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.