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, February 16, 2018

alzheimers news-doc im having memory issues

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yesterday i was contacted by someone who felt like he was having
memory issues
he is a retired professional who works one day a week
he has noticed that he has problems doing some of the work that
he used to do that involves memory and numbers

this has happened to me a lot over the last 7+years since i was
folks wanting to know what to do

for those of us like him with it in our immediate family
we are always concerned
is it going to happen to us

i was
it did

heres my advice

if you think you have issues
you should have an evaluation done
i read this morning in an article that when folks have memory issues
dont recognize them
thats more concerning

losing you keys is not abnormal
not knowing what car keys are for is abnormal
as we are finding out
there is a gradation between losing your keys and not knowing
what they are for
where you are on that grade is what you want to know

the first thing i tell folks
make an appointment with your primary care doctor for
only one thing
memory issues
nothing else

dont go alone
take your spouse or significant other
many doctors will want to interview them

if you dont think your primary doctor will listen to you
or do a good job
go to a neurologist

eg i if i was in practice now i think i could do a good initial workup
for memory loss

they are looking for causes that you can treat or do something about

go in prepared

if this individual has alzheimers starting he is real early
some of the memory testing will be normal
like the test called the mini cog
the one a lot of doc use
the mmse
trumps test the moca test is more sensitive to early changes

please dont go online and read and take the moca test
it affects its accuracy when you do have to take it for a diagnosis

if you dont do well on the moca test you should have a
full neuropsychological exam

if you are further along some of the previsit paperwork becomes
more important

to be complete
i would have his wife fill out this 21 question alzheimers questionnaire by herself
without his help
here is the link
sometimes spouses notice more things than you do
take that with you even if its normal
it helps the doctor out

then go online and take the sage test
here is the link
fill it out copy and take with you
this also helps the doctor out

if you are early in the disease these will be normal also
i expect his will be
mine were
now my moca test was initially abnormal
his moca test may not be normal

make a list of all your medications and all the supplements
that you take

i now take a lot of supplements
i have cross referenced all of them against each other and
against all my prescription medications

webmd.com has a good one to use to cross reference supplements
some supplements and over the counter meds i cant take
because of these interactions
i have to limit antihistamines use since they interfere with
my aricept (donepezil) that i take for my diagnosis

make a list of your health issues like high blood pressure
high cholesterol diabetes sleep issues anxiety depression etc

make your appointment only for memory loss
bring your online tests
bring your wife
bring you list of concerns of what you have noticed
yes write them down
hand your doctor a copy
it is entered into your medical records
it shouldnt now get ignored
you keep copies of the online tests and the other lists
for yourself

the doctor should take a good history and do an examination
thinking in terms of finding a treatable cause for his memory loss

these are the labs that he should have
a cbc
a metabolic profile like a chem 24 that is commonly done
a tsh for your thyroid levels
a vitamin b12 level

some like me would add
a vitamin d3 level
a homocysteine level which if elevated may be associated with
an increased risk of heart attack stroke and alzheimers disease

then some would had sex hormones like testosterone for males
estrogen progesterone for females

if the b12 or the vitamin d3 or the homocysteine level are abnormal
they are usually easily corrected with daily over the counter supplements
all thrre of these were abnormal on me

then after the history and exam and the lab testing is done
there should be a memory test done
a minicog is not a sufficient one for early disease
a better one is the moca test like trump took
it shows up early symptoms

if the moca test is abnormal he should if his labs and history and exam
are unremarkable have a
full neuropsychological exam
it will show if there is memory loss
these are usually done by a neuropsychologist

if the history and exam or lab shows things like sleep issues or depression
not well controlled or abnormal labs these need to be fixed
before more testing is done

if the neuropsycholigical test is not normal
a mri scan should be done
that will rule out things like old strokes tumors etc

at this point the cause of the memory issues should have been

for him
he might consider after this
if he wants to know more
to do genetic testing
spinal tap for beta amyloid and tau
an amyvid pet scan for beta amyloid
none of these are covered by insurance
and are expensive

for me
i wanted as much information as i could obtain

so i have
such that i feel like my diagnosis is as accurate as one
can have based on the testing thats available in 2018

as i told him
he is a good candidate for research

you can go to clinicaltrials.gov
type in alzheimers
click on the state you live in
a list of all the alzheimers studies available are there

i can tell you though sometimes they dont show up before
they are open
the alzheimers centers in your state will know whats coming
in the future that may not be listed

for him
since he could be early or even in that prealzheimers state
that state where the memory is normal but the scans are not
he would be a good candidate for
some of the new treatments that are being used on folks with
prealzheimers or those with mild cognitive impairment like me

also a new study that is the phase 3 of the adni2 i was in for 5 years
called the adni3 study is starting up in his state. it should be on the
clinical trials website

also you can sign up for the alzheimers associations trial match
on their webpage www.alz.org
they will let you know when a study comes available that you might
match up with

if he goes to his doctor and gets the run around
he should go see another doctor
he should make sure he has a complete work up

a history and exam
memory testing
maybe mri
maybe further tests for alzheimers not covered by insurance

he also
after he has had a complete workup
not before
should consider the regimen in dr bredesens article on reversal of cognitive decline
this should never be done without discussing it with your doctor
i reviewed them with my doctor and my neurologist before i started them

does it help
i think it might
its hard to prove if this is why im not worse now
if its the aricept (donepezil)
if its just the course of the disease
waxing and waning for now

tomorrow i will be on an alzheimers panel at a conference
at the huntingtom memorial hospital in pasedena california
sponsored by the alzheimers greater la at www.alzgla.org
answering questions about my story and diagnosis
how i feel about being diagnosed
how it affects my family and my life
what recommendations
i have for other folks

the panel im on at 1030am will be all folks who have
an early diagnosis

its interesting when you are around folks who are early on in the disease
that for many you would have no idea they had memory problems

here is the link to the conference

if you have memory issues
get a good workup
some causes can be treated

the organicgreen doctor

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