Your First 90 Days

Month 1 — Someone takes the whole picture

Your first visit is a conversation, not an examination. Its job is to take your history properly and to work out which of your prior records actually matter — imaging, previous evaluations, medication history, whatever exists from other specialists.

Before the next visit, any missing records are requested so they can be in hand and reviewed as part of your examination — not chased down afterward, and not skimmed while you sit there.

The examination itself is a full neurological and physical assessment, and it is where your first plan is built. Built from your history, records, examination, and baseline rather than from a short symptom summary.

Your baseline for cognition, behavior, and symptoms is established in these same early weeks. It happens early for a reason: a baseline you didn’t take is one you can never go back and get.

Your evaluation, examination and any treatment are medical care, billed to your insurance in the usual way. The program described below is separate from that care.

What gets measured — and what doesn’t

For most people this is the first time any of it has been measured. Not estimated. Not asked about. Measured.

Which of these come first, and whether anything else is added, depends on your picture. Someone with an active movement disorder is assessed differently from someone with no diagnosis at all.

Testing gets narrowed the same way your plan does: measure what is most likely to change a decision, first. Where insurance-covered testing answers the question, that is what we use — we don’t open with expensive cash-pay panels. Anything beyond that has to earn its place by changing what we would actually do, not by being new.

Notice what isn’t on that list. No biological-age test. No whole-body MRI. No sixty-marker panel. No supplement stack.

Each of those was a decision, and each one costs us money to leave out. We measure things that are worth measuring and that can actually change. Anything that produces an interesting number you can do nothing about is a bill, not a finding.

Ten things become two

By the end of month one there are usually eight or ten things that could reasonably be worked on. Every one of them is defensible. That is exactly the problem — a list of ten defensible things is how nothing happens.

So the list gets cut to two: one to start now, one to follow it. Alongside them sit two or three smaller changes that are low enough effort to simply begin.

Which two is a judgment, and it is the part that requires a neurologist rather than a coach or an algorithm. It depends on which gap is largest, which one can actually move in the time available, and which one has to come first because it changes how the others behave. Sleep before exercise, when sleep is the reason the exercise won’t hold. Hearing checked before anyone reads too much into a memory test.

The order is the decision. The same two changes in the wrong order is a wasted quarter.

You will be told the reasoning. Not “we’ve built you a personalised plan” — the actual reason yours is in this order and not another one, and the reason the other eight are waiting.

Two examples of the same decision, reasoned the same way, for two very different people. Nine things could reasonably have been worked on in one case, eight in the other. Two were chosen in each — and whatever was set aside was set aside for a reason. That reasoning is the part you’re paying for.

“We’re starting with sleep because it’s your largest measured gap, and because untreated sleep disruption makes everything else harder to judge — including your cognitive testing and how you respond to exercise. The gut work comes second, before we touch protein timing, because how fast things move through affects how medication is absorbed. And we’re not starting resistance training yet — not because it doesn’t matter, but because your blood pressure drop on standing needs sorting first.”

Month 2 — Where most programs quietly end

A plan you don’t execute is worth nothing, so month two is about execution.

Someone from the team works through the protocol with you. Not handing over a document — going through what it means on a Tuesday. What you eat and when. What happens the week you travel. What to do when the thing we asked for collides with the rest of your life.

And we find out what got in the way. Because something will.

That is not the plan failing. It is information the plan needs. Cost, side effects, logistics, not understanding what was asked, or simply not wanting to — each one leads somewhere different. Most programs record that you didn’t do it. We record why, and change the approach instead of repeating the instruction.

Your fitness and body composition are usually measured this month as well — strength, endurance, muscle against fat, and where you are compared with where you could reasonably be. Sometimes later, if something else takes priority first.

Then your plan is revised. Not re-explained. Revised, against what actually happened.

Month 3 — Your plan changes because of what you did

By month three there is something to look at that did not exist before: your own response.

The protocol work continues and gets more specific as the picture fills in — body composition against the nutrition work, sleep analysis where that is the live thread, whichever direction your first weeks pointed. It is not the same third month for everyone, and it is not meant to be.

And the plan is revised again.

By the end of month three your plan will have been rebuilt several times, each time against something that actually happened to you rather than against a template. That is the whole method. It does not stop at day 90 — it is what year two and year five look like too.