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.its been seven years since...

ALZHEIMERS NEWS-ITS BEEN SEVEN YEARS SINCE...

ten years ago i applied for long term insurance and got it
after passing a mental status exam
i got all of the questions correct
then
7 years ago i contacted the alzheimers center at ut southwestern in dallas
to be followed annually as i aged so i would know if i developed
memory issues
if i did i had decided that i would stop practicing medicine

i underwent a neuropsychological exam to get into the normal control
group of a large study called the adni 3
being in this study would allow me to be monitored long term
i was also added to a state run study doing the same thing

as a normal control you are what those with memory issues are
compared to

as i sat in that chair in that room answering those questions
many the same as i answered correctly 3 years before
for my long term care insurance
well
i felt like i was in a fog
got real sweaty
as i couldnt answer the questions
i knew then
my time like with my mom and my brother
it was my time

when i got the official report
memory loss greater than you should have for your age and education
you need to see a neurologist they said
i made a neurology appointment in a month
i started my month long slow down of my practice
not letting anyone know except my wife she
well
my nurse and our clinic supervisor sensed it
they knew
my last day she the supervisor said
you arent coming back are you

no
i said to myself
i knew that was it
i had promised myself i wouldnt stay too long
when the time arrived

my last patient i saw in practice was an employees son
who needed a two year check up
i contacted her to bring him in at the end of the day
he was the last patient i ever saw

the next day i got my diagnosis
mild cognitive impairment probably due to alzheimers diseas
i got a new drug
aricept (donepezil) to slow things down
it slows the symptoms but not the disease

i must say i felt devastated
as did most of my coworkers and patients

i couldnt go back
mentally emotionally i coudnt
legally with this diagnosis
medically legally i was now a high high risk physician
i retired my license
that was it

lucky for me
hundreds of patients reached out to me
ive maintained contact with many of my patients via social media
i have got to see the kids grow up
many now having kids
that all helps a lot

i reentered the study having been placed in the
mild cognitive impairment branch of the adni 2 study for 5 years

today i am receiving monthly infusions for another
3 plus years if not longer of aducanumab
which will probably slow down the disease
hopefully until even more new treatments become available


my goal is to see my granddaughter graduate from high school
she is 2 1/2


since my diagnosis
pat summit the tennessee womens basketball coach was diagnosed
with early alzheimers
she died over this 7 year span


my younger brother joe
the mirror i looked into when i saw him
died also from alzheimers disease during this 7 years

7 years ago
i really expected to be further along in this disease
at least where my brother joe was and pat summit was when
they were diagnosed

why am i better or why am i not worse than i was 7 years ago
aricept (donepezil)
healthy living
aggressively controlling my diet weight exercise blood pressure stress
cholesterol
i take a boatload of supplements that may possibly help
i think i was also really early in the disease
earlier than most are when they are diagnosed
having been diagnosed almost by accident

my diagnosis has been confirmed by several neurologists
diagnostic studies like spinal tap analysis and the amvid amyloid scans

so as i sit here typing this blog
i am so thankful to be here today
cognitively here
to be able to enjoy our family
our new life
still doing all the things i was doing before i was diagnosed
and since then

im lucky to be alive
im lucky to be this healthy
physically and mentally

thats my new years resolution
let this all continue
please

fire update
were done
the fire on this side is stopped
folks are being let back in their houses
the air is crisp and clear
thank you thank you thank you firefighters
you are the greatest

have a happy holidays
for those who celebrate
merry christmas

the organicgreen doctor

are things better

ARE THINGS BETTER

almost 4 years ago i took a neuropsychological examination
at the alzheimers center at ut southwestern in dallas

there was a portion of the test where i had to identify pictures
for some reason there were several pictures that i knew what
they were but i couldnt remember their names
sphinx hammock pretzel pelican eg
this is one of the items that gave me a low score on the initial
exam
now since ive taken this test 8 times in the last 4 years
i have learned the test
so that i get all those pictures correctly
in fact on the last test a few weeks ago i was 100% correct

was it because i learned the test or i am improving

my guess i learned the test i know thats the major part of the
reason
but i do think my memory is stable

there are lots of other parts of the test that you cant learn
as the answers are randomly changed each time
so
i still have short term memory problems but they dont seem
to have gotten worse

i was recently able to review my scores over the last few years
you can see the numbers improve from test to test then
they leveled off
still off slightly like a level where the bubble is
not quite in the lines

this week i got my official letter from the study
saying that my short term memory tests had improved
but i realize part of that was from learning the test

its been three weeks since i have been on the new
16 vitamin and supplement regimen that was discussed
in this article on
reversal of cognitive decline from the ucla department of neurology

(warning dont start this regimen without discussing it with your
doctor)

i am following the regimen but cannot tolerate the ashwaganda
and the melatonin
my sleep has improved slightly though even though i am not
taking these two supplements that would have helped my sleep

i notice a degree of alertness and pep that are due to something
in the vitamin and supplements i take
plus since my b12 and vitamin d was low that should be
eventually returning to normal

now i plan to continue this regimen until its disproved to not
be effective

a longer study i think is planned at ucla which will be expensive
and lengthy
the results will probably be years from now
these people need to be followed long term really to know how well
this works and even if it works to stop the disease

my guess its that it slows down the process but doesnt stop it

then studies will need to be done on folks years before symptoms
start to see if can actually prevent alzheimers disease
thats 20 years of taking stuff and changing your life style
before you know if it did any good or not

the studies that need to be done will be expensive
the only way they can get funded is by you
via
the national institutes of health (nih)
and
the alzheimers association
as
all the things are generic and cannt be patented by some company
so they can make millions
its all at your grocery store and drug store and up to your willpower


so
you can help you know by donating and or walking at a
walk to end alzheimers near you
click here to find a location 

the two walk to end alzheimers i will be walking in next month
are

bell county walk to end alzheimers at the pepper creek trails
in temple texas starting at 1000am on saturday november 1, 2014
team name   organicgreendoctor

little rock walk to end alzheimers at the clinton library
in little rock starting at 930am on saturday november 8, 2014
team name   #joe nash
in honor of my younger brother and mother and father

so help us find out if this new regimen will work for all of us

the organicgreen doctor

deja vu

DEJA VU
thats what it was like yesterday
deja vu

i walked into that room with the window
the same room for those of you that have seen the video
on my story with alzheimers disease that i am sitting in when
they filmed me doing part of my neuropsychological exam
and there was that window where i looked out of when
that stone faced poker faced examiner read those words to me

she is such a good one as she never breaks down
well i did get her to smile once and granted now that she
knows me she smiles more than once when im being tested

but there was that room
it was it seemed more surreal than before
i guess since ive being working on my presentation and have
thought more about the neuropsychological testing and that
initial one that was done
when i looked out that window
yes i did sweat some
as i realized that the moment arrived when i had developed
some problems with my short term memory

as i wrote yesterday she read me those 10 words from three
different word categories the first time i was tested and
those words just sailed through my brain and went somewhere else

you know like when you talk to your kids and they arent listening
sure mom ill do it
they didnt hear a word you said
or
you talk to your wife she while she is on her smartphone
she smiles and says sure
so i said
the cat ate the dog and laid 3 red eggs today
really thats good
she didnt hear a word i said

the same yesterday
that poker faced examiner (ok now she is a nice smiley person when
she is out of character)
im going to read you ten words and when i finish i want you to repeat
as many words as you can back to me
i said ok
im ready this time
she gives me a word and i try to associate some of them together
go
she slowly reads the list to me
i start associating words together
damn where did those first words go to
i learned quickly to repeat back the last words read to me

my score 3 of 10
i know thats not very good
but she does it several times and has me identify the 10 words out of
a list of about 30 words
i wonder if thats cheating
i got a few more
but i realize
no ive not improved in 2 1/2 years but ive not gotten worse

damn that room

then after that test i went to get my beta amyloid pet scan of the brain
the amyvid pet scan
the one that for me may give me the final answer

as i was laying on the table wanting for them to get the iv stuff ready
i was on my smartphone looking at a link my wife she sent me
it was a blog that a doctor in washington dc does about his journey
with a new diagnosis of mild cognitive impairment amnestic type thats
looking like its early alzheimers
story sounds familiar right

he is laying on a bed at georgetown university hospital recieving as part
of a study one of the new alzheimers vaccines that is being tested to see
if it will remove some of the beta amyloid from his brain and maybe
help him

i do feel a tie to him and his situation
it did seem surreal as i laid there about to get that test that will tell
someone somewhere whether i have beta amyloid accumulating in
my brain also
one question that i hope to have an answer to soon
then
what will i be able to do about it
it may be nothing thats the bad part
nothing may be the answer unless that stuff hes getting iv shows itself
to work and help by removing that beta amyloid from his brain

then after reading his blog and mentally getting ready for the infusion
and hearing that pet scanner whorl around and sound like im
underneath a freight train
im told there was a problem with the stuff i was going to be given iv
it needs to be remixed

so all this waiting gets delayed now for ten more days when i
will get another chance at getting this 2nd amyvid pet scan done

then
as part of another study im in i had to do smell tests on 30+- odors
to see if i could recognize them
see that ofactory nerve the smeller nerve goes right to the area
underneath the brain where alzheimers disease starts
heck if that will help in someway advance the knowledge ill smell things
all day long i if i need to

next on friday i do an mri scan of the brain
then that will be followed by a glucose metabolism pet scan of the brain

then next week
its spinal tap time for beta amyloid and tau protein then
followed by the amyvid the beta amyloid pet scan of the brain

those are the two final answer tests that i have
they will give me the final answer
do i have it or not

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

last day

LAST DAY

so far so good
were still here today

today is the two year anniversary of my diagnosis of
mild cognitive impairment amnestic type thats thought
to be due to alzheimers disease

at the time it felt like the end of the world but it wasnt
then either

in two years there has been little change
im still on aricept (donepezil) since this may be alzheimers
and its the only treatment available to slow the symptoms

that and taking care of my health with diet exercise staying
mentally active maintaining  adequate sleep when i can
maintaining a normal blood pressure maintaining a normal
cholesterol and staying active generally

im still able to do all the things i enjoy except of course
practicing medicine

i do this daily blog and communicate with folks from across
the united states and the world

my wife and i have traveled a lot the last two years
visiting california several times utah arizona new mexico
colorado arkansas memphis tennessee nashville tennessee and
nicaragua

i stay active at my country n maintaining my ten acres
and doing my organic green garden

i volunteer once or twice a week building habitat for humanity
houses and volunteer delivering meals on wheels to seniors
one day a week

i also have given talks on alzheimers (feel free to ask for one
if you know a group that whats to hear one) and have some
planned this next year

i also contribute frequently to the alzheimers association
discussion groups online answering peoples questions or
giving them advise as one with the disease one who has
family members with the disease and one who has
treated the disease as a physician

i also have had three teams in the walk to end alzheimers here
in this area and am on the committees that organize the walks

we hope to add another team in southern arkansas for its
first walk next year as our family has been hit hard with
this terrible disease

i am a study subject in the largest and most important alzheimers
research study that has and is being done called the
alzheimers disease neuroimaging initiative (adni) study
(click here to read about it)

because of this study i have been able to receive all the newest
studies that are currently being done to diagnose this disease
genetic studies blood biomakers volumetric mris fdg glucose
metablolism pet scans beta amyloid pet scans spinal fluid analysis
for beta amyloid and tau protein and neuropsychological tests

all of which allow me to know where im at with this disease

i have been able to stay in contact with many of my former
patients via this blog email facebook and twitter

so yes im busy and contented

here is the blog i wrote the day i was diagnosed
i read it occasionally with a teary eye
it helps me stay grounded

LAST DAY-THANKS 

'this is my last day to work as a physician

i always considered myself lucky to have been able to

do in life what i wanted to do since i was a middle schooler

in high school i was able to work in a local hospital in the

summer on weekends and during holidays

our family was poor so not only did i get financial benefit from

working but i also was exposed to a lot in the hospital setting

it made me know that i wanted to be a family physician

during college i worked as a emergency room technician

on weekends, weeknights, and holidays

this also gave me financial support but also exposed me to

different doctors and different emergency situations

i was accepted to medical school but never wavered on what

kind of doctor i wanted to be

a family physician

i was accepted to a family practice residency

after completing my residency i owed the federal government

three years to work at an approved federal undeserved area

i was able to create with some help a site in  the small

town near where i grew up       i  worked there for three years

although traumatic at times it was a learning experience that i

carried through out my career

after fulfilling my three year obligation and after sustaining a

large financial hit from my involvement with the local clinic

i was recruited to the area where i am working now

thanks to my medical school friend for helping me out in

my time of need

i have worked for 25 years as a family physician

i always wanted to be one

now it is time i have to quit not because i want to but

because a genetic health problem has risen its nasty head

and because of this i will have to discontinue what i like to do

i do not ever dread going to work every day

i feel like i have now just gotten good at what i do

i realize that patients dont necessarily need all of the new

medications we have, the new tests we can do or need

the newest treatments available

they do better if you just listen to them, pat them on the

shoulder, be kind to them and be their advocate when

they need it

i have honed my skills in taking care of kids over my career so

that many of the kids have felt comfortable seeing me and look

forward to seeing me to get a sticker or sucker, hear my

duck voice, or have me joke with them

that part i will miss a lot

thanks to all my patients in the past for allowing me to fulfill

my dream of being a family physician

i hope i have done you a good job

thanks to my wife she for putting up with me during

my quest for my career

know shes found hers now

love yall

the organicgreen doctor'

the organicgreen doctor