I DON'T KNOW HIS NAME, BUT HIS FACE RINGS A BELL

You are at a party.  You are introduced to the wife of an acquaintance.  You have met her before over the last 10 years, at least 3 times.  She shakes your hand as if she has never seen you.  As she walks away, you are likely to think, “She is so rude!  She knows she has met me before.”  Maybe you say it out loud, and maybe your friends agree with you, having experienced the same thing with her as well.

But there is another explanation.  She really does not remember meeting you.  She has prosopagnosia, also known as facial blindness.  Once thought to be very rare, it appears to be more common than we thought.  When people with facial blindness figure out what they have it, they are often relieved.  They finally have an explanation for why they cannot remember people and faces.  It is not because they don’t care about people, don’t have the intelligence to remember or don’t really try to remember faces.  It is just not a tool in their toolshed.  Like most things, there is a spectrum.  Some people say they never forget a face all the way to those that cannot recognize the face of their mother and father.

How do I know about this?  I happen to have a touch of it.  I didn’t know that facial blindness existed until recently.  I used to wonder WHAT was wrong with me.  I felt guilty about it for years.  I felt like there must be something wrong with me as a person that kept me from remembering people.  I am able to remember my kids, my husband, my siblings, and a few really close friends.  Beyond that, it is hit or miss.  

My particular form of prosopagnosia includes inability to recognize faces AND names.  For example, every year I dreaded our family reunion and the inevitable awkwardness of seeing cousins and aunts and uncles and having NO idea what their names were.  I might manage to remember how some of them were related to each other, at least group them in families, but that took a few years.  Unfortunately, since I only see most of them once a year, if I see them anywhere other than the Blazek family reunion, again, it’s a crapshoot if I will be able to figure out that it is a relative, and it is very unlikely that I will be able to pull up the name.  I have started seeing my cousins more often and that has made a big difference.

So how has this affected my life?  Is it a disability?  In a way it is.  I remember being with a group of people who were discussing a girl that was SUCH a snob because she always acted like she didn’t know them.  Gulp.  That could totally be me.  Actually it was me.   I distinctly remember someone telling me in a very rude voice, “You know, we have met several times”.  Please let a hole open up in the Earth and swallow me.   After that, I was very careful to be neutral when meeting new (?)  people in case, um, they actually weren’t new.  I have gotten pretty good at this.  I will either say “Nice to see you”, “How are you?” or some other phrase that fits both new and old peeps.  It’s a skill, like any other.

After my children were diagnosed with Asperger’s Syndrome, I learned about facial blindness.  I was actually quite relieved.  I knew I wasn’t just a cad, I actually have a disability.  Knowledge=Power.  Now that I know this, I can without embarrassment, explain it to people.  I have a name for it.  I don’t have to say “I’m a complete jerk so I won’t remember your face or name if I see you again.”   Instead I say, “I have facial blindness, so if I see you again and act like I don’t know you, please come up to me and tell me your name and how we know each other”.  I know that sounds weird, but it has really worked for me.  I was just at a wedding and a very nice person whom I truly really like approached me.  I was thinking, crap, she looks like someone I might know.  She came up and introduced herself and reminded me that how we knew each other.  Once she did that, I knew EXACTLY who she was.  Even though I have met her kids many times, I would not recognize them and have no idea what their names are.  I did know their names during my conversation with her, because she reminded me.  But I’ve forgotten those names.   I can pull her name up at the moment, but it will be gone by next month, unless I see her before then.

Another example: I introduced myself to a doctor at the hospital where I work.  He told me we had met before a few times.  He said it in a really nice way.  I explained the facial blindness and that I might just do it again 6 months from now (which I did, dammit).  He was actually very amused by the whole concept.  So is it a disability?  It can be, and like most disabilities, it is possible to figure out coping mechanisms.

I have developed a surprisingly positive perspective on this “disability”.  In my case, now that I know what it is, facial blindness really suits my life and my career.  I am a primary care physician in a large town, but in a neighborhood that acts like a small town.  Many of my patients are neighbors, related to each other, friends with each other, whose kids go to school together.  Just going to the grocery store or the local café, I may see a handful of patients.  

Most doctors would have a hard time truly separating out their life as a doctor from their life as a neighbor and friend.  This is not a problem for me.  I love my patients and spend more time with them than most doctors.  I am interested in what makes them tick, what makes them happy and sad.  When I see them out in the community, I really have no idea who they are unless they tell me.  Even if they tell me they are a patient, I have no idea what is going on with them medically.  Without opening their chart and reading what is in there, they are just Joe Patient.  Once I do see them back in the office, and open their chart, the whole story comes back together and I know exactly who they are, what problems affect their lives. 

I don’t know how to explain it except to say that my patients don’t have to worry about my gossiping about them.  If I am lucky enough to recognize them, I will likely not know if the person they are with is spouse or lover, even if the other person is my patient.  By being unable to recognize them in the community, I ensure full patient confidentiality without even having to make an effort. It’s an unexpected “benefit” of having a social communication disability, but it’s one that in this case works to my advantage…and my patients’ advantage.

KILLER SNOWBALLS

You probably know there is an obesity epidemic in this country. You likely also know that obesity can lead to heart disease, stroke, diabetes and lots of other potentially preventable diseases. Do you know why our country is so overweight and out of shape?

There are several reason. For one, our foods have changed. Most of the food we consumed is highly processed and barren of the good nutrients we used to get. The meat we eat is higher in saturated fat. The convenience foods that allow us to work 50 hour weeks are hell on our bodies.

That brings up the next issue: work. I rarely see people who are able to balance work and life. Usually the WORK side of the see-saw sends poor LIFE flying off the other end into the sandbox. Long hours, no time for exercise, eating the convenience foods, and add high stress with no release, and you have yourself a recipe for poor health. The average person who started off healthy and happy ends up with a progressively larger waistline, higher insulin levels, less energy, decreased flexibility, and a worse quality of life. I see this as a snowball effect that happens quite insidiously.

It begins with a little weight gain from overeating and not exercising. Then add a little sleep apnea. There may be no symptoms other than daytime fatigue and maybe some snoring, but every night there are repeated bursts of epinephrine and cortisol. This causes a nice round middle and an increase in weight. Now the sleep apnea is worse and the fatigue is worse, the person is just fighting to make it through the day, never mind trying to eat a healthy diet (which takes planning and energy) or hitting the gym on the way home.

By the time I see this poor soul, who has been working so hard to get ahead in life, the snowball has gotten so big and gained so much momentum that it seems there is no way to turn it around. The patient asks me why they feel so bad, and why they can't lose weight. Even if you embark on a wonderful diet of whole foods and start working with a personal trainer, it still seems hopeless. At this point, the sleep apnea needs to be treated for the snowball to go back up the hill.

This is where the conversation becomes serious. "There is no way I can wear a mask to bed." "I am claustrophobic." At this point, like Lucy, I have some splainin' to do. I give the example of a close friend's husband who was full-on a Frosty the Snowman. He finally got his sleep apnea treated and now, a few years later, he has lost 100 pounds and just ran his first Marathon. He has lost so much weight that he no longer needs his CPAP to treat his sleep apnea. (This is why some people call it Fat Apnea- it tends to go away when you lose weight.)

So if you finally get off your hamster wheel, and wonder how to become the happy, healthy person you once were, please see your doctor and be open to evaluation for sleep apnea. It can cause uncontrolled hypertension, sudden cardiac death and diabetes, among other things. And it is relatively easy to treat. If you don't believe me, just ask Frosty.