December 22, 2014

Happy Holidays and See You Next Year (Which I Intend To Live as Though It Were My Last)

I had intended a quick and easy post for today -- a "been there, done that" to those now planning travel to Cuba. The post would have included mostly photos -- with minimal narrative -- of my terrific (but unlawful) trip to Cuba in 2000 with my Brit pal Terry.

But after spending an hour struggling unsuccessfully with my Picasa photo library, I gave up. More than that, I decided to spend the rest of this holiday season spending quality time with family and friends... not with my computer.

December 19, 2014

Elderly at a Much Greater Risk of Flu This Year

During most seasons, it is estimated that 90% of seasonal flu-related deaths and between 50 and 60% of seasonal flu-related hospitalizations in the US occur in people 65 years and older. Influenza can be a very serious disease for the elderly.This is because human immune defenses become weaker with age. So influenza can be a very serious disease for those of us 65 and older.

This year's flu season got off to an early start and predictions are that it will prove to be a big flu season, 

This Year’s Flu Vaccine Is Seriously Defective
Several viruses circulate during any given flu season. And flu viruses are always changing. Every three years we have a problem with the match between the vaccine and the strains in the current year’s virus.

The CDC announced recently that this year’s flu vaccine is missing a key strain, one that accounts for 48% of what’s circulating. That strain was discovered in March 2014, but the vaccine strains for the northern hemisphere, including the U.S., had been decided a month earlier. (The southern hemisphere vaccine will include this drain.)

Unfortunately, this strain that the vaccine missedm, historically has produced more serious illness. That means more will get complications, such as pneumonia, and require hospitalization and intensive care. And, unpredictably, building more deaths from the flu – – a toll that ranges widely from year to year, causing 3000 49,000 fatalities

So we face a double whammy—a rogue flu strain and it’s of the more severe type.

The Flu Vaccines Have Never Worked Very Effectively on the Elderly
According to the CDC, the flu vaccine reduces the odds of getting the flu by 70% to 90%. That statistic only applies to healthy adults. The efficacy of the vaccine on the elderly is much lower.

Some claim the government has buried a definitive study done a decade ago  because the science came down on the wrong side. It found that after decades and  billions of dollars spent promoting flu shots for the elderly, the mass vaccination program did not result in saving lives. In fact the death rate among the elderly increased substantially. Check out this CBS News video.

What Can We Do To Protect Ourselves?
Most authorities still recommend that you get your flu shot.  People who get the shot have better protection even where there is a mismatch. They often get a less severe case of the flu and they’re less likely to spread the flu to someone else.

December 18, 2014

My New Docs on My Meds: Blood Pressure, Yes. Cholesterol, No.

"Less is more" is one of my mantras. So is "anything worth doing is worth overdoing." I've spent much of my life bouncing back and forth between these mantras.

Last year, "less is more" drove me to ditch both my blood pressure (BP) and cholesterol (statins) meds. In both cases, I seized upon new recommendations from some medical authorities that the +75 elderly without coronary issues could stop taking these medications.

During the past month, I've talked with more doctors than I'd normally see in a year. I wanted a new internist who was also a geriatrician. I've also been consulting a variety of doctors about my recent dual blood pressure problem -- spikes that carry stroke risk, and sudden drops that bring the risk of falling.  

December 17, 2014

A Parkinson's Encyclopedia: News, Symptoms, Treatments, Diagnosis, Biochemistry, Causes, Prevalence, People with, Books, Organizations, etc.

My online rambles brought me to a website that includes everything you always wanted to know about PD but were afraid to ask.
For instance, who knew that the Amish in the American northeast have the second highest incidence of PD in the world, after rural illiterate Egyptians along the Nile River? Or that Albanians have the highest per capita incidence of PD, and Ethiopians the lowest? Or that country dwellers, redheads, welders and Caucasians all carry clearly increased risk of developing the disease?

The are also synopses -- with links to detail -- about PD symptoms, treatments, prevalence, diagnosis, causes (biochemical, toxic, genetic), and history. There's also a list of famous people with PD, strange facts about the disease, and lists of PD books and organizations.

December 16, 2014

Parkinson's Disease and Enhanced Creativity

A recent story from the Parkinson’s Disease Foundation has this headline: "Dopaminergic Therapy Spurs Creativity in People with Parkinson's Disease." The standard treatment for Parkinson's is levodopa, which boosts brain levels of the neurotransmitter dopamine, the depletion of which causes the symptoms of the disease.

The news comes from Tel Aviv University in Israel, where researchers conducted creativity analyses on 27 people with Parkinson’s taking dopamine, and a control group of 27 healthy individuals not taking dopamine therapy – matched with the first group by age and education.

"It began with my observation that Parkinson's patients have a special interest in art and have creative hobbies incompatible with their physical limitations," said Rivka Inzelberg, Tel Aviv University professor and study leader.

Not a New Connection
Inzelberg’s observations weren’t new. Through the years, anecdotal evidence has accumulated about Parkinsonians on dopamine therapy suddenly developing sudden bursts of creativity, like writing poetry.

But a key question has lingered about the dopamine-creativity connection. Is the new inventiveness a direct result of higher dopamine levels in the brain? Or is it an offshoot of the impulse control disorders (ICDs) frequently linked to PD medication, especially dopamine agonists? Those aberrant ICDs among Parkinsonians manifest most often as hypersexuality and gambling compulsions.

December 12, 2014

Reflections on the Five-Year Age Difference Between My Brother and Me

A few weeks ago when Buffalo was hit by a storm that dropped almost four feet of snow on the city, I called my brother Roger who still lives in our hometown of Ithaca, NY. I wanted to know how he was faring in the blizzard, forgetting that what hits Buffalo is often isolated "lake effect" snow. Cleveland, Buffalo, Niagara Falls, and other cities on the shores of the Great Lakes can be socked with massive snowfalls, while just a few miles away there is no snow at all.

That was the case this time. It hadn't snowed in Ithaca, but I was glad I called. I love my brother, but neither of us is very good at keeping in touch, by email or telephone. We had a nice chat when I called this time.

Roger is five years my junior. Carol, our deceased sister, was a year and a half younger than Roger. The three of us grew up in a rather small three-bedroom half-house. The Slatterly family owned the building and lived in the left side of the house. The Schappis rented the other half on the right.

Here's a photo taken on a visit to Ithaca recently:

215 (or was it 217?) Prospect St.
Chatting with Roger on the phone, I was reminded that the five-year age gap between us was a big deal for the first 20 years or so. Then that difference faded into insignificance. Now, it's becoming significant again.

December 11, 2014

Pfizer Offers Settlement to Parkinsonians Who Developed Sex and Gambling Compulsions

Earlier this week, Pfizer Australia confirmed offering a settlement to 150 people who claim to have developed addictions – especially to gambling and sex – after taking Cabaser (generic cabergoline), a drug for Parkinson’s disease (PD). 

Those individuals – who brought their class action suit in 2008 -- say they were not warned about the possible addictive side effects, for years a connection well-known in the medical literature. The Australian federal court is scheduled to rule on the case next year.

Patients said they’d never had compulsive issues before taking the drug, which is designed to enhance the availability of dopamine, sometimes thought of as a “feel-good” agent in the brain. An excess of dopamine is associated with risk-taking behavior.

Some of the people involved in the suit claim they became gambling addicts and lost hundreds of thousands of dollars after taking the drug. Others developed compulsive sexual or shopping activities. The unusual behaviors typically ceased after patients stopped taking the drug. Of course, discontinuing the drug brought a return of PD’s troubling symptoms... a difficult cycle.

For Years, an Acknowledged Link 
Drug companies and doctors have known for over a decade about the causative link between PD drugs and compulsive behaviors. Interestingly, in 2005 the Parkinson’s Disease Foundation (PDF) posted an article online -- "Gambling, Sex, and…Parkinson's Disease?" -- that suggested gambling and sexual addictions might even be symptoms of the disease itself, not simply a consequence of medications. The PDF also noted that PD meds could exacerbate the problems. Here’s how that article began:
Add impulse-control disorders such as pathological gambling and hypersexuality to the list of possible non-motor problems that can occur in individuals with Parkinson's disease (PD). Recent studies suggest that seriously disabling impulsive behaviors occur in three to five percent of PD patients, affecting individuals at all stages of the disease. The exact prevalence of such disturbances in PD is not entirely clear since the behaviors are often performed in secret, or because the association with PD seems improbable and is therefore never reported at doctor visits.

To further explore the connection between the PD drugs and these compulsive behaviors, researchers at the Institute for Safe Medication Practices in Alexandria, Virginia, analyzed 2.7 million serious drug side effects reported between 2003 and 2012 in the U.S. and 21 other countries. That's an impressive sample.

December 10, 2014

Regular Stress for Caregivers + Holiday Anxieties = Potential Disaster

My internet explorations recently led me to the Minding Our Elders blog by Carol Bradley Bursack, a writer who also contributes to the online journal HealthCentral.

The particular piece I found concerned caregiving – a role that fate has spared me. My mother died of a heart attack at age 73. My father died at age 83, reading a book in a backyard lawn chair after playing a round of golf.  Over the years, I've often commented when talking with friends about the final exit, that it would be great to leave the way my father did, but perhaps a few years later than 83. Well, I got my wish as far as age goes, but I don't have a lawn or a lawn chair. I'll settle for the rocking chair on my back porch, overlooking the garden.

The fact that I’ve never had to assume the role of caregiver to a parent doesn’t mean my nearest and dearest will travel that same path. Yes, I’m feeling pretty good for an 85-year-old with Parkinson’s and prostate cancer… and a few other issues. I hope, one way or another, to spare my families the anguish of dealing with a demented father.

From comments and emails I’ve received, I know there are caregivers among the readers here. This past year I have also served as a guest blogger for Aging Care, a website designed to connect and support caregivers.

I also know that caregiving is hugely stressful, a constant challenge exacerbated by the normal anxieties we all feel at holiday time.

So, I offer this piece from Carol especially to them… and to all the others who may eventually find themselves in caregiving situations. Many of Carol's observations below might also have use for anyone, anytime.

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Acceptance of Change Important in Alzheimer's Caregiving
My dad went into surgery with a smile and hope. He came out with severe dementia. Something unexplainable at the time had happened and Dad became a statistic - one of those "poor outcomes" we hear about. My head knew this tragedy was permanent, but my heart wanted my "real" dad back.

December 9, 2014

Doctor-Patient Communication and the New Technology

In the good (?) old days, the doctor I saw most frequently was my internist. I saw him most often for my physicals. (Today many authorities question the need for and cost of those physicals.) We'd spend a relaxed half hour chatting in his comfortable office before I went next door to his equally comfortable examining room. There, he'd perform a general checkup and send me off for the blood work, EKG, and other tests.

Today, my internist has shifted to a concierge practice. I'd have to pay a $1,500 annual membership fee -- in additional to all the other regular costs -- to continue this pleasant arrangement. For this and other reasons, I ended our relationship.

Now, I usually find myself talking with a doctor in an office cubicle. No desk. Just a stand for the ever-present laptop. We're together maybe 15 minutes, and there's little idle chatter.

Electronic devices are everywhere in my health care these days. I was reminded of this reality during the past weeks, as I hired a new healthcare team. I was struck by the variety of positions these doctors took toward the use of email.

Email and Texting
I'm comfortable with using email and actually prefer it to talking on the phone. And either of those communication types seems better to me than being forced to make office visits when an information exchange is really all that's required.

December 5, 2014

News Alert: Schappi Steps Down as CEO for His Medical Care, Becomes Chairman of the Board

Since I started this blog over five years ago, I’ve used the imagery of being the CEO of my healthcare to indicate my intent to be actively involved in researching  and managing my health. Recent developments have convinced me that it’s time to give up this active involvement.

In the corporate world, when the CEO steps down, s/he often remains involved as chairman of the board of directors, the team that sets the company's goals and directions. That's the job I want -- board chairman.

Many Factors Drove this Decision
  • I now have in place the two key healthcare professionals I need to manage my healthcare – the leader/internist (a geriatrician) and the neurologist who addresses the issues of an 85-year-old Parkinsonian. I have complete confidence in these two doctors, both of whom signed on just this month.
  • My earlier, more active role as CEO was doing more harm than good. After my PD diagnosis, I began regularly using the OTC supplement 5-HTP to address the three major non-motor symptoms of my disease: depression, insomnia, and constipation. I had used 5-HTP occasionally in the past with good results. This encouraged me to belive that at times I could, on my own, devise helpful treatments. But, as usual, I overdid this in a big way.
  • I was spending too much time on the computer, researching and writing for this blog. As with 5-HTP, I got carried away, spending huge chunks of each day at the keyboard in my office. In retrospect, I see I should have devoted much more time exercising and pursuing other activities I enjoy. My life fell out of balance.
  • I meddled in other aspects of my healthcare, changing and tweaking my medications. It backfired, especially as the aging process rolled along.

December 4, 2014

Stroke Risk: Coffee Reduces, Soda Elevates

I’m a coffee drinker. I enjoy it in the morning and again around 5pm after my nap.

As a result, I was pleased to see the latest news that coffee actually reduces stroke risk. That particular issue has been a worry in recent months as I’ve struggled with occasional blood pressure spikes that have driven my systolic (upper) pressure above 200… and into stroke territory. On several occasions, those soaring numbers have also driven me right into the emergency room at my local Sibley Hospital for observation.

Conducted by researchers from Cleveland Clinic's Wellness Institute and Harvard University, this most recent study also showed that increased consumption of both sugar-sweetened and low-calorie sodas was associated with greater risk of stroke, the foundation of vascular dementia.

The news – published in the American Journal of Clinical Nutrition and reported in the article "In with the Coffee, Out with the Soda" in the November 25 issue of the online journal Alzheimer’s Weekly -- is especially worrisome for regular soda drinkers. In the past, we’ve seen evidence that sugary drinks were linked to a variety of health problems, including weight gain, diabetes, high blood pressure, high cholesterol, gout and coronary artery disease. Now we can add stroke to that scary line-up.

On the other hand, drinking coffee – both high-test and decaf – was associated with lower stroke risk in this latest study. 

December 3, 2014

Six Tips to Communicate Better with Your Doctor

Just a week ago, I wrote about my fear of dementia. Estimates suggest that 50-80% of us Parkinsonians end up with some type of cognitive impairment.

And this week, I’m embarking on a new venture with a brand new team of doctors – a new geriatrician (acting as quarterback), a new neurologist, and a new end-of-life therapist. I described my enthusiasm for this new arrangement in yesterday's post.

Worries about dementia… new healthcare team…. It’s little wonder that an article published on November 30 in the online journal Dementia Today got my attention. It’s title? "Alzheimer’s and Communicating with Your Doctor."

After I read it, I realized the title really should be “Communicating with Your Doctor,” an issue of universal interest. The topic has certainly been front and center for me during the past few weeks.

During a recent initial interview with a potential new neurologist, she won me over when she asked me to stop babbling about tangential issues and just answer her questions. She reminded me of my daughter and my late wife: both assertive, outspoken women… just the kind I like.

That’s my main problem – too much information (TMI), too little focus, and way too many words. I know I must do a better job condensing and clarifying my thoughts with the members of my new healthcare team. It’s the most important thing I can do to help them help me. That... and becoming a better listener.

The same thing – TMI – frustrated my brand new geriatrician recently when I tried to tell her everything in a single email. She politely urged me to limit my communications in future.

I’m reminded of the advice a 10th grade journalism teacher offered a friend of mine many years ago: DELETE TO STRENGTHEN. I’d do well to follow that advice, as an 85-year-old with new doctors.

Here's are the six suggestions from that article about communicating with your doctor. They made sense to me; maybe you'll feel the same way.

December 2, 2014

Late in the Fourth Quarter, My New Healthcare Team Takes the Field

As you might guess from the football-themed title above, I’m writing this post on Sunday afternoon. The Redskins are losing yet another game, so I turned off the TV and turned on my computer to work on the blog.

For the first time since I was diagnosed with Parkinson’s disease over five years ago, I’m dealing with a serious health issue. It has two separate parts.

1) The Lows
Several years ago, I began experiencing sudden drops in blood pressure (BP) that put me in danger of fainting and falling. At first, the few incidents occurred when I was out and about in Washington’s midday heat and humidity. But this year, these episodes became more frequent, happening without warning at any time of day. My doctors seemed mystified. My research indicated the problem arose from something called neurogenic orthostatic hypotension (NOH), a relatively rare condition that occurs only with patients who have Parkinson’s or similar diseases. Lucky me.

2) The Highs
At the same time, I’ve been experiencing occasional BP spikes which have pushed the upper (systolic) number as high as 200 -- stroke territory. Unlike the random BP drops associated with NOH, the spikes occur only in the “off periods,” when one levodopa pill -- the standard Parkinson’s treatment -- loses its effectiveness and before the next pill kicks in. It didn’t help that my former neurologist had prescribed two pills every three hours, creating eight possible "off" periods each day.

On any day, I might experience a BP drop with a systolic reading below 80, and later a spike above 200. Needless to say, I am not happy with this scary situation... or with the lack of progress by my doctors to fix it.

There have been two professionals involved: 1) my neurologist and 2) a nephrologist (kidney specialist) regarded as a BP expert. They did not collaborate and had little communication with each other. Not an ideal situation.

I've had other reasons, too, for establishing a new primary healthcare team. After a careful process, it's now in place. I’m happy with my choices, and I'm eager to begin working with these new docs.

November 25, 2014

Analytical Rumination: Depression as Evolutionary Problem Solver?

Last week I stumbled upon an intriguing article in the scientific journal plosONE with the title: “Measuring the Bright Side of Being Blue: A New Tool for Assessing Analytical Rumination in Depression.”

Really? The bright side of being blue? It warranted further investigation.

As the title above suggests, it’s all about Analytical Rumination (AR), a kind of cognitive clarity that supposedly accompanies depression. Its proponents consider it an ancient adaptive response by the body to stresses.

All my life, I’ve heard depression discussed as an unequivocally bad thing, unpleasant and dangerous, something we should do our best to treat and eliminate. Now, some researchers suggest that the symptoms we generally associate with depression – poor concentration, insomnia, lethargy, disinterest in the world generally – may in fact be useful strategies the body concocts to conserve a person’s resources, thereby enabling a more effective focus to identify and solve a particular troubling issue.

What’s more, some scientists now perceive Analytic Rumination as a possible CAUSE of the classic symptoms of depression. And so, they thought, if they could measure AR, healthcare professionals might be able to assess and address the condition before it becomes a dangerous clinical depression (which occurs, so they believe, when this natural and constructive adaptive process becomes overwhelmed and spins out of control, causing people to fully disengage from the world).

Data Already Links Depression and Brain Power
A recent study conducted at McMaster University – a public research facility in Hamilton, Ontario, Canada – included this comment in its abstract:
A substantial body of evidence indicates that depressed mood is associated with increased cognitive processing, improved accuracy on complex tasks, and enhanced detail-oriented judgement on tasks that require deliberate information processing. Individuals with depression have also been shown to consistently outperform non-depressed controls when the experimental tasks involve cost-benefit analysis.

That’s quite a line-up of cognitive advantages accruing to depressed individuals. Several of my friends with experience of clinical depression have described their bouts with the "black dog" very differently. If anything, they felt as if their powers of concentration and analysis were significantly diminished during their episodes. Then again, my friends characterized themselves as "clinically depressed," when mood and cognitive function spiral downward.

November 24, 2014

If Dementia Is Coming My Way, Is It HS-AGING?

My 85-year-old body houses a variety of conditions all under one roof -- prostate cancer (lingering after a prostatectomy 20 years ago), Parkinson’s disease, neurogenic orthostatic hypotension, occasional trouble with constipation, insomnia, depression.... I’ll stop there for now.

Add to those problems the interaction of many drugs and supplements I’ve been taking for years. While the pills I pop surely address the particular issues they’re designed to help, the combination of all of them creates a complex chemical brew in my bloodstream and brain.

I've talked often about my fears of Alzheimer's but now my concern is more specific -- Parkinson's disease dementia. My worries are well founded. Estimates are that 50 to 80 percent of us with Parkinson's end up getting this.  Three recent studies have identified traits that put those of us with Parkinson's at increaded risk for Parkinson's dementia. I have all three of those traits. And if that isn't enough, I'm seeing signs in my daily life that dementia is waiting to play a bigger role.

While Parkisnson's dementia is the best bet as the cause of any cognitive decline I'm experiencing, I uncovered a potential new explanation in a recent article  in  Alzheimer’s Weekly titled “85 with Dementia? Good Chance It's HS-AGING and Not Alzheimer's.”

They hit my age on the nose – 85 – in that headline, so I took a closer look.

The review is clearly laid out, so it’d be crazy for me to recap it. Here it is:

November 21, 2014

Reflections on My Past Reluctance to Talk about Death and Dying

Today, I had planned to share my answers to the same questions Dr. Atul Gawande asked his dying father... a process he recounted in his terrific bestselling new book, Being Mortal: Medicine and What Matters in the End. But I need to give those answers more thought.

So instead, I decided to discuss a related issue that has bothered me for years -- how I handled the many conversations I had with my wife in the months she spent at Georgetown University Hospital before her death from cancer in 1978.

I'd usually bike to the hospital from my office. On the 15-minute ride, I'd mentally assemble discussion topics for us -- the same news-weather-and-sports subjects typically bandied about at boring Washington cocktail parties.

My chosen topics were exactly what my wife had NOT been thinking about in her hospital bed. We did talk about our kids, her mother, our history -- subjects I'm sure she brought up. But her thoughts about dying? Never. I was surprised when she asked for my suggestions about her memorial service.

We both would have benefited -- drawn closer -- if I had just shut up and encouraged her to talk.

November 20, 2014

Surgeon and Author Atul Gawande on What REALLY Matters at the End of Life

"People with serious illness have priorities besides simply prolonging their lives.Surveys find that their top concerns include avoiding suffering, strengthening relationships with family and friends, being mentally aware, not being a burden on others, and achieving a sense that their life is complete. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The question therefore is not how we can afford this system’s expense. It is how we can build a healthcare system that will actually help people achieve what’s most important to them at the end of their lives."
--Atul Gawande, from Being Mortal: Medicine and What Matters in the End

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Atul Gawande is a highly respected surgeon and a writer for The New Yorker. His powerful and moving new book -- Being Mortal -- was number four on last Sunday's New York Times bestseller list for nonfiction.

He describes in vivid, heart-wrenching detail the final days of patients who are often in such denial of their imminent deaths that they, or their families, demand futile lifesaving measures. Meanwhile, his own profession treats aging, frailty, and death as if they were simply clinical problems to solve.

Usually at this point in blog posts I would go on -- and on and on -- summarizing the book's message. But I have a new resolve to shorten my posts. More compellingly, Gawande has provided his own excellent descriptions during recent interviews, and he is far more articulate than I am. There are several wonderful interviews at the end of this post.

November 19, 2014

Through a Positive Lens: "Aging" at the Annual Meeting of the Gerontological Society of America.

As I begin my own journey working with a geriatrician, I was intrigued to see a blog post in the British Medical Journal about the annual meeting of the Gerontological Society of America earlier this month here in Washington, DC. With 4,000 delegates this year, the gathering is a leading scientific congress on aging.

Blogger Desmond O’Neill -- a geriatrician and cultural gerontologist from Dublin, Ireland – recapped the gathering in such a way that I wish I’d attended the five-day event… or at least part of it.
I’ve been introduced to the philosophy of aging over the past few years by, an excellent website I visit often. The messages from that site are broad and positive, and help readers understand – among other things -- the foolish counter-productivity of anti-aging efforts. There’s no way to stop – or reason to – that fundamental process built into all life on earth. Instead, we should embrace aging, celebrate it, and find in our elderness the special, unique, and wonderful elements we’d have missed if we hadn’t been blessed with the opportunity to live into our senior years.

Dr Francis Collins, director of the National Institutes of Health (NIH), delivered the keynote address. In it, he described how aging has become integral to the work of all 42 constituent NIH institutes, not just to the National Institute on Aging. No surprise there, as the great wave of Baby Boomers begins to reach critical mass.

As a cultural gerontologist, O’Neill enjoyed a presentation by Dr. Thomas Cole, author of many books, including the Pulitzer-Prize nominee The Journey of Life: The Cultural History of Aging in America. O’Neill describes how Cole -- discussing the meaning of aging through engagement with scholarship in the arts and humanities -- identified three ingredients as intrinsic:
  1. Through compassion we recognize our vulnerability and our emotional, moral and spiritual response to others.
  2. We acknowledge the relationship between knower and the known.
  3. We seek an emphasis on moral and spiritual aspects of growing old, especially meaning. 
O’Neill also enjoyed a presentation by Rita Charon, “the doyenne of narrative medicine,” whose talk celebrated the life of the late Gene Cohen, “whose pioneering insight was that late-life creativity occurred not in spite of old age, but because of it."

November 18, 2014

The Pros Offer Tips for PWPs and their Caregivers

An article in the October 4 edition of reviewed the presentations at a recent symposium for people with Parkinson’s (PWPs) and their caregivers. Doctors and other healthcare providers from the University of Florida’s Movement Disorder and Restoration Department addressed several hundred people at the event, sponsored by the National Parkinson Foundation.

Dealing with a Variety of Symptoms
First up was Ramon Rodriguez, MD, a neurologist specializing in Parkinson’s disease. He acknowledged that his audience’s doctors would certainly be treating their most common symptoms, like tremor, stiffness, gait and balance issues. As a result, he wanted to focus on several other important, bothersome non-motor problems that often accompany the disease.

Low blood pressure and neurogenic orthostatic hypotension (NOH) topped Rodriguez’s list. (These are issues I’ve been struggling with for months now, along with scary blood pressure spikes that typically hit as the levodopa wears off at the end of each pill cycle.)

Rodriguez made these points:
  • PD is an idiosyncratic disease which people experience individually. Therefore, PWPs must learn their own individual blood pressure (BP) thresholds, beyond which dizziness and fainting may occur.
  • Drinking lots of water—up to 64oz a day – helps regulate BP.
  • Eating salt (a remedy I use regularly to help treat hypotension) is very effective in raising BP. Said Rodriguez, “This may be contrary to a lot of doctors’ advice, but anything that comes in a can has high sodium content — so buy it and eat it.”
  • Comfortable compression stockings help regulate BP. They’re less risky than drugs.
  • Rodriguez urged listeners to discuss all BP drugs with their doctors – the drugs that raise AND lower pressure.

November 14, 2014

I'm Finally Seeing a Geriatrician. It's About Time!

Yesterday, I had my first meeting  with my geriatrician Dr. G. My research into seniors' healthcare issues convinced me that seeing a geriatric specialist-- not a standard-issue internist -- made more sense for me. I'm hopeful that my new doctor will help me make my remaining years as comfortable and rewarding as possible.

Dr. G is highly regarded and wasn't accepting new patients. But she recently hired two young doctors as associates. At first I was disappointed that I'd been assigned to one of those young docs -- let's call him Dr. A. --  and wouldn't have  Dr. G. all to myself. But both G and A will work with me as a team. Upon reflection, I think the plan makes good sense.

It wasn't clear from my initial meeting but I  guess the associates will  handle the garden-variety ailments -- gaining experience -- while Dr. G gets more time to concentrate on  complex issues... all the while remaining available to her associates and their patients.

I had a relaxed, fun chat with Dr. A during our first visit. He asked questions and showed real interest in my situation. Often in the past, I've felt like I was on a patient conveyor belt that ran through the doctor's office. The conveyor would stop when I arrived but only for  15 minutes; the doctor would spend much of the time cranking data into a laptop scarcely looking at me. Not so with Dr. A.

What's a Geriatrician?
Geriatricians are physicians who have completed residencies in either internal or family medicine. They also spend a year or two studying the medical, social, and psychological issues common among elderly people.

These specialists diagnose and manage multiple disease symptoms, developing care plans that address the special needs of older adults. Their patients may suffer chronic, complex medical conditions, including physical, social and psychological issues.

November 13, 2014

New Questions about Deep Brain Stimulation for Parkinson’s

Deep brain stimulation (DBS) has become a standard treatment for people with Parkinsons (PWPs) who experience dyskenesia (uncontrolled trashing about) and have trouble with precipitous off-times, when their levodopa – the standard medication for PWPs – suddenly wears off.

As reported in the November 4 edition of the Parkinson's Disease Foundation, a recent clinical study from the University of Toronto takes a new look at the procedure and reaches some new conclusions, too – especially concerning which PWPs should think about undergoing DBS… and when.

Not long ago, another study considered PWPs who were still within three years of the first mild symptoms of motor complications. Researchers administered DBS on half of those subjects. The other half – also PWPs with the same early manifestations of the disease – did not have the surgery.

The results seemed compelling: after two years, subjects who had undergone DBS were showing movement improvements. Their counterparts in the second group were not.

However, the most recent study from Toronto  -- while not disputing the results of the earlier results on PWPs with recent, mild symptoms – concludes that the most important consideration in the decision to undergo DBS is WHO, and not WHEN. Earlier is not necessarily better.

November 12, 2014

Diets of the World: The Best and Worst

I’ve often said that diet and exercise are the two great components of health.

More and more, the exercise part now eludes me, especially as mobility and balance become trickier.

But thanks in large measure to Figs -- my local Lebanese restaurant / carryout place – I’ve got the diet part of the equation pretty much knocked. I like virtually everything on the Mediterranean diet, which continues to rank #1 on everybody’s “best” lists.

As we approach the great Thanksgiving pig-out, I found an interesting article titled 8 Healthiest and Unhealthiest Diets in the World.

There were a couple surprises on the list, and I enjoyed the review. Here it is.

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When it comes to healthy diets, the older the better.

November 11, 2014

Then: Fight Parkinson's. Now: Create the Best-Possible Life in my Final Years.

I’m 85 years old. Five years ago, I was diagnosed with Parkinson’s disease. I’m certain the diagnosis would have come at least three years earlier if I’d also exhibited the tremor usually associated with PD. Instead, my issues have involved gait and balance, symptoms that make PD harder to detect.

I just checked the Social Security Administration’s life expectancy table. An average male my age can expect to live another six years. With my Parkinson’s and prostate cancer, I don’t expect to see 2020. But who knows?

Age 90 to me is like 75 to Dr. Ezekiel Emanuel. He’s the guy who stirred up lots of controversy recently with his plan to reject medical efforts that would keep him alive beyond age 75. His reason? He thinks the quality of life after that age is simply too poor.

Living beyond 90 holds little interest for me, for similar reasons.

Two of my pals have mothers -- 96 and 97 – who still live independently and happily in their own homes. But they're the exception. So are the people 90+ who are swimming the English Channel or climbing Mt. Everest. We enjoy reading their special stories. But of the two million Americans 90 and older, too many are sitting in wheelchairs watching TV… the default scenario for “the super old.”

I’ve always told my doctors that it’s quality – not length – of life that matters to me. Over these last five years, I’ve focused on slowing the progression of my PD and adopting other health-enhancing measures. Now, I’ve decided to shift my principal focus to making my final years as rewarding, comfortable, and enjoyable as possible.

November 7, 2014

For Parkinsonians Like Me, Gait Problems May Presage Cognition Decline

I think it might be time to change the blog's title to "Aging and Parkinson’s and Dementia and Me."

Last week, a new study concluded that people with Parkinson's (PWPs) who also have neurogenic orthostatic hypotension (NOH) carry increased dementia risk. NOH is my latest and most troubling affliction.

Earlier this week, I discovered that people who feel lots stress and anxiety (“neurotics”) during midlife are at higher risk for developing late-life Alzheimer’s. I’m pretty sure my midlife situation fits the description – I was dealing with alcoholism, concealed sexual identity, the early death of a spouse, and all the typical family issues. I wrote about that study in this blog post.

As if that weren’t enough, a new study finds that PWPs whose symptoms principally involve gait issues – not tremor -- may be more susceptible to developing cognition issues. According to the study’s conclusion, “progressive gait problems may be associated with progressive cognitive decline in people with Parkinson’s disease.” My main Parkinson’s-related problem is gait and its associate balance.

Are Study Results Reaching Critical Mass?
These three studies – coupled with my own feelings and observations – make me think my odds for developing dementia are increasing.

When I’ve mentioned these thought to friends and family, they understandably try to reassure me, to downplay my observations. I know they mean well, and may even believe what they say.

November 6, 2014

Curcumin / Turmeric: Good Reports Just Keep Coming

I’ve written about curcumin – the active ingredient in the curry spice turmeric – so often it’d make your head spin. Residents of the Indian subcontinent call turmeric the “holy powder,” and for millennia it’s been used for both culinary and medicinal purposes.

There’s good reason for the attention I’ve devoted to the dietary supplement. It has undergone thousands of scientific, peer-reviewed studies through the years, and -- with its anti-inflammatory properties -- has demonstrated efficacy in treating many conditions and illnesses, including diabetes, cardiovascular disease, arthritis, several cancers, and neurodegenerative diseases like Alzheimer's and Parkinson's.

Several years ago, I established a “Google alert” for curcumin, which directs to my inbox the links to all new internet "mentions" about the supplement. I’ve been amazed by the frequency of reports… all positive.

So I wasn’t at all surprised to find this article -- “Six Reasons to Use Turmeric” -- from the October 21 edition of the online journal Counsel and Heal. Here it is:

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Turmeric spice is native to southeast India and it comes from a plant that belongs to the ginger family. Turmeric, which is an ingredient used in curry dishes, has been linked to several health benefits. Here are 6 reasons why you should add turmeric to your pantry:

November 5, 2014

Stress and Anxiety Now, Alzheimer's Later

If during midlife you show signs of neuroticism – being worried, anxious, and stressed out… suffering headaches and insomnia – you’re more likely to develop Alzheimer’s disease (AD) late in life.

That's the finding from a Swedish study published online last month in the journal Neurology. That study -- which continued over 38 years -- first examined data on 80 participants in the Prospective Population Study of Women in Gothenburg, Sweden.

Way back in 1968, the women completed the Eysneck Personality Inventory, which takes into account individuals’ fear and anxiety, feelings of guilt, low self-esteem, and depression to determine levels of neuroticism. The test also places personalities along the extroversion / introversion spectrum.

(You can take Eysneck's test yourself to see where you fall by clicking the link at the bottom of this post.)

November 4, 2014

The Parkinson's / Depression Connection

An article in the October issue of Pharmacy Practice News highlighted the common association between Parkinson’s disease (PD) and depression. The story follows up on the sad suicide of Robin Williams, who had struggled with depression for a long time before being diagnosed with PD not long before his death.

I’ve written often about this connection. Depression often accompanies PD; along with constipation and insomnia, it’s a common non-motor symptom of the disease. There is also evidence that depression is associated with later onset of PD. In any case, estimates suggest that half of the one million Americans with PD also deal with depressive symptoms during their lives.

Because the article appeared in a trade group publication, it emphasizes the role pharmacists can play when they interact with their PD patients. Naturally, the PD-depression connection is something all healthcare professionals should keep in mind.

Writing for her fellow pharmacists, Sarah Melton -- associate professor at the Bill Gatton College of Pharmacy, East Tennessee State University (ETSU), in Johnson City, TN -- said: “The most important thing is that you are very conscientious about following up to make sure the medication is working and they’re not having any adverse effects. And you always want to ask about suicidal ideation.”

Those Tough Questions
Melton said that many providers are uncomfortable asking the important questions, like “Have you thought about hurting yourself?” or “Have you ever thought the world would be better off if you weren’t here?”

November 3, 2014

My Name Is John and I'm a Recovering 5-HTP Addict...

... and I've been sober for three days.

I began this blog after receiving my Parkinson's diagnosis five years ago. I thought I'd discovered in the serotonin-boosting supplement 5-HTP a treatment for the three major non-motor side effects of Parkinson's disease (PD) -- depression, insomnia, and constipation.

I had successfully used 5-HTP years ago, when I was having lots of trouble with insomnia and depression. So, when I felt those problems returning after my PD diagnosis, I went to my CVS and bought a bottle of 5-HTP pills at the lowest available dose, 50mg. I recalled getting pretty manic when I overdid it years before.

The results amazed me. The depression, insomnia, constipation... gone. In addition, I was also bursting with creative ideas during my early morning "quiet time."

Occasionally I'd feel downright euphoric. But -- what the hell -- that just made the experience more fun. Actually this actually did concern me,  I just told myself to avoid the excess intake. (I seem to recall saying the same thing about martinis.)

Here on the blog, I began a vigorous effort to spread the word about 5-HTP's efficacy in treating those PD symptoms. I was sure others like me would experience similar benefits.

In time, I noticed I was the only person marching in the parade. So I began cautioning blog readers that my own experience with the supplement was apparently fairly unique. But I continued my research, eager to discover other connections between 5-HTP and PD.

5-HTP and Me
As I had years before, I learned again about 5-HTP's "dark side." This time around, I ended up in my neighborhood hospital's emergency room -- twice -- after taking too much. Even though I was using only half of the 50  mg pill at bedtime, I'd sometimes pop the other half during the day. It didn't take long to learn the lesson -- too much 5-HTP caused scary spikes in my blood pressure... the reason for those trips to the ER.

Once when I'd taken an extra pill after lunch,I soon realized I was about to pass out, and I called 911. When the ambulance got me to the hospital, my systolic (upper) pressure was well over 200.

October 31, 2014

My Goblins -- Alzheimer's and Dementia -- Stay with Me Year Round

Alzheimer's afflicts about one third of all Americans over 85. Becoming part of that group is probably my greatest fear.

Several developments this past week have given me more cause for concern:
  • After writing the post about our recent Nepali Tihar holiday celebration, I discovered I'd described another Tihar celebration two years ago. As if that weren't bad enough, I couldn't remember anything about that event at all. 
  • A major surge of fear accompanied my discovery that orthostatic hypotension -- a frequent issue for me these days -- is an especially strong predictor of Parkinson's dementia. 
  • Keyboarding and blog formatting are becoming more difficult and time-consuming. I met with my collaborator Stanley yesterday to discuss strategies for dealing with these issues. 
  • Regularly using the Dragonfly voice recognition software would be a big help, but my learning curve these days resembles a flat line. 
I know... simple aging might explain these developments. But my gut tells me I'm in the early stages of Alzheimer's or dementia.

October 30, 2014

Progress on the Ups and Downs of My NOH Blood Pressure

I thought I'd settled my decades-long problem with high blood pressure (BP) when I got my doctor's approval to quit the meds. Many authorities now say that people 80+ with no history of cardiac issues probably don't need BP pills. I gleefully reported this development in an April post.

I kept checking my numbers at home with my wrist monitor, because my favorite pill -- 5-HTP -- can cause a sudden increase in BP if I take too much of it. I was pleased to see that my normal readings did not exceed the adjusted 150/90 guideline for people 60 and older.

My recent medical history has resembled the whack-a-mole game -- I resolve one problem and a new one pops up. Here's latest example.

Sudden Drops In Blood Pressure
For several years, I've experienced occasional sinking spells -- feeling lightheaded and close to fainting. These incidents initially happened only on hot summer days when I was outside. I soon discovered that big drops in my systolic BP -- sometimes below 90 -- accompanied these incidents. 

In the past six months, these episodes have occurred much more frequently and at unpredictable times. One of my PD support group members recently talked about his fears of falling when he had similar sinking spells. His neurologist recommended eating salted pretzels to counteract those BP drops.

October 29, 2014

Half of All Seniors Receive -- or Need -- Assistance

About half of all seniors have care needs, according to a recent article in Medical News Today. That analysis was published in the September 2014 issue of the "Milbank Quarterly."

Here's how the research team framed the context of their study:
The cost of late-life dependency is projected to grow rapidly as the number of older adults in the United States increases in the coming decades. To provide a context for framing relevant policy discussions, we investigated activity limitations and assistance, care resources, and unmet need for a national sample of older adults. 
Using Medicare enrollment data from the 2011 National Health and Aging Trends Study -- a national sample of 8,246 older adults -- researchers from the University of Michigan and the Urban Institute determined that nearly 50 percent older Americans – 18 million people – have trouble, or receive assistance, with daily activities.

I’m already part of that half receiving help. A neighbor has been driving me to the grocery store – and on other errands -- for the past few months. With the progress of age, my Parkinson’s disease, and my increasing forgetfulness (more on that soon), I’ll need more and more assistance. 

As it is, I feel fortunate that – at 85, with PD and prostate cancer – I’m still as independent as I am.

Here’s how Vicki Freeman – UM researcher and, with the Urban Institute's Brenda Spillman, co-author of the report – broke down the numbers: "Although 51 percent reported having no difficulty in the previous month, 29 percent reported receiving help with taking care of themselves or their households or getting around. And another 20 percent said they had difficulty carrying out these activities on their own.”

The article in Medical News Today outlines other findings:

October 28, 2014

Electronic Gizmo Detects Depression Remotely

In recent months, I’ve highlighted a variety of new developments that are allowing seniors to remain in their own homes. “Aging in place” is what the majority of older people want to do; they don’t want to leave their familiar environments for the strangeness of a nursing home or assisted living facility.

Now, there’s a new twist in this “aging in place” saga: family members, doctors, and caregivers – all in different places – can now tell if their special senior might be experiencing depression.

Gerontologists know that people aged 70+ tend to follow fairly regular routines at predictable times – sleeping, watching TV, eating, washing, etc. When seniors vary from those normal patterns, something may be wrong.

Soon, seniors will be able to wear a small device on their forearm that records movement. Developed by researchers at the Autonomous Metropolitan University (UAM) of Mexico, the new gizmo – when hooked up to high-tech software and working in tandem with webcams – can give loved ones anywhere on earth a pretty clear picture of what’s going on with the monitored senior.

Looking for Irregularities
If there’s an anomaly in a senior’s activity course -- or in the time when they are positioned at a certain location -- the system issues an on-line alert to the computer or smartphone of any relative, physician, or caregiver.

Edwin Almeida Calderón -- Industrial Design researcher at UAM and project leader – said, "The sensor is connected to a modem using radio frequency systems. The processed information from the elder's movement pattern may include factors such as temperature, heart rate and deviations in the usual activity path."

October 27, 2014

Dashain and Tihar at Home in Washington

During the years when I traveled regularly to Nepal, I usually went in the fall. Those trips often coincided with at least one of the two biggest festivals of the year -- Dashain and Tihar. I always enjoyed them.

If I was at home -- not abroad -- I often celebrated these festivals at the homes of my local Nepali friends. Now I get to enjoy the celebrations in my own home, since the Nepalis outnumber me two to one in our household.

This year, the holidays were especially enjoyable because Bhawana's parents stayed with us during part of their U.S. visit. The photo above shows Bhawana with her parents as we did Dashain tika on the back porch a few weeks ago.

Here's a brief background on the two holidays:

October 23, 2014

Paralyzed Man Walks after Nose Cell Implantation: the "Miracle" and the Cautions

Darek Fidyka walks (photo courtesy of BBC)

The recent news -- a paralyzed Bulgarian man is walking again after cells from his nasal cavity were transplanted into his severed spine – has understandably made a big splash around the world.

Dr. Geoffrey Raisman, a professor at the Spinal Repair Unit at UCL Institute of Neurology in London, was a partner in the surgery. He said, “We believe that this procedure is the breakthrough which -- as it is further developed -- will result in a historic change in the currently hopeless outlook for people disabled by spinal cord injury.”

The surgery, done in Poland, has been touted with great hyperbole: as a major leap forward for humanity, more important for the future of our race than the moon landing.

The Usual Concerns
Other medical experts have been quick to sound the alarm: not so fast.

As reported in an article on October 21,  Dr. Simone Di Giovanni, chair in Restorative Neuroscience for Imperial College London, said that this single case "cannot represent any solid scientific evidence to elaborate upon. In fact, there is no evidence that the transplant is responsible for the reported neurological improvement.”

She continued:
The use of these cells for spinal cord injury repair have been implemented for 30 years now with very controversial results in rodents, non-human primates, and patients. Extreme caution should be used when communicating these findings to the public in order not to elicit false expectations on people who already suffer because of their highly invalidating medical condition.

We’ve heard the caution about creating false hope before. I’ve repeatedly taken Dr. Mary Newport to task for giving false hope to the millions of Alzheimer’s sufferers – and their families and caregivers – by touting coconut oil as a miracle cure based on the unique, positive, temporary experience of her husband Steve. Many whose spirits were immeasurably lifted by Newport's report -- and who then tried coconut oil without any results -- must have found the hyped remedy an unconscionable cruelty. 

October 22, 2014

Hibiscus Tea for Blood Pressure Issues

Once again, blood pressure (BP) concerns have taken center stage. For most of my adult life, the issue was finding a medication that would treat my high BP without causing troublesome side effects. None of the many drugs I tried was completely satisfactory.

Freedom at Last
Six months ago, I thought I had finally won my freedom from those medications. I kept seeing medical authorities suggesting that people age 80+ could stop taking BP meds if they showed no other signs of coronary trouble. My BP specialist said he "wouldn't lose any sleep" if I stopped popping the pills. So I did.

Since then, my numbers have usually stayed within the new guidelines (150/90) for people 65+. But now I'm dealing with neurogenic orthostatic hypotension (NOH), which causes my systolic number to tumble, sometimes below 90. There's also a danger from aggressive treatment of NOH, which can lead to an opposite problem -- supine hypertension. Naturally, I'm likely to overdo it on aggressive treatment.

All of this means I'm again searching for something that might prove helpful in dealing with my BP issues.

I recalled using hibiscus teas in the past for their alleged BP benefits. I've just checked several references about that product, including a link to one of my favorite sites for nutrition information:

On that site, Dr. Greger provides an update on hibiscus tea:

October 21, 2014

How Old are YOU? A New Way to Measure Age.

“You’re only as old as you feel."

“Sixty is the new forty.”

Those are just two examples we use to indicate that measuring age is a blurry business.

I might say “I’m 85 years old,” which is true. OK, it means I was born in 1929. But what does that fact really say about my health and my prospects for the future? A lot more than actuarial tables might suggest, according to a new study.

I’ve learned that every person with Parkinson’s has his or her own individual disease… and experiences its symptoms and medications uniquely. In an interesting post last month in one of my favorite blogs, “The New Old Age” in The New York Times, writer Judith Graham shows how measuring age – like the Parkinson’s example -- depends very much on the individual. Like never before in our history – as healthcare improves and longevity increases -- measuring age involves a lot more than counting the passing years.

In her article -- "On New Measurements of Aging" -- Graham recaps a Q&A with a professor of social and behavioral sciences. In that conversation, the teacher describes an easy, and – to me – completely novel way to determine when “old age” begins.

Here’s that brief exchange:

October 20, 2014

A Personal Log to Track Blood Pressure and Medications

I've been struggling to manage the timing and dosages of the many pills I take. Last Friday, I described the challenge in this post.

A thoughtful reader offered a helpful suggestion in this email:

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Save the attached file to your iPad and use it to track your medication and blood pressure (BP) records. Just put X in each of the meds columns to mark when you took meds (or # of pills taken if levodopa doses vary), then type in your BP readings. In the next column, enter anything you attempted other than meds -- wearing abdominal binder, drinking cold water, eating salt, etc.

Those columns are the only part you need to send your doctors. I included a final column where you can record your personal comments – digestion, sleep, dizziness, etc. You can delete that column before sending to your docs, unless they indicate otherwise. They probably won’t want it.

Open the blank table and “Save as New” every day to create a new record. Or you can copy/paste a new blank table into last page of a Word document to keep a week’s record in one file. Using an Excel spreadsheet to document a full week -- with days shown side-by-side -- would be even better, but I suspect you’re more adept with Word than Excel.

I think this type of table will give you and your docs a much clear picture of any pattern that emerges.

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Thanks for this great idea!

Here's what that attached document looked like.

October 17, 2014

Managing My Meds: Practically a Full-time Job

The Overview
Every night before I go to bed, I make this arrangement on my bathroom sink:  

What are all those things? We'll start from the lower left corner and continue around the sink:

My Carbidopa/Levodopa

This is my main Parkinson's med. I take two pills eight times a day. That's 16 pills! The photo shows the supplies for only three of those eight cycles.

After I take the 9:30 pill, I'll cross out the 9:30 and write 12:30. I take these pills at three-hour intervals. My body knows the schedule better than my memory. It will wake me up during the night when another three-hour cycle is up.

October 16, 2014

"Combination Therapy" REVERSES Memory Loss

A UCLA study, reported in the October 12 edition of "Alzheimer's & Dementia Weekly," showed that a combination of different therapies actually helped reverse memory loss. Yes, that’s right: REVERSE memory loss.

It was a very small study -- only 10 participants – and it did not include other elements, like control groups, necessary to render its results “scientific evidence.” Still, the results are worth considering.

Of those ten participants, nine displayed both subjective and objective memory improvement beginning within three to six months of the program’s start. “Subjective” improvements are those reported informally by the subject. “Objective” results are based on testing.

Before they became part of the 25 Step Memory Program (called “MEND” for Metabolic Enhancement for NeuroDegeneration), six of the ten had actually stopped working -- or were having trouble at work -- because of memory issues. In time, after participating in the study’s “combination therapy,” all six returned to work, or stayed on the job with improved performance.

All ten were patients with memory loss either from Alzheimer’s (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI), a condition where patients make their own assessments based on personal experience. That tenth participant – the one whose memory showed no improvement – was diagnosed with late-stage Alzheimer’s.

What’s more, improvements for the other nine people have been generally sustained, with the longest patient follow-up coming two and a half years from initial treatment.

October 15, 2014

Deep Brain Stimulation: Remain Asleep and Don't Stop the Meds

New state-of-the-art imaging technology now allows Parkinson’s patients undergoing deep brain stimulation (DBS) to reman asleep during the procedure.

I don’t know about you, but if someone was planning to drill a hole in my skull and insert a wire through that hole and into my brain, I’d just as soon not be awake through any of it.

DBS results have been so compelling that the Food and Drug Administration approved the procedure for treatment of essential tremor (in 1997), Parkinson’s (2002), and dystonia (2003).

Over 100,000 people worldwide have undergone the procedure to alleviate motor symptoms -- tremor, rigidity of limbs, and movement problems -- that medications did not effectively address. Until now, these DBS patients would have to awakened to let their surgeons know when the electric probe had hit the key spot in the brain causing the problem.

For instance, doctors might ask their wakened patients with tremor draw spirals on a whiteboard. Before the correct area of the brain was hit with the probe, the spirals were erratic and jagged. When the probe hit just the right spot – no bigger than a pea – the patient’s spirals would become much more even, steady, rounded. That’s where the surgeon would plant the wire.

From Eight to Four Hours
New MRI imagery gives surgeons very precise, real-time pictures of their patients’ brains at work… while those patients sleep comfortably. The new procedure also shortens the surgery time -- from about eight to four hours. When the right spot is located, a battery pack is then implanted under the skin near the collarbone to keep the signals coming.

Dr. Hooman Azmi -- director of the division of movement disorders at Hackensack University Medical Center in New Jersey -- said, “Surgery is safer because it’s shorter; the patient is more comfortable, and we can see the wires going in. If there’s any bleeding we could see it."

October 14, 2014

Is Levodopa the Cause of My Episodic Low Blood Pressure?

I was diagnosed with Parkinson's disease (PD) in September, 2009. The five years since then have been -- for the most part -- a "Parkinson's honeymoon." But as you'd expect, the storm clouds looming on the horizon are beginning to move in.

The End of My Parkinson's Honeymoon
The past month has been the most discouraging and depressing time since my diagnosis. I've had to deal with upward blood pressure (BP) spikes that generate systolic readings close to 200.  At the same time, I'm experiencing sudden BP drops with systolic readings in the 80s. In a single day, my numbers can vary by 100 points.

I soon identified the cause of the upward spikes. I keep a log of my BP readings, and a clear pattern began to emerge. These elevated readings came during the "off" periods in each three-hour pill cycle, when the old pill stopped working and the new pill had yet to kick in.

When I have BP issues, I consult a nephrologist (kidney specialist) recommended by my former internist, who described this doctor as "the most knowledgeable guy in town when it comes to blood pressure."

I described my current problem and he recommended some remedial actions I could try and gave me a prescription for nifedipine. My neurologist is exploring ways we might get more bang for the levodopa buck. I'm not happy with this situation, but at least I know what is causing it and we are developing a game plan for dealing with it

I was more concerned with the low BP problem, which was more threatening. But no one had a clear explanation for its cause. People kept mentioning "orthostatic hypotension" (OH). Many people, particularly the elderly, experience this lightheaded, dizziness that occurs when one moves from a seated to a standing position.

October 10, 2014

Videos for a Healthier You

Perhaps because I spent so many years in school, fall is my time of year for new resolutions and projects. One of my long-term goals is to apply my "less is more" mantra to my physical surroundings by getting rid of the junk I've accumulated over the years, the clothes I never wear, the books I'll never read. I'm using the extra energy I feel on these beautiful fall days to work on the down-sizing project.

I'm extending this clean-up campaign to my computer. I've got many files of saved emails and web links that are now obsolete. All the clutter slows me down when I'm searching for things.

During this process, I found several links to health-related videos. The light bulb went on: I could clear out four of these saved videos by turning them into one blog post.

I saved them because I found them helpful. I hope you will, too.

"The Best Five-Minute Workout"
I came across that claim, clicked on the link, liked what I saw, and (sort of) followed along. See what you think:

Deepak Chopra Interviews Rudy Tanzi on the Benefits of Meditation

October 9, 2014

Five Lessons for Us from Winston Churchill's Life

In a prior post, I talked about how much I was enjoying Paul Johnson’s biography of Churchill. I agree with Johnson’s opening sentence:
Of all the towering figures of the 20th century, both good and evil, Winston Churchill was the most valuable to humanity and also the most likable.
Winston Churchill led a full life, and few people are ever likely to equal it. But Taylor suggests we all can learn from it. He offers five lessons from Churchill’s life.

I was going to summarize the five lessons Taylor provides. But the idea of substituting my words for Taylor’s made absolutely no sense.  I know most of you would prefer shorter posts, but this isn’t all that long and it is well worth reading . . . and re-reading, which I have done and will continue to do.

October 8, 2014

Nobel Prize for Medicine: Promising Brain / Alzheimer's Discoveries

British-American researcher John O'Keefe – with Norwegian husband and wife collaborators May-Britt and Edvard Moser – won the Nobel Prize for medicine on Monday, October 6, for demonstrating how the brain enables us to move from one location to another.

The team determined that the brain’s hippocampus acts like a kind of internal GPS (global positioning system), which helps us to navigate from place to place. – the official website for the Nobel Prize – put it this way in the press release it issued:
How do we know where we are? How can we find the way from one place to another? And how can we store this information in such a way that we can immediately find the way the next time we trace the same path? This year´s Nobel Laureates have discovered a positioning system, an “inner GPS” in the brain that makes it possible to orient ourselves in space, demonstrating a cellular basis for higher cognitive function. 
In 1971, John O´Keefe discovered the first component of this positioning system. He found that a type of nerve cell in an area of the brain called the hippocampus that was always activated when a rat was at a certain place in a room. Other nerve cells were activated when the rat was at other places. O´Keefe concluded that these “place cells” formed a map of the room.
More than three decades later, in 2005, May-Britt and Edvard Moser discovered another key component of the brain’s positioning system. They identified another type of nerve cell, which they called “grid cells”, that generate a coordinate system and allow for precise positioning and pathfinding. Their subsequent research showed how place and grid cells make it possible to determine position and to navigate. 
The discoveries of John O´Keefe, May-Britt Moser and Edvard Moser have solved a problem that has occupied philosophers and scientists for centuries – how does the brain create a map of the space surrounding us and how can we navigate our way through a complex environment?
Enter Alzheimer’s disease
So, how does this new information help us better understand Alzheimer’s?

October 7, 2014

Exit Life at Age 75? Should This 85-Year-Old Have Done That?

In the current issue of The Atlantic, Dr. Ezekiel Emanuel argues that the quality of human life begins to drop off by age 75... enough, he says, that he will opt out of medical treatments and let nature run its course. The article has generated a firestorm of comment in the media, particularly since it was written by a leading oncologist from a prominent family.

Dr. Emanuel is chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and a former Obama administration policy adviser. He is also older brother to Chicago Mayor Rahm Emanuel and Hollywood talent agent Ari Emanuel.

At 75, Dr. Emanuel plans to issue new instructions to his doctors. No life-prolonging measures. No screenings, like colonoscopies or cardiac stress tests; no treatments like chemotherapy or heart bypass. Not even flu shots or antibiotics -- nothing but palliative care to alleviate pain.

The link above directs to Emanuel's article. Judy Woodruff of the the PBS NewsHour interviewed Emanuel last week. That video, with transcript, is here.

I've lived for a decade after age 75 and I'm glad I didn't follow Dr. Emanuel's plan. From the critical response to his article, others agree that his idea is wrong. Still, I find myself in accord with much of what he says. It's made me pause to consider my post-75 decade, and to re-evaluate how I'll handle the years ahead.

In this post, I'll review some of what's made the past decade the happiest time of my life. Later, I'll write about about mortality and how we spend our final years -- thoughts prompted by Emanuel's article.

What follows is mostly a photo montage. I'll comment on Emanuel's article later.

October 6, 2014

Yoga, Meditation Train Brains to Control Computers

If you meditate – as I do, in my own fashion – or do yoga regularly, the benefits may be greater than you thought.

A study published in the new journal TECHNOLOGY showed that people who often practice one of those two disciplines can condition their brains in ways that enable them to control a computer with their minds better and faster than people who have little experience with either.

Why does that matter?

As technology speeds forward, there are more systems that allow physically disabled people to control life-enhancing devices – like wheelchairs and artificial limbs – with their minds. Their bodies may not be able to manipulate those devices, but their brains are just fine.

Beneficiaries of new mind-computer technologies include people who are paralyzed; have lost hands, arms, or legs; or who suffer from physically debilitating diseases like ALS (Lou Gehrig’s disease), cerebral palsy, and neurodegenerative diseases -- like Parkinson's.

Now we learn that any of these people who meditated or did yoga regularly are significantly more successful operating devices with only their minds.

How the Study Worked
In a study -- funded by the National Science Foundation, the National Institutes of Health, and the University of Minnesota’s Institute for Engineering in Medicine -- biomedical engineers at the University of Minnesota recruited 36 people -- admittedly a very small sample – and put them into one of two groups.

October 3, 2014

Memory and Statins and Me

A few days ago, I was introduced to a stranger, or so I thought. Within a minute, he reminded me that we had met 11 years ago in an interaction a normal person would have remembered. But when it comes to memory, I'm not a "normal person."

You might assume I'm Alzheimer's-bound in light of my age (85) and my Parkinson's disease (people with PD have higher AD risk). I worry about Alzheimer’s, but most of the evidence from my life – like researching and writing this blog – reassures me that I’m OK.

I've been embarrassed before by incidents like this week's. Throughout my adult life, when friends mentioned details from a play or movie we'd recently seen, I’d often draw a blank. Same with books. I’d be stymied to name my 15 most favorite books – a question that’s been making the rounds on social media for a while. I might have trouble simply listing any 15 books I've read.

After the incident this week, I half jokingly told a friend I needed to find a study that showed you can lose your memory without losing your mind. Then I remembered (!) a bit of information I’d encountered during my research about statins, a medication I’d been taking for a long time to help keep my cholesterol in check. I discovered that memory loss was just one of the drug’s side effects, and I decided to finally ditch the pills. See Bye-Bye to My Statins.

I've done some additional research, and here's what I found:

The FDA Mandates Risk Warning on Labels
Since 2012, the FDA has required that statin labels include a warning that some people have developed memory loss or confusion while taking statins – a conclusion based on various databases of bad reactions to drugs, and also statin clinical trials that included assessments of cognitive function.