Are you concerned about your weight?   Obesity takes its toll in the long term. These include snoring, insomnia, diabetes, and knee arthritis.  BMI (body mass index) is a tool for measuring weight.    

Overweight occurs when you eat more calories than you burn through daily activity. Cutting down your calory intake and increasing your activity is a solution.  A sedentary lifestyle is bad for your health. An unhealthy diet and poor eating habits will result in more body fat. Instead of a coke, drink diet coke.  Eat more fruits and vegetables and fruits. You can't change your genes.  However, genetics affect the amount of fat you store and where it is stored. Instead of a coke, get a diet coke. Include more fruits and vegetables in your diet. 

Obesity runs in families. You can't change your genes, but you can change your eating habits. Genetics affect the amount of fat you store. It is affected by family lifestyle.

If you are not physically active,  you are storing calories. Inactivity leads to lower extremity arthritis. 

Climb the steps rather than using the elevator. 

When you go to the grocery store, read the ingredients. Be calory conscience.  Read the food labels. Pay attention to the contents of fat and sugar. Practice "portion control." 

Insomnia may trigger the need for snacking between meals. However, increase your activity.  Climb the stairs rather than using the elevator. Snoring may be a sign of sleep apnea. You may want to contact your primary care physician to order an overnight sleep study.   

Obesity can lead to shame, guilt, social isolation, disability, and lower cognition.  

Walking, swimming, and bicycling, will burn calories and improve your balance and sleep quality.  Limit your snacking between meals. 

A ketogenic diet lowers brain inflammation and promotes cognition. Consider purchasing "The Ketogenic Diet Cookbook," Amanda C. Hughes. Easy, Whole Food Keto Recipes for Any Budget."   

Keep a notebook or food diary to track how often you eat and portion control. 

Weigh yourself no more than twice per week to track your progress. This will bolster your confidence and keep you on track. 

Stay with your program and keep yourself busy. Don't get discouraged. Be careful during the holidays and avoid splurging.

Famous quote:  "I found there was only one way to look thin. Hang out with obese people."  Rodney Dangerfield

Source:  Mayo Clinic.


  

Sundowning:  Late Day Confusion. Source:  Mayo Clinic

Sundowning:  Late-day confusion. The term "sundowning" refers to a state of confusion occurring in the late afternoon and spanning into the night. It can cause a variety of behaviors such as confusion, anxiety, aggression, or ignoring directions.  Symptoms may lead to pacing or wandering.  It is not a disease, but a group of symptoms that occur at a specific time of the day that may affect people with dementia, such as Alzheimer's disease.  

The exact cause of this behavior is not known. Factors that aggravate late day confusion include fatigue, low lighting, insomnia, increased shadows, disruption of the body's internal clock, difficulty separating reality from dreams, and presence of an infection such as a urinary tract infection. 

Here are tips for reducing sundowning.  Try to maintain a predictable routine for bedtime, waking, meals, and activities.  Plan for activities and exposure to light during the day to encourage nighttime sleepiness. 

 Limit daytime napping.  Limit caffeine and sugar to morning hours. Avoid eating a large meal within several hours of goint to bed.  Keep a night light on to reduce agitation that occurs when surroundings are dark or unfamiliar.  

In the evening, try to reduce background noise and stimulating activities, including  TV viewing, which may be upsetting. 

In a strange or unfamiliar setting, bring familiar items, such as photographs, to create a relaxed, familiar setting. If you have a pet, the pet may lower your stress level and promote falling asleep.

Play gentle music in the evening or relaxing nature sounds such as the sound of ocean waves. Get a checkup with your care provider to determine if you might have an underlying condtion, such as a urinary tract condition or sleep apnea. The condition may worsen if  sundowning develops quickly. Consider Melatonin, an over the counter medicine that induces sleep. 

When sundowning occurs in a care facility, it may be due to the flurry of activity during staff shift changes or the lack of structured activities during staff shift changes.  

Source:  Mayo Clinic 

Famous quote:  "I only went out for a walk, and finally concluded to stay out till sundown. for going out, I found, was really going in.  John Muir."  

Source:  Mayo Clinic

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Knee pain is a common condition that affects middle-aged people. It may be due to an injury, such as torn cartilage in the joint, as well as arthritis, or gout. Joint infection can cause knee pain. Physical therapy and knee braces can alleviate discomfort. If these treatments fail, and function is impaired, surgery is considered.

Signs and symptoms include joint swelling, stiffness, and instability to straighten the knee. You may have joint redness,  and "giving out" of the joint.  

There are multiple causes of knee pain. It may be due to an anterior cruciate ligament (ACL) injury, fracture, torn meniscus, knee bursitis, and patellar tendonitis. An ACL injury is tearing of the anterior cruciate ligament. The knee meniscus is a rubbery cartilage that functions as a shock absorber, It can tear due to direct trauma or twisting of the joint. It's a common injury for those who play golf. Knee fractures or ligament tears could include the kneecap, as well as trauma due to vehicle accidents. Osteoporosis increases risk for knee fracture.

Patellar tendinitis is inflammation of the knee tendons in those who jog and cycle. Bone and cartilage could break off into the knee joint. The loose body might interfere with joint movement. 

Iliotibial Band Syndrome (IBS) occurs when the patella slips out of place. Distance runners are at risk.  

A dislocated kneecap occurs when the patella slips out of place due to dislocation. Those with hip or foot pain should change the way they walk or run in order to avoid joint dislocation. 

Degenerative knee arthritis is the most common type of joint arthritis. 

Patellofemoral pain syndrome is common in joggers. It is due to    instability of the patella. 

Risk factors for knee pain and weakness include obesity, lack of muscle flexibility, and joint weakness. Be cautious if you take part in alpine skiing, basketball, use of rigid ski boots, and history of prior knee injury. 

Here are some suggestions to lower your risk. Maintain a healthy weight, take time for conditioning your legs, and consider weight reduction. Focus on re-conditioning your hamstrings.  

Finally, be "smart" regarding your exercise. You might consider 
swimming, water aerobics, and walking.  

 Don't forget to exercise your upper extremities. Be cautious when you climb stairs. Use the handrails. Practice a healthy lifestyle, to include proper diet, and sleep hygiene. Consider tai-chi, yoga, cycling, and stationary biking. 





































source: www.mayoclinic.org/diseases-conditions/knee.

Are you sleeping well?  If not, read on, as disrupted sleep can have a profound effect on your happiness, well-being, productivity, and general health.  

First, talk to your doctor.  Your primary care provider may evaluate you for hypo or hyperthyroidism and do other blood work.  Keep an updated diary to determine your wake-sleep activity for several weeks. This can be helpful to show to your doctor during an initial visit.  If the cause isn't clear, your doctor will consider an overnight sleep study at a sleep center, to rule out sleep apnea or restless legs syndrome.  These are important causes of sleep disruption.  During a sleep study you get hooked up to multiple sensors overnight in a comfortable bed and get checked for brain wave activity, breathing, heartbeat, eye movement, and leg twitching.  More recently, simple equipment can be sent home with you to collect the data from the comfort of your own home.  

Your doctor may prescribe certain medications including Eszopiclone (Lunesta), Ramelteon (Rozerem), Zaleplon (Sonata), Zolpidem (Ambien,) Edluar, Intermezzo, and Zolpimist.  Work closely with your doctor as these prescription medicines could be habit-forming.  Prescription sleeping pills have side effects, including daytime sleepiness and grogginess, and risk of falling.  Discuss this with your provider. Melatonin, an over-the-counter supplement can be very effective and is inexpensive and readily available.  Nonprescription sleeping pills containing  antihistamines may cause drowsiness, confusion, memory problems, and difficulty urinating, which may be worse in older adults.  Don't neglect personal medical issues, such as prostate enlargement, which could lead to excessive night-time bathroom trips.

Cognitive behavioral therapy (CBT) can be just as effective as sleep medication. CBT trains you to recognize and change beliefs that disturb sleep.  CBT is a type of talk therapy (psychotherapy).  You work with a mental health counselor in a structured way, attending a limited number sessions.  CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way.  CBT can be a helpful tool in treating mental health disorders, such as depression, post-traumatic stress disorder (PTSD), or an eating disorder. Not everyone who benefits from CBT has a mental health condition. It can be an effective tool for anyone to better manage stressful situations. 

If you wake up in the middle of the night and your mind starts racing, get out of bed and read a magazine or calming book.  You don't want to associate lying in bed with being awake and worrying.  Keep your pets out of bed as they can disturb your sleep.  Get blackout curtains and keep the temperature down, as the ideal place to sleep is dark, quiet, and cool.  Sound machines can be purchased to filter out noises from within your home and outside, including airplanes and sirens.

It is very important to stay on a regular sleep schedule, especially so if you travel a lot for work. Exercise and activity also promote sleep. Schedule exercise at least several hours before going to bed. Do stretches and meditation in your bedroom before you go to sleep. Find ways to relax before you get in bed. A warm bath, reading, and soft music can help. Review the labels of all your over the counter medicines.  You want to check the labels to determine if they have caffeine or other stimulants, such as nicotine.  

We're learning more and more about blue light, which comes from electronic screens such as phones, tablets, and computer screens.  Get blue light filters for your screens, download the apps to decrease blue light, or get special blue-light filtering glasses (can buy online!)  Even better, just limit your exposure to electronic screens to before 6pm.  

Nothing beats an afternoon cat-nap!  But a word of caution, if you do take a mid-day nap, keep it to no more than fifteen or twenty minutes or it will disturb that night's sleep.  Try not to nap after three pm. Avoid large meals or alcohol right before bedtime. A light snack of carbohydrates can help. Make your bedroom comfortable for sleep. 

Additional relaxation treatments can include yoga, tai-chi, and self-hypnosis. Do you have a hobby to occupy your time and put you in the "zone" or "flow"?  This helps decrease anxiety.  Do you have a purpose in your life? Keep up your social connections. Consider volunteering at a food bank.  You learn to view life with thankfulness and appreciation.    

Schedule an appointment with your care provider. Bring along your medical files and get ready for the best night of sleep you've had in a while!!

Source: MayoClinic.org-diseases-condtions/insomnia/diagnosis-treatment/drc-203551/drc-203555173?p=1

Alzheimer's is not a death sentence.

If you are diagnosed with Altzheimers, daily function is crucial. Allow yourself to slow down and manage your capabilities. This is important before you flood yourself with various medications that could lead to drug interactions.

Compensatory strategies help you deal with Altzheimers. Make life easier for yourself by placing items in the same location. Make them easily visible by marking them with colorful tape. Consider using your cell phone calendar to help you remember the day of the week and the month. What about items you need at the grocery store? Do you have your or your to-do list? You can make "to do lists" for errands and appointments.

Try making "jingles" that you sing to yourself regarding groceries. Sing the list as you write the items down on an index card. Keep a small notebook in your pocket to recall important information, such as appointments. If you forgot your grocery list, sing the items to yourself.

Assess your overall health. Cognition can be affected for other reasons, such as job loss, traumatic brain injury, drug abuse, PTSD (post traumatic stress disorder ), depression, and a death in the family. These conditions mimic Altzheimers.

Insomnia disturbs sleep quality and hampers short-term memory.Consider stretching your back, shoulders, and legs before going to bed. If you awaken early, or you can't sleep, consider Melatonin, an over the counter sleep aid.

If your brain is getting tired, take a "Brain Break." Walk outside, play Sudoku, and try word puzzles.

If insomnia is keeping you awake and you can't fall asleep, take a Melatonin tablet, at bedtime.

Don't carry a grudge against someone. Apologize and let it go. Consider a tune from the
Beatles, "Listen to Words of Wisdom, Let it Be."

There is evidence that hearing aids improve cognition.They are are expensive. However, if you are a military veteran, you may be eligible to get them at no cost.

Should these strategies boost your mental function, you may notice a "dopamine rush" that will give you a "feel good" sensation.

Walking, running, and bicycling are great for exercise. Allways wear a protective helmet.Traumatic Brain Injury hampers cognition, which mimics Alzheimer's.

Consider taking Vitamin B6 and B12. Low levels of these vitamins can hamper cognition. How do you know? Try it.

Holidays can be depressing, especially if you have Alzheimer's, job loss, death in the family, and divorce. Anger and depression disrupt function, sleep, appetite, and cognition.

Depression can be managed with Tai Chi, aerobic exercise, or taking a walk in the neighborhood.

Having short term, goals and a long term purpose alleviates depression.

Sign up for volunteering, This can be something as simple as volunteering at a Veteran's Hospital, Dumb Friends League, or Food Bank.

If you angered someone, apologize promptly. Don’t allow your thoughts to ruminate. An apology diffuses depression and anxiety. If you feel guilty, frustrated, or angry with yourself, take a few deep, slow breaths to destress and recalibrate

A walk outside can calm you down and bolster your cognition. This is like pushing the reset button on your computer. Managing your emotions is beneficial. Don't shutter yourself from others, especially your family members.

Assertiveness training is a method to get what you need without causing confrontation. It allows you to bargain with others without animosity. Give it a try.


Misplaced car keys or cell phone? Methodically start searching your home starting from the bottom floor to the top. Put a red fob on your car keys and hang the keys at the entrance of your home. Consider getting a spare set of car keys and put them in a magnetic box that can be attached to the underside of your car.

A mental thealth check-up can dig deeper to see whether your are experiencing Alzheimers symptoms, or if there is another related conditon that has not be evaluated or treated.

A diagnosis of Alzheimer's does not mean that your life is over. Hopefully, you will find that these suggestions help you cope. Build a purpose inyour life, other than your Alzheimer's.

Vitamins B-6 and B-12 can improve cognition. Foods that are rich in these iinclude chickpeas, fish, potatoes, bananas, cottage cheese, and poultry

A wide variety of foods supply vitamin B-6, including chickpeas, fish, potatoes, bananas, cottage cheese, poultry and meat. B-6 plays a role in cognitive function, and it is also involved in more than 100 enzyme reactions. Along with B-12, B-6 helps control homocysteine, a substance that is linked to an increased risk of cardiovascular disease.

You get B-12 from fish, cheese, dairy, meat and eggs, as well as from fortified cereals. Vitamin B-12 plays a crucial role in energy metabolism and the production of red blood cells. Because B-12 helps your body convert carbohydrates from what you eat into fuel, low levels of the vitamin can lead to fatigue. You also need B-12 for healthy nerve function, so a deficiency may lead to nerve damage. In addition, vitamin B-12 promotes healthy neurological function and DNA production, and it's also needed for normal brain function.

Many famous people have had schizophrenia, including Vincent Van Gogh; Mary Todd Lincoln; John Nash- a brilliant mathematician; Brian Wilson, the Beach Boys; Nathanial Ayers;  and “The soloist,” a black American who was a double bassist at Julliard. Those with schizophrenia can be gifted.

 Schizophrenia symptoms include auditory hallucinations, disorganized speech, delusions, hallucinations, and catatonic behavior. Those affected are diagnosed between sixteen and thirty years of age. Symptoms include delusions, hallucinations, thought disorders, and lack of motivation. There is no specific gene that triggers the disorder. Schizophrenics are aware of their thought disorders. They have control over thoughts and behavior.

      The affected person may believe they are being persecuted. They may think they have extraordinary powers and gifts.

Symptoms include hallucinations and hearing voices (auditory hallucinations).  This may include visual images (seeing things that are not there).    When speaking, the person might jump from one subject to another for no logical reason. Speech may be muddled and difficult to understand.

         Lack of motivation is typical. The affected person loses their drive. They may give up on daily activities, such as personal hygiene, washing and cooking.   They may not respond to happy or sad events, or may react inappropriately.

        Social withdrawal is typical. When a patient with schizophrenia withdraws, it is often because they believe someone may harm them. They might not be aware of the illness. Hallucinations and delusions are real to the patient. Schizophrenics have difficulty with concentration, planning, organizing, and communication.   Treatment goals include having few or stable symptoms. Hospitalization is not recommended unless there is another medical issue that demands inpatient treatment.  Some have no family history of the disorder. It may be due to a new mutation.

A psychiatrist experienced in treating schizophrenia guides treatment.  The team may include a psychologist, social worker, psychiatric nurse and a case manager. The team approach may be available in clinics with expertise in schizophrenia treatment. Medications are the cornerstone of treatment. Antipsychotic medications are the most commonly prescribed drugs.  They control symptoms by affecting the brain neurotransmitter, dopamine.

Treatment goals include antipsychotic medications to manage signs and symptoms at the lowest dose. Medications could include antidepressants. It may take several weeks for the patient to notice improvement. 

Willingness to cooperate with treatment determines drug choice. The patient should consult with their treatment provider regarding side effects. 

Newer, second-generation medications are preferred. They have a lower risk of side effects. These include Chlorpromazine, Clozapine, Haloperidol, Fluphenazine, and Perphenezine. 

Older antipsychotic medicines could cause frequent and potential side effects, including possibility of a movement disorder (tardive dyskinesia) that may or may not be reversible. Once psychosis recedes, in addition to continuing medication, psychological and social interventions are crucial.

Psychotherapy helps normalize thought patterns.  Learning to cope with stress and identify early warning signs of relapse help with symptom management..

Socials skill training improve communication and facilitates daily activities. This provides support and education to families dealing with schizophrenia. Vocational rehabilitation can help those with schizophrenia prepare for further education and employment.

Many communities have programs to help those affected to find housing, self-help groups, and crisis intervention. With appropriate treatment, most people with schizophrenia can manage their illness. During crisis periods or times of severe symptoms, hospitalization may be necessary. If drug treatment is not effective, electroconvulsive therapy (ECT) is considered.

Coping with a mental disorder as complex as schizophrenia is challenging,  both for the person with the condition and for friends and family. Here are some ways to cope.

Learn about schizophrenia and join a support group. Education motivates the person to stick to a treatment plan. Support groups can help them reach out to others facing similar challenges.  Stay focused on goals. Managing schizophrenia is an ongoing process.

Stay motivated.  Help your loved one take responsibility for managing the illness and working toward goals.

Learn relaxation and stress management. The person with schizophrenia and loved ones may benefit from stress reduction techniques, such as meditation, yoga, or Tai Chi.

Go with your loved one to their appointments. Getting the information first hand will help you know what you're facing.

My amiable brother started hearing voices in his head at the University of Kansas in1970. I try to keep in touch with him by phone.

Manifestations of the disease process include psychotic disorders, such as delusions, hallucinations, and dysfunctional ways of thinking, called thought disorders (such as believing that” I can fly).”  Depression is common. It runs in families, even if the genes may not manifest. Auditory hallucinations could interfere with activities of daily living.

Clonazapine is a drug that may be prescribed. Social skills training is another treatment.  Treatment goals include avoiding hospitalization.  Once you get in the hospital patients tend to stay a while.  

Source: NIH www.nimh.nih.gov

Have you had your annual flu shot?  Influenza symptoms include a runny nose, congestion, fever, muscle aches, cough, and wheezing. The flu could progress pneumonia in the elderly.

The Centers for Disease Control recommends that everyone six months and older should receive the annual influenza vaccine. This includes those older than sixty-five, pregnant women, and those with a weakened immune system, such as AIDS.  The vaccine is available as a nasal spray.  It provides protection for two weeks after receiving the vaccine.

The annual flu vaccine prevents flu sickness.  Symptoms include muscle aches, weakness, and fever.  The vaccine cannot cause the flu. It is especially important for those with long term health conditions, such as AIDS.  The current flu vaccine is injectable.  The nasal spray vaccine is not recommended this season. 

Flu vaccination reduces the risk of hospitalization, especially in children and older adults. Those older than fifty years reduce their risk of hospitalization by fifty-seven percent. You cannot get the flu by getting the flu vaccination.

Here is a list of medical conditions that increase risk for getting the flu:  asthma, sickle cell disease, diabetes, chronic obstructive pulmonary disease, heart failure, kidney and liver disorders, those younger than nineteen years and on long-term aspirin. system, those with AIDS, cancer, adults sixty-five and older, Native Americans, and Alaska Natives. The vaccine changes annually. 
Source:  www.cdc.gov/flu.

You can call 1-800-CDC-INFO.  1-800-232-4636