So many pills… so little memory

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.

Can you beef up your brain?

Not multi-tasking fast enough? Trouble concentrating? Worried about memory loss?

Maybe those neurotransmitters in your poor, information-overloaded brain can be expanded to improve these functions… and maybe not.  A panel of experts on the PBS series Life (Part 2) is tackling the topic of brain exercise — a topic which has been tackled in this space several times in the past (How’s your brain fitness today, 10/5; Diet, exercise and Alzheimer’s, 11/28.)

We talked with panelist Denise Park, PhD, founder of the Center for Vital Longevity at the University of Texas, who starts right out by debunking any notion that those crossword puzzles will keep you sharp: [youtubevid id=”xZBzZZJHic0″]

But all is not lost. Jigsaw puzzles could indeed help. “With jigsaw puzzles you’re manipulating materials,” Park comments, “and actively puzzle-solving; what we call executive function.” This may explain — though only in part — the brilliance of British novelist Margaret Drabble, whose new memoir, The Pattern in the Carpet is subtitled A Personal History with Jigsaws; although my own personal history with jigsaws unfortunately hasn’t enabled me to write like Margaret Drabble.

It is the combination of functions that stimulates, and perhaps enhances, those brain cells, Park explains. She recommends doing something both stimulating and fun: dancing (“I believe the social component is important”), learning to play a musical instrument, etc. — in which motor, auditory and other systems all come into play. Or taking up something like photography, with which one masters one step and then moves on to the next.

“I’m reluctant to prescribe anything to improve cognition,” Park says, “because we don’t know yet. We need to know a lot more.” Still, current findings — Park’s Center is doing fascinating work with aging citizens who are learning to quilt — are heartening, and anecdotal evidence about those of us reciting lists of numbers to each other and then trying to do them backwards, as suggested by the SharpBrains people, suggests that hilarity is good.

And the best news may be that computers aren’t the be-all and end-all here. Park suspects that sitting in front of a computer playing games, even games advertised to stimulate the brain, may have no great brain-building value at all.

So this space advises getting out the dancing shoes or the mandolin, inviting friends in to play numbers games — and maybe buying a giant jigsaw puzzle (for two.)

New cancer insights from man's — and woman's — best friend

Lessons on love and fidelity have long been learned from the canine kingdom; now add cancer and aging.

The Gerald P. Murphy Cancer Foundation, a not-for-profit research foundation headquartered in West Lafayette, Indiana, has a mission “to accelerate medical progress in the fields of cancer treatment, cancer prevention, and aging,” and is coming up with useful data through studies of pet dogs. (The center was named posthumously, after his untimely death, for founder Gerald Murphy, developer of the Prostate Specific Antigen (PSA) test that remains the gold standard for early detection of prostate cancer.) Most recently comes news of discoveries made with the help of Kona, a Rottweiler who is getting along in years herself. It was reported last week on MSNBC by by Anne Marie Tiernon of WTHR-TV.

There are new clues about why some of us live longer than others. A new study of dogs has revealed a new role for the ovaries. Ovaries produce eggs and hormones and also have a primary role in bearing children. But the study in West Lafayette points to a larger ovarian ecology, meaning the ovaries have a role in how long we live.

Kona, a 13-year-old Rottweiler from Cleveland, has achieved exceptional longevity for her breed. Most live about nine years. Data about Kona and 304 other Rottweilers was collected and analyzed at the Gerald P. Murphy Cancer Foundation.’We are trying to find ways to promote exceptional longevity in pets and people,’ said Dr. David Waters, DVM PhD. director of the Exceptional Living Studies Center.

In combing through the dog data, the Center’s researchers found links between ovaries and a long life.

‘To reach exceptional longevity is to live about 30 percent longer, similar to the difference between a 100-year-old person and a person that would only live, let’s say, 72 years,’ Dr. Waters said. So we are talking about a big difference and that keeping ovaries longer was associated with an increased likelihood of reaching exceptional longevity.’

Being a female, Kona was born with a 2-to-1 advantage over male dogs to reach her 13th birthday.

‘But the interesting part was when we take a look at the dogs who lose their ovaries, the females who lose their ovaries in the first four years, now the female survival advantage disappears,’ Dr. Waters said.

Dr. Waters, whose research work has extended to a variety of complex issues relating to cancer and aging, sums up the bottom line for women:

The takeaway from these studies, including the one with Kona? That doctors and women will pause and question the routine removal of ovaries during a hysterectomy. In the United States, the standard practice for decades has been to remove the ovaries during a hysterectomy to prevent ovarian cancer and maybe some breast cancers that are estrogen-fed.

The findings are something new to add to your plus and minus columns when making a decision with your doctor.

Recovery Act funds boost Alzheimer's research

Spotting brain changes before symptoms appear… identifying risk-factor genes… finding drugs that improve memory… these are a few goals of newly-funded Alzheimer’s research. And for millions of us, tomorrow won’t be too soon. The National Institute on Aging (NIA), part of the National Institutes of Health, is boosting these and other research areas in grants made with American Recovery and Reinvestment Funds.

Dementia is the looming fear of most of us over 50, an age group that recently inducted my son. My own mother died at 70, after a decade of strokes and the gradual fuzzing-out of a once sharp mind. My father-in-law, and his father, both suffered from “Alzheimer’s-related” illness. We are now light years beyond what we knew then, but probably another few light years away from prevention or cure. When you have witnessed close-on the devastation that dementia wreaks, any step toward those goals is very good news.

A few of the new or ongoing projects getting a boost from Recovery Act dollars were summarized several days ago by Medical News Today:

“We are delighted to announce the award of Recovery Act funds to many dedicated, hardworking scientists committed to advancing scientific discovery into Alzheimer’s disease and cognitive impairment,” said NIA Director Richard J. Hodes, M.D. “Over the next two years, the recipients will use this unprecedented boost in research funds to help reach our ultimate goal of understanding age-related cognitive decline and reducing the individual and societal burden of this devastating disease.”

More than 100 Alzheimer’s or Alzheimer’s-related research grants were awarded under the Recovery Act.

The complete list, a daunting read for the scientifically challenged, is available online at the ARRA (Recovery Act) site. Snippets of the list, paraphrased from the Medical News Today, summary, include:

$24 million to the Alzheimer’s Disease Neuroimaging Initiative to track changes in the living brain as older people transition from normal cognitive aging to amnestic mild cognitive impairment (MCI), in which individuals have a memory deficit but generally retain other cognitive abilities, and from MCI to Alzheimer’s disease.

A grant of more than $5.4 million to add 3,800 Alzheimer’s patients and an equal number of people free of the disease to a previously funded study by the Alzheimer’ Disease Genetics Consortium (ADGC), which aims to identify the additional risk factor genes for late-onset Alzheimer’s disease. These huge datasets will allow scientists also to search for genes associated with a number of traits associated with Alzheimer’s, as well as for genes related to cognitive decline.

Another study, examining cognitive decline in older African-Americans will collect and analyze the DNA of 4,140 elderly African-Americans enrolled in NIA-funded aging studies already taking place in Chicago and Indianapolis. The study will assess the associations of over 900,000 genetic markers for such issues as stroke and high blood pressure.

Another $820,000 in Recovery Act funds will advance Alzheimer’s genetics research by developing methods for identifying combinations of genes that might influence age-related risk of AD.

There are more — some looking at drugs and exercise, some studying specific populations, many (including the above) examining a multiplicity of factors in the search for answers to the puzzles of the brain.

This space will be following the progress of them all — if I don’t forget.

Recovery Funds Advance Alzheimer’s Disease Research.

New Cancer Guidelines: One Good Message

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

Facing Up to Dental Terrors

The only thing worse than toothache/jaw pain, to be cruelly specific, is toothache/jaw pain without insurance. Most of us are without such insurance. It has not even been on the radar of health reform advocates, which is just as well — if you add dental terrorism to abortion and public options we won’t see reform for another few decades.

Nevertheless, tooth reform, euphemistically referred to as full mouth restoration in some circles, is ahead for increasing numbers of Americans sooner or later. It comes down roughly to a choice between fixing the mouth or buying a yacht, but if your jaw aches, you forgo the yacht.

New York Times health writer Jane Brody traced the new path of dental repair journeys in a thoughtful article yesterday, explaining her own costly route from tooth decay to bridges to implants, and throwing out an estimate of approximately $3,500 to $4,000 per tooth for the now-preferred latter. Multiply this by at least three or four times if you have other issues, which most of us do once things start going south in the mouth, needing attention. That would be gum problems, repair to surrounding teeth or necessary attention to bone.

I write with authority. Some years ago, facing all of the above, I visited an assortment of dentists with an assortment of solutions that frequently had me in tears when contemplating the time, details (one would have had screws in my jawbone which I would tighten every few days for months as it rebuilt itself) and costs. Like Brody, I grew up before the days of fluoridated water and have had more repair work since childhood than the Bay Bridge. It was a mess in there.

Finally my husband, whose best wives have been born in 1933 but with bad teeth, said, “Just do it all. Don’t be going patch-patch-patch; do it all.” I proceeded to choose the most sympathetic and understandable (most of them were, except for the screws-in-the-jaw guy) dental professionals, assembled a team and went to work. Or rather, I scrinched my eyes shut while they went to work. Some 18 months and $40,000 later we were free at last.

(Out of this experience, during which I was doing a great deal of entertaining just to keep us happy and sane, came one of my finer unpublished books, Cooking for the Dentally Impaired: Recipes and Menu Suggestions for the Impaired and Unimpaired in Difficult Times. I think it’s a book whose time has come; my agent disagrees.)

Brody’s article is a must-read for anyone stewing over this issue. The following are abbreviated tips for anyone with teeth and plans to keep them:

1 – Consider early-decision. The sooner things like gum surgery, crowns, implants-v-bridges or bone issues are dealt with, the likelier all can be made well and kept that way.

2 – Get second opinions. You may even choose the screw-in-the-jaw route, but there are many different procedures and it is good to find one suited to your temperament and bank account.

3 – Ask questions. I asked so many that I was fired by one team; a polite letter said they did not believe they should take my case. It’s just as well. Those I wound up with answered my questions and seemed happy to do so.

4 – Ask for references. Brody suggests this, and I agree. Because I already knew several people who had been patients of the dentists with whom I eventually invested all that time and money, talking with them about their experiences helped keep me from any surprises.

5 – Talk finances. Several friends of mine have had major dental expenses that were far outside their budget, but worked out payment schedules with their dentists so that necessary work could be done sooner rather than later.

Meanwhile: floss.

Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.