Tag: Health

California/Health/Lifestyle/Medicine/seniors/USA
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When Mom & Dad go wandering: dementia on a relentless rise

by Fran Johns

“MISSING,” the sign reads. “Distinguished-looking elderly man. 6′ 1” slightly stooped. Gray hair. Wearing dark blue sweater and gray slacks. Name: George; does not always respond. Suffering from mild dementia. Wandered away from the Laurel Village shopping center area. Please call 415-xxx-xxxx with any information.”

The sad, 8″ x 10″ flyer has appeared (once the words were slightly different, but it was clearly the same George) at the bus stop near my home twice in recent months. I kept the number in my wallet for a while, hoping I might spot him because I walk the city myself. But the difference is that I have on a warm jacket — it’s way too cold in San Francisco, especially after dark, for only a sweater — and I know how to get home.  I have wanted to call the number and learn whether George got home, but it seems intrusive.

Last year for the first time, as reporter Kirk Johnson writes in The New York Times, people like George and a 60-year-old Virginia woman named Freda Machett accounted for more missing-person alerts than children and adolescents. They are confused and lost, and often are not found in time.

Ms. Machett, 60, suffers from a form of dementia that attacks the brain like Alzheimer’s disease and imposes on many of its victims a restless urge to head out the door. Their journeys, shrouded in a fog of confusion and fragmented memory, are often dangerous and not infrequently fatal. About 6 in 10 dementia victims will wander at least once, health care statistics show, and the numbers are growing worldwide, fueled primarily by Alzheimer’s disease, which has no cure and affects about half of all people over 85.
It started with five words — ‘I want to go home’ — even though this is her home,” said Ms. Machett’s husband, John, a retired engineer who now cares for his wife full time near Richmond. She has gone off dozens of times in the four years since receiving her diagnosis, three times requiring a police search. “It’s a cruel disease,” he said.
“You have to stop thinking logically, because the people you’re looking for are no longer capable of logic,” said Robert B. Schaefer, a retired F.B.I. agent who cared for his wife, Sarah, for 15 years at home through her journey into Alzheimer’s. He now leads two-day training sessions for the Virginia Department of Criminal Justice Services.

How to deal with dementia is the most bewildering of end-of-life issues, whether for oneself or for a family member. Most of us would choose almost any other scenario for our last months or years, but the choice is often not ours to make. We can file advance directives (mine includes a “Dementia Provision“) and express our wishes and do brain exercises; still, one in seven Americans, according to most fairly recent reports, now suffers from dementia and the numbers are on the rise.

Here’s one interesting perspective. My greatly beloved brother-in-law, who recently relocated with my sister to a retirement community, has Parkinson’s. Though his mobility and function are diminished, the disease has yet to affect his mind. Several weeks ago he told me he no longer fears dementia. “I see people more and more with varying stages of dementia,” he said, “and I believe you can be happy.”

But you can also wander off.

More Wander Off in Fog of Age – NYTimes.com.

California/Environment/General interest/Health/Lifestyle/seniors/teens/USA
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Dr Oz worries about cell phones too

by Fran Johns

More on cell phones and brain tumors: a reader yesterday sent along a link to an earlier commentary by Mehmet Oz, the cardiac surgeon/author/media guru who has also weighed in with advice that links between cell phone use and cancer are indicated.

We rely on them to connect us to the people we love, to help us stay organized, and, in an emergency, to keep us safe. But more and more experts are saying that cell phones may pose a very serious health risk – increasing your chance of developing a brain tumor.

That means that over 270 million Americans may be playing Russian roulette with their cell phones every day. Each year, more than 21,000 adults and 1,500 children are diagnosed with brain tumors, and researchers believe some of them may have been caused by talking on a mobile phone.

A new study examined a decade’s worth of research and concluded that people who use cell phones for more than 10 years are up to 30% more likely to develop brain tumors than people who rarely use them.

Nothing has shown proof — yet — that if you use a cell phone often enough, long enough, you’re going to get brain cancer. Dr. Oz lists ways to improve your chances — keep your phone in your pocket, use it on speaker (and Lord help us all when everyone’s not just on cell but on speaker…), use wired rather than wireless when possible. And however much some of us vow we’ll resist texting to the bitter end, atrophied thumbs might still be preferable to brain cancer.

Still, the cell phone industry is not going to issue credible warnings. The FCC should do so.

California/General interest/Health/seniors/USA
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So many pills… so little memory

by Fran Johns

If you’ve ever had a serious or chronic illness you know the routine: a line-up of all the little pills beside the breakfast plate, or maybe one of those little-old-lady boxes with a cubicle for each day, or perhaps a high-end color-coded wheel of medical fortune.

Now, it turns out, for a mere $100+ or so you can have a machine that does it all for you. Counts out the pills, spits them into a little cup, rings a bell when it’s time to pop another, calls your family if you skip something. When technology can address an issue, count on someone to perfect it. Even if its complexity boggles the mind.

Actually, for aging adults who must rely on a whole bunch of pills, these devices turn out to be a real boon. We learned this in a news release just out from the Center for Technology and Aging, through its Medication Optimization Position Paper, which is far more useful than its tongue-twisting name would have you believe.

The Center for Technology and Aging, a non-profit organization that was founded in 2009 with a grant from The SCAN Foundation (www.thescanfoundation.org,) is affiliated with the Public Health Institute (www.phi.org). It aims to find and advance technologies that help older adults stay independent and lead healthier lives — including technology for monitoring patients, for helping with tasks, social networking… and keeping track of pills.

It turns out, there are pill-counting wonders of every sort and price range. So if you can’t remember which vitamin comes before which super-drug, or you think Mom and Dad won’t remember, there’s a tech-app for that.

California/General interest/Health/Medicine/seniors/USA/World Affairs
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Cycling a relief for Parkinson’s?

by Fran Johns

That old saw about bike-riding as something one never forgets has taken on a new meaning. According to a report in the latest New England Journal of Medicine, cycling skills learned long ago can remain even when the ravages of Parkinson’s have destroyed most other abilities to get around… or even to stand without aid.

Dr. Bastiaan R. Bloem of the Radboud University Nijmegen Medical
Center in the Netherlands thought he had seen it all in his years of
caring for patients with Parkinson’s disease. But the 58-year-old
man who came to see him recently was a total surprise.



The New England Journal of Medicine

A video from the Netherlands of a 58-year-old man
with a 10-year history of Parkinson’s disease showed him freezing in his
movements after a few steps. Yet he was able to ride a bicycle.

The man had had Parkinson’s disease for 10 years, and it

had progressed until he was severely affected. Parkinson’s, a
neurological disorder in which some of the brain cells that control
movement die, had made him unable to walk. He trembled and could walk
only a few steps before falling. He froze in place, his feet feeling as
if they were bolted to the floor.

But the man told Dr. Bloem something amazing: he said he was a regular
exerciser — a cyclist, in fact — something that should not be possible
for patients at his stage of the disease, Dr. Bloem thought.

“He said, ‘Just yesterday I rode my bicycle for 10 kilometers’ — six
miles,” Dr. Bloem said. “He said he rides his bicycle for miles and
miles every day.”

“I said, ‘This cannot be,’ ” Dr. Bloem, a professor of neurology and
medical director of the hospital’s Parkinson’s Center, recalled in a
telephone interview. “This man has end-stage Parkinson’s disease. He is
unable to walk.”

But the man was eager to demonstrate, so Dr. Bloem took him outside
where a nurse’s bike was parked.

“We helped him mount the bike, gave him a little push, and he was gone,”
Dr. Bloem said. He rode, even making a U-turn, and was in perfect
control, all his Parkinson’s symptoms gone.

Yet the moment the man got off the bike, his symptoms returned. He froze
immediately, unable to take a step.

Parkinson’s has to be among the most bewildering of diseases, to the patient and caregiver alike. A very old friend of mine, former dean of a major theological school and author of a long list of acclaimed books, has had Parkinson’s for decades. He is fortunate also to have a wife with spine of steel and persistence of Job. More than a decade ago, when he was in a period of severe decline, she agitated for changes in his medications she felt needed to be made — and they subsequently left for an anniversary cruise to Scandinavia.  Some years later, after he had lost control of his mobility and most other functions it was determined that his Parkinson’s was not Parkinson’s after all, but “Parkinson’s-like symptoms,” and once again his treatment was dramatically changed. To dramatic effect. Having missed his sharp wit and ability to make conversation on earlier visits, the last time I was in their town the three of us enjoyed a long and hilarious lunch in a local restaurant.

If the old, familiar bicycle can be utilized to revive mobility and offer a new route to exercise and enjoyment, it will be very good news for Parkinson’s families.

For Some, Cycling Eases Parkinson’s Symptoms – NYTimes.com.

California/Health/Lifestyle/Medicine/New York/seniors/USA
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How not to get Alzheimer's

by Fran Johns

Of all the Big Fears, for aging parents or our aging selves, Alzheimer’s probably ranks #1. So what if we could stave it off?

A new project, the Cognitive Fitness and Innovative Therapies, or CFIT, is trying to keep people at risk for Alzheimer’s intellectually and physically fit with quizzes and other cognitive challenges to see if onset of the disease can be delayed, perhaps indefinitely. The program, which is being advised by many famous names in Alzheimer’s research and treatment, also promotes diet changes and maintaining a social life to try to slow cognitive decline and lower the risk for Alzheimer’s.

View Interactive

Try some problems some people practice to delay the onset of Alzheimer’s.

The Wall Street Journal’s invitation to try a few of these Alzheimer’s-prevention exercises seemed tempting for this reporter, so I clicked on over. It should be noted here that although I hold undergraduate and graduate degrees from reputable institutions, they are in Art and Short Fiction. These exercises are not for the faint-hearted, or the right-brained. (Actually, after following a few more links and trying another quiz it was determined that my right brain/left brain dominance is split 16 to 16; this may be the problem.) Maybe they are for the MIT alumni.

Kenneth S. Kosik, co-director of the Neuroscience Research Institute at the University of California, Santa Barbara, launched CFIT with a center in Santa Barbara last year. Dr. Kosik recommends that individuals start efforts to prevent the disease in their 50s.

“By the time someone walks in my door with symptoms of the disease, it’s too late” to stop it, says Dr. Kosik, who plans to open four CFIT centers in New York and California. The idea behind the new research is that lifestyle interventions may delay or prevent the disease before symptoms appear—or slow the progression of Alzheimer’s once they do manifest.

The CFIT exercises seem to go a step — or perhaps a leap — farther than the SharpBrain exercises, which are also recommended by all sorts of people who understand brain function. (And seem, I have to say, a lot more like fun and less like Alzheimer’s prevention.) Any of them will keep you awake, and quite possibly stave off dementia.

The shift in thinking has been bolstered by public health efforts to prevent cognitive decline and delay or prevent Alzheimer’s disease, which affects some 5.3 million Americans. A 2007 report by the Centers for Disease Control and Prevention and the Alzheimer’s Association, a nonprofit group that funds research and supports advocacy and education, called for implementing findings on exercise and diet into actions people can do to maintain cognitive health. A CDC review of the scientific literature is expected to be released this year. The groups have been working together to gather data from individual states on the extent of cognitive impairment and meeting with state health officials to develop public campaigns to promote brain health.

Scientists don’t know exactly what causes Alzheimer’s, a progressive brain disorder that accounts for the majority of dementia cases, although genetics and age likely play a role. There are only four drugs approved for the disease, but these just treat individual symptoms and don’t stop the relentless course of the illness. New medicines are in testing but are likely to take years before they reach medical clinics.

This space highly recommends that you get started right away. We all want to believe it’s not too late.

Ways You Can Stave Off Alzheimer’s – WSJ.com.

California/General interest/Health/Lifestyle/seniors/USA/Women
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When Mom & Dad stay home — and need care

by Fran Johns

Years ago when my grandmother was dying — a process that seemed to consume her for a very long time — her children took turns having their semi-invalid mother live with them for a period of months. Grandmother was not an easy patient. She spent most of her days talking about how everyone she loved was dead — which used to make me wonder where my sisters, my long-suffering mother and I stood with her. But Grandmother’s decline was before technology complicated such events, and pretty much all that was needed was to put a borrowed bed somewhere, try to keep her comfortable and entertained and call the doctor if she needed anything. Most of her six children had at least one at-home family member who could handle Grandmother’s care for a few months without straining the family budget or everyone’s patience and good humor.

Caring for aging family members today is not so simple. Few families have a stay-at-home member able to juggle regular routine with patient care, such  care now often calls for high-tech equipment and/or high-cost drugs and interventions, and doctors don’t make house calls every other night.

In an informative and enlightening ‘Encore’ feature, Wall Street Journal writer Anne Tergesen follows the adventures of several families wherein siblings have become caregivers to aging parents.

Family cohesiveness is a tall order at any time of life. But as parents grow frail, brothers and sisters often encounter new obstacles to togetherness—at precisely the time they most need to rely on one another. Sibling rivalry can emerge or intensify as adult children vie, one last time, for a parent’s love or financial support. And even as parents grow dependent on children, the desire to cling to old, familiar roles can create a dysfunctional mess.

Today, with the economy and household finances in disrepair, such strains are more pronounced. According to a recent report by the National Alliance for Caregiving and AARP, about 43.5 million Americans look after someone 50 or older, 28% more than in 2004. In comparison with 2004, a smaller percentage—41% versus 46%—are hiring help. And more—70% versus 59%—are reaching out to unpaid help, such as family and friends.

Experts say it’s crucial that families figure out ways to work together, to work through their differences, for the common goal of caring for a parent. If they don’t, their parents will suffer—and so will they.

“Family caregivers are the backbone of the long-term-care system in this country,” says Francine Russo, author of a new book about how siblings can cope with aging parents, “They’re Your Parents, Too!” Siblings who work together, she adds, can help preserve not just one another’s health and sanity but also a “last link to their first family.”

There is, fortunately, a lot of support for family caregivers, through sources listed above, the Family Caregiver Alliance and other local or national groups. There are also helpful tips, many of which are outlined in Tergesen’s article: use new technologies, seek help, be flexible, keep lists, and laugh a lot.

The latter was what saved my family from collapse during Grandmother’s stays in our home. Grandmother would today be easily identified as clinically, chronically, severely depressed. My sister Mimi and I devised a game, after the first few days of jockeying for position as the one not to have to spend the afternoon with Grandmother. Whoever came up with the most hilarious joke to tell and see if we could make her laugh, or the most bizarre question (“Did Uncle James really go to jail, like we’ve heard?”) to prompt a family story, would win. I don’t know if this technique has real merit but it worked for us. We laughed a great deal, and Grandmother got to tell a LOT of previously untold family stories. Some of them were even true.

Siblings Overcome Conflicts to Care for Aging Parents – WSJ.com.

California/General interest/Health/Lifestyle/Medicine/Politics & Causes
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Medical marijuana: a painful issue all around

by Fran Johns

Courtesy of http://prospect.rsc.org/blogs/cw/?p=655She is 46, a breast cancer survivor for four long years, a regular user of medical marijuana. She told me — as we were introduced by a mutual friend and she was updating the friend — a horror story too ridiculous even for an ‘Only in California’ tale. Her name is not Emily, but I’ll call her Emily to protect the innocent.

Emily has a solid career in social services with a California nonprofit. For years their funding has come partly through federal grants. This has been fine with Emily’s regular use of medical marijuana, which is legal in California and which keeps her chronic pain — a result of cancer and several other issues — under control. She smokes one joint in the morning, and four at night. (An editorial caveat here: I’ve not tried marijuana, which is wise since I’m addicted to anything that comes down the pike, so I know from nothing about dosages, etc. I’m just repeating what she explained.)

Not long ago, a new project was offered Emily’s organization and she was named as its head. Only problem? Everyone would have to take the federally-mandated drug test. Only solution? get Emily off of the weed for six weeks in order for her to pass the test. She had done that, finishing it all and passing the test and starting the project, a few months earlier. It was not fun.

“In order to get through all this,” she said, “I was prescribed a total of six different pain-relief drugs which I took every day. They were expensive, but the only way I could have made it. So for six weeks I poured six different toxins into my system at an obscene cost, both financially and physically. But hey, you do what you have to do.”

Emily is now back to growing, and smoking, her own.

California voters, thanks to a ballot issue certified yesterday by our secretary of state, will decide next November whether to legalize marijuana for any adult use. The issue is being rather hotly debated elsewhere on True/Slant and I frankly have no idea where I’ll come down when the dust settles and I read the whole business. Friends tell me it’s fine, others tell me it’s addictive, the state needs the money, who knows where legalization and regulation could lead? Neither does much to curb alcohol abuse, but then, I quit drinking years ago so it’s easy to be holy about alcohol abuse; some of us can handle the booze, some of us can’t.

But all of us need pain relief. Marijuana is a proven pain-relief drug. Why in the world it should be denied those who need it boggles this increasingly boggled mind.

California/General interest/Health/Lifestyle/Medicine/Politics & Causes/Religion/seniors/Women
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Patients fight hospitals (& not just Catholic hospitals) for proper care

by Fran Johns

“Suppose I wind up being taken to a hospital,” said the lady with the penetrating blue eyes and a lovely, long braid over her shoulder. “How can I keep them from doing all those things I don’t want — ventilators, feeding tubes…?”

The lady with the lush braid was among a small group of retirement community residents with whom I spoke yesterday about end of life choices. None of them fear death. All of them fear aggressive, unwanted treatment. A colleague and I had been invited to talk with them about documents (advance directives, POLST forms, etc) and legal measures that can help insure a compassionate end. But the distressing reality is that there are no guarantees.

This is where we are with health care: patients having to fight against doctors, hospitals, systems — and directives from Bishops — for the right to die in peace.

A recent Kaiser Health News article (KHN is a publication of the Henry J. Kaiser Family Foundation and unrelated to Kaiser Permanente) cited problems arising from directives to Catholic hospitals about a variety of issues. The directives, issued in November by the U.S. Conference of Catholic Bishops, changed the policy on feeding tubes, for example, from “presumption in favor of”  to an “obligation.”

“This obligation,” the bishops said, “extends to patients in chronic and presumably irreversible conditions,” such as persistent vegetative state, who might live for many years if given such care. A feeding tube is not required, however, if it wouldn’t prolong life, would be “excessively burdensome for the patient,” or would “cause significant physical discomfort.”The directive raises fresh questions about the ability of patients to have their end-of-life treatment wishes honored — and whether and how a health care provider should comply with lawful requests not consistent with the provider’s religious views. Hospitals and nursing homes do not have to comply with requests that are “contrary to Catholic moral teaching,” according to longstanding policy that, as in the case of the revised directive, applies to non-Catholic patients as well.

As the women in our group yesterday understand, you can wind up with unwanted treatment in all sorts of circumstances, not just when you’re dying.

Dr. Lachlan Forrow, a Harvard University medical ethicist and palliative care specialist, expressed strong concern about the new policy, stressing its potentially broad scope. “That gets to be a very, very large number of people,” said Forrow, who heads a panel developing recommendations for the state of Massachusetts on end-of-life care.

(A)ccording to Catholic officials and outside experts, the directive may well apply to a wider range of patients, those that it describes as having “chronic and presumably irreversible conditions,” though the organization representing Catholic health facilities downplays the impact. Experts say this affected group could include those with massive strokes, advanced Alzheimer’s disease, traumatic brain injury and Lou Gehrig’s Disease.

If a patient or family didn’t want a feeding tube “and the reason they don’t want it is they basically want to die, then the Catholic institution would explain to them they can’t cooperate with that and they would have to go to another institution,” said the Rev. Thomas G. Weinandy, executive director for doctrine at the bishops’ conference, who helped draft the policy.

Weinandy said “obviously the public should know what the directives say,” and patients and relatives “can easily download the directives or get a copy.”

Oh, sure. The EMT people are loading mom into the ambulance, and you ask them to wait until you download a few pages of papal edicts.

In the days before she died two weeks ago (in a non-Catholic hospital) my sister Jane occasionally showed signs that, though sleeping, she might be experiencing pain. My niece, who was keeping round-the-clock watch over her mother, more than once asked the attending physician for additional pain medication and was told, in a “There, there now, dear” voice that “We can’t hasten!!” My niece is a tenured law school professor.

Doctors make a lot of fuss about that “First, do no harm” business in the Hippocratic oath. Is withholding pain medication because it might cause death a few hours sooner than later doing no harm? Is inflicting painful, unwanted and unwarranted interventions for some obscure religious reason doing no harm?

Catholic Directive May Thwart End-Of-Life Wishes – Kaiser Health News.

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