And they have many many causes. And to order the one and only test that can definitely detect this imbalance in the blood, it says that doctors must suspect an acid base disorder, which is hard since most of the symptoms and signs are nonspecific….like suddenly losing your mind and not knowing it and not being able to tell anyone because of mental confusion and tendency to be silent and withdraw, or like massive distress which is not a normal part of the normal spectrum of emotions but you cannot convince any one of this and your are dead tired [hence the stooped posture] and do not know why, etc…
Hence, no one , in practice orders an arterial blood gas test for ambulatory patients anymore, even though it can clearly lead to depression, euphoria, irritability, combativeness [quiet, mixed, wild – locomotor and mood change subtypes] of delirium [mental confusion] and/or dementia [long lasting mental confusion eventually [years, decades] leading to a slow agonizing death.
And still no one orders an arterial blood gas test because 1] detecting mental confusion and mood changes is hard to name yet easy to detect, as in- something bad and weird is going on with Paula]. and because 2] primary care doctors, nurses, speech therapists, and other health professionals ignore and possibly ” forget” that persistent, non corrected acid base happens in ambulatory patients [patients who can walk] and cause disturbance to the brain , thus causing mental confusion with changes to mood and locomotor activity. because 3] the mental health field has convinced all doctors including themselves that these persistent changes to mood, motor activity, cognition, and vital signs [not considered to be relevant to mental changes say the doctors-it is something separate…even though all textbooks say very clearly that mental confusion and distress [read mood change] and poisoning [read euphoria and mania] and even asphyxiation [again poisoning and inner suffocation] can be caused by the very common occurrence of acid base imbalance in the blood. and because no one would know what they should do, should an acid base problem of the blood be shown by an arterial blood gas test in an ambulatory [walking about patient with locomotor walking about changes-ie. not moving or saying much, pacing silently, moving and talking too fast- all visibly abnormal locomotor behaviours]..
The motor changes of acid base disorders of the blood and of delirium [same] and of dementia [often same] in walking about patients are obvious to all , but simply identified as ” not due to a medical condition” mostly because the obvious medical conditions has not been sufficiently explored AND because of the magic trick of deflecting attention by naming it with entirely different mostly descriptive words or jargon.
So “mood disorder” even though “mood” tells us nothing. Persistent mood change tells us nothing. And keeps us ignoring many possible illnesses or injuries that the patient is not aware of which may be causing said persistent “mood” change.
This is what happened to Paula, the most likely thing that happened to her is that she suffered some neural/motor injury which made motor pulmonary ventilation [the motor act of breathing] harder during and after an attack of upper respiratory obstruction and Paula was not able to defend her blood against further derangement of the acid base of the blood and no one understood this even though it is really a classic textbook case if you have looked at her respiratory rate which is completely broken and unable to respond to certain respiratory challenges or exposures.
The real puzzle is why Paula still has broken breathing [no upper respiratory obstruction or exposure mind you, and has healed and regained her baseline highly functional mental status even though it took 10 years to slowly get better and better.
No one understands.
No one even knows, [because no one looks at the motor act of breathing unless you have a deteriorating neuromuscular disease and are dying].
So Paula suffered a quiet really unpleasant, distressing delirium [since she recovered and can tell us, we now know it is not a dementia]. Understand, we seem to know nothing unless she tells us, which makes mental confusion difficult to diagnose because Paula will not be able to tell us and makes acid base problems difficult to diagnose because the blood cannot tell us either.
What a dilemma for doctors, but not psychiatrists, because they simply call it something else less scary than a persistent delirium or potentially reversible dementia and acid base problem of the blood [which is apparently very common] so they do not have to look back at their first year medical books or consult with other doctors, none of which will know about ambulatory patients walking about feeling horrible [pH issues of the blood do not feel good] with mood changes because the mental health doctor’s sold everyone a bill of goods because they faint at the mention of blood.
but I digress…..to be continued.
to be continued.