alzheimers news-the answer to your question is

ALZHEIMERS NEWS-THE ANSWER TO YOUR QUESTION IS

well
its according to what the definition of is is

the most common question i get asked about alzheimers is
i get asked at least once a week is

should i get tested

this last week a former nurse stopped me
you know my mom died from alzheimers disease
im worried i will get it too

i knew what was coming out of her mouth next

should i get tested

first
ill answer this for this date 4/20/18
an important date each year

soon
though the question will be answered differently

so
on this day
should you get tested

if you are having memory issues you should go to your doctor
make an appointment only for memory issues
make a list of what you have noticed
dont let them ignore your complaints
dont bring up other health issues just the memory problems

you should be given a history and exam looking for causes
this history and exam may find the source of memory issues
like poor control of health things like blood pressure diabetes
sleep issues mental issues medications cholesterol etc

you should have a memory test
the clock test or the mini cog test are not good enough
i recommend trumps test he took the moca test
please dont take it online as if you are exposed to it too much
its not as accurate

if you flunk the moca test you should have a neuropsychological exam

you should have lab tests
cbc blood count   metabolic profile   thyroid level
maybe a vit b12 and vit d3 levels

then based on these results
you may need an mri
looking for brain shrinkage and or strokes and or masses etc

you may get your answer when all this is done

in private offices thats the workup thats done

now some doctors will do more
but insurance doesnt pay for them

genetic tests for apoe 4 status and early onset alzheimers genes
spinal fluid analysis for beta amyloid and tau proteins
amyvid pet scan for beta amyloid

if you have or are going to have alzheimers disease
those last two tests will be positive

most folks dont go this far
the noncovered tests cost close to $10,000

i have had them done
i know the answer to the question
do i have it
i do

now 8 years ago those spinal fluid tests and amyvid scan
were not usually done in the private doctors office
they were done mostly in research settings
like in the adni 2 study i did
its the study that actually led to my diagnosis

now its common for private doctors to do these tests
if the patient wants to pay for them

now
in the research world only
how and when you make the diagnosis of alzheimers disease
is about to change

in the research world
the diagnosis of alzheimers disease will not be based
on symptoms like memory loss
yes
thats right
i repeat
the diagnosis of alzheimers disease will not be based
on symptoms like memory loss

it will be done by diagnostic testing
genetic tests
spinal fluid analysis
amyvid pet scans for amyloid
tau protein pet scans for tau

thats how it will be diagnosed

think about this
its not based on memory issues

so
lets say when i was 55 years old
i would go to the doctor
should i be tested to see if i have it
yes
why
strong real strong family history of alzheimers disease

so
beside a history and exam
they would do the labs
then
draw blood for genetic tests
mine would be positive for apoe 4 apoe 4 gene the late onset gene
a spinal tap for amyloid and tau would be done
my levels would be starting to become abnormal
an amyvid pet scan would be done
it would be positive for amyloid plaques
a tau pet scan would be done
it would be positive most likely

now at 55 years old i had no memory issues
in fact at 58 years old i had memory screening for my long term care
similar to the moca test that was normal

my diagnosis at 55 years old
based on these 4 diagnostic tests
would be
alzheimers disease

now this is in the research world
what happens there eventually gets into the private medical world

its explained this is like coronary artery disease early on
its not based on symptoms like chest pain or heart attack
its based on diagnostic testing like cholesterol stress testing
heart ct scans
you can be told you have coronary artery disease before symptoms
start

so
it will be with alzheimers disease

ive had all my tests done
so
i know my diagnosis

what this means is
many of you reading this right now have alzheimers disease
that could be diagnosed before symptoms start

unlike coronary artery disease
which can be treated
alzheimers disease cant be treated yet
yet
but the thinking is
within 10 years there will be treatment
so then
you want to know as soon as you can that you have it
so you can start treatment

so
nurse i met
this is the reason i hesitated to answer that question

should i be tested


a new research study using these tests is available across the us
its the 3rd one of the adni studies
i did the adni 2
its called the
adni 3 study
you can click on the link for more information

you can also go to clinicaltrials.gov or to trial match at www.alz.org
to find more information on research studies

the lack of research volunteers is the biggest obstacle to doing
alzheimers research
to find a cure for this awful disease

do your part
i am

the organicgreen doctor

alzheimers news-trumps memory test

ALZHEIMERS NEWS-TRUMPS MEMORY TEST

ill be the first to admit
i dont like donald trump
but
lets be fair to him regards his memory test

alzheimers starts in the brain 15-30 years before
any symptoms start
before any memory tests are abnormal

there are subtle things that can happen before the
memory tests become abnormal

sometimes the first thing is spatial things
missing things in your peripheral vision
which can show up when driving
sometimes subtle memory things happen
im speaking from personal experience here
things you notice that others do not

eventually when the time comes
the memory tests become abnormal

first let me say
if you are going to need memory testing anytime
soon
dont be reading whats in those memory tests
it affects how accurate they are

now i have personally been administered the same memory
test he had done more than 15 times over the last 8 years
i have personally administered that particular test to
family members and friends several times
i am quite familiar with the moca memory test

when you go to a doctors office
he might administer one of three tests

one is the minicog test
it involves being told three words to remember
then
you are given a time and asked to draw that time
on a clock

if you dont pass that one
you have memory issues
you need more evaluation

its a quick and simple test
its not sensitive though in picking folks up early
with memory loss

the next is the mmse
multimental state exam
its scored up to 30
get 30 and you might be ok
but
for those like me when i was first tested
it missed me
i got a normal score on the mmse

the third test is the moca
thats the one that trump took
the best score you can get is 30
a normal score is 27-30

when i was first tested in 2010
my score was 25
which was abnormal
its in the mild cognitive impairment range

the moca test is a more sensitive test to pick
up those early changes
like what you see with early alzheimers or mild cognitive impairment

its not a 10 minute test
its a 20-30 minute test

so with a normal result
a 30 score
as of right now
trump probably doesnt have any symptoms of dementia
or short term memory loss
the first thing that usually shows up in alzheimers disease

my scores earlier this year on one of the moca test
was 30
a perfect score

so why did mine get better
medication ie aricept (donepezil)
supplements
correcting things like cholesterol blood pressure weight exercise
stress sleep staying mentally engaged
all helped to make my scores improved

so i have a perfect score on my last moca test
does that mean i dont have alzheimers disease
no
the diagnosis is made on more than just the moca test

they use
family history
past medical history
risk factors
spinal fluid for tau and amyloid
a pet scan for amyloid the amyvid pet scan
genetic tests
serial memory tests
then
the gold standard
the neuropsychological exam
eg mine is abnormal even though my last moca was normal

the neuropsychological exam is more accurate
if there are memory issues it will show up
yes you can have a normal moca and have
an abnormal neuropsychological exam
it take 2-3 hours to do this exam

the moca test is a screening test
it doesnt rule out alzheimers disease

there is a state
called
prealzheimers or prodromal alzheimers disease
the memory tests are all normal
the scans and spinal fluid levels are abnormal
in this stage
you just dont have symptoms yet

so
trump
either does not have alzheimers disease at all
or
he is in that prealzheimers state or prodromal state
a time that can last 10-20 years

so
as a medical doctor
as a family doctor
as someone who has had this test multiple times
as someone who has administered this test multiple times
as someone who reads 10+ articles on alzheimers disease each day
as someone who has lectured on alzheimers disease multiple times
as someone who has been and is now in two of the most
important alzheimers studies ever done
i feel like
i can speak with some authority about alzheimers disease

so
if i was trumps medical doctor
if i had administered the moca test to him
i would tell him
right now there is no evidence that you have memory loss or dementia

i would tell him to correct those other health issues
like
the what i called heart attack levels of the ldl cholesterol
he is just a point or so away from being labeled morbid obese
get more sleep
get more physical activity
greatly improve his diet
let your calcium score on that heart ct be a warning
if a heart attack or a stroke dont get you
demential or alzheimers might in the future


the posting of the moca test for all to read
i think does a disservice to those who may need a moca test
in their workup for memory loss
practicing or reading the tests affects its accuracy
i am not allowed in my studies to have other memory testing
since it causes what they call testing effect

also
this doesnt mean trump doesnt have mental problems
or psychological issues
this moca test this screening test
doesnt check
for anxiety
for depression
for bipolar disorder
for psychosis
for paranoia
for narcissism

those are tested usually by a psychologist or psychiatrist

so
no he dont appear to have active dementia or alzheimers
manifesting itself right now

lets all move on from this

mudslide update
maybe next week the 101 will be open
no new recoveries no change in the death toll
we saw what seemed to be miles of trucks loaded with mud
and stuff on the freeway waiting to go to a dump place
way north of santa barbara
they are expecting to dump over 20,000 dump truck loads of
stuff in those dump sites

thatcher update
he is awake
playful
tape free
looks like iv free except for the pic line
oxygen free
soon to be moved from icu
you go thatcher

here is his gofundme account
#thatcher strong

the organicgreen doctor

alzheimers news-am i in

ALZHEIMERS NEWS-AM I IN

this last friday
as my wife she and i were driving up to dallas
to the alzheimers center to begin this journey
hopefully
to get a new treatment for alzheimers disease
that may slow it down or if we are all lucky
stop it in its tracks

i did a lot of contemplating as i drove north
thinking back over the last 6 years
when
we made this same journey to the center
then
i was simply volunteering to be in the normal control group
of the large alzheimers study
alzheimers disease neuroimaging initiative phase 2

i was simply going up
to do my part to further our knowledge of what happens
in alzheimers
and
at the same time start a monitoring process for myself
since
it runs so strongly in our family

friday
as i sat in the same damn chair that i sat in
6 years ago when all this happened
i looked out the window
well the blinds were closed

in my reoccurring dream i have about this
there is a large tree growing up to the 4th floor outside
this window
in my dream it is a sycamore tree
i think because my grandparents one who had dementia
had a huge sycamore tree in their yard
and
i use to climb on it as a kid

all that really is there is just the windows of a building

but as i sat down to take the memory test friday
the same tester was giving the test that gave me the first one
i said you know in my dreams there is a big tree out there
she smiled that sweet smile of hers

now 6 years ago
i was broadsided by failing my memory test
ive done the thing so many times now
i know the parts i cant do very well
interesting is
some of the parts i have gotten better at
some i dont do as well

now
this study is called the aducanumab study
by the company biogen
of all the drugs out there right now
it has the most promising chance of being successful

i have had my eye on this study now for several years
well
i have fought hard to get into it
knowing that this could be my last chance to
plug into one of these new drugs
if i wait too much longer
i may to late for them to do any good
so
i know its now or never for me

now i continue to do all the healthy things i should be
doing
the same ones that all of you who read this should be doing
control blood pressure cholesterol weight
do exercise eat right get sleep avoid stress etc

all those no matter what i will keep doing
oh if you are genetically kin to me you should be aggressively
doing the same
since this drug is really meant for those of you
who have no symptoms but are going to get alzheimers

yes i was a little bit nervous
its like a terminal cancer patient
getting this glimmer of hope
from a new research drug
that will slow down the cancer or cure it

this is what this study means to me

so here we go

we arrived there at 930am and left there at 200pm
with no downtime

first
we met with the screening nurse
who went over the lengthy protocol with us
who went over my medical history with us
who took my vital signs weight etc

then
second
they drew some blood
well a lot of blood
i think i counted 10 vials of blood
its 2/3 of a can of soda
now i didnt faint
but
i need to eat a lot of iron foods for awhile to build
my blood back up
its almost like donating a unit of blood

they are testing cbc chemistries ua all kinds of biomarkers
genetic tests dna and rna studies etc
even saving some for perpetuity
in case its needed for more research some day

i realize i have my blood stored all over the place
across the usa

then
third
since i didnt pass out
i was able to proceed to the next testing
the much dreaded memory testing
it took about an hour
i did parts of the mmse memory test
some components of the moca test
and
a new test thats used specifically for this study

to get in this study
i have to be in the upper part of the mmse
but
must have difficulty with parts of the short term memory part
that correlates with mild cognitive impairment amnestic type
the stage right before alzheimers disease

knowing what i know from taking these things
i passed the mmse and will qualify based on how i felt i did
i had difficulty with the parts of the test that is correlating
with what i have noticed in my day to day life
which is what they are looking for

so far after these three things i feel like i am qualifying
for the study

then
fourth
i underwent answering questions on my memory
by a alzheimers center interviewer
comparing what my wife she has told them
to what i say

first question
do you have memory issues
the answer
yes
granted its subtle probably not recognizable to most
folks who know me

then
fifth
i underwent a lengthy neurological history and examination
by the main investigator at the alzheimers center for
this aducanumab study
he was good at picking out the parts of my history and exam
that correlates with my memory loss

so
at the end of the day
how do i feel about my chances of getting past this step
i feel like i met the criteria
unless something is hidden in the labs somewhere

all this information is sent to the biogen folks
to review
they make the final decision

if they say ok
then
i have an mri of the brain
if i pass that one
i have a amyvid pet scan for the bad beta amyloid
the test that is missing from all that i have had done

the one
that i feel will give me my final answer
the one
that will provide me with what i need to plan
the rest of my life

fingers crossed

the organicgreen doctor

what to do, tomater star

WHAT TO DO
this is a question i get a lot especially recently maybe because of
the holidays
these questions come in on email, texts, facebook, this blog and in
personal phone calls or conversations

what do i do if i think i have short term memory problems or if a
relative has short term memory problems

its simple get it checked out
sometimes these things are treatable
sometimes what you are worried about is just normal aging

what happened in my situation was different
i did not go in looking for an evaluation or complaining of a problem

i had a normal mental status evaluation for long term care and passed
then 1 year later while volunteering for a alzheimers research study as
a normal volunteer i underwent a neuropsychological evaluation that
showed i had short term memory problems greater than expected
for my age and my degree of education
thus the mess i am in now was discovered

if you think you have a problem whether some one else notices it or
not you should get evaluated
the goal is to look for treatable causes-anemia, depression, low thyroid,
b12 deficiency, stroke, sleep problems etc
you want these things and not the big A

go to your primary care provider or neurologist or psychiatrist
and talk to them
if you think theres a problem dont take dont worry about it for an
answer

you need a complete neurological history and physical examination
looking for abnormalities
evaluate any history of drug or alcohol abuse or head trauma or
family history of the big A

you need some type of mental status evaluation
-mmse (this one is not as thorough and is commonly used)
(it misses my deficits), its done in the doctors office
-moca test is more thorough in picking up a problem (it picks up my problem)
it is also done in the doctors office and
-a neuropsychological examination if there is still a question you should
have it done by a psychologist or neuropyschologist
the neuropsychological examination is the gold standard to use to evaluate
short term memory loss

you should be screened for depression
you should make sure there is no sleep disorders such as sleep apnea

here are the labs that are usually done
complete blood count, complete metabolic profile (electrolytes, glucose,
kidney functions, liver function tests), vitamin b12, syphilis screen, hiv test,
tsh (thyroid test for low thyroid function), urinalysis
these are looking for some of the treatable causes of memory loss

then if these are all normal you should have a mri of the brain to rule out
stroke, tumors, aneurysm, increased fluid, and shrinkage of the brain

if all these are normal and the mental status exam confirms a problem with
short term memory then it is possible that you are dealing with the big A

you and your doctor will need to look at all the information and make a
clinical decision on whether this is what you have-the big A

soon you will be able to get biomarkers done on blood, in the spinal fluid,
and beta amyloid pet scans to get a more definitive answer
i had some of those done

if it appears to be the big A
would recommend you start treatment as early as possible
it gives you time with your family that youll lose if you dont
it gives you time to prepare for the future
even though it wont cure you most people opt for treatment
i did

TOMATER STAR
my wifes shes tomato she has at her school will become a tv star
this weekend on klrus central texas gardener at 1200 noon and
at 400 pm
ive told the story of that tomater before
will leave it to the tv show to do the complete job

cant wait to plant one of these weird ones this spring in the garden
and see what grows

the organicgreen doctor

first anniversary

FIRST ANNIVERSARY

here is the posting from one year ago titled 

last day thanks

it has been my most read blog-it was posted the same 

week with 

neurology visit

one year ago was my last day to practice medicine

i had tried to get everything in order that day because

i knew i wouldnt be back but no one else knew

although one person did come up to me that day and

said 

youre not coming back are you

i had slowed my practice down some by trying not to see

new patients and by not seeing as many every day

i also had been trying to catch everyone i could up on 

their medicines for refills until they could get in to see

some one else

i even did a well child check after hours my last day so that

i could get the check up done for one of the employees

am sure she suspected something was up

i didnt want to stop practicing until i had a definitive answer

even though i knew what was going to happen

i left abruptly 

i was there one day and the next i was gone

once i got the official diagnosis and recommendation for

treatment the decision was easy for me

i had already decided years before that if i were to develop 

early problems that i would stop practicing medicine

so thats what i did and i havent looked back at all

in medicine there is a motto do no harm 

so thats what i wanted to follow

would never forgive myself if i had continued to practice and 

had made a mistake that harmed someone

i have had a busy year

my son was married so that kept us busy with all the events 

associated with that wedding

(told my younger son he that he would have to go to las vegas

to get married when his time came)

i had planned on retiring in 3 years and had programmed things to 

do when i retired

i just started doing them 3 years before i had planned on doing them 

luckily i had a disability plan that covers me until i reach social 

security retirement age-66

it was a battle to get them to pay off but after 6 months they

approved the claim but not untilafter a grueling 8 hour neuropsychological

exam ordered by the insurance company 

slept good that night felt like i had ran a marathon

i stay busy with this blog as it takes 3-4 hours of my time each day 

to research write respond to comments, emails, face book messages etc

this blog has grown over 5 times its volume in the last year

i am in the adni-2 study at ut southwestern alzheimers research center 

and have had to go up there for the study and my neurology visits

frequently this year-logged over 4000 miles traveling

at $0.23 per miles thats $920 i was able to send in to my flex 

account for reimbursement this year for medical travel

i was in 2 short studies there also-one a videoconference for

doing remote neuropsychological exams and the other a video 

that shows medical students and residents how to do a neurological

evaluation and how to do the mental evaluation test called the moca

two article were written about my story and what happened to me

those are easily access on the upper right side of this blog

one article written by mary roser from the austin american statesman

was picked up by the ap news and by mulitple newspapers and

online news services across the us and canada and europe and india

our team the organicgreendoctor.com for the walk to end alzheimers

was one of the most successful teams in the walk this year

we raised the most money and had the most members of an 

individual group

got the plaque for that in the mail yesterday

i gave a talk to a group in lousianna on my story, alzheimers, and on 

organic gardening

i also gave a talk on this-alzheimers not organic gardening- to a large 

group of family doctors recently 

they asked lots of questions

hopefully they will use what we talked about in their own practices and 

will do more evaluations hopefully earlier on their patients instead of 

referring them all 

so ive been busy this last year

and occasionally reflect back over the year and 

realize that it has been a productive one 

maybe i reached more people with this blog and the talks and the

news stories than when i was practicing 

do i miss it 

yes

i miss the interactions with my patients

felt like i did a good job

luckily with face book and twitter and with this blog i have 

kept in contact with a large number of them 

what do i have planned next year

i plan to do more talks on alzheimers

(in fact contact me if you would like a 30-45 minute talk on alzheimers

to your group)

i will continue to do this blog

i will be starting doing habitat for humanity building projects in january 

have always wanted to do that

we have several trips scheduled this year to places we havent been

and frequent trips to see our two sons in san francisco

i will continue to exercise daily-have starting seeking out local hiking

trails to walk regularly 

i will continue to be involved in the adni study this year

no spinal tap this year thank goodness but still have to do those dang

neuropsych exams but only once this year

i will continue to do my organic gardening all year long

part of our christmas dinner will be out of our garden

i will continue to blog on organic green stuff 

and to make my wife she happy i will

continue to be a good house keeper

a good cook

a good shopper

a good travel agent

a good lover

a good husband

so overall not a bad year considering that i didnt plan all this

to happen this way 

just hope this year will go as well

and things will not progress this year

(there appears to not have been progression on neuropsych exams

this year)

keep in touch for year two

the organicgreen doctor

follow up, veterans day

FOLLOW UP
that dang neuropsych exam got me again
its the same one that got me last year
in fact i sat in the same room where i had my neuropsych exam
done last year at about this same time
i can remember sitting in that same room looking at the window
when i couldnt remember those words she asked me to repeat
back to her
thats when i knew i had a problem

so i dont like to take those exams as i know whats coming and
i know that i wont do well on them
i didnt
the problem is still there but doesnt appear to me to have worsen
much over the last year
of course ive taken one of these every 2-3 months over the last year
now i get to go 6 months without doing one

although most people cant believe i have a problem
when i do the moca test that is administered now in some doctors
offices as a screening test i have a problem with memory that shows
up on that screening test
it definitely shows up on that dang neuropsych exam

they also drew 9 or 10 large vials of blood from me also
told them why dont they just draw it into a blood donor bag
as it would be easier
guess ill have to take extra iron this week to replace that  blood

then i had that jet engine sounding mri yesterday
dang its noisy and i had ear plugs on and ear covers on
would hate to be in their without those on

next follow up in 6 months for annual visit

the future is looking better for alzheimers disease as a lot of
research is going on
the prediction is that in the next 10 years they will be treating patients
with medicine to prevent alzheimers disease
meds will be given to hi risk patients before they show symptoms
exciting times in alzheimers research

glad im around for the ride

VETERANS DAY
today is 11-11-11
veterans day
thanks to those who are serving and who served in the military

now lets take good care of those who served
a large group are coming back from the middle east wars and
will be entering schools and the job force
lets take care of them properly
many of their kids have not seen their mom or dads much over
the last few years because of the multiple deployments
many of them have mental health issues that need proper medical
treatment to help them enter back into the private world
the unemployment rate is higher in this group of vets than in the
general population
lets give them the extra help they deserve
weve done it in past wars
these guys and gals sacrificed a lot for us
lets take care of them

they will be our leaders and
have a lot to offer society
lets do whats right
come on congress take care of them
make your cuts somewhere else

thanks veterans
this is your day

the organicgreen doctor