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Tuesday, December 10, 2019

dx: Parkinson's?

https://www.amazon.com/Parkinsons-Primer-Indispensable-Patients-Families-ebook/dp/B06XBT8KKH/ref=pd_ybh_a_1?_encoding=UTF8&psc=1&refRID=0S39J1GJ76CF12BB47PT
Chapter 1

Diagnosis

Symptoms


PARKINSON’S CREPT UP on me. The early symptoms of the disease were so subtle and progressed so slowly that it was remarkably easy for me to dismiss them as signs of advancing age.

I turned 60 in 2004. I felt healthy. Thanks to successful surgery, prostate cancer—the only serious medical problem I had encountered in my adult life—was four years behind me. I looked forward to completing my career at the law firm in Washington, DC, where I had practiced law since 1971. I also looked forward to retirement years that would give me more time to devote to my wife and family and to the travel, writing, photography, and other hobbies that I had largely neglected while practicing law.

True, in recent years my handwriting—which had never been good—had deteriorated significantly. I often could not read my own notes. I had greater difficulty with a keyboard. My hands and arms ached after only a few minutes of typing, and my typing errors mounted. I thought I might have carpal tunnel syndrome, but nothing more serious than that.

Oh, yes, there was also that nettlesome tremor in my right arm. It was particularly noticeable when I went outside in the morning to collect our daily newspaper. The tremor, I thought, was probably just a symptom of aging. I blew it off. I told myself that my father (who lived until his 90s) also had a very minor tremor in one of his hands in his later years, and so did one of my brothers (15 months younger than I). Nothing serious, I told myself.

One other thing. I was a little unsteady when I went downstairs to have breakfast each morning. No big deal. I didn’t fall. I didn’t even come close to falling. Nothing I couldn’t accommodate by holding on to the railing…


John M. Vine. A Parkinson's Primer: An Indispensable Guide to Parkinson's Disease for Patients and Their Families. Paul Dry Books. Kindle Edition.
Yeah. Let me paraphrase for the sake of comparison.
Chapter 1.alt

Diagnosis

Symptoms


PARKINSON’S HAS PERHAPS CREPT UP on me. The early symptoms of the disease were so subtle and progressed so slowly that it was remarkably easy for me to dismiss them as signs of advancing age.

I turned 70 in 2016. I felt healthy. Thanks to successful 2015 Calypso radiation treatment, prostate cancer—the most serious medical problem I had encountered in my adult life 'til then—was a year behind me. I looked forward to getting back on the basketball court and continuing my blogging. I also looked forward to my “retirement” years that would give me more time to devote to my wife and family and to the pleasure reading, travel, photography, and other hobbies that I had often neglected during my meandering, random-walk career.

But in 2017 I started getting increasingly “jittery,” and my handwriting—which had never been good—began deteriorating. I often could not read my own penned notes. I had greater difficulty with a keyboard (and my 12-string guitar). My hands and arms ached after only a few minutes of typing, and my typing errors mounted. I thought I might have carpal tunnel syndrome or arthritis (like both of my late parents before me, but nothing more serious than that.

Oh, yes, there was also that increasingly nettlesome tremor in my left hand. It was particularly noticeable in the evenings. The tremor, I thought, was probably just a symptom of aging (and the unrelenting stress of my younger daughter’s cancer illness). I blew it off. For one thing, I told myself that my father (who lived until his 90s) also had a very minor tremor in one of his hands in his later years. Nothing serious, I told myself.

One other thing. I was a little unsteady when I went downstairs. No big deal. I didn’t fall. I didn’t even come close to falling. Nothing I couldn’t accommodate by holding on to the railing…


Bobby Gladd, KHIT.org
Swell. Whatever. Deal with it.

John Vine again:
In Appendix 1, I address some of the myths and misconceptions about Parkinson’s disease. For example, Parkinson’s is sometimes referred to as a “movement disorder,” and Parkinson’s specialists are sometimes called “movement disorders specialists.” However, Parkinson’s has numerous nonmovement symptoms, and I have tried, throughout the book, to clear up any confusion caused by references to movement symptoms. 

Similarly, Parkinson’s is sometimes referred to as a “disorder of the brain” despite mounting evidence that it is not exclusively a brain disease. Because I am concerned that “brain disorder” terminology could also be confusing, I have tried throughout the book to make clear that Parkinson’s might not be exclusively a brain disease. 

I do not refer to people with Parkinson’s as “victims” as some commentators do. Calling people “victims” implies that they have no control over their condition. In fact, people with Parkinson’s can influence the course of the disease. I prefer to use the term “patients.” Victims commiserate about their misfortunes. Patients get treatment. 

Likewise, I do not use the term “caregiver” to refer to the people who care for Parkinson’s patients. “Caregiver” implies that Parkinson’s patients are merely “care receivers.” This is far from the truth. Most Parkinson’s patients are largely responsible for their own care, especially in the years immediately following their diagnosis. Accordingly, I refer to the people who care for Parkinson’s patients as the patients’ “partners.” [Kindle location 54]
Stay tuned. I have much to learn. (What's new?) Time to schedule with my KP Primary. I need to get a cardiology referral anyway for a post-SAVR surveillance Echo px.
Most Parkinson’s patients are largely responsible for their own care, especially in the years immediately following their diagnosis.
Bring it, then.

I first started wondering about my symptoms while working on blog posts earlier this year focused on "science communication" issues. Saw an interview with actor Alan Alda, wherein he spoke of his own experience with PD. I recall thinking "yeah, that sounds familiar."

We shall see.

DEC 17TH UPDATE

Finished this excellent book. Five stars. I feel fortified. Saw my Primary today. She got me a Neurology consult for Thursday. To be continued...

OK, BACK TO WORK

From my latest (paywalled) snailmail issue of Science Magazine:
Algorithms on regulatory lockdown in medicine
Prioritize risk monitoring to address the “update problem”


Summary
As use of artificial intelligence and machine learning (AI/ML) in medicine continues to grow, regulators face a fundamental problem: After evaluating a medical AI/ML technology and deeming it safe and effective, should the regulator limit its authorization to market only the version of the algorithm that was submitted, or permit marketing of an algorithm that can learn and adapt to new conditions? For drugs and ordinary medical devices, this problem typically does not arise. But it is this capability to continuously evolve that underlies much of the potential benefit of AI/ML. We address this “update problem” and the treatment of “locked” versus “adaptive” algorithms by building on two proposals suggested earlier this year by one prominent regulatory body, the U.S. Food and Drug Administration (FDA) (1, 2), which may play an influential role in how other countries shape their associated regulatory architecture. The emphasis of regulators needs to be on whether AI/ML is overall reliable as applied to new data and on treating similar patients similarly. We describe several features that are specific to and ubiquitous in AI/ML systems and are closely tied to their reliability. To manage the risks associated with these features, regulators should focus particularly on continuous monitoring and risk assessment, and less on articulating ex-ante plans for future algorithm changes.
I have an irascible (Quixotic?) pick with the cavalier use of the word "algorithm" apropos of AI/ML. Maybe that's just the pedantic bias of an old-school out-to-pasture former 3GL/4GL pre-OOP RDBMS programmer and SAS analyst (large PDF). We need a term encompassing something in between the "heuristic" and the "algorithmic." Fundamentally, algorithms are "black boxes." They don't "learn" anything. Data in, replicable results reflexively out. Lather, Rinse, Repeat. Empirical science 101. There's obviously something else at work here beyond the Boolean.

To this point, see Science Magazine's "Artificial intelligence faces reprodicibility crisis."
"You never step in the same training data stream twice." --BobbyG

OK, but, contrarily, to the extent you in fact can and do, and you get differing results per iterative (and/or recursive) immersion, do you have a "reproducibility crisis," or "learning?" (The "definition of insanity" joke comes to mind.) If it's the latter ("learning"), which data stream dive gets you to durably actionable "truth?" (Keyword actionable.) How will you know? How will you know when to stop "training?"

BTW, I jokingly call myself a "life-long unlearner."

#COVERINGCLIMATENOW ERRATUM


POTUS will not be amused.

#AI UPDATE
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More to come...

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