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

Tuesday, November 19, 2019

organicgreendoctor: give me a stent

organicgreendoctor: give me a stent: GIVE ME A STENT if you give a medication to a patient for long term use the compliance rate is only 45% unless you are my wife she then ...

give me a stent

GIVE ME A STENT
if you give a medication to a patient for long term use the compliance rate is only 45%
unless you are my wife she then the rate will be much lower
why she struggles with a five day zpack

the study that was written about treatment of heart disease compared getting stented or heart bypass vs just taking medications showed that the long term results were about the same no matter which way you go

now if you go to the er having a heart attack you are going to get stented or get bypassed to preserve the heart muscle thats getting damaged

this article was about lets say you go to the doctor with symptoms let say short of breath when walking or chest pain while walking or some of the other heart symptoms one has

you go in and get diagnostic testing that shows a blockage that one day will clot over or get worse

you can stent it or bypass it
or
you can take medications like statins and blood pressure medicines and do lifestyle modifications like diet exercise stop smoking

the end result of the outcome is about the same no matter which way you go

so which would i do if i had chest pain on exertion that was limiting my lifestyle

without blinking an eye
i want to be stented
bam
its done
youre finished

knowing of course you will probably have to do those lifestyle things anyway i would still want to be fixed with a stent

i think my wife she would want to be stented since her chances of doing lifetime medications to prevent a heart attack is problem low

what would you do

read the article and think about it

in my thinking its like well i would sort of do both
well actually im already on all those medications treatments and lifestyle modifications anyway
so
my choice seems easy for me to make
get stented

the organicgreen doctor

Monday, November 18, 2019

organicgreendoctor: understanding the impeachment process

organicgreendoctor: understanding the impeachment process: UNDERSTANDING THE IMPEACHMENT PROCESS archives.gov the impeachment of a president has only happened 4 times in the lifetime of our count...

understanding the impeachment process

UNDERSTANDING THE IMPEACHMENT PROCESS

archives.gov

the impeachment of a president has only happened 4 times in the lifetime of our country
the impeachment of a  president has happened 3 times in my lifetime

here is what the constitution says

The President, Vice President and all civil Officers of the United States, shall be removed from Office on Impeachment for, and Conviction of, Treason, Bribery, or other high Crimes and Misdemeanors.
wikepedia.com

impeachment just means they were charged with something they did that met these criteria

andrew johnsons probably did not really meet those criteria but he got impeached anyway
remember being impeached doesnt mean you get convicted
its like us regular folks getting charged with a crime
we would go to trial and get convicted
or not

the vote on andrew johnson was 35 to 19 one vote shy of conviction

or not seems to be what usually happens with the impeachment trial of the president

in nixons case he just did a lot of illegal things after they hired folks to break into the democratic office
remember they didnt have emails back then
it was all the lying and cheating and corruption he did afterwards that got him impeached

if he had gone to trial in the senate he would most likely have been convicted and removed from office
he like his vice president did before him resigned before the process could go forward to the senate

if nixon would have just admitted the breakin in the beginning and stopped there he might have made it through his term
but
he didnt
he resigned instead

then there was bill clinton who lied about having sexual encounters with an intern
if he just would have said yes i did it and ended there then so would have the whole investigation and process stopped
remember this was a spinoff of the whitewater investigation that showed no corruption or crimes by  clinton just that he lied about the affair

rule one
dont lie to congress or the police or the fbi or to a grand jury
clinton his actions were not a crime until he lied

now was it a reason to impeach him in the house and convict him in the senate
no
the senate didnt think so

on article one the vote was 55 to 45 not guilty
on aricle two the vote was 50 to 50 not guilty
remember you need 67 to convict

now here we are today
i am not going to get political here
or
take a side

so the house has the right to investigate what the majority a simple majority decides could be a impeachable offence
above is what the constitution says

so the house can investigate doing either a special prosecutor like in the nixon or clinton case
or do their own investigation like they are now

thats whats called an impeachment inquiry
like a grand jury except in this case we get to watch it all

if potential crimes are found then the house votes to impeach
a simple majority is all thats needed

if he is impeached then the trial happens in the senate
the judge will be chief justice john roberts
who has the reputation of doing whats right legally

the case will be presented again
the senators will vote
then
this is where the writers of the constitution our forefathers did a good job
2/3 of the senators have to vote to convict him

if he is convicted he is removed from office
the vice president then becomes president

now
most of us know that in our present political climate that the president unless something else pops up is not going to be convicted

most of us agree that he pressured a foreign countrys president to dig up dirt on one of his opponents
thats all there in the open in that transcript for us all to read in black and white

most of us agree as do a lot of the republicans that what he did was wrong
but
does it meet the criteria for removal of office established under the constitution

well
only 67 people in the united states can make that decision
and
they are all senators

so
the president will be impeached probalby on more than one article ie crimes like with clinton
eg
withholding aid to urkraine for poltical reasons ie bribery
obstruction of justice
intimidation of witnesses

he will be tried
he is unlikely to be convicted

the real jury and real trial though will be on tuesday november 3 2020
you and i will make that final decision

as it should be

may this never happen to us again

the organicgreen doctor

Saturday, November 16, 2019

organicgreendoctor: alzheimers news-bill likes it also

organicgreendoctor: alzheimers news-bill likes it also: ALZHEIMERS NEWS-BILL LIKES IT ALSO last friday my wife and she made the trip to ucla to see the brightfocus documentary called turning poi...

alzheimers news-bill likes it also

ALZHEIMERS NEWS-BILL LIKES IT ALSO
Image result for organicgreendoctor
last friday my wife and she made the trip to ucla to see the brightfocus documentary called turning point about the story of the development of the alzheimers drug solanezumab and its subsequent failure to meet its endpoint in its phase three research studies

below is what bill gates the billionaire who recently donated 10 million dollars for alzheimers research said after he saw the documentary

from the brightfocus.org website
Gates said, “Turning Point is an excellent documentary that gives us an inside look at the doctors, scientists, and patients who are working to uncover the mysteries of Alzheimer’s disease through clinical trials.

i was asked to be on a panel afterwards to answer questions from the audience after the documentary was shown

the moderator was the principal investigator from the ucla california alzheimers disease center
on the panel with me was 
the interim director of the ucla easton center for alzheimers research
a neurologist researcher for the ucla easton center for alzheimers research
the executive vice president of alzheimers los angeles
the director of the drug discovery lab ucla department of neurology

before we all watched the documentary i sat by the interim director and we talked for about 30 minutes
he seemed to be intrigued by my story over the last 9 years
during the q and a afterwards he was the one that asked me a question asking me to repeat my story so everyone in the audience could hear it
now ive done a 50 minute presentation on this before but i condensed this one to 5-10 minutes
when i finished everyone clapped and some stood up

another question i got was what would i recommend for someone who had memory issues or if their family had issues
that was an easy one to answer since ive written and talked about it numerous times
simply i said
get evaluated by your primary care or a neurologist
make the appointment only for memory issues
if its for someone else dont let them go in by themselves
do online memory testing before you go or fill out online forms on the loved one and take them in with you
write down what your issues are

the panel got a lot of questions most of them i could have answered on research and medical questions
even though i could have answered i deferred to these other panelist since they were the experts
however
i realized how much i knew about all this since i knew the answers
i had read about most of the research studies they talked about or since i have talked about them myself with folks

i felt honored to be on the panel with this group

now 
ive watched the documentary three times
my remarks would be similar to what bill gates said

i watched a well know researcher for the solanezumab study cry as she talked about the drug as it had failed to reach its desired end point

she was hoping for a treatment for her family and for herself and for her grandkids
she does have hope since she is the director of the big a4 study where prealzheimers patients are receiving much higher doses as those given in the documentary and these folks will receive it for a long extended time
right now the study participants have been on the drug for 6-7 years
she had hope that these prealzheimers patients who have no symptoms yet but have the positive amyvid pet scan for amyloid  that they will have a delay in when the disease shows up in them
maybe none at all
there is hope for this study to be successful

i tried to get in the a4 study several years ago but was denied entry since my original memory testing was abnormal even though subsequent memory testing is in the normal range

this documentary is being shown across the us frequently at locations that do alzheimers research
the director did the glen campbell documentary on his journey with alzheimers called
ill be me

so
i liked it
bill liked it

if you are interested in alzheimers research watch this documentary
on the brightfocus website linked above you can watch the trailer

the first time i watched it as i told the audience that day i was down since it hadnt been very long since the biogen aducanumab study i was on had been canceled
i really had a negative attitude as i watched the documentary
what got to me though was the patients and their caregivers and the researchers as they described their feelings
ok they all cried and i cried all three times

the second time i watched it was after biogen had reactivated its aducanumab study and i found out i might be able to be put back on the drug next spring
i paid more attention that second time to the volunteer study subjects and their families

then
the third time i was more clinical in my viewing of the documentary
as i paid more attention to the details of the film

there were a lot of well known alzheimers researchers interviewed in this documentary
all of them i have heard talk before or read their interviews

watch the documentary if you get a chance
then
consider volunteering for a study

as i told them that day the lack of
money
clinical volunteers
thats why we dont have a treatment and cure yet for this disease

i would like to thank all who donated to my walk team this year
we had another successful walk and fundraiser

so
im raising money check
im a clinical research subject check
and
how about you

go to clinicaltrials.gov for sites to volunteer

you can follow me on my facebook blog page link organicgreendoctor

the organicgreen doctor

Wednesday, November 13, 2019

organicgreendoctor: how to celebrate your 100th birthday

organicgreendoctor: how to celebrate your 100th birthday: HOW TO CELEBRATE YOUR 100TH BIRTHDAY this is a real feel good story we need one all of us do now with all thats going on in the world thi...

how to celebrate your 100th birthday

HOW TO CELEBRATE YOUR 100TH BIRTHDAY
this is a real feel good story
we need one all of us do now with all thats going on in the world
this satisfies that need

now my wife she is always emailing me links to things
sometimes i read them and well dont tell her sometimes i dont read them

this morning i saw this email with this link to a story about a 100 year olds birthday
i almost passed it over moving on to more newsy things
when
what caught my eye was the words pat mahomes
so
liking him as i do as a football fan
yes
yes a true blooded cowboy fan
i always read stories about him and watch his games

as i read the article and watched the video
i thought
we all need a real true feel good story considering whats going on in the world

well
it doesnt get any better than this one

read this article and watch the video and make yourself feel good and smile and make your day better

enjoy


the organicgreen doctor

Tuesday, November 12, 2019

organicgreendoctor: my last one

organicgreendoctor: my last one: MY LAST ONE since i retired i have tried to practice what i preached on preventative medicine like doing yearly flu shots doing all th...

my last one

MY LAST ONE
since i retired i have tried to practice what i preached on preventative medicine
like
doing yearly flu shots
doing all the preventative shots ones needs for my age like the pneumococcal shot and shingles shot
and the tdap for tetanus diptheria and pertussis ie whooping cough
i have my eyes examined each year actually more than that since i have chronic iritis and have to have them checked at least every 6 months
i have been screened frequently during the year as part of the research studies i am in for depression and for the status of my memory
i have had my prostate checked and the psa done although medicine cant seem to decide if that even needs to be done
i have my cholesterol monitored and take treatment for this to keep my levels normal
an aside a recent study showed that lowering cholesterol has decreased heart disease in our population and as a side benefit it appears to be helpful in slowing down the incidence of dementia
i monitor my blood pressure and keep it under control with medicine
although since ive lost weight recently i have had to cut the dose in half
i eat a mind diet with now almost totally vegetarian content
switching to this diet totally has made me lose several pounds
i have been screened for aneurysm
i get regular skin checks since i had my nose job done removing a basal cell cancer twice
i have my vitamin d3 checked occasionally since its low
i have my vitamin b12 level checked since i dont absorb b12 well anymore
i have dental visits regularly

i always said i didnt want to die from something i could prevent

then
the big elephant in the room
the snake test
the hose job
the awful prep for the exam test
the one thats left as its been almost 10 years is the
colonoscopy

this will be my third one
the nurse i worked with before i retired gave me good advice
use lots of vaseline
drink lots of fluids
follow the prep correctly
use lemon lime and put lime in the stuff you have to drink to cut out that awful taste
thats what i did the last two times and things went well
so
this time
i plan to do the same

i think though this time i will do a preexam weight and a post exam weight to see how much i will lose in those two days

then
i have decided
this will be the last one
im done
i have done my duty followed the rules on preventative care
but
my last prep
my last snake job
im done

the organicgreen doctor

Monday, November 11, 2019

organicgreendoctor: the lost veteran

organicgreendoctor: the lost veteran: THE LOST VETERAN wikipedia.org each fall my historian brother sends out a list of our family who have served in the military over time ...

the lost veteran

THE LOST VETERAN
Image result for epinal cemetery france
wikipedia.org

each fall my historian brother sends out a list of our family who have served in the military
over time
as he has progressed in his documentation of our ancestry that list has grown to include more distant relatives
many times as you read his list he has included historical information along with the listed names

in a county in southern arkansas where most of my relatives are from there is a monument that lists those who have served and died in past wars and on that list are around twenty people who were killed in world war 2
and
are all in my ancestry tree

below is the story and information on one of those

the lost veteran

in 1944 he graduated from high school in this county
a county where everyone knows everyone
many are kin to each other
he is actually kin to me from both sides of my mothers family

not long after he graduated he had a niece born
then
he was drafted and off to war he went
shipped to france
in his wallet was a picture of that niece em

there was a battle at dinoze france where 1500 american soldiers were killed
he was one of them
this was about 5-6 months after he graduated from high school
he was single
he like most of the americans were buried at the american epinal cemetery in dinoze france

what belongings he had were sent home to the family
including ems picture as a baby in his wallet

over time some of his records were lost
the family over time lost sight of where he was buried and his story
he had few living ancestors
his parents died later
the only ones left were the niece and a few others

in dinoze france each american soldier buried there is assigned a french family to maintain his grave
the french family assigned to w s grave had a lady that was american who married a french man
she had been trying to locate the w s family for years

now fast forward these 75 years

the french american contacted my historian brother who has has a lengthy thorough ancestry tree on the ancestry websites
on the website was w s fathers name but not his
so
the french american contacted my brother asking if he could help her locate relatives

well
my historian brother is a tenacious researcher
in fact some  private investigators have sought him out to help solve things for them
he always finds the answer

so
he located
the little baby who was in the picture in w s wallet when he was shot in dinoze france
she was living in houston texas

now
little em has talked and communicated with the french american about how they are honoring w s each year

this all made me think about maybe my mother and father during world war 2 as they heard of their relatives all 20 of them that were killed in the war
all around their age
im sure they knew all of them
this at that time was a small community that county of folks

i know during the vietnam war i knew of two neighbors sons who were killed in that war
i can remember when i visited the vietnam war memorial in washington dc
i sought out their two names
put a piece of paper over the names
then marked out the names on the paper

as i pulled the names off and looked at the names
i remember how i felt at that moment as i teared up thinking of them and their families

i can only imagine what the people of that community thought as they lost more than just those 20 young men kin to me

so
today
i want to honor this lost veteran whose remains are buried far far away in france

thank you
for your service and the ultimate sacrifice

may we not put our country through this ever again

SUMNERS, William A., Private, 399th Infantry Regiment, 100th Infantry Division, U.S. Army, Service #38662643, State of Entry: Arkansas, Death: 17-November-1944, Plot A, Row 27, Grave 51, Purple Heart, World War II
epinal american cemetery

may he rest in peace

thanks to my three older brothers who served in the military for 20 years
and
thanks to all the other relatives who also served

the organicgreen doctor

Friday, November 8, 2019

organicgreendoctor: alzheimers news-another alzheimers event and panel...

organicgreendoctor: alzheimers news-another alzheimers event and panel...: ALZHEIMERS NEWS-ANOTHER ALZHEIMERS EVENT AND PANEL today my wife she and i will make the journey down to the james bridges auditorium at u...

alzheimers news-another alzheimers event and panel

ALZHEIMERS NEWS-ANOTHER ALZHEIMERS EVENT AND PANEL
Image result for organicgreendoctor
today my wife she and i will make the journey down to the james bridges auditorium at ucla for the showing of the documentary turning point about the lilly drug solanezumab story and its failure to reach its end point ie folks would get better ie their memory after taking infusions for several months
it didnt reach its end point so the study was canceled
ala
like the biogen aducanumab study did
unlike aducanumab there has been no plans to reactivate theirs
im sure they lilly are looking closely at their data to see if higher doses are needed

i will be on a panel made up of alzheimers researchers from ucla
i will be the representative of the patients in the studies

i have seen the documentary twice
the first time was before biogens announcement to reactivate their study
the second time was last week

my perspective on the documentary was different after each of the viewings

the first one
i was like
im done i aint doing these no more
it was draining to have gone through nine years of alzheimers clinical trials then just to be dumped suddenly one day
all the work to get to this point and all the hope we had
was dashed
to smithereens it was

i could see it in the faces and hear it in the voices of the patients like me who had placed so much hope for these drugs
i could see it in the faces and hear it in the voices of the researches all who were personally affected by this disease in their families and had spent their lives on this drug some for 15-20 years
i realized they were as dashed emotionally as i was

after the second viewing last week
having just been told i would be considered as one of those who might qualify for the reactivation study next spring with the biogen aducanumab

it was a real roller coaster emotional trip over the last few months

i know like those folks in the documentary that this drug my drug this study represents my last chance to get a drug that might make a difference
for me the train may have left the station if i didnt get this second chance

i was ready to accept that
do my medications and supplements and all the healthy things im doing
dont look back just move on with the rest of my life
i was done with being in these studies

i and others are now getting this second chance hopefully
i am honored
i feel lucky
to have this opportunity

in this documentary is some of the story of the a4 clinical trial
they are using solanezumab infusions monthly long term
in patients who are prealzheimers or have prodromal alzheimers these mean the same thing
ie
they have normal memory tests
but
their amyvid pet scans are positive for amyloid
and or
their lumbar spinal fluid is positive for abnormal levels of tau and amyloid

what this means is that they will be developing alzheimers symptoms one day
they are now given higher doses of the drugs
they will be followed long term to see if solanezumab will slow down or prevent alzheimers

if it does
then folks may one day be identified before symptoms start and receive this drug or one like it

i will be watching this study closely

one question i am anticipating from the audience is what is it like to be in these clinical trials

i will give a one word answer

hope
thats all we can ask
is
hope

the organicgreen doctor

Thursday, November 7, 2019

organicgreendoctor: prior disapproval

organicgreendoctor: prior disapproval: PRIOR DISAPPROVAL this is a picture of a tube of 5% fluorouracil cream that has been generic now for awhile it should be cheap right n...

prior disapproval

PRIOR DISAPPROVAL
this is a picture of a tube of 5% fluorouracil cream that has been generic now for awhile
it should be cheap
right
not
this spring i had mohs surgery to remove a basal cell cancer on my nose
its the second one i have had in 3 years
this second surgery was more involved than the first
it required a plastic surgeon to do two procedures to cover up the big ole hole left on my nose
it was located you know on the cute spot
if you have seen a freckled kid with a sunburned nose
its that spot that has peeled after the sunburn

alas
i had a lot of those cute freckled nose sunburns in my life
leading to
both my skin cancer surgeries

now after this surgery the dermatologist suggested i do a treatment with the fluorouracil 5% cream
or
as its know in the medical field
5fu

not only is it a cream for skin cancer but its given iv for other cancers
ie
my 5fu is my chemo for my skin cancer

if i use it it will kill any precancer cells and any cancer cells that are growing in the skin flap he pulled over to fill up the nose hole

seems straight forward right
oh
i will do this every year or two to keep the skin cancer at bay
i dont
i repeat
dont want to do this surgery again
so
i decided im going to be persistent here in getting my prescription

so
the derm sent over my rx to the three letter pharmacy
sir
they said
you need to have this get a prior disapproval
thats not what he said but thats what i heard

then
later the nurse called
we just got notified we need to do a prior disapproval on this drug

so
i decided
im just going to see how well the system works to get my prior disapproval done

i have one more procedure to do in two weeks then when its healed i will start my 5fu
well
if my prior disapproval goes through

so i waited
the three letter pharmacy waited
they sent me prior disapproval notices
the derm called we need your updated drug insurance this was 3 weeks after the rx was sent in
so
now im 4 weeks into the prior disapproval process

i thought
ok
now im giving them 2 more weeks to get this prior disapproval to be done

then
after two weeks i made the dreaded phone call to the first letter of the alphabet insurance company

of course
i was put on hold
it took 50 minutes for this phone call to be completed
after talking to four different folks

they asked what i wanted
i said i need my chemotherapy cream for my skin cancer before my nose falls off
they said
you need this to have prior disapproval
that not what they said thats how i heard it
so
i said to the person whose accent made me think she was in atlanta
deep drawl she had
i said
oh you mean prior disapproval
there was silence
no thats not what i said
let me send you to my boss
then another boss
then to a pharmacy decider technician

as i was talking i could tell she didnt know what she was talking about

she started asking me questions about why i was having this done
i thought to myself i think she is confused
i think she thinks i am the doctors office
so
i answered the questions like i was the doctors office

she said
is this being used for what sounded like some terrible skin cancer going awry
i wasnt sure what that was but it sure sounded bad
so
i said
yep thats why im using it

oh ok she said
we will approve it for one year

what the heck i thought to myself

oh by the way i said
how much will it cost me with insurance
$192

later i called the three letter pharmacy and asked the cash price
$230

so
i thought
i wonder if that wholesale company that you have to have a membership fee to use but not the pharmacy if they would have a cheaper price
the pleasant pharmacy tech said sure here is the cash price
$98

thats right i said what the heck again

so i pulled out a hundred dollar bill and paid the man
saving over a hundred dollars by not using my insurance

i thought im glad i wasnt dying or something needing this medicine
one that has been around almost my whole medical career

if i was going to put a fair price on the medicine it would be $45

so you can see theres a lot of profit or someone is making money on the deal
had i not been persistent and sort of understood the game i could have paid almost 3 times the price

so
next time
say to your doctor or hospital or pharmacy or insurance company
oh
so i need this prior disapproval done

some will laugh
some wont

the organicgreen doctor

Wednesday, November 6, 2019

organicgreendoctor: my story revisited 27-my final answer part two

organicgreendoctor: my story revisited 27-my final answer part two: MY STORY REVISITED 27-MY FINAL ANSWER  PART TWO after our alzheimers walk this weekend i sure have be doing a lot of soul searching think...

my story revisited 27-my final answer part two

MY STORY REVISITED 27-MY FINAL ANSWER  PART TWO
Image result for organicgreendoctor
after our alzheimers walk this weekend i sure have been doing a lot of soul searching
thinking about my moms course with the disease
thinking about my younger brothers course with the disesase and why he was struck with it so young
thinking about my father knowing now all i know about this disease that he probably had it when he died
thinking about my older brother who was told he had it but since changing up his medications for his heart and changing off his aricept and nameda he has seem to be stable
thinking about a lot
thinking about when i was diagnosed and how overwhelming it was
our life sort of came to a screeching halt
thinking about a lot of the decisions i and we made picking out research and doing the workup that now is becoming the standard workup for someone who has memory loss

i ran across this blog i wrote below

now i know
my fdg glucose test was negative which is negative early on in the disease but later turns positive
my amyvid pet scan for amyloid in the brain was positive
my spinal tap for amyloid and tau was positive and knowing what i now know a second one being tested would even be more positive
my genetic test for apoe4 apoe4 was positive and how today i know what that really means

my b12 level did continue to drop below normal but with oral supplements has returned to normal as long as i stay on the b12

so
here is my blog from about 8 years ago on all my diagnositic testing i had done
i am glad i had it all done and participated in the adni2 and later the biogen aducanumab study
so
i sit here today with normal memory on my memory tests
for now anyway
awaiting notification of being able to restart the biogen aducanumab study next spring

over the last 9 years i have has as complete a workup that one can have for memory loss

there were lots and lots of ups and downs the last 9 years
with
the overall projectile being upward

XXXX

07-22-2011
MY STORY-FINAL ANSWER PART TWO
this is the part two of a three part blog on my story-final answer
this blog today will deal with the neurology visits, the medication
i am on, the research study im in, and the diagnostic tests that
have been done

next week the blog will be on what it all means for me and maybe
for you and your family

neurology visit
i met with the neurologist on december 21 2010
she interviewed me and my wife she
she also did a neurological exam on me
she reviewed the neuropsychological exam i had done-the one
where i did poorly on the short term memory portion

because i had a normal neuropsychological exam 2 years ago
followed by a abnormal neuropsychological exam 2 years later
because i had noticed problems with my memory over the last
few months and
because of my strong family history of alzhiemers disease in my
family-mother, father, a close younger relative and probably
numerous aunts and uncles
she felt and i agreed with her that i had early mild cognitive
impairment amnestic type probably from alzheimers disease
(remember alzheimers disease is only 100% diagnosed at autopsy)

she felt and i agreed with her that i should start on a medication
called aricept (donepezil)
i knew that medicine well
i had just written it for a patient of mine the day before as he
has mild alzheimers disease
my mother was on the same medicine and my close relative is
presently on it

so why do i need to be on this medicine
if what i have is due to alzheimers disease then it will progress
rapidly or may progress slowly but it will eventually progress to
the same awful end point

the medication aricept (donepezil) doesnt stop the disease process-
that deposition of amyloid in the brain and the unraveling of the tau
proteins in the nerve cell that may be the cause or end result of
alzhiemers-
it just marches on no matter what

the aricept (donepezil) inhibits acetylcholine esterase an enzyme
that breaks down acetycholine in the nerve cells
by inhibiting this enzyme the levels of aceylcholine stay elevated in
the nerve cells so what nerve cells remain work better

by taking the aircept (donepezil) the aceylcholine levels are kept
high and the brain works better
if you stop the aricept (donepezil) the acetylcholine levels drop and
the brain doesnt function as well
the bad thing is when you restart the aricept (donepezil) you dont
regain back to where you were

so it was decided that i take the medicine to maintain my status
where it was now rather than wait to see if my memory got worse
then start the medicine ie i would have lost ground that i could
never regain

so i have been on the medicine now for 7 months
the side effects are tolerable
it causes vivid dreams more than ive had in the past
it causes a figgidness especially in the morning time after i take it
i have to go outside and work or take a long walk
it also causes a restless leg like symptoms especially at night
it also interferes with sleep
both of these symptoms are relieved somewhat by taking a
childs dose of benadryl
i have not had any of the gastrointestinal symptoms that some
people have

so i have stayed on this medicine now and will stay on it until
it doesnt work anymore
at that time usually another medicine is added to the
aricept (donepezil)
when that will be i dont know
it could be in 1-3 years or 5 years or 10 years or never

i then underwent testing to rule out other treatable causes of
my memory loss
i had a complete blood count to rule out anemia, infection, leukemia,
a complete metabolic panel to rule out diabetes, electrolyte
problems, kidney disease, liver disease, a tsh level to rule
out hypothyroidism, a b12 level, a hiv test, a syphilis test, hepatitis
screening, a urinalysis, and a sed rate to rule out inflammation--
all of these were normal

i had an ulrasound of the carotids to rule out blockage to the arteries
in the neck--this was normal

i also had a mri with and without contrast to rule out aneurysm,
tumors, strokes, circulatory problems, brain shrinkage, and
increased fluid in the brain--the mri was nomal

i was also screened for depression several times and i dont feel
depressed and the screens were negative for depression

after a few months on the aricept (donepezil) i did a followup
visit with the neurologist
i will see her every 6 months and will remain on the medication

i also was now able to enter the adni-2 (alzheimers disease
neuroimaging initiative) study at the university of texas medical
school memory clinic since i was stable on the medication

this study is important as it may define how a person is
evaluated for alzheimers disease in the future with these tests
that i am having done

this time i was entered not in the normal control group but in the
early mild cognitive impairment group
the other groups are normal, late mild cognitive impairment
and alzheimers disease (aint there yet)

during the initial visit i had another neuropsychological exam,
a screen for depression, the same labs as above, and an
mri of the brain-the short term memory problems were still
present and the labs and mri were normal

i then had blood drawn for genetic tests and other dna and
rna tests-one of these genetic tests is for the apoe 4 genotype
which is known as the alzheimers gene
i underwent a spinal tap for amyloid protein (beta amyloid protein)
and tau protein-more about them later
i had a fdg (flurodeoxyglucose) pet scan which measures glucose
metabolism in the brain
in alzheimers disease the glucose metabolism slows and the fdg
pet scan shows early on in mild cognitive impairment a decreased
uptake in or near the hipppocampus on the undersurface of the
brain where memory occurs


above is a fdg scan that shows decreased uptake (the red color)
in mild cognitive impairment  and in alzheimers disease
the less red the less glucose being uptaken

i also had a florbetapir f 18 pet scan which measures amyloid in the
brain-this is a research pet scan not available outside of research-
in mild cognitive there is an increase uptake in the hippocampus area

as the disease progresses (as more amyloid gets deposited) the
scan turns positive diffusely across the brain


this is a scan similar to the amyloid scan mentioned above
you can see the increased red amyloid deposition in alzheimers
disease vs a normal control scan

i will never see the reports of the labs, mris or the pet scan reports
as they are protected by the research study
that is part of the deal

i will have the pet scans and lumbar puncture every 2 years
i will have the mri at 3 mo 6 mo 12 mo 24 mo 36 mo 48 mo
i will also do neuropsychological tests, depression tests, and
blood work at each visit

i elected to have the apoe genotyping through my primary care
provider as i wanted to know the results
i felt like i was well versed on alzhiemers disease and understood
what the apoe tests mean and what limitations it has

the apoe gene is called the alzheimers gene although it is one of
several that may be associated with alzheimers
the apoe gene can be 2, 3, or 4
apoe 2 may be protective for alzheimers
apoe 3 may have milder degrees of alzheimers
apoe 4 i call it the sucky gene

a genotype of  a single apoe 4 gene (heterozygous for you
science folks) carries a risk of 10-50 % chance of developing
azheimers disease
a genotype of double apoe 4 gene/apoe 4 gene (homozygous)
carries a risk of 50-90 % chance of developing alzheimers disease

well i got screwed it looks like
i have the apoe 4/apoe 4 homozygous gene
ie i got it from each of my parents

i also opted to obtain spinal fluid for analysis of biomarkers for
alzheimers disease through my primary care provider
one of them is the beta amyloid protein
in alzheimers disease as the amyloid gets deposited in the brain
the amyloid levels go down in the spinal fluid

well i got screwed again as my beta amyloid protein is low in my
spinal fluid

the other test on the spinal fluid is the tau protein
its a protein thats found in the brain thats involved in the nerve cells
as this protein gets unraveled it gets phoshorylated and the p-tau
levels in the spinal fluids go up
well my levels were in the borderline level for alzheimers disease

here is a graph of my results
the left side of this graph  is the beta amyloid level
the level is low
the horizontal side is the ptau level
the level is borderline

so i have a normal neuropsychological exam 2 years ago followed
by abnormal neuropsyhological exams showing short term memory
problems,
noticeable memory problems to me,
a strong family history of alzheimers,
a positive apoe 4/apoe 4 genotype,
a low beta amyloid in the spinal fluid and
a borderline level of p tau protein in the spinal fluid

all of these point to azheimers disease as the cause of my mild
cognitive impairment

if i could see the reports of the fdg pet scan and the amyloid pet
scan i would have an even more accurate picture of where i stand

next week in part three i will try to put all of this together and what
it means to me, my family and possibly to you

XXXX

the organicgreen doctor