May 31, 2013

I'm Feeling Better, but Why? The Perennial Mystery

I posted yesterday about a week-long spell of not feeling up to par -- a par that keeps changing. Today, I'm seeing some progress. This experience is typical of the often mysterious ups and downs we experience as we age.

I recalled some lessons I'd learned -- and forgotten -- and I picked up some new information. Here are some of the issues involved in my recent roller coaster ride.

Checking for Drug Interactions
I recounted yesterday my finding out, courtesy of my CVS pharmacist, that the pain pill prescribed by my internist had the potential for reacting adversely with the Parkinson's meds prescribed by my neurologist. After researching drug interactions, I reread the chapter on over-medicated seniors in the book Are Your Prescriptions Killing You? 

After, I vowed to restrict my pill popping -- of prescribed meds and over-the-counter supplements -- to the absolute minimum.

Here are several user-friendly sites you can use to check for possible adverse drug interactions:
  • Medscape has a good drug interaction checker. I often start any medical research with Medscape; it beats WebMD by a long shot for accuracy, currency and depth of info. I wish I were more adept with apps for my iPhone, since I just got a promo email from Medscape offering its free app on clinical care that includes the drug interaction checker and much more. It's the fastest growing medical care app, used by over 3 million healthcare professionals.
  • Another easy-to-use drug interaction checker is provided by www.drugs.com
  • The nurse-practitioner at my CVS Minute Clinic thinks highly of Epocretes drug interaction checker. It's available online after a free registration. But what she likes is their app that has some nice features in addition to the drug interaction checker. 

May 30, 2013

A Health Setback Prompts the Old Question: Are My Meds Helping or Hurting?

I've had a week of feeling poorly . . . and debating the question many of us raise: Are my medications creating a solution or another problem?

My Current Setback 
I've been dealing with several issues at the same time:
  1. I was prescribed a new blood pressure med that worked too well: I began getting systolic (upper) readings below 100. I felt exhausted, and feared fainting or falling. I stopped taking the bp med but continued to monitor my pressure.  
  2. My CVS pharmacist said they were trying to contact my neurologist before renewing my Azilect prescription because their drug interaction software showed potential adverse interaction with the Tramadol I was taking for lower back pain. (Azilect is commonly prescribed with carbidopa-levodopa for Parkinson's.) I discontinued the Tramadol and started using the CVS equivalent of Motrin.  
  3. These developments prompted some web searches on drug interactions. I discovered that Azilect and carbidopa-levodopa have the potential of interacting to elevate blood pressure. I also learned that 5-HTP -- the supplement I've been taking for years -- can interact adversely with Azilect, since both boost serotonin, and the "double boost" could cause serotonin syndrome. My neurologist said earlier this month that I could try discontinuing the very expensive Azilect, so I did. He also advised me to return to the Azilect if I experienced increased Parkinson's problems. I've resumed the Azilect because I've been having some trouble with the PD symptoms.

May 29, 2013

My 84th Birthday Celebration on Sunday Was Great, But It Would Have Been A Really Big Deal in Nepal!

I enjoyed a fine 84th birthday on Sunday: a nice lunch at home with Ramesh, Laxmi and Rahel (my Pokhara family), dinner with my son and daughter at our favorite restaurant, lots of email and snail mail greetings, phone calls from Kathmandu, Macau and North Carolina. Topping the day was the news that a third great grandchild will arrive early next year.

I couldn't have asked for more. Or could I?

In a birthday email, a good Nepali friend wrote:
In Hinduism, 84 is taken as a special number. Many people in Nepal do something called a "chaurasi pooja" to mark this special achievement. It is also taken as a special number because there are supposed to be 84 lakh (84 thousand!) life cycles and one can be reborn in different cycles including the human being.
I got busy on Google to learn what I'd missed. Here's what I found:

May 28, 2013

Hospital Safety

On May 21, we discussed hospital costs. Today, it’s hospital safety.

As Consumer Reports described in its May 2013 issue, the story isn’t especially positive. Its latest survey includes data from 2,031 hospitals, focusing on five key measures:
  • Readmissions 
  • Complications 
  • Communication 
  • Overuse of CT scans, and 
  • Infections 
The highest-scorer – at only 74 out of 100 – was Bellin Memorial Hospital in Green Bay, Wisconsin. At the bottom – a distinction that must certainly have created a PR nightmare for the facility’s administrators – is Clinch Valley Medical Center in Richlands, Virginia. Their score? 14.

The average score for all hospitals was 49 – a failing grade in most assessments I know that are based on a possible 100. Said Dr. John Santa, director of the Consumer Reports Health Ratings Center: “When it comes to health care, average should never be good enough, and this average is not even close.”

Even more alarming was the performance of the nation’s teaching hospitals, where doctors are trained. In that “elite” category, nearly two thirds of the scored hospitals fell BELOW that average (49). The CR article calls out the 28 teaching facilities in and around New York City, of which only ONE scored above the already-sketchy national average.

May 24, 2013

Update on Coconut Oil: The "All Hat, No Cattle" Nutrient

I've always liked that Texas rancher's description of someone who's all show and no substance. I've used it to describe a Texan who became president. But it came leaping back to mind as I considered doing an update on the over-hyped coconut oil, widely touted as a treatment for Alzheimer's based on anecdotal claims from people who, if you look closely, are making lots of money from pedaling the product.

The Coconut Oil / Alzheimer's Hype
There are countless websites, blogs, and videos touting coconut oil as an Alzheimer's "cure." The website for the "Coconut Research Center," for instance, includes this promise:
. . . there is a way to both prevent and reverse Alzheimer's Disease . . . the solution involves coconut ketones -- a high energy brain food.

May 23, 2013

Update on Curcumin, "Unsung Hero" among Nutrients

Last week, I reported on the curcumin-based compound J147. It's the most promising drug in the pipeline for treating Alzheimer's and other age-related diseases, including my Parkinson's.  

I've written several posts about curcumin, the active ingredient in turmeric, the curry spice Indians call the "holy powder." Curcumin/turmeric has a rich history in ancient cultures, both for it culinary and medicinal uses.

Today's researchers have called it "the unsung hero" among many more widely touted nutrients. While it hasn't received much publicity, curcumin has been the subject of more scientific study than any other compound. Most of those studies have been very encouraging about its potential to treat not only neurodegenerative diseases like Alzheimer's and Parkinson's, but also diabetes, cardiovascular disease, arthritis, depression, and a variety of cancers.

I've set up a "Google alert" on curcumin that sends daily email links to new reports on the subject. I've been amazed by the continuing positive commentary, and astounded by the unwillingness to fund human trials for something with so much potential to treat our most serious diseases. 

Latest Research Reports  On Curcumin
Here are just a few of the recent curcumin research alerts I've received:

May 22, 2013

Less Dementia in Sweden? What About Here?

With all the alarms about the coming Alzheimer’s epidemic – and its frightening impact upon our country’s already out-of-control healthcare costs – it’s a surprise to see a Swedish study that actually reports a DECLINE in dementia risk over the past 20 years.

The apparent reason? Improved cardiovascular health.

This particular study on aging and health began in 1987, and has tracked over 3,000 people aged 75 and up in a Stockholm neighborhood. Even though people with dementia have been living longer for several decades, the “prevalence” of dementia in men and women over 75 remained steady through the study periods (1987-89) and (2001-04).

Researchers conclude that the risk of developing dementia has fallen because treatment of cardiovascular disease has improved – a conclusion that isn’t especially surprising, since protein plaque accumulations have long been associated with Alzheimer’s and other dementias. If medicine can now better control vascular health, it follows that development of new cognitive impairment might be correspondingly reduced.

May 21, 2013

Ante Up for Concierge Medicine? Three Key Questions and My Decision

As I've mentioned, I face a decision: whether to continue with my longtime internist now that he is converting to concierge practice, a subscription-based arrangement available for a $1,500 annual fee. If you haven't already, you may well need to make a similar choice soon. More and more internists, especially senior doctors, are shifting to concierge medicine.

It hasn't been an easy decision. But I've benefited from your blog comments, emails, phone calls, and personal chats. In making my decision, I focused on the three questions:

1. Can I Afford It?
This is the threshold issue. Fortunately for me, it's the easiest question to answer. Yes, I can afford it.

For many others, this issue isn't so easily dismissed. Coughing up an extra $1,500 or more every year can be difficult. And remember: under these arrangements, you will still pay the usual charges for all office visits.

Those who can't afford it will need to find another doctor at a time when there is already a shortage of internists. That squeeze will only get tighter when the Affordable Care Act ("ObamaCare") offers medical insurance to about 30 million people who are now uninsured.

2. Are the Extras Worth the Fee?
"There's little value added. It's a rip-off." That was the assessment I got from an astute, knowledgeable friend . . . and I'm inclined to agree. Here are some of the "extras" I'd get as my internist's brochure described them:
  • An expanded physical of up to 90 minutes. One of the many things I like about my internist is that he already allows plenty of time to talk about my health concerns and offer advice. I don't need more time. Nor do I think I need more tests as part of my physical. Many health authorities are questioning the need for annual physicals. A Danish research team found no benefit to the risk of death or serious illness among apparently healthy people who had general checkups compared to those who did not. The American Academy of Family Physicians itself has recommended against routine annual EKG screenings of asymptomatic patients -- a screening I've been getting every year as part of my annual physical. Sounds like my "less is more" mantra applies here.

May 20, 2013

What Hospitals Charge and What Medicare Reimburses: HUGE Variations

On May 8, the Centers for Medicare and Medicaid Services released some eye-opening information: A) the amounts that hospitals across the country charge for medical procedures, and B) the amounts that Medicare reimburses to those hospitals. The big story here: the vast differences among the “A” figures, and the similar discrepancies among the “B” numbers.

It’s a broad study of 2011 data from 3,300 hospitals, and tracks the costs associated with the 100 most frequent procedures and treatments, including joint replacement, gall bladder removal, and coronary operations. To avoid odd “one-offs,” hospitals had to have performed a particular procedure at least 11 times for their prices to be included in the study.

As far as I know, it’s the first time that consumers who CAN plan ahead have the opportunity to “comparison shop.” For people on Medicare or covered by private policies, these numbers don’t affect us too much; we make hospital choices based on other factors, like reputation, convenience, or affiliation with our own doctors. But for people without insurance – millions of Americans who need to pay the bills themselves -- this new information can be very helpful.

What Hospitals Charge
Here’s just one example from an excellent New York Times article from May 8: “In one hospital in Dallas, the average bill for treating simple pneumonia was $14,610, while another there charged over $38,000.” That higher price is 2.6 times MORE than the other. Why?

May 17, 2013

Promising New Paradigm for Testing Alzheimer's Drugs May Also Work for Other Age-Related Diseases

Yesterday we reported on the curcumin-based compound J147, which looks like the most promising drug candidate in the pipeline to treat Alzheimer's disease. It was developed by scientists at the Salk Institute for Biological Studies using a novel approach that may signal a new way of researching AD and other neurodegenerative disease-fighting drugs.

No question: a new approach IS needed. So far, Big Pharma has had little success with AD drugs, or with my own concern -- Parkinson's drugs.

Previous studies demonstrated that several compounds including J147 can prevent or delay onset of AD-like symptoms in young mice. But that methodology doesn't exactly address the issue for people, who typically experience symptoms before being diagnosed.

Salk Institute researchers therefore used older, AD-engineered mice, whose symptoms were already advanced. Treating these mice with J147 improved their memories in several tests. Examinations of their brains showed decreases in proteins associated with cell death, and increases in proteins that form the connections responsible for learning and memory. Yesterday's post provides more info about J147.

May 16, 2013

Curcumin-Based Drug That Reverses Alzheimer's in Mice Is Ready for Human Trials, But . . .


A curcumin-based drug that can stop, even reverse, Alzheimer's symptoms is ready for human clinical trials, according to Salk Institute researchers. This development may be the most promising to date in a search that has challenged the best brains in medical research. But Big Pharma has declined to fund the human trial.

The initial report  on the Salk study came out over a year ago. Earlier this week, an update appeared in the online journal Alzheimer's Research and Therapy.

The scientists' follow-up study used an experimental design that separates this research from most of the work being done on Alzheimer's.

Tomorrow I'll describe the study's methodology, and the Salk scientists' suggestion that Big Pharma has been on the wrong path for drug discovery. But today, let's look at the follow-up study's findings about the curcumin-based drug and Alzheimer's.

Progression of AD Halted in Very Old Mice
No available drug can stop the progression of Alzheimer's disease. But the Salk researchers now believe their curcumin-based compound can do just that.

It's a bold claim, but rigorous experiments on laboratory mice have held up, revealing the great promise of J147, the new curcumin-based product. The initial 2011 report on J147 showed that it could improve memory in AD-affected mice. Researchers demonstrated that J147 prevented disconnections in the brain's synapses, which in turn halted the ravages of the disease.

May 15, 2013

Cranberries and Lemons: Powerful Cancer Fighters?



On May 10, Dr. Michael Greger released a video on his NutritionFacts.org site about the impact of 11 popular fruits on the growth of human liver cancer cells in a petri dish.

I had to wonder -- if veggies with edible nicotine can prevent Parkinson’s disease, as I mentioned in yesterday's post – can fruits fight cancer cell proliferation?

In a nutshell, here’s what Greger found:
  • Plain water had NO effect on the cancer cells. 
  • Pineapples, pears, oranges had negligible impact. 
  • Peaches at high concentration reduced cancer growth by about 10%. 
  • Bananas and grapefruit reduced cancer growth by about 40%. 
  • Red grapes, strawberries, and apples – even at half doses – cut cancer growth up to half. 
  • Lemons and especially cranberries dramatically cut cancer growth, even with tiny doses. 

May 14, 2013

Can the Peppers Peter Piper Picks Prevent Parkinson’s?


Perhaps.

Eating foods with small amounts of nicotine – like peppers and tomatoes – MAY reduce the risk of developing Parkinson’s disease, according to a study released May 9 in the Annals of Neurology journal.

Dr. Susan Searles Nielsen -- with colleagues from the University of Washington / Seattle -- recruited 490 patients newly diagnosed with PD. For controls, they enlisted another 644 unrelated people with no neurological issues.

All study subjects answered questions about their dietary histories and tobacco use. For this investigation, tobacco use was defined as having ever smoked more than 100 cigarettes, or regular use of cigars, pipes, or smokeless tobacco.

The Solanaceae Family of Flowering Plants
Results showed reduced risk of Parkinson’s disease among people with increased consumption of foods from the flowering plant family Solanaceae, which includes peppers (red, green, yellow), tomatoes, and potatoes. Those edible plants contain small amounts of nicotine . . . not surprising since tobacco is also a Solanaceae family member.

May 13, 2013

Aging and Gardening and Me

Myra's Little Garden - New Yorker Cartoon Premium Giclee Print

Gardening gives me great pleasure, but it wasn't always that way.

During my working days (and weeks and years), I puttered in the garden now and then, but bike riding was always my first choice for weekend activity. If the weather wasn't good for biking, it wasn't good for gardening either. 

When I retired (1/1/1995) and had more spare time, I gradually began to spend more time gardening. Then the huge hackberry tree that had dominated (and shaded) our backyard died. I loved that tree. To console myself, I hired the wonderful Janet Gaskin of Landscape Design to completely redo the backyard. We did away with the grass lawn, planted three big river birches, installed a pond with waterfall and stepping stones, and created the lovely oasis I've enjoyed ever since from the screened back porch, where I can be found whenever the weather permits. 

When age and Parkinson's forced me to retire the bike, gardening took over as my prime outdoor activity.

May 10, 2013

Three New (Unapproved) Drug Applications for Parkinson's

We haven't talked about Parkinson's for a while. Time to check in on recent news.

Three recent drug therapies show promise for people -- like me -- with Parkinson’s. The findings were presented in late March at the annual meeting of the American Academy of Neurology in San Diego, CA.

DROXIDOPA for Dizziness when Standing Up
About one fifth of the one million Americans with PD experience light-headedness when they stand up, a result of rapid blood pressure drops. Patients’ autonomic nervous systems fail to produce adequate amounts of the hormone norepinephrine when their postures change.

Dr. Robert Hauser, professor of neurology and director of the University of South Florida Parkinson's Disease and Movement Disorders Center in Tampa, studied 225 people who shared this problem. Half of those subjects received droxidopa (still unapproved in America), which the body converts into norepinephrine. The other group received a placebo.

After ten weeks, the droxidopa group had experienced a “two-fold decline” in lightheadedness and dizziness, and fell lest often.

TOZADENANT to Combat the “Wearing Off” of Levadopa
Hauser studied 420 patients who regularly experienced a decline (“wearing off”) in the effectiveness of their levadopa therapy. Subjects on average encountered about six hours of “off time” every day as a result of the wearing off effect of levadopa.

May 9, 2013

Why I Blog

None are so old as those who have outlived enthusiasm.
--Henry David Thoreau

That pretty much answers the question of why I blog.

A century ago, life expectancy was still defined by the Biblical three score years and ten. Today, for the first time in human evolution, we have to figure out what to do with an extra 20 years of relatively active life.

I mentioned a few days ago that heading my list of good books about aging is Diana Athill's Somewhere Towards the End. But right up there in contention for the top spot is John Lane's The Art of Ageing. (I just realized that both of these favorite authors are Brits, for whatever that may be worth.) 

Lane says he wrote his book in the belief that, as poet T.S. Eliot urged us to remember, "Old men ought to be explorers / Here or there does not matter." Lane continues:
I take this to include old women. I also take it that Eliot is urging us to make the most of our remaining years, years not infrequently impeded by ill health. That is to say, to follow curiosity, to be creative and contribute to the society into which we have been born.
A MacArthur Foundation Study of Successful Aging found that 80 percent of older Americans agreed that "life is not worth living if one cannot contribute to the welfare of others." Looking around, I find that most of my contemporaries are doing just that. Many are involved in tutoring young school children or working with them in other ways. Others are contributing in a wide variety of ways: visiting bedridden friends, taking elderly neighbors to doctors' appointments, raising funds for the parish church, serving on the boards of charities. 

May 8, 2013

Why Do I Blog? "Crabby Old Lady" Explains Better Than I Could


First, a confession. I came down with a nasty head cold on Sunday, and for the past few days, I haven't felt like researching and writing anything for the blog. I'm taking this opportunity, and you the reader should be thankful, to share the elegantly expressed wisdom of two women whose writings about aging I have enjoyed and admired. 

Yesterday, I quoted from Diana Athill's beautiful memoir Somewhere Towards the End, in which she perfectly expresses my sentiments about the joy -- in old age -- of having young friends. 

Today, I'm turning again to my favorite senior blogger, Ronni Bennett. Last month, I posted her blog essay "A Few Words about Elder Sex," because she came so close to describing my own thoughts on the topic. The self-described "Crabby Old Lady" has done it again, this time capturing my take on blogging.

Still, there are key differences between us. Ronni is 72 or 73 years old, I think, and seems in pretty good health; I'll soon be 84 and have two progressive ailments: Parkinson's disease and prostate cancer. I'm ten years further into the aging process. I'll elaborate tomorrow about why I blog.

But now, here's Ronnie:

IN HER OWN WORDS: Ronni Bennett on Why She Blogs
Several times I have told the story here of how and why, 17 years ago, I started researching aging. I was still working in 2003, when I launched this blog as a place to write down what I was learning and try to make some sense of it all. And here I am, a decade later, still doing it.

May 7, 2013

The Good Fortune of Having Young People in Your Life As You Age

I had planned to post a reflection today about the pleasure I felt last week getting back to work in my garden -- finally! -- after a long cold, wet spring. I remembered that Diana Athill, in her memoir Somewhere Toward the End, had written about her love of gardening. I retrieved my copy of her book, which I had placed at the top of my list of recommended books about aging.

I checked the pages I'd dog-eared and underlined when I'd read Athill's book book about two years ago. Happily, I came across her description of the good fortune she felt having young people in her life, particularly a friend's son and daughter, now young adults "who symbolize my good fortune in this respect."

Rereading it now, after more than a year of sharing my house with two young Nepali newlyweds, I'm struck by how perfectly she describes my own good fortune.  

Diana Athill on the Joy of Having Young Friends 
What is so good about it is not just the affection young people inspire and how interesting their lives are to watch. They also, just by being there, provide a useful counteraction to a disagreeable element in an old person's life.

May 6, 2013

Book Signing for Marione Ingram on a Lovely Sunday

Despite aches and pains from two days of working in the garden and then coming down with a bad head cold, I had a great time Sunday afternoon as friends, old and new, gathered at the house for a book-signing by my treasured friend Marione Ingram. I did  a post earlier this year about the book -- The Hands of War --  and the Daniel-and-Marione  love story.

So let's just do a picture story today:

The Hands of War Being Signed by Marione . . .


. . . with The Hands of Love


May 3, 2013

Concierge Medicine: So What Do YOU think?

I've been writing this week about concierge medicine, prompted by a letter I received from my longtime internist announcing that he was joining the many other primary physicians switching to that model. I can stick with him and get more personalized care . . . for an annual "membership" fee of $1,500.

I'm still debating whether to go this route. Yesterday, I described my initial thoughts. Many of you have already dealt with your internist's switch to concierge medicine. The rest of you may well be confronted with this decision in the near future.

I'd love to know your thoughts. I've already benefited by hearing from some of you. Here's a sample of those emails and blog comments.

Comments from Others on Concierge Medicine
From Carol A.:
If you can find a boutique geriatric specialist, it might be worth the price  -- especially since more and more drs. are declining to take any more Medicare patients . . .
That said, I do think there’s value to having a primary internist who serves as central command – someone who knows all your miscellaneous health conditions, your complete medical history, all your current meds, all the past meds you tried that either didn’t work or had adverse reactions to, etc. 
That’s one thing I like about my MD – even though he’s recognized as a top diagnostician and specialist in the endocrinology field, he takes his role as internist seriously enough to request info on anything I have done elsewhere that’s of any significance. That way, if I’m ever hit by a bus or otherwise incapacitated, there’s someone who has a fairly complete file ready for whatever medical professional might need it – w/o having to contact, wait for callbacks, and piece together info from a dozen different specialists who only have a slice of the picture.

May 2, 2013

Concierge Medicine: My Initial Reaction

For the past few days, I've been writing about the growing movement by primary physicians to concierge medicine. In this arrangement, physicians restrict their practices to patients willing to pay annual fees of $1,500 or more for a higher level of personal attention from their doctors. My investigation was prompted by a letter from my longtime internist announcing that he, too, will switch to a concierge practice.

Yesterday, I reported on commentators' assessments of the advantages and disadvantages of concierge medicine. Today, I'll review my preliminary thoughts as I decide whether to pony up and sign on.

My History with Dr. Schubert
Schubert has been my primary care doctor for about 20 years. He gives me an annual physical exam and always takes plenty of time to talk with me about my issues. I enjoy working with him because he's smart and caring and -- important for me -- has a great sense of humor.

May 1, 2013

Concierge Medicine: The Case For and Against


Developed in 1996 mainly for affluent patients, "concierge medicine" offers fee-paying subscribers a higher level of personal attention. This type of practice is growing, becoming a more affordable option for many more people. 

Last year, there were about 4,400 concierge doctors in America, and 1,000 practices opened in 2012, according to Tom Blue, executive director of the American Academy of Private Physicians. The number is expected to double in the next three years, Blue adds.

When concierge medicine started in 1996, annual membership dues averaged $10,000 or more. Fees have now drifted down into the $1,500-$1,800 range.

The Problem: Primary Care Doctors Are Getting Scarce
Increasingly, private practice doctors have given up their independence for employment at hospitals, clinics, and elsewhere. Independent physicians have dropped from 57% in 2000 to 39% in 2012, according to an Accenture study. Of those who remain in private independent practice, Accenture says, a rapidly increasing number are adopting subscription-based models.
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