like thebenign positional vertigo.
I wonder if there's somethingmore I should be aware of.
So I went to my primary caredoctor and he and I thought that
getting an MRI scan made somesense.
Now, as I titled this, whatcould go wrong with an MRI scan?
(03:53):
Well, as I walked in there, thetechnician said well, do you
have any metal in your body,like a foreign object or an
artificial joint or a pacemaker?
And I had this image that if Ihad one of these things with the
magnet in the MRI scan and it'sa huge, powerful magnet all
(04:15):
these things could come flyingout of somebody's body, which,
of course, would be ratherdangerous.
And what I learned was no, Idon't have any metal in my body.
But if I did something likethat, they aren't going to come
flying out of your body, butthey could get dislodged a
little bit, and that wouldn't beideal.
(04:37):
And so, of course, you want totell people at the MRI scan
place about it.
Well, I live in Austin andeverybody and his brother has a
tattoo, and they ask you abouttattoos because I guess some of
the tattoo paint may have somemetal in it.
And no, the tattoos are notgoing to come flying out of your
(04:57):
body.
Again, that was the image I wasthinking, but the tattoos and
some of the metal can distortthe image, and so it's very
important to tell folks aboutthat before you go into the
scanner.
Well, back to my story.
That was just a little bit of adetour.
So I went and did the MRI scanand doing the study was pretty
(05:21):
uneventful.
Now they talk about what arecalled open MRI scans, and this
means that you know the head ofthe scanner and the foot of the
scanner are open, but whenyou're actually doing it, you're
in a tube.
Even though the tube isn'tclosed at one or the other end,
you're in a tube, and for somepeople it can cause some
(05:47):
claustrophobia or feelinguncomfortable.
Now, as we learned in episodefive about mind-body harmony and
meditation and breath work,that's what I did.
I closed my eyes while I was inthe scanner and it took 15-20
minutes.
I closed my eyes while I was inthe scanner and it took 15-20
(06:07):
minutes and was able to meditate, and if I had any anxiety about
being in this narrow tube, thebreathing and the meditation
helped me a lot.
So if you ever need to do anMRI scan, and this is something
you're a little uneasy about.
Maybe try some breath work ormeditation.
Okay, so the results Now.
What was remarkable is that whenyou leave the MRI scanner area,
(06:31):
the technician says, well, thishas to be reviewed by the
radiologist and you'll getresults in the next one to two
days.
And it turns out, at least inTexas.
I don't know if this isabsolutely true everywhere, but
once the radiologist hascompleted the report, in the old
days they would send the reportto your doctor who ordered the
(06:53):
test.
The doctor would review thatand then it would be released to
you, the patient.
But now, apparently, the lawsare at least here that they have
to release the results to me atthe same time as they release
it to the referring doctor.
So before I got to my car, Ilooked at my email and, lo and
(07:19):
behold, there was the report,which was unbelievable that I
got it within probably 10 or 15minutes.
This is all now electronic, sopresumably they sent the MRI
scan to some remote locationwhere the radiologist was just
sitting and available, read thereport and within 10 or 15
minutes I had it, which is quiteremarkable.
(07:42):
Okay, so the good news is thatwhen I read the scan results,
there was no evidence of a tumor.
There was also no evidence thatmight explain the vertigo.
And here's the kicker.
They wrote on the report thefollowing chronic
microhemorrhage in the leftfrontal lobe, white matter.
(08:07):
Now, obviously there's a lot ofgobbledygook here and you
probably don't necessarily needto worry about what exactly it
said.
But chronic microhemorrhage.
It said but chronic microhemorrhage.
Now, that can't be good.
As I was reading this, I'msaying this can't be a normal
(08:31):
thing and I'm not sure I'm happyabout hearing I have a chronic
micro hemorrhage in the frontpart of my brain.
And this also brought to memorymy brother-in-law who at a
young age, had frontal lobedementia, which was quite
devastating on the family, andso this brought to mind could
this lead to something like that?
All right, so now I'm thinkingabout this as I'm driving home
(08:56):
in my car.
Of course, as soon as I get homeI have to start doing my
scientific homework.
What is chronic microhemorrhage?
What does this mean?
And I found review articles andI found primary studies and
reached out quickly to myprimary care doctor and again,
(09:18):
he didn't know definitiveanswers about this either.
So what did I do and this maybe a lesson for you.
I started a list of questionsbecause I knew, ultimately, I
was going to have to see aneurologist, and so this was the
beginning of getting ready forthat visit.
(09:38):
First question what does itmean?
What does it mean to havechronic micro hemorrhage?
Secondly, what causes it?
And I learned that it could behigh blood pressure, and I have
high blood pressure, which hasbeen treated well, but maybe
that caused it.
And then there's something thatworried me more and it's called
amyloid angiopathy.
(10:00):
Now when you hear the wordamyloid, you think maybe
Alzheimer's disease.
So now I'm worried thatpotentially this puts me at
significant risk for Alzheimer'sdisease at a young age.
Now, all of these specificquestions are not ones that are
probably going to apply to you,or hopefully won't apply to you,
(10:23):
but the process of asking thesequestions, and I'm just giving
you these as examples as to whatyou might do if something like
this arises.
So, as I was reading aboutamyloid angiopathy, which is
basically a blood vessel problemdue to the amyloid, I was
(10:44):
asking questions does itincrease my risk of dementia?
The answer is yes, several-foldincrease, it appears.
How common is finding somethinglike this at my age, finding
something like this at my age?
And if there are chronic microhemorrhages, how do I reduce
getting more of them, becauseclearly more of them can't be
(11:05):
good?
I was on low-dose aspirinrelated to my cardiac risk, and
should I stop the low-doseaspirin?
All right?
So these were some of thequestions that I was starting to
wrestle with Now over the nextnumber of days.
There was an emotional impact.
(11:25):
So I'm very healthy.
I follow the six pillars.
Of course I talk about themwith you.
So of course I have to followthem.
And you realize, well, look,bad luck happens even when
you're healthy or appear healthy, and even when you're doing all
the preventive care work thatyou can do.
So maybe this is something thatwas my bad luck.
(11:51):
And then I began to sort ofreflect on well, I'm not going
to die tomorrow from this, butit could mean that dementia
strikes in some number of yearsin the future not 20 or 30 years
, but maybe over the next three,five, seven, nine years.
And what if I only have thosenumber of good years left?
(12:14):
Am I approaching life how Iwould like to?
And I basically felt, yes, thelife I have, running the exotic
animal ranch and the bed andbreakfast and then, of course,
working with you, my audience,with the podcast and with
coaching.
Yes, I think I am living mylife like I would like to.
(12:36):
I love my wife, I love myfamily, I appreciate them.
So that part I felt pretty good.
But then I was like things like, well, you know, I've saved
money over the years.
If I had a more limited numberof future years, would I do
anything different?
And my wife and I have beentalking about going to Europe
(12:57):
and I'm like, yeah, we'redefinitely going business class.
There's no reason to not atthis point in our lives.
Whether I'm destined to havedementia in the near term or not
, let's make that decision, allright.
So these were the questions thatI had queued up.
This is some of the emotionalimpact that I was facing.
(13:17):
What do I do next?
Well, clearly, the next stepwas to see a specialist, in this
case a neurologist.
So this is something that manyof you will face, which is in
many, many cities increasingly,to see a specialist can take a
long time.
(13:38):
Increasingly, to see aspecialist can take a long time.
It can take months to get tosee the specialist you really,
really want to.
So I had a discussion with myprimary care doctor.
Do I wait for the specialneurologist at the academic
center who might be the mostexpert at this issue of chronic
(14:00):
micro hemorrhage, or do I find aneurologist that's more
available?
Maybe not on the you know 10best neurologists list in the
United States, but I wasthinking, you know, this has got
to be a relatively commonquestion that comes up, and any
(14:20):
good neurologist should be ableto help me at least take things
the next step.
So we chose, my primary caredoctor and I, to go to a
neurologist who had availabilityquickly for me, and I was able
to schedule to see him within aweek, which was really quite
(14:41):
remarkable.
On Tuesday I had the MRI scanand, as I said, 15 minutes later
I had the results and thenwithin a week, I would get to
see a neurologist who could helpme begin to understand what the
journey was ahead of me.
Now, if you've listened toepisode 20, do you like your
(15:01):
doctor?
I walk through a whole seriesof things about how you judge
your relationship with yourdoctor and ways that you might
make it better.
By all means, listen to episode20 if you haven't, or if you'd
like to refresh your memory.
And so there were a whole lotof things I was thinking about
as I was going to visit theneurologist and, as it turned
(15:25):
out, he checked off many of theboxes of things that are very
important.
He saw me on time, he took timein the exam room, he answered
questions.
When there were some follow-upquestions, I could email through
the portal and he had referralsthat made sense.
(15:47):
Well, what did I learn Well?
Well, what did I learn?
Well, the good news is I am aphysician, so it was very, very
helpful to walk through the MRIscan together in detail, because
what I got from the radiologydepartment was just a written
report, didn't really give me adetailed sense of what was there
(16:08):
.
So we walked through each sliceof my brain, slicing it top to
bottom, side to side and everyother which way, and it turned
out there was a little microhemorrhage in the location where
they talked about.
It was very small.
And then there was a thing inanother part of the brain that
(16:28):
might have been a microhemorrhage or could have just
been a blood vessel that we werelooking at.
So the first lesson that cameout of this is that looking at
the scan was way moreilluminating with my doctor.
Of course I wouldn't be able tounderstand the scan myself than
the report.
And in hindsight that reportshould have been more precise
(16:52):
about how many micro hemorrhageswere there.
Was this something they commonlysee in doing thousands of these
MRI scans?
That all ideally could havebeen included in the report.
And since these reports go tothe patient right away, even
more important, obviously theradiologist has to be cautious
(17:16):
about what it means.
But there's a few things theycould have said that would have
just clarified things a lot.
So in talking to theneurologist I said look, this is
my scan.
Is this something you seecommonly as folks age?
And he said it's really notuncommon, doesn't mean it's
(17:38):
normal, but what he saw did notworry him.
He said, look, this kind ofthing does pop up.
And he said there's noindication that this little
micro hemorrhage puts me atgreat risk of dementia.
And and this was the good newsbecause you know, as I've talked
(17:58):
about, when you do a screeningtest and again this wasn't a
screening test you want toreassure yourself that there's
no evidence of early disease.
So I took this as anopportunity to say well, I got
the scan and obviously I gotthis abnormality we're not happy
about.
But let's take a look at thebrain more generally.
(18:20):
And what do you think of thebrain?
And he said look, it looksgreat.
There's no evidence of thinningor shrinkage or all the things
that you think about when youlook at an older person's brain
as indicators that maybe there'searly dementia.
And none of that was there.
So that was very reassuring.
(18:41):
And then we got into adiscussion about the level of
blood pressure that would beideal to reduce our risk of
stroke.
And he said well, if you keepit under 135 over 85, that's
really good.
But I said well, myunderstanding of the literature
is that if you can get it downbelow 120, that's even better.
(19:05):
And he said yeah, you're right,that's true.
But for most people, if you tryto lower the blood pressure
that low people will get dizzy.
So although statisticallythat's what you want to do, for
most people, as they get older,their brain needs a higher blood
pressure to keep all the bloodflowing in the brain.
(19:27):
Now, for me, getting below 120doesn't cause symptoms.
Of course, if it drops below 90, I do start to feel a little
dizzy.
So that made me feel good thatI guess my brain was doing well,
that it could tolerate asomewhat lower blood pressure.
So I walked into my neurologyvisit with a lot of fear, a lot
(19:49):
of concern about what this meansand my future, and for me I was
very fortunate that I left theneurology office feeling even
better about my brain thanbefore, because it was clear I
didn't have a brain tumor andnot likely to get one in the
next year or two because theseare often slow growing and that
(20:13):
the brain looked good andhealthy and no early signs that
maybe something's going on Allright.
So now I'm left with the mostlikely diagnosis that I in fact
have that benign positionalvertigo, even though usually
it's gone within days, weeks orup to a month.
Yes, after two months I didhave continuing symptoms, but
(20:38):
the good news is actually,between the two months and three
months it finally did prettymuch go away.
But you have to ask yourself thequestion.
I asked myself the question,but I don't want the vertigo to
come back.
What's the likelihood it will,and this is true for all sorts
of illnesses.
(20:58):
You want to know is it going tocome back?
Well, there's about a 25% rateof reoccurrence in the next year
.
So of course I asked thequestion can I reduce that risk?
So went to the literature and itappears from some studies that
vitamin D can reduce the risk.
Oh, great, so let's takevitamin D supplements.
(21:21):
But and this is why it's soimportant not to get carried
away with studies withoutreading them more carefully the
only time vitamin D helped forthese vertigo patients was if
your vitamin D level was alreadylow.
Well, that kind of makes sense.
If it's low, maybe treating itcould make it better.
(21:42):
Well, in my case, my vitamin Dlevel is just fine, so there's
no reason for me to take vitaminD, and some reasons we can talk
about it at next podcast, aboutwhy you don't necessarily just
want to take vitamin D,especially at higher doses, for
no reason.
And it turns out, if you havethis vertigo problem, there's
(22:05):
some really good physicaltherapy they can do.
Basically, it has to do withlying you down and turning your
head in certain positions, andthe vertigo can be resolved
within one session, maybe twosessions, but generally you can
really do a good job by doingthat, and so, even though I
(22:27):
don't know how to prevent it, Inow know if one of these
episodes pops up, I'm going backto the physical therapist.
Now this is a special physicaltherapist that focuses on
balance and dizziness, that Iknow what to do for the future.
And here's something that Ididn't realize is possible.
Maybe I don't, you know, I havea referral to the physical
(22:50):
therapist and those are good fora year, but I'm like, well,
what if I get this episode again18 months from now?
And what the physical therapistsaid to me is what you can do
on a yearly basis is ask yourdoctor just to put in a referral
, even though you don't need it,and that referral will be good
(23:13):
for the next year.
So if anything happens, I don'thave to reach out to my primary
care doctor, wait for them tomake the referral, the referral,
get to the physical therapyplace.
It can be like a standing orderand it will always be available
to me.
So if you have recurrentepisodes of back pain or
(23:36):
something else, this could besomething you just keep in place
so you're ready if a problemoccurs.
All right, let's sum things up.
This was an episode I wanted toshare with you because there
were lessons learned, lessonslearned by me and maybe lessons
that would be helpful for you.
(23:56):
First lesson even a test thatyou need, in this case the MRI
scan, which was clearlyindicated after several months
of symptoms not going away.
Even a test that's needed cansend you down an anxiety-ridden
rabbit hole, because it may comeup with something that doesn't
(24:20):
explain what's going on butcould lead to worry.
Second lesson when choosing forme when to see the neurologist
and whether to go to the supersuper specialist or somebody who
is more available, sometimesquick answers beats the super
super specialist answer.
(24:42):
So waiting six months wouldhave led to a lot of anxiety, a
lot of uneasiness, and in theend I would have learned from
the super specialists that, yeah, it's not something to worry
about.
So for me, getting that answerwithin a week was really
important.
Now, I could have always seen asecond neurologist from a
(25:07):
tertiary care center after that.
So for me and this is somethingto keep in mind maybe you just
want to find somebody that'srelatively available and then
see how that goes, and if youstill have uncertainties, by all
means then go to the next tierof specialist.
(25:27):
But for me that quick approach,which gave me an excellent set
of answers, really was wonderful, rather than waiting six months
.
So I hope you don't get aworrisome diagnosis as we age.
Probably we will at some point,but perhaps my journey might be
(25:49):
helpful for you and give yousome ideas about how you might
address it.
Let me know your story ifsomething like this has happened
, and maybe I can share thatwith our listeners and help all
of us.
Thanks so much for listening toLive Long and Well with Dr
(26:12):
Bobby.
If you liked this episode,please provide a review on Apple
or Spotify or wherever youlisten.
If you want to continue thisjourney or want to receive my
newsletter on practical andscientific ways to improve your
health and longevity, pleasevisit me at
drbobbilivelongandwellcom.
(26:35):
That's Dr.
As in D-R Bobbylivelongandwellcom.
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