old willie, scans

OLD WILLIE

old willie will be 80 years old today 

according to him 

but according to states records its april 30

of course

i think he should change his birthday to 

4/20

if you dont understand why 4/20 and what it means

just ask you kids or your grandkids

my guess is they know what that means

willie played last night at the backyard in the austin area

im quite sure it was packed

and there probably was a strange odor in the air

and im sure austin kept the concert weird

i do admit when i see willie he looks 80 years old

all that rough living hes done

well he actually looks 100 years old

but

he still has that distinctive voice

and his old guitar

ive seen him play live twice

once in little rock at a concert at barton coliseum

a lot of drunk people

but it was interesting that the people in the crowd were

a mixture of all ages and sizes and looks

obvious red neck country people with dressed up city folks

with a lot of hippie looking people

all enjoying his music

thanks to my medical school friend for introducing us to

willie and his music

ive been hooked since

then

we took my motherinlaw to a fourth of july picnic in 

ft worth texas

it was hotter n hell

the place was packed all day as tons of other musicians played

then willie showed up when it was cooler in the evening

and everyone didnt seem to mind the wait

yes a lot were drunk and 4/20ed

my motherinlaw endured that hot sun and long day 

but it was worth it 

she sure loves willie

when willie finally leaves us one day which i hope is 

a long time away

there will never ever be another one 

happy birthday today or tomorrow willie

may you have many more

SCANS

friday i went to dallas and had 

a mri scan of the brain as part of the adni study that im in 

typical mri scan 

louder than hell 

be still for over an hour

stuck up in that cylinder 

keep your eyes open for the next 7 minutes

you ever tried that before without blinking

sorry i blinked couldnt help

why dont you try it and see if you can do it

not

looked at my old mri scan report

and oops there were some white matter hyperintensities (wmh)

areas on my scan

had forgot about those

since the scan more has been written about these

they are found commonly in elderly patients 

but im not elderly

if you have an increased number of these they can be associated with 

an increased risk for developing dementia alzheimers and stroke 

and 

are found in patients with high blood pressure obesity diabetics high cholesterol

this is why its important to keep these things under good tight control 

over a life time

i only have one or two which are not significant

hopefully all im doing to control things with my health 

living right eating right exercising controlling my cholesterol and blood pressure

and maintaining a normal weight will keep those wmh where they are now

then i had a glucose metabolism pet scan of the brain 

got an iv infusion of labelled glucose 

when i got home that night my wife she said you sure taste sweet 

when she kissed me

in alzheimers patients since they cant use the glucose in the damaged 

brain cells there is no uptake of the labelled glucose

and it will show up as blank areas on the scan 

my last glucose metabolism pet scan of brain was normal

thursday 

spinal tap for beta amyloid and tau protein

amyvid pet scan of the brain for beta amyloid

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