welcome to the organic green doctor blog

i am a family physician who was diagnosed with
early mild cognitive impairment(mci) amnestic type on december 21, 2010
this is a precursor to alzheimers disease
because of this diagnosis i have opted to stop practicing medicine
this blog will be about my journey with this disease
please feel free to follow me along this path
i will continue blogging on organic gardening, green living,
solar power, rainwater collection, and healthy living
i will blog on these plus other things noted to be interesting

Friday, October 23, 2015

alzheimers news-can you help me please

Image result for alzheimers association logo
i frequently get messages like this via facebook email
messenger or texting
folks asking for help deciding what to do for
themselves or a loved one with memory issues

this person a former patient
no i consider them once a patient always a patient
messaged me
asking for help with her parent who lives with the family

my parent is having memory issues
my parent had an episode of several minutes where
they didnt know who they were or where they were
they were confused
then it cleared up
i dont know what to do

so i went into my doctor mode
my alzheimers disease memory loss mode

from hearing the story i knew this patient would eventually
end up at a neurologists office for definite care
knowing the system like i do it can take awhile for someone
to get into see a neurologist

so enter the primary care provider
the entry road to the healthcare system

i knew that there were possibilities causing this
some of them real bad
some of them that couldnt wait that long to see the neurologist

like a brain tumor a stroke a hematoma from a fall an aneurysm
too much fluid in the brain
things that really needed to be ruled out sooner than later
things like vascular dementia alzheimers disease could be
diagnosed at a slower pace with no rush in doing the workup

i recommended a primacy care provider appointment as soon as
if before the appointment the episode occurred again
the parent should go to the emergency room

eg i remember my mom had slipped and fallen
when she was taken in a ct scan was done which showed
a subdural hematoma from the fall
luckily it was small and nothing had to be done about it
a larger one that continued to bleed would have required surgery

if i was the primary care provider for this patient
i would do a careful history and examination to look for causes
of thier memory loss and confusion
an irregular heart beat eg atrial fibrillatin can cause clots
to be sent up to the brain causing these symptoms
a fall uncontrolled blood pressure uncontrolled cholesterol
uncontrolled diabetes
medications that would affect the memory
symptoms of depression or severe anxiety or lack of sleep
on exam i would look for signs of neurological deficits
like drooping of face or eyelids or muscle weakness or
increased or decreased reflexes gait problems
confusion in answering questions

i would probably do a brief mental exam to generally find out
what the memory level was

my priority for this visit would be to find an acute cause
that could be life threatening that needed to be addressed

then based on what showed up in the history and exam
i would do screening labs like cbc chemistry profile thyroid level
vitamin b12 and probably add a vitamin d level while i was
drawing blood and add an urinalysis
elderly patients especially females can get confused from utis

then i would do an mri on this patient to rule out most of the
bad things that could be going on that would need sooner

other things to consider would be a carotid ultrasound to
check neck circulation

so a primary care provider could and should do all this workup
then fine tuning the care can be done by them
or referral to an appropriate specialist

on her parent the mri showed some brain shrinkage
and what sounds like white matter hyperintensities
although i dont have the mri to look at

these are areas that start showing up in folks who may
have eventually have a stroke or have alzheimers
its associated with high blood pressure high cholesterol diabetes
i think of them as microscopic strokes in some cases
from either hemorrhage or ischemia
eg i have two of these on my scans but over five years there have
been no new ones

so she is left with a parent who has some mild atrophy of the
brain with memory loss

there is an upcoming neurology appointment
this parent should not let the parent go to any of their appointments
so whats left to do
maybe more labs
carotid ultrasound
memory test probably in office or neuropsychological test to see where
the patient is with their memory and to act as a baseline

so if nothing else is found
this parent may have memory loss from vascular causes
ie vascular memory loss

the idea is to maximize a persons health
good control of blood pressure and diabetes and cholesterol
maintain good sleep habits
watch for anxiety and depression
be careful with medications
avoid excessive alcohol
do exercise even if its walking around the block once a day
be active
make sure the person is active socially
dont let them isolate themselves get them involved in something
make them stay mentally active reading writing using the computer
if possible
dont let them get stagnate

sometimes aspirn is added
sometimes based on what the memory loss looks like
aricept or (donnepezil) like i take is added

they and their family need to be ready for the future
start planning now
make sure these documents are done now
will power of attorney power of attorney for healthcare living will
no cpr form for when things get worse
families wait too late sometimes to do this and it takes
the legal system and courts to get these done
please dont wait on these

i have all these forms done

then be ready as someone in this family will become
a caregiver
a tough tough job sometimes

then do all this
enjoy each day as much as you can with this person
sometime in the future you and your family will
be glad that you did

thats what i would tell her and others that ask me
enjoy the moment

Image result for walk to end alzheimer's logo
october 31   hays county in san marcos
team organicgreendoctor

november 7   bell county in temple
team organicgreendoctor
i will be the honorary chair for this event

the organicgreen doctor

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