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

Thursday, June 20, 2024

organicgreendoctor: my story revisited #206-my story on my story

organicgreendoctor: my story revisited #206-my story on my story: MY STORY REVISITED #206-MY STORY ON MY STORY nine years ago i was asked to give an alzheimers talk at a senior expo in the area where i was ...

my story revisited #206-my story on my story


nine years ago i was asked to give an alzheimers talk at a senior expo in the area where i was in practice for 10 years
the talk was well attended
i gave the almost 50 minute presentation then answered questions for probably close to an hour

now when i look at what was on my slides
some things havent changed much
some have

the clinical trials i mentioned have been all completed
the a4 study showed after 10 years that infusions of solanezumab a monoclonal antibody didnt help at all
since then the monoclonal antibodies against amyloid plaques aduhelm leqembi and now donanemab has been approved for use in early alzheimers to slow down symptoms

the colombian study showed that these drugs didnt work in early onset genetic alzheimers disease

the bace inhibitor study showed that bace inhibitors didnt work but actually made things worse

the amyloid pet scan is routinely used now in a workup for alzheimers disease
medicare even pays for it as it also pays for these 3 new drugs

the alzheimers blood test is routinely used in clinical trials and will be coming to your doctors office soon to help diagnose alzheimers

if you look at that amyloid pet scan on the right side thats a positive amyloid pet scan
mine use to look like that in 2015 
in late 2023 my amyloid pet scan was negative like the one on the left side

who would have hoped for that when i was doing my presentation
the answer
me thats who
here is a link to information on the senior expo where
i will be doing a presentation on alzheimers disease today
at the bottom of the article is a few paragraphs
about my presentation

senior expo article

below are the slides from the talk
for those not attending
for those who did attend

slide one

slide two
slide three

slide four

slide five

slide six

slide seven

slide eight

slide nine

slide ten

slide 1 is a normal vs an alzheimers brain
total destruction has occurred
the theory is it starts with the bad beta amyloid accumulating then the
tau protein unravels resulting in brain cell death
it all starts in the underneath portion of the brain called the hippocampus
then spreads over the brain
what area of the brain thats affected determines what you see in
your loved ones

slide 2 is information on aricept (donepezil)

slide 3 is a list of tests that someone should have if they have memory loss
the ? ones are now available to private practice but are not paid for by
the last one the alzheimers blood test should be commercially available soon
its 90% accurate

slide 4 is the labs that are generally done
some providers add the homocysteine level since it may be associated
with an increased risk for alzheimers stroke and heart disease
i would add a ua in the elderly

slide 5 is an mri scan
this one shows a stroke

slide 6 is the new amyvid pet scan that highlights the beta amyloid
that accumulates in the brain
if you have alzheimers this test will be positive

slide 7 is the alzheimers graph that shows when things happen
as alzheimers develops
note that the bad beta amyloid and tau accumulates years before
symptoms develop

slide 8 is a list of things to do to slow down the disease
it is especially important to start as young as possible

slide 9 is a list of treatment research studies ongoing now
hopefully the treatments will be available in 5 years+

slide 10 is a reference list
the clinical best practices is a pdf file from the texas health department
on the recommended evaluation and treatment of memory loss

i look forward to the presentation today
hoping to give answers to those who cant get their questions answered
the evaluation one does for memory loss hasnt changed much in nine years
exam history memory testing labs mri of the brain
now if needed an amyloid pet scan of the brain can be done to see if amyloid plaque is present in the brain 
it is the hallmark of alzheimers this amyloid plaque
soon in 2-3 years an alzheimers blood test will be done 
if its negative no amyloid scan is needed
if its positive an amyloid scan may be done to verify the diagnosis
if the disease is early enough treatment with leqembi or donanemab can be started to maybe slow things down

so we have made progress in the last 9 years
we need to make more progress in the next 9 years to treat tau tangles and inflammation in the brain

i wonder what i will be writing about in 9 years
hopefully more successes

the organicgreen doctor

Monday, June 17, 2024

organicgreendoctor: alzheimers news-here comes another one

organicgreendoctor: alzheimers news-here comes another one: ALZHEIMERS NEWS-HERE COMES ANOTHER ONE there will soon be three drugs that will remove amyloid plaque from the brains of alzheimers patients...

alzheimers news-here comes another one


there will soon be three drugs that will remove amyloid plaque from the brains of alzheimers patients 
doing this may slow down cognitive loss by about 30%
will removing this plaque make a difference

follow me over the next 10 years
if i am still doing this blog in 2034 then you know that removing amyloid plaque will have made a difference

in the theory of what happens with alzheimers
amyloid plaques accumulates first and kills brain cells
tau proteins in brain cells unravel forming tau tangles and kills brain cells
inflammation in the brain occurs as the body attacks this brain cell destruction and kills more brain cells

this is what happens in alzheimers

we now can remove amyloid plaque with three new antiamyloid monoclonal antibodies that bind to the plaques and removes them

the first drug to get approved was my drug aduhelm or aducanumab
i took 34 months of infusions which has removed all the measurable plaques in my brain as shown on an amyloid pet scan done last winter
will it make a difference
time will tell

aduhelm made by biogen and eisai was recently taken off the market since its sister drug leqembi works better and may have fewer side effects

the second drug is leqembi or lecanemab made by biogen and eisai which removes the amyloid plaques also but quicker than aduhelm and maybe will less side effects
its given as an every 2 weeks infusions
it may only need to be given for 12-18 months
its approved by the fda and medicare pays for it and the accompanying scans required ie amyloid pet scans and mri scans
its also will be soon probably approved to be given just once a month and maybe given as an injection at home

the third drug is donanemab which removes the plaques quicker than the other two but maybe with more side effects
it may be used only less than a year
this drug made by lilly just got fda pre approval and will receive full approval soon

the major side effect of these drugs are brain bleeds or aria or amyloid related imaging abnormalities
these aria can be just edema or they can be bleeds
it is more likely to happen in those with the homozygous apoe4 apoe4 gene
called the late onset alzheimers gene
that one  i have
i didnt have aria ie edema or bleed
i did develop ocular migraines manifesting as visual changes headache nausea 
the headaches would last for several days
the visual changes for up to an hour
these were strong at first but gradually become less intense
the drug was stopped for a couple of months until serial mris of the brain were normal
these headaches are resolved now that i am off the drug

so the biggest risk is these brain bleeds 
most that occurred resolved and didnt prevent folks from continuing treatment
there were a few deaths though from these bleeds

when i signed up for the aduhelm clinical trial the risks were spelled out on the consent forms
pages of paper work were signed it seemed every year i was on the study

i decided i was willing to take the chance since the potential outcome of a potential new treatment for alzheimers was significant
time will tell if it worked

probably most folks in the studies felt the same

would i take one of these drugs now if i was early in the disease
i would maximize my health
i would take aricept of donepezil to slow down symptoms
i would seek treatment with either leqembi or the new one donanemab
probably leqembi especially if it goes injectable at home and just once a month
i would watch closely the new clinical trials with new drugs to treat tau tangles and inflammation
i would watch closely the research on when the amyloid reaccumulation would need to be treated
right now it may require periodic treatments with leqembi or donanemab 
hopefully something that can be done at home

we are entering a new era of alzheimers treatment
we are just at the beginning 
sort of like they were with heart disease by treating cholesterol long before it caused problems
now we will be treating amyloid plaques and tau and inflammation long before alzheimers starts
maybe like with heart disease we can prevent the disease alzheimers from developing

i think thats the goal

for me
i am getting in on part of all this but probably will miss all the treatments coming down the pike
if my disease doesn't progress too fast or far i may make it to these newer future treatments

the organicgreen doctor

Thursday, June 13, 2024

organicgreendoctor: garden news-begetted another rainwater tank

organicgreendoctor: garden news-begetted another rainwater tank: GARDEN NEWS-BEGETTED ANOTHER RAINWATER TANK when i started gardening at our community garden 7 years ago we had no rainwater tanks i gradual...

garden news-begetted another rainwater tank


when i started gardening at our community garden 7 years ago we had no rainwater tanks
i gradually changed all of that

i looked around thinking why dont we save rainwater from falling off sheds and buildings and letting it flow down the garden to the creek to end up in the ocean
why cant we save some of it to use in our garden

i found 2 rainwater tanks that looked like these two online for a good price
i looked around and thought why dont i collect the rainwater off our two chicken coops
i found some old gutter and some old 2 in pvc pipe and guttered both chicken coops
and put a tank at the back of each coop to collect rainwater
my daughter in law give me these two tanks above to use in our garden
i hooked them up to the two tanks behind the coops
leaving us with 240 gallons of rainwater capacity
i added the grey tub to catch any overflow from our 4 tanks
we mainly use the water to water new plantings and to mix with fish emulsion when we do our twice a month feeding to our vegetables

then someone gave us three 60 gallon tanks 
i cleaned them up sanded and painted them 
i placed them under a shed out front and put a gutter and downspout to collect 180 gallons of rainwater
this water is used out front to water plants and to use in our greenhouse to water our new seedlings

now we have 420 gallons of rainwater capacity

with a 1 inch rain we collect 120 gallons of water
it takes 3 1/2 inches of rain to fill them up
this year they filled up multiple times since we had over 30 inches of rain
the average here is around 12 inches of rain

my wife she is always looking at freebie websites like buy nothing
last week she found this 50 gallon rainwater tank online for free
it is shown in the top picture above

in the picture above in the distance if you look closely you can see the 3 brown rainwater tanks sitting against the brown shed
i ran a water line from these tanks down to the new rainwater tank at the edge of my garden
a distance of about 50 feet
the tank sits lower then the tanks along the shed

we plan to use it to access the rainwater tanks on my side of the garden for myself and other gardeners
we i will use the rainwater to water in new plantings and mix up my fish emulsion seaweed molasses solution in our gardens

also in that picture there are two grow bags with dirt in them
this is dirt from my walkways which will be used in the main garden to help build up our beds
the front 2 grow bags have fava beans growing in them
they are a good cover crop and fix nitrogen in the soil
i will harvest some this year to cook since we have never cooked with them before

now over the last 20 years i have begetted several rainwater tanks to school gardens neighbors friends and habitat for humanity recipients
most of them are probably still being used

i feel like they are my children

the organicgreen doctor

Wednesday, June 12, 2024

organicgreendoctor: it was his birthday

organicgreendoctor: it was his birthday: IT WAS HIS BIRTHDAY waltdisney.org this is what donald duck looked like when he was first created this is from the website which chronicles ...

Tuesday, June 11, 2024

it was his birthday


this is what donald duck looked like when he was first created
this is from the website which chronicles his journey

when i was a kid my rainwater brother and i would try to talk like donald duck as we watched saturday morning cartoons on tv
until my mom would kick us outside to paly all day

over time i got better at talking like donald duck 
such that you could mostly understand what i was saying in donald duck language

last sunday donald duck turned 90
he doesnt look that old does he

he was started to be a side kick for mickey mouse
he donald was more aggressive and well sort of moody and grumpy
he also had a donald duck temper
which i have but it doesnt manifest itself very often
when it does i become a dr jekyll mr hyde person
once i would have murdered someone if i could have gotten my hands on them
lucky for them i was 20 miles away on the phone with them

i noticed as i was seeing kids in my medical practice that that they liked when i talked to them like donald duck
some even called me dr duck

i still have signs that were given to me by patients that says dr duck on them

when patients would go to disneyworld or disneyland they would bring back pictures with donald duck or a donald duck souvenir doll or a signed donald duck autograph
they proudly gave them to me when they came in to the office

before i retired someone built this shadow box for some of my donald duck characters
thanks dc and mc
now i had boxes of them to chose from
these are the ones that made the cut
most were given to me by patients and by my motherinlaw

the rest were either donated or sold as fundraiser when we moved
one person bought a lot of the donald duck stuff at our moving sale

i still do my donald duck voice for my grandkids
they are use to it and dont enjoy it as much as they did when they were younger
my younger son does a donald duck voice so his kids are use to it
his son is practicing his voice regularly so maybe he will carry on the donald duck voice tradition

in my practice i would use the voice to calm down my young patients 
sometimes they would quieten down and allow me to examine them

i did find though that younger kids less than one didnt usually appreciate donald duck as much as when they got older

i talk to the kids in the preschool next door to our community garden in my donald duck voice and whenever we do a tour of younger kids in the garden
one thing they all say is 
do it again do it again

i use to have patients cry when they left my office
whats wrong mom asked
he didnt talk like donald duck

some would tell mom
im sick i need to see dr duck

happy belated birthday donald
your voice has entertained hundreds of kids via my voice over the years

thank you for the inspiration

the organicgreen doctor

Thursday, June 6, 2024

organicgreendoctor: my vehicles over the years

organicgreendoctor: my vehicles over the years: MY VEHICLES OVER THE YEARS the first car i owned was this blue ford my younger brother and i went 50/50 on it we bought it from an old gentl...

my vehicles over the years


the first car i owned was this blue ford
my younger brother and i went 50/50 on it
we bought it from an old gentleman who hardly drove it
one foggy morning on my way to work a black angus bull walked in front of me destroying the front of the car
it cost him his life

i hadnt thought about this car until i saw this list of the worst cars to own
i looked at the top five 
ive owned some of those 
lexus and toyotas and accura
we now own two toyotas

i looked at the bottom 12
ive owned some of those
volkswagen chrysler chevrolet dodge ford
chrysler was ranked #1 worst for 2024 

after my 55 ford i bought a ford maverick
drove it two years
then a motorcycle for a year
then a ford falcon which i bought from a friends grandmother for very little and drove it for 6 years
then a ford pickup that was an old forest truck
i drove it for 4 years through medical school
then i bought a ford ranger pickup 
i called it my residency truck
i drove it for another 7 years
i willed it to a friend who used it for his ranch truck
later he traded it to a contractor for some driveway asphalt work on his ranch

my wife she owned a yellow volkswagen bug she owned when we got married
one cold snowy day in northwest arkansas she was driving slowly and a large truck which was racing with another truck hit her and my son head on on a hill
they both survived
my wife she had multiple body bruises and my son sustained multiple head lacerations and a broken arm
the car was demolished
it had been a reliable car up to that point

during medical school we bought a car for the family a chevrolet chevette
we called it the shove it
it was a badly made car
no more chevrolets after that one
next we bought a chevrolet nova which was really a toyota car
we drove it for several years and gave it to our son when he started driving
then we switched to a minivan either a chrysler or a dodge
nowadays we would have bought a toyota or honda van

it was after all that we only drove toyotas accura or lexus
one of our best cars was a toyota echo 
at one time i had one and my wife she had one
it got great gas mileage and never had any problems

later my wife she drove a toyota yaris which gets about 40 miles per gallon
we have owned it now for 15 years
i now drive it for my vehicle
it is a hatchback so i call it my truck

in the early 2000s i decided i needed a farm truck
i heard my friend was unloading a truck a ford f150 that his son drove but gave it up
i contacted him to see if he wanted to sell it to me
it had just been traded it in to a dealership in dallas
i called and they still had it
i flew up to dallas and bought the truck and drove it home

when we moved to santa barbara in 2017 i gave it to our friend for her farm truck
its still going strong even though its 25 years old
i must admit i severely abused it while i had it
it had scrapes dents bruises all over it
it was a true beat up farm truck
it was one of the best vehicles ive owned 

we also owned a toyota corolla which was wrecked
its a long story 
we replaced it with a new one 

so looking back 
my favorite vehicle was my ford falcon
although i enjoyed my old forest ford truck and my black ford f150

maybe my toyota yaris im driving now would be my newest favorite one even though its now 15 years old
it has handles to roll up the windows which my grandkids love a key a real key all the doors are manual and its a stick shift
i like a roll down window in case i run into a body of water
i can roll the window down and swim out without worrying like you do with an electric window
this yaris will probably be the last one i will own
so im enjoying it

so we have owned a variety of cars over the years
several were replaced due to car wrecks 
others just got too old

if i do have to buy another one for me i plan on getting an electric car or truck
but im hoping my yaris will last as long as i do

the organicgreen doctor