questionnaire, questions and answers, symposium

QUESTIONNAIRE, QUESTIONS AND ANSWERS, SYMPOSIUM

here is the link to
the 21 question questionnaire
yesterday when i did an q and a on alzheimers disease
i recommended folks use this as a way to evaluate
their family member or friend to help decide if they
had a problem with their memory
and
if it is needed then
a medical evaluation

here is how to use this form
answer the questions
score it
if they score high
they need evaluated
take a copy of the completed form to their doctors
you go with them
the doctor will accept the form and will usually act
on what it shows
it also gets entered in the medical record so it wont
usually be ignored by their doctor
ie
now their memory is ok wont be an answer
if you have documented a problem

doctors and medical systems get audited and will
usually act when provided this document


for yourself if you are concerned about your memory
go to
this link for the best five self administered tests

if the results are abnormal
further evaluation is warranted
it doesnt necessarily mean there is a problem
remember these are screening tests
and again
copy the test and take it with you to the doctors visit



yesterday i did a question and answer session on alzheimers disease
at a facility near my home for caregivers and representatives
of different home health agencies and long term care facilities

i enjoy these as i let the questions determine which direction the
session goes
although i have talking points of questions i want to answer
like politicians do
i try to let the audience get the questions out and hopefully
answers to things they want to know
about medications
side effects
how to get a workup for dementia
how to get your doctor to listen a real problem im afraid to say

i suggest the 21 question test and take it in with them to the visit

what new tests are becoming available

what a person can do if they are diagnosed
or
what a person can do to keep from getting dementia
the answer to that is the same
healthy stuff like control weight blood pressure diabetes
cholesterol depression anxiety decrease stress sleep well
exercise be happy etc
and
for those younger folks its important to do that also

whats new in alzheimers research
they are looking at diagnosing folks earlier and earlier
as the push is to begin treatment before symptoms occur
a lot of research is ongoing now starting new treatments that
if it works will slow down or prevent alzheimers disease

a lot of questions got answered yesterday
hope it helped
the caregivers the ones who feel the brunt of this disease
the most asked most of the questions
good questions
hope i answered them to their satisfaction


on april 30 2014 for those of you in the central texas area
there will be the 2nd annual alzheimers symposium
at the mayborn center in temple texas

here is the link on the symposium

this is the one i spoke at last year
this year the symposium will be almost totally focused
on caregiving

i plan to attend and look forward to the sessions
as i too am doing some planning for the future
and
hope to learn some things that will be helpful

remember im luckier that most patients
i get to do planning
while most dont get to

the organicgreen doctor

successful, rosie you go girl

SUCCESSFUL
i feel like the first alzheimers symposium yesterday was successful
there was  a large attendance and they all seemed to be quite engaged
asking questions
no i didnt notice anyone dozing off during my presentation
of course it was at 930am so that with coffee probably kept them
form sleeping

here is a link to a article written in the temple telegram about
my presentation and the symposium

my presentation seemed to be well received based on the attentiveness
questions afterwards and through out the day as i hung around to watch
the other presentations

i think people are starving for information about this disease as they
worry about getting it and have to deal with it personally in their family

the other presenters did a good job

i was especially intrigued by a presentation on music therapy
here is a youtube video they showed
i found it quite powerful
ok it brought tears to my eyes as i remembered how much
my mother enjoyed the church music and gospel singing
when they did it at the home she was at

hope that next years symposium will be this good

i find it interesting than an area of over 2,000,000+ people hasnt
had something like this on alzheimers disease before
well thats changed now

ROSIE YOU GO GIRL
this weekend in the kentucky derby all eyes will be on a female participant
that will be running against the guys
she a proven winner

she is rosie napravnik
one of the top jockeys the last two years
she has survived at 25 years old in a mans world
one of the few sports where women compete against men
shes the dana patrick of horse racing
except that shes a winner

shes been shoved over the rail under cut forced off her horse
causing multiple injuries in her career
many caused by male resentment to her participation
you can if you are a female imagine the abuse she must have
to endure

but this year shes for real
she did lose her horse to an injury
a horse that had good odds of winning
but she has found another one thats listed at 13-1 odds

ill be watching saturday
rosie you go girl

the organicgreen doctor

alzheimers symposium

ALZHEIMERS SYMPOSIUM
welcome to my blog for those of you who were at the
alzheimers symposium today at temple texas

below you will find

-the video that was shown on my story

-all my slides from the presentation

-a list of self administered tests that you can can do on yourself
or on a loved one or relative
these are screening tests for memory loss
remember the gold standard test is the neuropsychological exam

-next there is a  link to an article about whether or
not to start medicine in alzheimers patients

then
if you have a question feel free to go to the comment section below and
post the question
i will then answer the question for you and others to read

thank you
the organicgreen doctor

here is a link to 5 self administered tests for memory loss

the sage test is one of the better ones

here is a link to the 21 question alzheimers questonnaire test

here is the link to the article on whether you or a family member should take
medication if diagnosed with alzheimers
do alzheimers medications work, who should take them

feel free to leave a question in the comment section below and i will be glad
to answer it for you and others to read

the organicgreen doctor

alzheimers symposium part 2

ALZHEIMERS SYMPOSIUM PART 2
i will present a talk on my story with possible alzheimers
at the alzheimers symposium at the mayborn center in temple texas
on tuesday april 30, 2013

here is the the link to register for the event

part 2
neurology visit

so i went to dallas to the neurology appointment with my wife
they asked that i get the following labs before i came to the appointment

labs to be done
cbc complete blood count
metabolic profile with electrolytes liver function tests kidney function tests
and glucose
vitamin b12 level
syphilis antibody test
hiv antibody test
tsh for thyroid function
urinalysis
mri scan of the brain
depression screen
neuropsychological testing or a good mental status exam
good history and physical

this is the list of lab tests and exams that you need to have done if you
are being evaluated for memory loss or dementia
anything less is not acceptable

a cbc complete blood count checks for anemia or a low white count

a metabolic or chemistry profile checks the electrolytes for a low or high
sodium or potassium which can cause memory loss
abnormal liver tests
abnormal kidney tests the bun and creatinine which is elevated
if you have kidney failure

a glucose which can detect diabetes

a vitamin b12 level
if you have a low b12 level you can have problems with memory

syphilis antibody test
you can have latent syphilis that shows up as later in life in the
central nervous system and cause dementia

hiv antibody test

tsh for thyroid function
thyroid stimulating hormone will detect hypothyroidism or low thryoid
which can cause depression and memory loss

urinalysis to check for blood or protein in the urine

a depression screen
depression can cause memory loss

a mri of the brain
this is looking for increased fluid in the brain shrinkage or atrophy of the brain
brain tumors or masses or cancer old scar tissue evidence of stroke
aneurysms or white matter hyperintensities which can be associated with
an increased incidence of dementia
they are looking for something treatable

a neruopsychological test the gold standard for evaluation or a
good mental status evaluation in the office as  a screening test
the mmse test misses me but a mocha a more involved test picks up
some subtle changes on me that would make a physician want to do more
testing with the gold standard neuropsychological test

then a good history and physical examination looking for something in the
exam that would explain the memory loss

so i saw the neurologist who looked at my neuropsychological test and
my lab tests and mri scan that were done and did a history and exam

she said
dr nash
you have early mild cognitive impairment amnestic type
(short term memory loss) that is earlier than what we usually see
and it may be due to alzheimers disease

here why
you had a normal mental status exam three years ago with your long term
care insurance and now using the same test you have an abnormal result
and other short term memory tests are abnormal

your labs and scans show a normal evaluation for other treatable causes of memory loss

you have a very strong family history of alzheimers disease
mother father brother cousin aunts and uncles grandparents

you put this all together and it says possible alzheimers disease
(later other tests done point towards this diagnosis also)

i think you should consider getting on the medication aricept (donepezil)
i had read enough about my diagnosis and knew thats what i wanted to do

aricept (donepezil)
is an acetycholineterase inhibitor
it raises the acetylcholine levels in the brain and makes the brain and nerve
cells work better

it does not treat slow down or prevent the disease
it only delays the symptoms

one neurologists told me that 1/3 get better on it
1/3 stay the same
1/3 dont get better

so 2/3 of those that start it stay the same for a while or improve
near 100% of those who dont take it dont get better

the earlier you start the aricept (donepezil) the longer it seems to work
it however will get to the point where it doesnt work any more
as the disease just marches on

the side effects of the medicine is related to the elevated acetylcholine
the first month you take as i found out is when the side effects are the worst
they get better however over time

i have had most of the side effects
i get insomnia that is worse if i take it before bedtime
my brother took his however at bedtime and never had any sleep problems
i take it in the morning after breakfast to counter the nausea that occurs
and to help with the insomnia
i also snack some in the morning to keep the nausea at bay

i have the most vivid dreams those aricept dreams
the kind when you wake up you want to go back to sleep so you
finish them
they are never bad ones just pleasant ones

i have restless sleep
i get restless during the morning not long after i take it
which gets better as the day progresses as does the nausea

i get severe leg cramps when i sleep
the kind that get you up out of bed
they are worse if i have done a lot of exercise

i get blurry vision about 2-3 hours after i take it but that goes away
fairly quickly
it was worse the first month but now is better

warning
if you or a family member is on this medicine dont abruptly stop it
without talking to their doctor
eg if i were to discontinue this medicine i might drop down to the level
i would have been without the medicine and if i restart it
i might not ever return back to the same cognitive level i was at

other drugs used in alzheimers are
exelon which works similar to aricept
it also comes in a patch form which helps with the nausea

namenda works differently that the other two
its usually used as an add on medicine when things start getting worse or if
there is problems taking the other two

recent studies have shown that using the aricept and namenda together at
the beginning of the diagnosis may be helpful
eg
pat summitt started on those two meds when she was first diagnosed

so she wrote that prescription for aircept and handed it two me
a surreal moment as i had just 24 hours before written the same prescription
handed it to a patient and his daughter and reviewed those same side effects

i was not accepted in the normal control group of the
alzheimers disease neuroimaging initiative study
but was told after i was on the aricept (donepezil) for 3 months that i
could reenter the study in the early mild cognitive impairment group

i never returned to work
i went on short term disability then later on long term disability

once i was diagnosed i became uninsurable
no life insurance no disability insurance no health insurance no long term
care insurance no malpractice insurance

luckily i had those all in place before the diagnosis was made

so put a lot of thought into getting this evaluation
you need to be ready
soically psychologically and economically ready
if you are not ready it can be devastating

next friday april 19 i will blog on
alzheimers symposium part 3
the alzheimers disease neuroimaging initiative

the organicgreen doctor

alzheimers symposium presentation part 1

ALZHEIMERS SYMPOSIUM PRESENTATION PART 1
i will be doing a presentation on my story with possible alzheimers at the
alzheimers symposium in temple texas at the mayborn center
on april 30 2013 at 930 am

you can sign up at this link

here is my presentation that will be posted in a four part series
over the next four fridays

my story

here is a video that was done by the alzheimers research center
at the university of texas southwestern medical school in dallas

alzheimers disease is a devastating progressive neurodegenerative disease for which
there is no cure
it is a fatal disease
how many of you here today have someone in your family with alzheimers disease

1 in 4 females will get alzheimers disease if you live long enough
1 in 8 males will get alzheimers disease if you live long enough
its the 6th leading cause of death in the united states
of the top 10 leading causes of death in the united states its the only one
for which there is no cure
it may be the disease that breaks our healthcare system

im speaking to you from three different perspectives

a family member whose mother died in the final stages of alzheimers disease
whose father although not officially diagnosed probably had it also
then my younger brother a year younger than i was diagnosed at 55 years old
and is now entering into the final stages of the disease

i am speaking to you as a family physician who has treated patients with
alzheimers disease although looking back now i did  not do a good job

then im speaking to you as a patient today
my diagnosis is early mild cognitive impairment amnestic type that may be
due to alzheimers disease
ill tell you why as this talk proceeds

5 years ago i applied for long term care insurance and was evaluated and
received my insurance without a problem

during the mental status evaluation one test they did was they read me
10 words from 3 different word categories and asked me to repeat them
back to them
i got all 10 correct

then 2-3 years later because of my family history of alzheimers disease
and because of the fear of developing it  i decided when i reached a
certain age that i would start having yearly evaluations with
neuropsychological evaluations and
mri scans or whatever was deemed necessary to check and make sure
i was not developing problems with my memory

i contacted the alzheimers research center at ut southwestern  and talked
to kristin martin-cook and told her what i wanted to do and why

she said yes they could do that or i could enter the alzheimers disease
neuroimaging initiative study in the normal control group
and i would get those tests i wanted done plus other new tests that
were available in the studies-biomarkers for beta amyloid and tau
pet scans for glucose metabolism and for beta amyloid

i agreed so i went to dallas for testing
during the neuropsychological testing i was sitting at the desk like in
the video where i was doing the block test and looking out a window
when the examiner read me 10 words from 3 different word categories
and asked me to repeat them
the words entered my brain and most of them disappeared
i only could recall 4 of them
after a series of hints i was able to only recall 5 of them
whereas before i had gotten all 10 correct the first time

that is the moment a surreal moment when i knew that i had a problem

i also had other short term memory tests done that day and had
problems with all of them

it would be 3-4 weeks before i would get the results back so when i
got back to work i became extremely careful in everything i did

then 3 weeks later i got a phone call from kristen
dr nash i wanted to call and let you know what your results were before
you get this letter in the mail

it appears that you have short term memory loss thats greater than it
should be for your degree of education and your age
i really think you should see a neurologist

so i made an appointment with a neurologist there in 3 weeks

it was during this period of time that fall when i began to notice
some issues with my memory
i had trouble recalling things about patients that i should have remembered
i also had trouble reading cme material then taking the cme online test

no one my wife my nurse my colleagues my patients clinic employees
noticed any problems
but i did
and still do but they dont

the neurologist office asked that i get some tests done before the
office visit

here is the list of tests that i had done and they are the ones that
you should have done if you are being evaluated for memory loss
complete blood count
metabolic profile for electrolytes kidney function liver function and glucose
vitamin b12 level
syphilis antibody test
hiv test
tsh for thyroid function
urinalysis
screen for depression
neuropsychological exam or a shorter in office version
mri scan of the brain

next week
part 2
neurology visit

the organicgreen doctor