Friday, January 31, 2014

Alzheimers and Dementia

Any of us that have been close to a victim of Alzheimer's disease knows just how heartrending the condition can be.

I remember, as a young man, when my intelligent and fiercely independent grandmother first began exhibiting symptoms.  On top of the difficulties of the actual disease, she was aware of her decreasing ability to function and communicate....and it distressed her greatly.

I remember her crying with frustration simply trying to ask and answer simple questions...the look in her eyes...the panic, the fear, the frustration....and I remember the doctor telling us the only real hope was that, eventually, she'd be so far gone she wouldn't be aware of her incapacity: she wouldn't be afraid.  

She would diminish, she would decline, she would lose every scrap of her dignity...and the best medicine had to offer was that she would lose her fear.

Now its forty years later and, truly, not much has changed.  We think we know more about how the disease works...maybe a little about how to stall it or slow it coming on; but it's still irreversible.

And it's still profoundly, incredibly sad.

So if we're going to understand this, deal with it, let's start by trying to look at it clinically.  To remove some of the pain and emotion and review what's known, what's suspected and what, if anything, can be done.

 First off, Alzheimer's and dementia are not the same thing.  Alzheimer's is a disease or a condition and dementia is a symptom.  Much like the flu, influenza, is a virus and a fever is the symptom.

You can have a fever for a variety of reasons, not just the flu...and dementia can occur for a variety of reasons, not only Alzheimer's.  Alzheimer's is believed, though, to be responsible for 50-80% of dementia cases in the first world.

At this time, it's believed that there are three distinct types of Alzheimers disease.  
  • Familial, which is very rare, less than 1% of the cases.  
  • Early On-set, where people are diagnosed before the age of 65, and this is also rare, less than 10% of known cases.
  • Late On-set, the most common form, which accounts for more than 90% of all the cases and is believed to strike more than 50% of people over the age of 85.

Lastly, for this week, diagnosis.

At this time, Alzheimer's cannot be positively diagnosed in the living.  An autopsy is required for positive diagnosis. I've read that a biopsy can work as well, but it would seem unlikely that coring a small section of a living person's brain simply to positively identify Alzheimer's, as opposed to other causes of dementia, is a common protocol.

Most commonly a diagnosis of Alzheimer's is made simply by a careful review of the symptoms.  Because this can lead to misdiagnoses, the search for biomarkers or other positive methods of identification will be key, in upcoming years, to understanding, and eliminating this terrible, terrible disease.

In the next couple weeks, we'll expand...exactly what does Alzheimer's do to the brain, how can you slow down it's impact, etc.

Until then, be well, my friends!

And please spare a thought for the Alzheimer's caregivers: if you haven't done it, you simply can't imagine...

Tuesday, January 28, 2014

Universal Flu Vaccine?

Could there be a universal flu vaccine in the future?

There are many, many different "strains" of influenza floating around out there and, leading up to each year's flu season the CDC, basically, guesses which strains will be active and those strains go into that seasons flu shots.

In this article from Scientific American, Maryn McKenna discusses

Friday, January 24, 2014

Beyond DNR: Indiana POST

Late last year (2013), Indiana's POST (Physician Orders for Scope of Treatment) legislation went into effect.

POST is an attempt to broaden your choices beyond just a simple DNR (do not resuscitate) request.  Maybe you want EMS personnel to perform CPR but not to intubate, etc. 

POST, living wills and DNR issues can be a difficult and challenging subject for families and it's important to make your wishes known before you're unresponsive.

A POST directive, a living will and a DNR are all different things, so understand the differences between them and how they work to reflect your wishes.

Here's a great site to understand what a POST is and how it can better reflect your own, individual choices.

And here's a link to Indiana's actual POST form so that you can see what those choices are.  Note that a POST form must be signed by a physician.

The State strongly suggests that the POST form itself be kept with your medications or taped to your fridge.  They also recommend that it be printed on pink paper so it really stands out.

Speaking as an emergency services provider myself, I encourage you to consider medic alert jewellery if you have POST or DNR directives.  When you're unresponsive, we're moving pretty quickly and that's no time to wait for your friend to dig through your filing cabinet looking for a piece of paper you showed them a couple years ago...  

Truly, if you have any life threatening medical condition, we encourage you to consider medic alert jewellery.  

Tattooing yourself might be considered taking it to an extreme, but you can bet we're probably going to see that this fellow is a diabetic.  

You might choose something a bit more subtle...but medic alert jewellery works.  We really do see it and it helps us to help you.

Tuesday, January 21, 2014

An apple a day...

150 years ago, when the saying first seems to have begun, it was "Eat an apple on going to bed, and you’ll keep the doctor from earning his bread"

Then "an apple a day, no doctor to pay".

Either way, even though that pithy little saying is pretty recent, it seems apples have been used as a part of medicine for over 1,500 years.

The American Heart Association has published an article showing that an apple a day is associated with a 9% lessened risk of stroke.

More recently, Oxford University has recently calculated that an apple a day would prevent about 8,500 deaths from heart attacks and strokes every year. 

Considering the population of Great Britain, that translates into almost 40,000 fewer deaths per year in the United States!

Apples?  Who knew?

Friday, January 17, 2014

Flu widespread in Indiana

Flu season is well underway in Indiana.  Nationally, the CDC is watching this flu season very closely because the main strain is H1N1 (swine flu)...the same virus responsible for the flu pandemic in 2009.

Widespread flu activity was reported in Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Georgia, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Texas, Utah, Virginia, Washington, Wisconsin and Wyoming. You can track the activity on the CDC "Influenza-Like Illness" tracker located on their website.

People with flu can spread it to others up to about 6 feet away.  Most experts think that flu viruses are spread mainly by droplets made when people with flu cough, sneeze and talk. 

From the CDC: To avoid this, people should stay away from sick people and stay home if sick. It also is important to wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Linens, eating utensils, and dishes belonging to those who are sick should not be shared without washing thoroughly first. Eating utensils can be washed either in a dishwasher or by hand with water and soap and do not need to be cleaned separately.

If you didn't get a vaccine, anti-viral medications can be of some help, but are often recommended only if (a) you're very sick and (b) have some type of complicating underlying health condition (asthma, heart disease, etc)

Tuesday, January 14, 2014

Feed a cold, starve a fever?

Maybe not.

In this short article from Scientific American, Mark Fischetti explains why it should be "feed a cold, feed a fever"

And remember, sick or well, hydrate, hydrate, hydrate.

Friday, January 10, 2014

Money, honey.

It's the elephant in the room.

When you or a loved one is sick or hurt, you're not thinking about money, you're thinking about getting well...and that's just as it should be.

Never the less, analyses over the last several years show that 62% of all personal bankruptcies in the United States are caused by ruinous medical bills.  Not credit card binges, not mortgages, not flim flam investments... ....medical bills.  And 4 out of 5 of those folks actually HAD health insurance.

I suspect we've all heard of the Blue Shield cases where they were paying bonuses to employees to cancel coverage on high dollar cases.  You might even have heard that they were fined two million dollars for dropping over 1,000 insured with expensive claims, but that money went to Los Angeles City attorney's office.  Earlier, they'd promised three million dollars to the insured...but three million dollars across a thousand expensive health claims didn't go very far to help the folks they'd fraudulently dropped.

So yes, please keep your focus on getting well...but do what you can to keep yourself from being financially ruined in the process.  Fight for more and better insurance coverage.  Find out if your doctor has financial stake in how you're treated. 

Ask questions, do your own research:  Avastin and Lucentis are both made by the same company, both equally effective at treating the same condition....but one dose of Avastin costs $50 while a single dose of Lucentis costs $2,000.  Doctors choose the more expensive drug more than half a million times every year, a choice that costs the Medicare program, the largest single customer, an extra $1 billion annually.

GlaxoSmithKline has been found guilty of fraud and just agreed to a three BILLION dollar fine over pharmaceutical misuse.  Earlier this year Abbott Laboratories was fined 1.6 billion dollars and it looks as though Johnson & Johnson will soon be fined two billion dollars. 

Right before Christmas GlaxoSmithKline said it will quit paying doctors to promote their drugs.  We can only hope that these fines motivate ALL pharmaceutical companies to follow suit.

And it doesn't have to be fraud.  My own doctor is great: righteous and true....actively concerned for my good health.  He belongs, like all doctors, to a specific network...and when I needed some imaging done, the network was happy to make an appointment for me at their imaging center...for a cost of about $1,200.  

A few phone calls and I found an independent imaging center in Merrilville that did the exact same work for $160.  I told my doctor and he was happy to send me up there.  Before that, though, he'd had no idea....he's the doctor, his expertise is in getting me well, not in being a good shopper.  I have to do that part myself.

And so should you.

Wednesday, January 8, 2014


A rough couple days for us all, eh?  Who ever knew that 4 degrees could feel balmy!

We could all use a little humor!

First, Steve Berry's take on winter training for EMTs....

Secondly, more training for EMTs...this from Australia where they're having summer....Emergency Responders have to free a naked man from his washing machine using his own olive oil...and they used his good stuff, too.

( )

SYDNEY (AP) — A naked Australian man who became stuck in a washing machine as part of an ill-planned practical joke was freed from the appliance with the help of an unusual rescue device: olive oil.

The 20-year-old man, identified only as "Laurence," told Australia's Fairfax Radio that he was on his way to take a shower on Saturday when he decided to climb into the top-loader to have a bit of fun. The fun quickly evaporated, however, when he realized he couldn't budge.
He called out to his friend for help, who rang the police. They responded to the scene, along with firefighters, paramedics and a search and rescue squad.
"He was very well wedged in there and we were concerned for his health and well-being," Shepparton police Sgt. Michelle De Araugo told the Shepparton News. "It was just a game gone wrong. It would be fair to say the gentleman was very embarrassed."
Rescuers tried in vain to pull Laurence from the machine. But when it became clear he was seriously stuck, they grabbed a bottle of his favorite olive oil to help lubricate his escape. The oil worked, and he popped out.
"I was quite disappointed they used my good olive oil," Laurence told Fairfax Radio. "As soon as the washing machine went on its side, it was a bit like a birthing."

Be well, my friends!  Stay safe, stay warm.

Friday, January 3, 2014

The medical benefits of meditation.

No, it's not just for the nutty.  There's a growing body of medical science showing that as little as 15 minutes a day spent meditating can significantly promote overall wellness.


And now, a new study shows that a daily meditation can significantly slow the progression of cognitive impairment condtions, like alzheimers and dementia.


You don't have to be Buddhist or some other special religion, meditation works for anyone and everyone, regardless of spiritual preference.

You don't have to eat granola, you don't have to wear spandex, you don't even have to sit funny.

It works for skeptics, too

Truly, at 15 minutes a day, it couldn't hurt to try.


Wednesday, January 1, 2014

...and the 2013 winner is....

not indiana.

According to the United HealthCare Foundation stats, we remain in 41st place in the nation.

Our strengths were:
  • High immunization coverage among adolescents
  • Low incidence of infectious diseases
  • Small disparity in health status by educational attainment
and our weaknesses were:
  • High prevalence of smoking
  • High levels of air pollution
  • Low immunization coverage among children
Some of the report's highlights:
  • Indiana has one of the highest prevalences of smoking in the nation,with more than 1.1 million adults still smoking.
  • More than a half million adults in Indiana have diabetes, and more than 1.5 million adults are obese.
  • In the past year, the prevalence of physical inactivity decreased from 29.2 percent to 25.9 percent of adults; however, 1 in 4 adults remain inactive.
  • In the past 2 years, the high school graduation rate increased from 74.1 percent to 77.2 percent of incoming ninth graders who graduate within 4 years, the highest rate for the state.
  • Over the past 5 years, the percent of children in poverty remained high at 1 in 4 persons younger than 18 years.
  • The infant mortality rate in Indiana has been between 7.3 and 8.0 deaths per 1,000 live births since 1998 and now ranks 45th among states
In slightly happier news....our overall ranking for SENIORS was 32nd place.   

But really, folks....41st place?  I mean, I don't want to come off like one of those one button, granola eating, mud wrestling triathlon reality show guys...but 41st?  Can't we do better than that?