3-13-14

 

I was re-organizing my files today when I came across a Wall Street Journal article describing a woman’s predicament following a diagnosis of Alzheimer’s disease. The story, “Curse of a Diagnosis,” detailed her perilous journey through brain imaging, spinal fluid analysis, and imaging tests. Her husband commented, “There’s no way this diagnosis benefits people who have it”, and allowing his wife to be tested “was the biggest mistake of my life … a bomb has gone off ….”  He acknowledged that his wife “sometimes gets confused and repeats herself. But why not me; I eat right, exercise, and no one else in my family has this.” The couple owns an import saddle business in California. To add to the couple’s misfortune, she had to relinquish her driver’s license by California regulation.

This story, though not uncommon, touches my soul. The most compelling dimension of the article is what it doesn’t cover.

Let's put aside this woman’s unhappy situation for a few moments and look at the subject matter from another dimension. A healthy lifestyle that includes exercise, strong family and social connections, and dietary changes can delay and may prevent most chronic disease, including Alzheimer’s. A through medical evaluation is mandatory before we label someone with the “A-word.” Health conditions that act like Alzheimer’s are lengthy -- chronic heart disease, endocrine problems, Vitamin B12 deficiency, heart disease, uncontrolled diabetes, multiple sclerosis, depression, stroke, mini-stroke (transient ischemic attack), Lyme Disease, pesticide exposure, traumatic brain Injury, and medication side effects. 

Now consider a healthy lifestyle approach. Anti-oxidants, such as pomegranates, avocado, fish, turmeric, cinnamon, and alcohol/caffeine in moderation can improve memory and long term brain function. Regular exercise, such as walking, dancing, Tai Chi, and golf relieve stress, improve concentration and balance, sharpen the mind, and enhance blood flow to the brain. In other words, what’s good for the brain is good for the heart.

Neurocognitive rehabilitation can help with mental focus, memory recall, name recognition, and abstract reasoning. Two excellent references on healthy brain strategies include The Alzheimer’s Prevention Program, Keep your Brain Health for the Rest of Your Life (Small and Vorgan, Workman Publishing), and Neuropsychological Rehabilitation, Theory, Models, Therapy,and Outcome (Wilson, Gracey, Evans, and Bateman).     

There are numerous peripheral issues regarding treatment and evaluation of memory impairment, including insurance coverage and Social Security Disability.  Finally the medical term, “dementia,” evokes images of insanity, derangement, idiocy, and lunacy. In my opinion, we should avoid the “dementia” when referring to memory impairment and use, “mild cognitive impairment,” and “organic brain dysfunction of the Alzheimer’s’ type.”

It’s time to show optimism regarding Alzheimer’s evaluation and treatment. More diagnostic and  treatment strategies are on the horizon. Alzheimer’s is not a death sentence.

                                                                                                                                                                               Clement Hanson D.O. MPH

cataracts

Insomnia is a condition of fragmented sleep. Those affected have early morning awakening that leads to poor concentration and irritability. It hampers job performance and slows reaction time.
Your doctor might have you complete a questionnaire to determine your sleep-wake pattern and daytime sleepiness. You may be asked to keep a sleep diary.
• How often do you have insomnia and when did it begin?
• How long does it take you to fall asleep?
• How many hours do you sleep?
• Do you snore or wake up choking for breath?
• How often do you awaken at night? How long does it take you to fall back to sleep?
• Are you refreshed when you wake up?
• Are you tired during the day?
• Do you doze off or have trouble staying awake while sitting or driving?
• Where do you sleep? What's the noise level, temperature and amount of lighting?
• Stressful life events?
• Alcohol and tobacco use?
• Family history of sleep issues?
• Recent travel and time changes?
• Long work hours, shift changes, and night shift?
Keep a current list of medications, vitamins, and herbal supplements, including doses. Have your sleep partner come along for your next doctor’s visit. The partner could provide observations that verify information. Your doctor could suggest an overnight sleep study. A blood test might be appropriate to rule out hypo or hyperthyroidism. .
Parkinson’s Disease and Alzheimer’s aggravate symptoms. Ritalin, prescribed for Attention Deficit Syndrome, inhibits sleep. Coffee, tea, and “energy drinks” are detrimental. Other sleep-related disorders include Sleep Apnea and Restless Legs Syndrome. Other disorders include depression, anxiety disorder, post traumatic stress disorder, and substance abuse.
If the cause isn't clear, or you have symptoms and signs of another sleep disorder, such as sleep apnea or restless legs syndrome, referral to an overnight sleep center is recommended. This study monitors brain waves, breathing, heartbeat, brain waves, eye movement, and body movement.
Behavior therapies are recommended as the first line of treatment for those with insomnia. They are equally or more effective than sleep medicines. Cognitive behavioral therapy helps or eliminates negative thoughts and worries that inhibit sleep, such as the concept, “a bad sleep night will make me sick.”.Muscle relaxation, biofeedback and deep breathing reduce anxiety. These modalities bolster breathing, heart function, muscle tension and mood.
“Stimulus control” is a technique that limits time spent awake in bed. The bed and bedroom should only be associated with sex and sleep. Sleep restriction decreases time spend in bed, causing partial sleep deprivation. This strategy creates fatigue the next night. When sleep quality has improved, time in bed is decreased. Other treatments include remaining awake. Also called “paradoxical intention,” this method reduces worry and anxiety about being able to sleep by getting in bed and trying to stay awake, rather than expecting to fall asleep.
If you fall asleep too early and awaken too early, you can use light to push back your internal clock. Go outside during times of the year when it's light outside in the evenings. Consider purchasing a medical-grade light box kept in your bedroom.
Prescription sleeping medicines, such as zolpidem (Ambien), zopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) can induce sleep. Physicians might not recommend “prescription sleeping pills” for more than a few weeks.
Over the counter nonprescription sleeping medicines contain antihistamines that cause drowsiness. These reduce sleep quality. Side effects include daytime sleepiness, urinary retention, dry mouth and confusion.
Antihistamines worsen urinary problems, causing urinary urgency during the night. Additional options include Melatonin. This over-the-counter (OTC) supplement could reduce insomnia.
Valerian is a dietary supplement sold as a sleep aid. It has a sedating effect, but hasn't been well studied. It is released into the bloodstream at dusk and tapers off in the morning. You might want to discuss it with your doctor. Those who take it at high doses or long term may develop liver inflammation (hepatitis). When it's time to stop, it should be tapered to prevent withdrawal symptoms.
Stick to a sleep schedule. Keep your bedtime and wake time consistent, including weekends.
Avoid large meals before bed. A light snack is fine. Drink less before bedtime so that you won't have to urinate as often.

Don’t work or eat in bed. Avoid TV, computers, video games, smart phones or other gadgets before bedtime.

The TV and an i-Pad may interfere with your sleep cycle.

Close the bedroom door or create a subtle background noise, such as a fan, to dampen noise sources. You might want to silence your cell phone and bedroom clocks.

A warm bath or massage can prepare you for sleep. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer. Avoid trying hard to sleep. The more you try, the more awake you’ll become.

Read in another room till you’re drowsy, then go to bed to sleep. If you can't sleep after twenty minutes, do something relaxing, such as reading. Try again.

Yoga and Tai-Chi help with sleep quality. Start slow and work with a coach or instructor who listens to your needs and limitations.
“Mindful Meditation” along with conventional treatment can improve sleep. Research suggests that regularly practicing meditation reduces stress and lowers blood pressure.

Source: MayoClinic.org
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Famous quote: “The best cure for insomnia is to get a lot of sleep.” W.C. Fields

 

             Alcohol use among active military and veterans is a major health issue.

Throughout military history, holding one’s liquor has been akin to a “real soldier, on par with knowing how to handle one’s weapon. Heavy drinking glamorized the culture of those serving in uniform. Following active duty, veterans who served abused alcohol. Post-Traumatic Stress Disorder was linked to battlefield experience.

            Alcohol causes cancers of the esophagus, mouth, pancreas, larynx, and liver. There is no risk-free level. The more alcohol a person drinks, the higher the cancer risk. Alcoholic beverages contain at least fifteen cancer-causing compounds. These include acetaldehyde, acrylamide, aflatoxins, arsenic, benzene, cadmium, ethanol, ethyl carbamate, formaldehyde, and lead. The most toxic alcohol product is acetaldehyde.

            The fine cilia of the esophagus can be be destroyed by high alcohol concentrations in “hard liquor”. Smoking has long been established as a cancer risk factor. Heavy smoking combined with heavy liquor is especially dangerous. 

            The rate of ethanol metabolism is determined by genetics. Ingested ethanol is changed to acetaldehyde, present in alcoholic beverages. Over time, acetaldehyde can cause cancer of the throat, pharynx, mouth, esophagus, and larynx. Alcohol interacts with folate metabolism and inhibits nutrient absorption from the gut. Poor absorption interacts with ethanol to impair DNA. Alcohol increases estrogen levels, which stimulate cell growth. Other cancer mechanisms include production of reactive oxygen, nitrogen, and tobacco use. The mouth, intestines, liver, and esophagus have the greatest risk for alcohol related cancer. 

            Avoiding alcohol could prevent up to eighty percent of oral and ninety percent of larynx cancer cases. Those who have health problems related to alcohol should quit all forms of use. Warning labels should convey risks associated with alcohol in simple language. Reduction of alcohol consumption is the cost-effective way to reduce disease.

            The more alcohol is consumed in any country, the more alcohol-related diseases occur. Price and availability are tools to decrease consumption. Price is regulated by taxation. Drunk-driving policies and health service measures have some effect. Health information campaigns are valuable for control measures. A return to prohibition isn’t necessary. Increased public awareness would reduce risk. Patients should be informed and concerned about overall risk. Here are strategies to reduce cost and disease burdens. 

Monitor your alcohol intake ("know your number"). This is similar to knowing your blood pressure, weight, Body Mass Index, cholesterol level, blood sugar, and calorie intake. Limit alcohol consumption to twenty grams per day for men and fifteen for women. This is about one and a half drinks for men and one drink for women.  

Less is more. Lower alcohol consumption leads to better health and longer lifespan.

Take a day off. Avoiding alcohol for one to two days weekly lowers risk. 

 Source: http://emedicine.medscape.com/article/805084-overview;

“There is more refreshment and stimulation in a nap, even of the briefest, than in all the alcohol ever distilled.” Ovid.