May 29, 2014

Should You Be Screened for Cognitive Impairment?

While the new health law requires Medicare to pay for seniors’ cognitive impairment screenings during annual wellness visits, the U.S. Preventive Services Task Force (USPST) -- an independent panel of medical experts -- isn’t sure it’s a good idea for asymptomatic seniors.

As reported in a recent issue of Kaiser Health News, those USPST experts evaluated evidence of the benefit, harm, and clinical utility of several screening tools for cognitive impairment, and determined that the evidence was not sufficient to recommend the tests for seniors without symptoms.

Why not?

Asymptomatic seniors might perform poorly on these cognitive tests for other reasons, like sleep apnea or depression – which can also affect memory and function. Dean Hartley, director of science initiatives at the Alzheimer’s Association, recommends that people take cognitive tests only in a medical setting with a trained profession who can draw reliable conclusions based on the full medical history from patients and their families.

The Risk of Fear
Experts concur that isolated screenings at health fairs and shopping malls – tests that do not take into account patients’ broader medical history – are a bad idea. They can cause unnecessary fear and raise more questions than they answer.

Nonetheless, the Alzheimer’s Association endorses the tests when they’re properly performed, because they establish a baseline for comparison against future results. In addition, large-scale testing might give individuals and their families an early warning, important because drugs – like Aricept – are most effective during the early stages of dementia.

May 28, 2014

Seniors Abusing Prescription Drugs: A "National Epidemic"

According to an article in the May 20 edition of USA Today, hundreds of thousands of American seniors are misusing prescription drugs. The two biggest culprits? Opioid pain relievers and benzodiazepines, which include psychoactive anxiety meds like Xanax and Valium.

For its investigation, the paper evaluated data from various federal agencies and private firms. Among its findings:
  • Last year, doctors wrote 55 million opioid (pain relief) prescriptions for patients 65 and older. That number represents a 20% increase over five years, which is nearly double the growth rate of seniors during that time.
  • Doctors wrote 28.4 million benzodiazepine (anxiety) prescriptions for seniors 65 and older, up 12% in five years.
  • According to the Substance Abuse and Mental Health Services Administration (SAMHSA), about 336,000 seniors were either misusing or dependent on opioids. That number is up from 132,000 ten years before. SAMHSA defines “misuse” as using drugs without a prescription, or not as prescribed.
  • From 2007-11, for people 55 and older who sought help for substance abuse, there was a 46% increase in the share of cases involving prescription narcotics.
  • During that same period, emergency room visits by seniors 65 and older caused by pharmaceutical misuse jumped 50%, to over 94,000.
  • The CDC reported that death from drug overdosing tripled from 1999 to 2010 among people 55 and older.
  • In 2010, according to the CDC, 75% of deaths from prescription drug overdose involved pain killers. Of those, one third also involved benzodiazepines. The combination presents grave dangers.

May 27, 2014

Thoughts on My 85th Birthday

This year my May 26 birthday coincided with the Memorial Day holiday, which is strange to someone old enough to remember Memorial Day as May 30 (and Columbus Day as October 12, and Washington’s Birthday as February 22). Thanks to the 1971 Monday Holiday Law, my 85th birthday came at the end of the three-day holiday weekend.

My housemates offered to throw a big gala for the birthday. I nixed the idea. The only thing worse than a big party would have been a surprise party. I encouraged them to visit relatives in Chicago over the long weekend... and so off they went.

Sunday after breakfast, I went out on the back porch with my coffee, the Sunday New York Times and Washington Post, and several smooth jazz CDs. As I settled into my rocking chair, I noticed something unusual – quiet!

All I could hear was the waterfall bubbling in my back yard pond, and the birds chirping as they lined up for access to the birdfeeder. In the distance, I heard the call of a great horned owl.


The Sunday of a Memorial Day weekend must be the quietest day of the outdoor season. No power lawn mowers. Very few jet planes en route to National Airport, on the flight path that often passes directly over my house. None of the birthday phone calls I’d get the next day.

The temperature was 65 degrees. Washington’s horrible humidity was non-existent.

I was overcome with a feeling of peace and contentment I’d experienced only once before, about 15 years or so ago. That time, it was a gorgeous fall day and I’d just pedaled up the three-block hill (now a mountain) to my house after a long bike ride. I still remember just standing there, feeling happier than I’d ever been.

So I put aside the newspapers and the CDs and simply sat still for two hours, reflecting. After a while, I picked up a pen and began jotting down some notes on the thoughts that were popping up. Here are a few of them:

May 23, 2014

Curcumin: A Cure-All?

For several years, I've followed reports on nutritional supplements. Along with most researchers, I've concluded that virtually all supplements are a waste of money, and that we're much better served meeting our nutritional needs from diet, not pills.

Two supplements, however, have intrigued me: coconut oil and curcumin, the active ingredient in turmeric, known in India as "the spice of life."

As I reported in yesterday's post, the coconut-oil-for-Alzheimer's theory has been supported only by anecdotes, not clinical trials (although one is now underway). On the other hand, curcumin has been studied at least 5,000 times, more than any supplement. But virtually all those studies have involved mice or petri dishes. A major problem with curcumin for humans is the compound's difficulty in crossing the blood/brain barrier, so it can effectively do its work. Since the turn of the century, over 50 curcumin trials have involved humans and over 80 more are in the works.  Researchers are accelerating  progress oncurcumin and its bioavailabily for humans,.

My curcumin file is filled with reports about its effectiveness to treat almost every disease and illness. I've selected the  videos below from the NutritionFacts.org website, since they provide a good introduction to recent curcumin findings.

The first concerns curcumin and rheumatoid arthritis:


May 22, 2014

Coconut Oil for Alzheimer's: The Hucksters Are Quieter

I've criticized the hype for coconut oil as a cure for Alzheimer's. You can find earlier comments by entering "coconut oil" in the search box at right.

In those posts, I should have been clearer about my objection -- that the media hucksters were over-promoting coconut oil as a "miracle drug," unfairly raising the hopes of those afflicted by the disease.

A case CAN be made for coconut oil as a potential therapy for Alzheimer's (and Parkinson's). When asked about coconut oil and Alzheimer's, prominent AD researcher Dr. Rudolph Tanzi said:
I'd like to see a real trial. I'm intrigued by the anecdotes, but as a scientist, you get burned by anecdotes all the time. There are companies doing some trials now. Non-virgin coconut oil can have negative health effects - it raises your triglycerides.
That sums it up. A year ago, I wrote about the trial now underway at the University of South Florida.

The Coconut-Oil-for-Alzheimer's Bandwagon
Most people would agree that the leader of the band has been Dr. Mary Newport, a neonatalogist whose husband Steve was diagnosed with Alzheimer's disease about 10 years ago. Five years ago, Dr. Newport saw reports that linked AD with glucose deficiency. Glucose is a sugar, and chief source of energy for cells.

In her quest for AD relief for her husband, Newport heard about a promising drug based on the theory that glucose-deficient brain cells could obtain energy from another source -- ketones, organic molecules created when the body produces fat. But the drug was years away from approval. Dr. Newport asked about other sources that might deliver ketones to Steve's brain, and was told that coconut oil was a good source. So, she began feeding it to her husband. They soon noticed dramatic improvements.

May 21, 2014

Coconut Oil, Curcumin, and More from a Leading Neurologist

Two subjects generate the most traffic on this blog: coconut oil and curcumin, the active ingredient in the curry spice turmeric. While I'll post more soon, I thought it was time for a quick update on both topics.

Coconut oil and curcumin have been touted as potential cures for Alzheimer's, Parkinson's, and other neurological disorders. I recently saw an excellent introduction: a four-part video interview, "Q&A with Dr. Rudy Tanzi: Alzheimer's Risk & Prevention."

Dr. Tanzi is the Joseph P. and Rose F. Kennedy Professor of Neurology at Harvard, and Director of the Genetics and Aging Research Unit at Massachusetts General Hospital. One of the ten most-cited Alzheimer's researchers, he has co-authored over 340 research articles and won many honors, including the two highest awards for Alzheimer's research. With Deepak Chopra, he co-authored the best-seller, Super Brain.

This clip is from Part 2 of the interview. Pertinent text below the clip.




Excerpts from Interview

May 20, 2014

Resveratrol: Does It Extend Lifespan and Help Prevent Heart Disease and Cancer?

Resveratrol – the plant-based antioxidant found in red wine and foods like chocolate and blueberries – has made headlines again. For years, it’s been touted as an effective anti-inflammatory agent in preventing cardiovascular disease and some types of cancer.

But a study published in the May 12 online edition of the New England Journal of Medicine suggests differently.

Scientists at Johns Hopkins University Medical School reviewed the records of 783 men and women -- 65 and older -- from Italy’s Chianti region, where people’s diets would likely be high in natural resveratrol from the area’s popular red wine.

Those researchers based their conclusions on the amounts of metabolized resveratrol present in study participants’ urine, figuring that the healthiest seniors would show the highest levels of resveratrol.

Said lead author Richard Semba:
We were initially surprised by the lack of any apparent protection against heart disease or cancer, and no association with lifespan. Since limited animal and cell studies suggested that resveratrol might have beneficial effects, I think people were quick to extrapolate to humans. In retrospect, this was really oversimplified. But there are still ongoing trials, so one must keep an open mind about possible benefits.

Of Mice and Men, Again
Semba identified the key weakness in the claims for resveratrol’s ability to prevent disease and extend lifespan: the lack of evidence ON PEOPLE. Science has established that plants produce the substance to combat fungal infection, ultraviolet radiation, stress, and injury.

May 19, 2014

My Sunday Sermon from Tim Minchin on the Meaninglessness of Life

I love my neighbors and my neighborhood. Sunday offered another example "why."
  • It was a beautiful day -- too cool to eat breakfast on the back porch, but it warmed up nicely by midday. 
  • My weekly visit to our local farmers market. Fresh strawberries and asparagus!
  • Lunch on the back porch with the NY Times and Washington Post. Then a nap and my 15-minute meditation tape.
  • An afternoon gathering of our always-interesting neighbors at a house right up the street. The 1968 riots that followed MLK Jr's assassination caused a flight to the suburbs, and I was pretty sure I'd end up living with a bunch of old fogeys like me. No way. We now have more young couples and children than ever. 
  • Even though I've lived in the neighborhood longer than anyone else at the gathering, I knew only half the guests. Most of the others were well acquainted because they meet while walking their dogs.
I had a great time catching up with old friends and meeting new ones. I later realized I'd been standing for nearly two hours (which I rarely do) and hadn't taken my Parkinson's pill on time. Though energized by the company and conversation, I dragged my self home, an easy walk of half a block. I was wiped out and wondered how I'd produce a quick, easy blog post for tonight. I drew a blank.

I opened my email and found the weekly Caring Bridge post from Mark. A neighbor and friend, he reports each week about his son who -- as a Harvard freshman -- was stricken with a rare autoimmune disorder that led to devastating encephalitis. Vadim has been in the hospital since March 26, 2013.

I look forward to Mark's posts and find them uplifting, not depressing. They're filled with insights and links to interesting websites, which brings us to my post for today. With the season of commencement speeches upon us, Mark wrote:
In the spirit of the season, a friend who has sat with Vadim many times brought to our attention this punchy 2013 college address by Australian comedian Tim Minchin, who lets it all hang out with glee.
Bingo! I found my blog post for today:

 

May 16, 2014

My Take on "Living to Age 90 and Beyond"

On May 4, 60 Minutes began a two-part report, "Living to 90 and Beyond." I'll hit a personal milestone -- my 85th birthday -- later this month, and have a few thoughts about Part 1 of that report. You can watch it by clicking the video link below, or you can skip it for now and just read my comments. :-)

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I love that this piece opens with an ad for Viagra! This report follows the pattern we typically see for media coverage of the elderly: They're climbing Mount Everest or swimming the English Channel -- by any standard a distorted view of most seniors' lives. More about that later.

The 60 Minutes show is based on a UC-Irvine study examining lifestyle factors that contribute to longevity. The researchers reviewed medical records of people -- now in their 90s-- at a Los Angeles Leisure World "active" retirement community. Remember them?

The show came to my attention when I saw a piece on the NextAvenue website that listed two things the CBS show got right, and the two things it got wrong.

May 14, 2014

5-HTP, Serotonin and Parkinson's: A Wrap and a Request

After researching my two recent posts about 5-HTP as a therapy for Parkinson's non-motor symptoms, I'm convinced that something significant is going on here. That process has also given me an idea for reducing the danger of a serotonin buildup that could lead to serotonin syndrome, a potentially dangerous side effect.

Getting the Right Dopamine-Serotonin Balance
That first post detailed my positive experience taking a minimal dose of the OTC serotonin-booster 5-HTP. I'm sure the supplement has helped me avoid the common non-motor Parkinson's symptoms -- depression, insomnia, constipation, and deteriorating executive function.

Recounting the experience, I was reminded of the connection between dopamine and serotonin as sister neurotransmitters. Parkinsonians know that levodopa -- the "gold medal" med we take to restore the dopamine that Parkinson's destroys -- must be mixed with carbidopa so the levodopa can cross the the blood-brain barrier to become effective.

What's not as well known is that carbidopa plays the same role with serotonin. That's why people who don't have Parkinson's can take 500-1000mg of 5-HTP daily, while I risk overdosing if I exceed 100mg a day.

Neurologists and Parkinson's researchers have typically concentrated on dopamine's role in the disease. But newer studies are shifting the spotlight to serotonin. Two recent studies were particularly interesting:

May 13, 2014

Google Glass: High-Tech Support for People with Parkinson’s



Researchers at Newcastle University in England have found that people with Parkinson’s (PWPs) can benefit significantly by using Google “Glass,” the high-tech wearable technology that sounds like something out of “The Twilight Zone.”

Users wear the device just like eyeglasses and see information displayed right on the lenses they’re wearing. The technology is linked to the internet – like any smartphone – but it’s voice-controlled. That hands-free feature is especially useful for PWPs, whose symptoms sometimes make using a standard smartphone keyboard difficult.

Google Glass users can read text messages or emails, search the internet, take photos and shoot video without having to reach for a mobile phone. The technology combines voice recognition software, a camera, Wi-Fi, bluetooth and a very small screen looks like a 46-inch monitor to the wearer.

Google donated five pairs of Glass to the British team at Newcastle University's Digital Interaction Group in Culture Lab, part of the School of Computing Science. The scientists recruited a group of PWPs between 46 and 70 years of age to determine first if the volunteers would accept the space-age technology.

Lead researcher Dr. John Vines said:
Glass opens up a new space for exploring the design and development of wearable systems. It is very early days -- Glass is such new technology we are still learning how it might be used but the beauty of this research project is we are designing the apps and systems for Glass in collaboration with the users so the resulting applications should exactly meet their needs.
The Power of Prompts
Once the team determined that their volunteers could comfortably adapt to the new technology, they wanted to explore how Glass could offer discreet “prompts” to help wearers deal with symptoms that frequently distress PWPs. 

Those prompts might be audible cues – heard only by the wearer – to swallow (in order to prevent drooling), or to help PWPs overcome "freezing of gait" (FOG), another troubling PD symptom. 

May 12, 2014

Is Serotonin-Booster 5-HTP Safe for People with Parkinson’s?

Last Friday, I recounted my positive experience using the OTC serotonin-booster 5-HTP as a therapy for the non-motor symptoms that typically accompany Parkinson’s.

Several readers asked about possible negative side effects. Several had researched the supplement and found cause for concern. I underwent the same process when I started taking it, and I continue to monitor this safety issue.

Here’s what I’ve found.

Safety Issues
As with all pill questions, I start my research with ConsumerLab.com. You have to be a member to access their reports. Membership costs $36 a year.

They had a double-header review on 5-HTP and tryptophan. Their encyclopedia includes articles about both, last reviewed in August 2013.

Here are some pertinent quotes from the report:

·       Many antidepressant drugs work at least in part by raising serotonin levels. The supplement 5-hydroxtryptophan (5-HTP) has been tried in cases of depression for a similar reason. The body uses 5-HTP to make serotonin so providing the body with 5-HTP might therefore raise serotonin levels.

·       A typical dosage of 5-HTP is 100 to 300mg 3 times daily [my daily dose is between 50 and 100mg].

·       Several small short-term studies have found that it may be as effective as standard antidepressant drugs. Since standard antidepressants are also used for insomnia and anxiety, 5-HTP has also been suggested as a treatment for those conditions, but there is only very preliminary evidence as yet that it works.

·       No significant adverse effects have been reported in clinical trials. Side effects appear to be generally limited to short-term, mild digestive distress and possible allergic reactions.

·       One potential safety issue with 5-HTP involves an interaction with a medication used for Parkinson’s disease: carbidopa. Several reports suggest that the combination can create skin changes similar to those that occur in the disease scleroderma.

May 9, 2014

5-HTP and Parkinson's: Am I the Only One Experiencing this "Miracle"?

I recently watched a webinar that featured leading neurologists and scientists discussing the latest Parkinson's developments. One panelist -- after extolling levadopa's efficacy in treating PD's motor symptoms -- bemoaned the the lack of a similar drug to treat the disease's non-motor symptoms.

For me, the OTC supplement 5-HTP has proved a more effective therapy for my non-motor symptoms than levadopa has been for my motor symptoms.

What is 5-HTP?
It's basically a serotonin booster. Serotonin is one of the neurotransmitters that light up the brain. It is allied with another neurotransmitter, dopamine. Parkinson's results from the depletion of dopamine-generating cells in the brain.

Dopamine regulates muscle movement, motivation and reward seeking, sociability, and pain processing. Serotonin primarily affects mood, impulsiveness, appetite, intestinal motility, sex drive, and the sleep/awake cycle.

5-HTP and me
Here’s a quick rundown on PD's major non-motor symptoms, and my experience with 5-HTP as a therapy for them.

Symptom 1)  Depression
Before my 2009 PD diagnosis, I’d experienced only one bout of depression. That unpleasantness occurred about 10 years ago during my "Summer from Hell," when I over-used Tylenol PM and Ambien in an effort to remedy bad jet lag after a trip to Nepal. Popping  meds prescribed by doctors and sleep specialists only made things worse. What finally worked were holistic remedies, including meditation and 5-HTP.

Depression returned with the arrival of Parkinson’s. When it did, I almost sold my house and moved into a senior residence. The neurologist who diagnosed the Parkinson’s prescribed Elavil for the depression. Then, my present neurologist expressed concern about that drug's possible adverse effect on cognition. I told him about my earlier, positive experience with 5-HTP. He approved my suggestion that I try it again, and I've been depression-free for four and a half years now.

Symptom 2)  Insomnia 
I have a much longer history battling insomnia. Until March 23, 1978, my drug of choice for dealing with insomnia was alcohol. Most nights, I went to bed half drunk. Toward the end of my active alcoholism, I kept a small glass of vermouth by the bed, to help me get back to sleep after my middle-of-the-night bathroom visits. After I quit drinking, I began using Tylenol PM or Ambien for fairly frequent spells of insomnia. Sometimes, particularly when traveling, I’d take half an Ambien pill along with the Tylenol PM.

May 8, 2014

The Growing Threat of Clever, Drug-Resistant Pathogens: Continued

On Tuesday, I reviewed the World Health Organization’s April report about antimicrobial resistance (AMR), the alarming proliferation of dangerous, adapting pathogens that are impervious to our latest drugs. The WHO analysis actually used the word “apocalyptic” to sound the alarm.

The AMR theme reappeared yesterday, when I read an article in the April 2, 2014 issue of the Princeton Alumni Weekly titled “Invasion of the Superbugs: The stubborn problem of drug-resistant bacterial diseases is escalating.”

That article makes many interesting points:
  • In the USA, two million people become infected each year by drug-resistant pathogens. About 23,000 of them die.
  • Big Pharma isn’t scrambling to develop new antibiotics, since research costs are too high for the small profit those drugs might generate. In the 1980s, the FDA approved 30 new antibiotics. Since 1999, it has approved only 15.
  • Even Congress – action-averse these days on most issues – passed legislation two years ago that gave priority to applications for new antibiotics. The law also extended the period BEFORE new antibiotics would become available as cheaper generics – more financial incentive for Big Pharma.
  • For the most drug-resistant, disease-causing bacteria, the last line of defense is now highly toxic antibiotics that can damage the liver and other organs. These extreme cases now affect about 240,000 Americans each year, and the number is growing.
  • Drug-resistant varieties of MRSA (methicillin-resistant Staphylococcus aureus) bacteria – the one found often in hospitals – is now appearing more frequently outside healthcare settings. That bacteria now kills more than 11,000 Americans each year.
  • According to the CDC, half of all antibiotic prescriptions are either unnecessary or not issued for the correct dose.
  • The CDC estimates that a whopping 70 percent of all antibiotics in America are used on farm animals – to prevent disease and make animals bigger. The use of antibiotics on the farm gives bacteria that much more opportunity to develop drug resistance. In December 2013, the FDA suggested a voluntary removal of certain antibiotics from livestock feed, but it’s unlike to meaningfully reduce drugs in farm feeds when such great profits are at stake.
Ramanan Laxminarayan, a Princeton economist who works with the government on drug-resistant antibiotics, said, “People start paying attention when people start dying, and many more people are now dying from bacterial infections around the world.”

May 7, 2014

Bits and Pieces for Your Information and Enjoyment

This is the first entry in what may become a regular blog feature. I keep coming across entertaining or informative "bits and pieces of this or that" on the web. They don't really warrant full blog posts, but I've saved them anyway. Today, seized by the spirit of spring housecleaning, I dove into the folder where I store this stuff, and decided to post a few.

1)  Happy in the Seniorhood
It all started with a 4-minute song by rapper-producer Pharrell Williams called “Happy.” Williams decided to make a 24-hour video based on the song. Shot in four-minute segments with regular people dancing in the streets of Los Angeles, “24 Hours of Happy” is an infectious wake-up call to get moving, get smiling, get with the beat, and get happy.

The videos are so infectious that people all over the world have created their own versions. Here's an Italian offering that stars seniors:



2)  Harry Truman's Campaign against the "Do Nothing" Republican Congress
I remember well that April day in 1945 when a high school buddy called to tell me President Roosevelt had died. My immediate reaction was: "Oh my God! Truman will be president!"

May 6, 2014

World Health Organization Warns of Frightening, Growing Antimicrobial Resistance


For decades, we’ve heard the alarm: Microorganisms dangerous to human health become resistant to the drugs we create to kill them. The persistent, clever adaptations of these pathogens – managing to flourish in environments our space-age science aims to make as inhospitable for them as possible -- is surely an impressive example of Darwinian survival.

Just last month, the World Health Organization (WHO) released its assessment, "Antimicrobial resistance: global report on surveillance 2014." Its review of the growing worldwide threat posed by antimicrobial resistance (AMR) is scary. Here’s how the overview begins:
Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi… a problem so serious that it threatens the achievements of modern medicine. A post-antibiotic era – in which common infections and minor injuries can kill – far from being an apocalyptic fantasy, is instead a very real possibility for the 21st Century.

The WHO report is the most comprehensive ever, based on statistics from 114 member states and other partners. The issue is not just a Third World concern; AMR is a huge problem in the U.S., where over-prescribing and improper use are common. The alarm is global, and only countries in western Europe were acknowledged for their “well-established national and international systems for tracking antibiotic resistance.”

WHO warns that all countries must work harder to address the problem, and – since everyone on the planet faces the dire consequences of inaction -- that all countries must work more closely in concert.

May 5, 2014

April Showers Bring May Flowers


We've lived through a winter that wanted to go on forever, followed by an unusually cool April, then five inches of rain last week. Now -- at last -- we have a beautiful spring weekend to celebrate the beginning of May.

On Friday, I spent a couple hours at the annual Flower Mart at the Washington National Cathedral. I returned home with two flats of flowers and spent several hours choosing what to put where -- the most fulfilling part of gardening for me.

My age and my Parkinson's keep me from planting big shrubs, spreading mulch and performing other heavier tasks. But I've found a great gardener to help with those chores. Still, I enjoy puttering around in the garden. Most of my work is done near a tree, a bird feeder pole, or a fence -- so I can hang on to something and get up without losing my balance.

In her wonderful memoir Somewhere Toward the End, Diana Athill describes the joy seniors can still find in their gardens:
I manage to do at least a little bit of work myself; tie something back, trim something off, clear some corner of weeds, plant three or four small plants, and however my bones ache when I've done it, I'm always deeply refreshed by it. Getting one's hands into the earth, spreading roots, making a plant comfortable -- it is a totally absorbing occupation, like painting or writing, so that you become what you are doing and are given a wonderful release from considerations of self. 
And so for that matter is simply sitting in your garden, taking it in.
That's exactly what I did a few hours ago as I finished my Saturday-Sunday plantings. Here's the secluded nook in the back of the garden where I sat and took it in:

May 2, 2014

Deep Brain Stimulation: Progress Today, Questions Tomorrow

The May 2014 issue of Smithsonian magazine includes a fascinating article by David Noonan about the current state of deep brain stimulation (DBS). It’s titled “Mind craft: The most futuristic medical treatment ever imagined is now a reality. But it won’t be long before brain implants are even more amazing – and troubling.”

The surgery involves strategically implanting electrodes in a patient’s brain. Those electrodes are powered by a battery pack sewn into the patient’s chest. By delivering a weak, steady electric current to the exact area of the brain, they reduce or eliminate the patient’s troubling symptoms. A century ago, the surgery would have seemed like bizarre science fiction . . . like wirelessly transmitting sounds and images through the air or landing a man on the moon.

DBS, of course, is of particular interest because of its growing – and successful – use as a treatment for people with Parkinson’s (PWPs) for whom disabling symptoms of the disease cannot be adequately managed with medication.

A Treatment for Many Ills
DBS gained approval in the 1980s as a treatment for movement disorders, like PD, essential tremor, and dystonia – involuntary muscle contractions. Estimates suggest about 100,000 people worldwide have undergone the surgery.

Now, DBS is showing promise as a treatment for Tourette’s syndrome, obsessive-compulsive behavior, post-traumatic stress disorder and other neuropsychiatric conditions. It may even help improve memory for Alzheimer’s patients. (So far, treatment remains elusive for multiple sclerosis, Lou Gehrig's disease, and myasthenia gravis.)

Dr. Michael Okum, a neurologist whose practice with neurosurgeon Dr. Kelly Foote is profiled in the Smithsonian article, reports that over 90 percent of their patients rate themselves as “much improved” or “very much improved” on standard post-operative scales.

May 1, 2014

Old and New Ways of Handling Doctor Office Visits

We've all been there. Fifteen minutes after leaving a doctor's office, you realize you forgot to ask a question or can't recall instructions she gave you. It's an increasingly common problem as we age. But help may be on the way.

Note-takers for the Patient
Many senior Villages -- the organizations where volunteers provide services to elderly neighbors who want to "age in place" -- are now offering the services of trained note-takers to accompany the senior on his doctor visits and make notes of what's being said.

A  few months ago, USA Today provided this description of how a Washington, DC Village provides this service
It used to be difficult for Edith Couturier, an 85-year-old resident of the District of Columbia, to explain to her adult children on the West Coast all the details of her medical appointments. But now she doesn't go alone — she takes along a volunteer "medical note taker."
"There are four ears listening to what the doctor says," said Couturier.
That second set of ears belongs to Sharon Wolozin, who takes notes the old-fashioned way — with pen and paper — and then reads some of the main points aloud to confirm them with the doctor. If the patient forgets a question she told Wolozin she planned to ask, Wolozin will remind her. But she is not an advocate and has no medical training.
"We don't get between the doctor and the patient," said Wolozin. Her role is only to create an accurate record of what happened at the appointment that she gives to Couturier, who can then share it with her children or others.
I wrote last week  about my decision to become an associate member of the Palisades Village in my neighborhood. I was told they are getting ready to offer this note-taking service to their full members.

Scribes for the Doctor
The note-takers who accompany the elderly to doctors' offices do it the old fashion way: with paper and pen. But doctors are now switching from paper to electronic medical records. Any doctor who doesn't make the switch by 2015 will face Medicare penalties.

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