My monthly meetings with caregivers take place at a beautiful Italian Romanesque building on 100 acres atop a hill. At our last meeting, the weather outdoors was cold and a winter storm was looming. As was typical for our meetings, we had a mix of men and women; some brand new, others long-time participants.

I sat back and listened as stories were shared and advice was gently offered. I observed the ways in which group members cared for one another, and I thought about the wisdom around that table and how these men and women have enriched me over this past year.

Caregivers continually remind me of the importance of living life simply and the value of finding joy in small blessings and ordinary victories. They reveal that it is important and necessary to reach out to others when life gets difficult even though the desire to isolate ourselves can be intense. Caregivers bestow on me the perspective I need to cope with my own disappointments and challenges.

As a parent, I can get aggravated by the fact that my son hasn’t done what I’ve asked him to do once or twice (or more) already, or I become annoyed at my daughter who “borrows” my things or gives me “that look.” As a wife, I become upset when my husband can’t simply know what I need or figure out why I feel the way I do. But still, in the face of these challenges, I am somehow reminded that this is as it should be.

As I sit around the table with caregivers or read the comments and stories on this blog, I realize that here is a group of people doing something that isn’t as it should be.

You are engaged each day in an extraordinary challenge with no time off. Yet, as undeserving as it may be, you have found a way. I am humbled in these moments of clarity. These are the moments when I look outside myself and my own life and recognize that the issues and needs of others are far greater than my own at this time. This clarity and perspective is a gift – a gift I believe that makes me a better wife, parent and friend to those in my life.

I will conclude my first posting for 2009 with these beautiful words posted on this blog Dec. 9 by Lisa.

“It (caregiving) is a lonely, thankless, tiring, sad, never ending job but I see my face in his and pray someone will be kind to me too when the time comes.” – Lisa. Free Medical Advice published By Dr Vivienne Balonwu.

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For the past several weeks I have been taking better care of myself through daily yoga practice, meditating, eating more mindfully and taking in less caffeine.

I always stress the importance of self-care to the caregivers I encounter. I share with them that family members giving care to someone with a dementia such as Alzheimer’s disease often experience their own health problems due to stress.

According to the Alzheimer’s Association, family caregivers are more likely to report their health is in poor condition than non-caregivers. Caregivers are also more likely to have high levels of stress hormones, inhibited immune systems, slow wound healing, hypertension and coronary heart disease.

I have seen reports that spousal caregivers will often die before the person with Alzheimer’s disease due to these factors. Yet, I am sure the thought many of you have is “how do I find time for self-care?” In past blogs we have written about support groups and respite care which are vitally important to a caregiver’s well-being. But what about caregiver nutrition?

According to the “American Journal of Alzheimer’s Disease and Other Dementias,” approximately one-third to one half of the health problems older people encounter are indirectly or directly related to dietary deficiencies. Combine that with the fact that caregivers’ lives are stressful, and it is not surprising they are likely to neglect their own nutritional needs.

Just what would optimal caregiver nutrition look like? In my mind, it would need to meet the needs of the older adult, incorporate foods that are good for the brain, and most importantly be simple.

Nutritional experts at Tufts University developed a Senior Food Guide Pyramid that emphasizes eating patterns that are necessary for good health for older adults. An important feature in the pyramid is its base, which displays a row of eight glasses of water or other non-caffeinated liquids. As we grow older, the importance of keeping well hydrated cannot be overstated. That would be my first suggestion for caregiver nutrition.

When it comes to the food we eat, there is encouraging research demonstrating that eating more omega-3 fatty acids may help reduce stress and inflammation in the body, which are associated with numerous chronic diseases that become more common as we age. It has also been reported that omega-3 fatty acids may help reduce the risk of memory loss by stimulating the growth of neuron connections, which improves the brain’s ability to process and retrieve information.

High omega-3′s are found in some fish. The American Heart Association (AHA) recommends eating fatty fish such as mackerel, lake trout, herring, sardines, albacore tuna and salmon. The AHA also recommends including tofu and other forms of soybeans, walnuts, flaxseeds and nut and canola oils as a way to increase amounts of alpha-linolenic acid, which produces omega-3 fatty acids in our bodies.

Another word we hear a lot of these days is antioxidants. Antioxidants are found in fruits, vegetables and grains and help in preventing “free radical” destruction of cells that leads to aging. Studies show that high antioxidant intake from foods results in reduced rates of cancer, cardiovascular disease and macular degeneration often associated with aging.

Here are some foods you might start placing in your grocery cart the next time you’re out shopping:

Fish, preferably the fatty fish (omega-3) such as mackerel, lake trout, herring, sardines, albacore tuna and salmon.Vegetables are high in disease-fighting nutrients. Fresh, frozen or canned vegetables are excellent sources, but particular winners are leafy greens (contain folate) such as spinach, kale, collard greens and mustard greens. Also brussels sprouts, broccoli, beets, avocados and red bell peppers.Berries have the highest antioxidant concentration among fruit. Blueberries contain flavonoids, the natural compounds that protect neurons from the negative effects of oxidation and inflammation. Others include blackberries, cranberries, strawberries and raspberries.

As a caregiver you will feel limited some days in what you can do, but we all must eat. With a few minutes of thoughtful planning, your next trip to the grocery store can be a choice to improve your health. Ultimately, when you take time to care of yourself, good things happen – you avoid health problems, feel better about yourself, have more energy and are more likely to have a better outlook about your caregiving role. Free Medical Advice published By Dr Vivienne Balonwu.

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I often receive inquiries similar to the one above from families affected by Alzheimer’s who have heard or read about an “Alzheimer’s cure.” Time and time again, I’m saddened by these “stories” that build unrealistic expectations for families who desperately await a cure.

It’s important to realize that research being done on mice creates only possibilities in humans – although vital to research, animal research is only a first step.  It’s important to realize that that mice and humans simply don’t suffer from the same illnesses, including Alzheimer’s disease.

Mice used in Alzheimer’s related studies are genetically altered to display signs of Alzheimer’s disease, but they don’t have the disease the same way humans do. In fact, there’ve been many promising studies in animal models that once conducted in human clinical trails turn out to either not work or to have unexpected toxicity.

A cure or treatment for Alzheimer’s disease that works in mice has no immediate application to humans, and any potential benefit would be years away. As with most things you read on the Internet or elsewhere, if it sounds too good to be true, it probably is. Free Medical Advice published By Dr Vivienne Balonwu.

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Probably the most difficult are those that alter the core of our most intimate relationships. If your partner of many decades has Alzheimer’s disease, with whom do you share your most personal thoughts, or share your day, your joys and challenges?

Does your loved one know you, feel a connection to you, sense love toward you? Do you love differently? Who are you now – a wife, husband, caregiver, stranger? These I believe are complicated questions reflecting profound losses.

At the 2005 Frontotemporal Dementia Caregiver Conference in Philadelphia, Dr. Dan Gottlieb said, “If we didn’t love we wouldn’t suffer – and the more we love the more we suffer.” It’s only because we love that we grieve, making grief a human response that can’t be avoided.

And although we do not fully get over all of our losses or our grief, we can change our relationship toward them. Grief, according to my teacher and mentor, Lyn Praschat, Ph.D., is the most powerful untapped resource for human transformation.

Each of us has the opportunity to transform our grief, yet the transformation does not come without anger, pain, loneliness, and sometimes terror. I see this transformation unfolding when caregivers begin to work on what they can change and begin accepting what they can’t.

I observe a shift in caregivers from “saving” their loved one to finding hope and meaning in other ways. This may be in discovering creative ways to offer the best care they can to be fully present with their loved one, and finding joy in everyday happenings. Others discover qualities about themselves they didn’t know they had, including patience, resilience and even humor in the most challenging of situations.

Some caregivers find ways to help others who are experiencing similar pain or advocate for laws that support persons with Alzheimer’s disease and their families. The key I believe is to avoid feeling helpless. With incredible tenacity, many caregivers transform a heartbreaking situation into one of hope and meaning. Yes, Emily, we will pray for you.

“Grief deepens you … Grief forces you to look at those parts of yourself that are not yet healed. If you look at grief as a teaching you will grow.”

- The Power Deck, by Lynn Andrews. Free Medical Advice published By Dr Vivienne Balonwu.

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The “Los Angeles Times” wrote that the 4-part HBO documentary is “an ambitious, disturbing, emotionally fraught and carefully optimistic film exploring virtually every angle of Alzheimer’s disease that can be explored on television.”

If you haven’t already, I invite you to watch these films and offer your reaction, beginning with “The Memory Loss Tapes.” After watching, consider sharing your thoughts. What affected you the most and why?

The series is available on HBO, HBO on Demand, or you can watch for free on your computer at www.hbo.com/alzheimer’s, where many other resources are available.

Here’s a brief summary of what the films are about:

“The Memory Loss Tapes” portray an up-close and personal look at seven individuals living with Alzheimer’s. The captivating stories include a mother who adamantly struggles to maintain her simple lifestyle in the face of her memory loss; a woman in a nursing home who believes the image in the mirror is her best friend; and a father who steals the show with his vocal performance, but can no longer remember his family. The film focuses on issues of independence, communication, changes in intimacy and sexual behavior, caregiving and end of life choices.

The other films are:

“Grandpa, Do You Know Who I Am?” with Maria Shriver. The film captures what it means to be a child or grandchild of one who suffers with Alzheimer’s disease.

“Momentum in Science” is a two-part state-of-the-science film taking you inside the laboratories and clinics of 24 leading scientists and physicians, revealing some of the most cutting-edge research advances.

“Caregivers” shines a light on the sacrifices and successes made by people experiencing their loved ones’ gradual descent into dementia. Free Medical Advice published By Dr Vivienne Balonwu.

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Being reasonable, rational and logical will just get you into trouble.
When someone is acting in ways that don’t make sense, we tend to carefully explain the situation, calling on his or her sense of appropriateness to get compliance. However, the person with dementia doesn’t have a “boss” in his brain any longer, so he doesn’t respond to our arguments, no matter how logical. Straightforward, simple sentences about what’s going to happen are usually the best.

Therapeutic communication reduces stress.
We tend to be meticulously honest with people. However, when someone has dementia, excessive details may lead to distress, for both them and the caregiver. Does it really matter that your loved one thinks she’s the volunteer at the day care center? Is it OK to tell your loved one that the two of you are going out to lunch and then “coincidentally” stop by the doctor’s office on the way home to pick something up as a way to get her to the doctor?

It’s perfectly normal to question the diagnosis when someone has moments of lucidity.
One of the hardest things to do is remember that we are responding to a disease, not the person. Everyone with dementia has times when they make perfect sense and can respond appropriately. We often feel like that person has been faking it or that we’ve been exaggerating the problem when these moments occur. We’re not imagining things; they’re just having one of those moments to be treasured when they occur.

Offering a sense of control goes a long way.
All of us want to feel like we’re in control of our own lives and have the capability to make our own choices. This doesn’t change when someone has dementia – even the later stages of Alzheimer’s disease. Although somebody with advanced Alzheimer’s disease is no longer capable of maintaining the independence and choice they once had, we have the opportunity to offer them at least an “illusion of control”. For example, instead of saying, “I want you to take a bath now” you could say, “I know how much you love taking a bath on Sunday evenings, thank you for letting me help you out.”

The advice I often give caregivers is to communicate with words, tone and body language that can most often generate reassurance and a sense of contentment.  When we communicate in this way, we’re letting go of our own need to control a disease which we simply cannot. Free Medical Advice published By Dr Vivienne Balonwu.

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Ben’s funeral was one of story-telling. Family members young and old went to the podium and shared personal experiences in their life with Ben. Later, the podium was open to anyone who wished to tell a story. For nearly two hours, dozens of Ben’s friends, colleagues and students shared heartfelt memories.

Ben was a hugger who made a connection with everyone he met. This story was shared over and over. I knew this personally because I always received a hug when Ben came to Memory Club. He wanted to know how I was doing, and in our groups, Ben would pay close attention to the person speaking; curious to understand the person behind the words. Ben’s hugs and his connectedness to others were reflected in many stories that day.

For several decades, Ben and his wife had opened their home and hearts to numerous foreign and minority students and families. One gentleman told the story of arriving in small-town Minnesota from the inner city of Washington, D.C., in the 1970′s. It was Ben and his wife who embraced him and helped him make his way through this difficult transition.

Ben was a teacher at a local college. A gentleman from the Middle East told the story of arriving in one of Ben’s college classes. As they developed a relationship, Ben encouraged him to follow his dreams rather than be confined by his own limitations.

“Because of Ben, I am now a college professor at a prestigious university,” the man tearfully said. Ben had received “Teacher of the Year Award” for several years running. After a while, the students decided that they would simply have to make Ben ineligible so someone else could receive the award.

Another woman shared that while living in this country, Ben became her surrogate father. He even walked her down the aisle on her wedding day.

Many more stories were told that captured similar themes about this incredible person I was blessed to have known for the last couple years of his life. I reflected on the richness of Ben’s life and how little I really knew about him.

That day at Ben’s funeral I realized the importance of storytelling, life review and reminiscence – not so much as a vehicle for dwelling on the past but instead as a way to see each person in all their wholeness.

Since Ben’s funeral, I have encouraged the older folks in my groups to share and listen to one another’s stories. Through this process, I find participants define themselves less by their losses and more by the accumulation of life’s experiences, accomplishments and relationships.

A story is so much more than a story. Sharing life stories seems to offer validation, peace, forgiveness, wholeness and acceptance – accepting oneself with where they are at the present time is a profound experience. I encourage you to ask those older individuals you love to share some stories, and then really listen. I believe we can play a privileged role in improving the quality of someone’s life – one story at a time. Free Medical Advice published By Dr Vivienne Balonwu.

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The 10-day program involves daily cognitive compensation training, brain fitness activities, support groups, wellness education, and a fitness/movement program. HABIT builds on the strength that persons with mild memory problems often retain the ability to learn new habits.

These specific “habits” – if practiced consistently – may help compensate for memory loss, possibly extending independence and improving self efficacy. I’ll write more about HABIT in an upcoming blog. For general information, visit the resources tab on this page.

The 26 individuals who participated in HABIT last month shared some common reasons for doing so. First, they believed that an early diagnosis doesn’t help much if you don’t understand what it means or what to do. They came with many questions and uncertainties about their diagnosis. Second, they were committed to doing something to make the situation better. Taking action gave them hope.

It’s difficult to describe what transpired in the two weeks and almost fifty hours we spent together, but clearly relationships grew and genuine bonds were made. Many faced for the first time the challenging step of accepting their diagnosis or that of their loved one. Care partners began the process of adapting to a new “normal” and although not easy, found immeasurable comfort in one another.

Some began to look at what may lie ahead with both a sense of empowerment and an appreciation for living fully in the present. Persons with memory loss gained a renewed sense that they’re individuals with rich experiences, accomplishments, and spirit, and that a diagnosis of memory loss doesn’t take that away.

I’m sure my words can’t fully capture the experience for these individuals or the profound wisdom they offered me or one another. Nevertheless, I’ll conclude with some of their words that will stay in my heart for a very long time.

“I am now open to our new life and prepared emotionally to move forward.” – Spouse of someone with mild cognitive impairment

“The disease has given me the gift of loving my husband all over again.” – Spouse of someone with mild cognitive impairment

“I find Alzheimer’s so freeing, you don’t have to remember yesterday or tomorrow, you just live today.” – Person with early stage dementia

For more information on HABIT, please email customerservice [at] mayoclinic.com. Free Medical Advice published By Dr Vivienne Balonwu.

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The reality of persons diagnosed with Alzheimer’s disease or a similar progressive dementia is that many will ultimately need to make a move because they need more care than can be provided at home.

Families can sometimes lose sight of the fact that the demands of full-time caregiving are more then any one person can realistically manage. Understandably though, they may resist the thought of moving a loved one to a care facility.

In making the decision of when to move, there are no right or wrong answers. All caregivers, families, and persons with dementia are unique and will have different circumstances. Friends, doctors, and individual family members will each have opinions about when or if someone should be moved.

However, for most of you the decision to move a loved one is based on a combination of practical, psychological and/or medical reasons that may include one of more of the following:

Caregivers own health is being compromised (including sleep deprivation).Caregivers own physical limitations (lifting, mobility).Caregiver is experiencing loss of work and/or the inability to manage other household or family responsibilities.Sufficient respite support or qualified home care are not available or become unaffordable. Symptoms of the disease are evident and challenging to manage at home (incontinence, aggression, paranoia, wandering).Person with disease needs more supervision than can be provided at home.Home environment is no longer safe (negotiating stairs, getting in and out of bathroom, narrow doorways).Person with disease is becoming more dependent with more activities of daily living such as eating, dressing, bathing.Person with disease is experiencing weight loss, dehydration or simply refusing to eat.Proper medication management is compromised. Person with disease no longer recognizes home as home.

Even when a thoughtful decision is made to a move a loved one, caregivers are bound to feel sadness, grief, fear, and probably plenty of guilt. These feeling are normal. Caregivers may feel guilty over not upholding old promises to parents or spouses, or they may fear what others will think or say, or fear that the care will be inferior. In addition, the decision underscores the inevitable decline of their loved one, resulting in further sadness and grief.

Once the move is made, many families say it was harder than they had imagined, and that they probably waited too long. The degree to which you can reasonably adjust to the transition is often associated with the planning that was done before the move. In other words, accepting the move seems to be less painful when families feel that they took the time to explore options and then made the best decision they could.

Keep in mind that the role of caregiver doesn’t abruptly end once a loved one lives elsewhere, it just changes. You still play a vital role as your loved one’s caregiving advocate. However, without direct care responsibilities, you can resume with renewed appreciation the time you spend with other loved ones.

Finally, if you love someone with Alzheimer’s disease, remember you are entitled to have a life of your own. Taking care of yourself is a gift to your loved ones as well as yourself. You simply cannot meet every demand. Your thoughts and feeling are normal. You feel guilty because you love.

“The promise to always keep mother at home might have been made with the best intentions and hopes, but inherent in that commitment is the idea that the family will do what is best for Mother. It may be a promise that should be broken, because keeping mother at home may not be best for her.”

- from “The Best Friends Approach to Alzheimer’s Care”. Free Medical Advice published By Dr Vivienne Balonwu.

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One in eight persons 65 and older has Alzheimer’s, and that number increases to nearly 1 in 2 persons aged 85 and older, according to the Alzheimer’s Association 2009 Alzheimer’s Disease Facts and Figures report.

By 2050, the number of individuals aged 65 and older with Alzheimer’s is projected to number between 11 and 16 million unless medical breakthroughs identify ways to prevent or more effectively treat the disease.

“The fact is that the older the population the more cases of Alzheimer’s there will be,” says Dr. David Knopman, a Mayo Clinic neurologist.

Seventy percent of people with Alzheimer’s live at home where friends and family take care of them. More than 40 percent of family and other unpaid caregivers rate their emotional stress as high or very high.

So, what are we doing about it?

The Alzheimer’s Association organizes memory walks nationwide to help research and fund support and education programs in local communities, including the Alzheimer’s Association Helpline. Helpline has highly trained and knowledgeable staff answering the phone 24 hours a day, seven days a week, in 140 languages. Call 1-800-272-3900.

In Minnesota, legislation was recently passed to establish an Alzheimer’s working group to examine the needs of individuals diagnosed with the disease, the services available to them, and the capacity of the state to meet current and future needs. The working group and other interested persons is made up of researchers, professional and family caregivers, and persons diagnosed with the disease. The group will ultimately present a comprehensive report to the governor.

In North Dakota, recent legislation resulted in passage of a dementia services bill. This bill created a care consultant system to provide community education and individual consultation to families impacted by Alzheimer’s. This is a tremendous victory and one that will impact families immediately. Other states and communities are beginning to take similar action.

Research has made considerable progress over the past decade and is moving forward with great momentum. Research has lead to current therapies that can ease symptoms and reduce the rate of cognitive decline. We now know the fundamentals of the disease process and how it damages and destroys brain cells and their ability to communicate. Experimental drugs are being explored every day. The next generation of drugs will target not only the symptoms but rather the underlying pathology.

Evidence from epidemiological studies suggests that the factors affecting heart health, such as blood pressure, cholesterol and blood glucose, may play a role in risk factors and protective factors involved in Alzheimer’s. Research offers us hope that we can one day prevent the disease.

Most of you reading this blog have been diagnosed with Alzheimer’s, or are caring for someone with it. Yet, it may seem that our efforts are focused on better days down the road, not today. So, what can you do today? Many things! My recommendations to persons with memory concerns, or who have a diagnosis of Alzheimer’s disease, or who are caring for someone with dementia are:

Know the 10 warning signs.Seek a diagnosis early and get treatment.Maintain overall brain and body wellness.Seek out and understand the resources in your area.Get support (in your own way).Plan ahead.Reduce stress by improving/changing the way in which you (caregivers) communicate. Believe that if you are a caregiver, you must first care for yourself.Join the efforts to move research forward.

Over the next several blogs, I will speak to each of these recommendations in detail. Meanwhile, continue to share with one another your concerns and struggles, but also your joys and successes and the ways you are taking action to live with Alzheimer’s. Free Medical Advice published By Dr Vivienne Balonwu.

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Sometimes it can be difficult to differentiate between the normal changes that occur with aging and the signs of something more serious like Alzheimer’s disease. The Alzheimer’s Association has an updated list of 10 warning signs of Alzheimer’s that I find helpful. Each warning sign includes a description with some examples. In addition, there is a brief statement of normal or typical age related changes that may not be a cause to worry.

Alzheimer’s Association 10 warning signs of Alzheimer’s:

Memory loss that disrupts daily life
One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
What’s typical? Sometimes forgetting names or appointments, but remembering them later.Challenges in planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
What’s typical? Making occasional errors when balancing a checkbook.Difficulty completing familiar tasks at home, at work or at leisure
People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.
What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show. Confusion with time or place
People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
What’s typical? Getting confused about the day of the week but figuring it out later.Trouble understanding visual images and spatial relationships
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not realize they are the person in the mirror.
What’s typical? Vision changes related to cataractsNew problems with words in speaking or writing
People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).
What’s typical? Sometimes having trouble finding the right wordMisplacing things and losing the ability to retrace steps
A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.
What’s typical? Misplacing things from time to time, such as a pair of glasses or the remote controlDecreased or poor judgment
People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.
What’s typical? Making a bad decision once in a while.Withdrawal from work or social activities
A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.
What’s typical? Sometimes feeling weary of work, family and social obligationsChanges in mood and personality
The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.
What’s typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted. Free Medical Advice published By Dr Vivienne Balonwu.

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One of the events is National Memory Screening Day, Nov. 17.  Some of you may have noticed various screening day campaigns in your area. Screenings often take place on senior campuses, long term care facilities or local retail businesses. To check screening sites in your area go to www.afascreenings.org.

Regardless of whether you were to pursue a screening this week or another time, consider a few things. While screenings can be a good thing, widespread screenings for anyone who is not showing symptoms are not unanimously endorsed. The U.S. Preventive Services Task Force issued a statement in 2003 that there was insufficient evidence for or against the screening of older adults.

The American Academy of Neurology recommends screening only when dementia is suspected. One of the main reasons against screening for everyone is that they result in a lot of false positives. In addition, many sources indicate that when a screening indicates a concern, many people never take the information to their doctor for further evaluation.

Yet, a community-wide memory screening can be a helpful first step for families if they are seeing signs of memory problems. The screening is relatively simple, accessible, and takes little time. It may help persons with memory concerns or their partners learn more about dementia and can be a good first step toward early diagnosis.

In general, we can all decide for ourselves if we want to participate in a community based memory screening given our own circumstances. If physicians and patients have a long standing relationship, memory problems usually get noticed in the office. The most important thing if you suspect memory changes is to see your doctor early and discuss your specific concerns. Free Medical Advice published By Dr Vivienne Balonwu.

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Accepting that my grandmother had Alzheimer’s disease also meant that I accepted the symptoms that accompanied her disease. Her dementia placed her reality back to a time when she was a young woman. I asked her what she liked about being 16 and she replied, “Well, it’s wonderful, I am going to my senior dance!”

Our conversation continued with excitement about the dress and shoes she had picked out, her date, and the music she expected they would dance to. I was fully present with my grandmother, living her reality in that moment.

Maybe the effortless capacity for persons with Alzheimer’s to live with sheer contentment in the moment and in their reality is a silver lining within the disease. Maybe our capacity to provide unconditional reassurance by living and accepting their truth is the gift we give in return.

Yours in support. Free Medical Advice published By Dr Vivienne Balonwu.

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“As we baby boomers start to deal more with Alzheimer’s disease, doctors must be more willing to listen to anecdotal comments by well informed spouses/caregivers … and doctors along with local/national associations must start providing more services for those with early onset Alzheimer’s and those in early stages of Alzheimer’s.

My wife has Alzheimer’s. Only 63 when diagnosed six months ago, she’s technically classified as having early-onset Alzheimer’s … a tag given to those who are diagnosed before the age of 65. There are many day-care activity programs available to those with moderate to severe stages of Alzheimer’s, and that’s a good thing. However, there’s virtually no support available to those with early-onset Alzheimer’s or in the earliest stages of Alzheimer’s.

As is true for many eventually diagnosed with Alzheimer’s, my wife began exhibiting symptoms several years before the official diagnosis was made. I told doctors about her worsening symptoms at each visit, but my comments were routinely ignored. I noted how she kept asking me the same question over and over without any recollection of having just asked me that same question minutes earlier. I mentioned her getting lost while driving in our community, her disorientation, her aphasia … but these comments weren’t seen as red flags by anyone but me.

Her behavior during doctor visits didn’t seem to indicate any problems — her initial cognitive testing results were good, MRIs and blood work didn’t show any problems, and the neurologist suggested that the symptoms I described were probably due to anxiety or stress. When cognitive testing results worsened later on, the diagnosis became severe cognitive impairment due to depression. For many months, the recommended treatment brought no improvement … only a worsening of Alzheimer’s symptoms … and we eventually went for a second opinion at a hospital-affiliated Alzheimer’s Disease Research Center. There the diagnosis was probable Alzheimer’s … not depression.

Some of the early signs of Alzheimer’s are identical to signs of depression or stress. It seems that neurologists and cognitive psychologists too often base their diagnosis and treatment recommendations solely on objective testing results after relatively brief visits with patients. This needs to change! Doctors need to give more attention to the anecdotal observations supplied by spouses/caregivers.

National organizations such as The Alzheimer’s Association must also change how they provide services. They do a great job of providing support groups for spouses/caregivers, as well as day care opportunities for those with more advanced Alzheimer’s, but they often provide no groups for people with early-onset Alzheimer’s or in the early stages Alzheimer’s.

Alzheimer’s takes a terrible toll on those suffering from the disease and on their spouses/caregivers. A good first step would be to begin forming groups around the country designed to meet the needs of those who are diagnosed at a young age, and for those who are in early stages of the disease!” Free Medical Advice published By Dr Vivienne Balonwu. Original article.

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Thank you, Allan, for your well crafted article that so many can relate to. As many of you note, we have an inadequate system of diagnosing, treating and supporting persons with Alzheimer’s, and their families.

With the looming epidemic of Alzheimer’s, drastic changes are needed and new approaches to early diagnosis and support must be implemented. There are, and will be, challenges. To all of you, thanks for the constructive conversation. Keep it going.

My colleague, Michelle Barclay, vice president of programs for the Minnesota-North Dakota Alzheimer’s Association, offered the following response:

“There is tragically little funding for these interventions (support groups for early stage), and they are costly to administer. It’s my belief that people need special training to lead such a group if the results are to be meaningful or therapeutic … The Alzheimer’s Association has in its strategic plan to develop more early stage support groups across the country … over the next few years, more and more places will be creating early support groups.

“Like adult day, which was created over many years, it will take time. Adult day really did not take off in California until there was a reimbursement source. We need to figure out a way to get non-pharmacological interventions reimbursed or at least partially reimbursed for families.”

A doctor I know and respect said recently, “If we accept that Alzheimer’s presents only a terrible toll, providers naturally will avoid the diagnosis. If, however, we believe that it is only unrecognized and untreated Alzheimer’s that causes the terrible toll, there is a reason to diagnose.

“(Without early diagnosis) you miss the opportunity to ‘see’ things while you still can. And you also miss the chance to design a future that accommodates your blindness. The difference is that with most other progressive diseases, you know what the problem is, where it is headed, and what you can do to maximize the time you have and minimize the adverse consequences ahead.”

My view?

We need to believe that short of a cure, the benefits of early identification and intervention are substantial to those with the disease and their families, as well as to communities as a whole.We must look for ways to provide immediate access to affordable insurance options for people with younger onset dementia to ensure that they receive early diagnosis and ongoing treatment and support.We need to ensure the availability of interventions aimed at improving disease knowledge and management, promoting overall physical and mental health, delaying progression of disease symptoms, and enhancing quality of life.And we must implement a systemic education strategy for physicians/medical providers that increases awareness and reinforces the benefits and incentives for early identification.

The unfortunate part in all of this is that it will take time, yet it’s important for folks like you to know that you’re being heard and the problem is being recognized. For now, I support and encourage people to be assertive in getting a diagnosis and advocating for programs and funding that can change the way we think about a diagnosis of Alzheimer’s. Free Medical Advice published By Dr Vivienne Balonwu. View the Original article.

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I just completed delivering another session of a program called HABIT (Healthy Action to Benefit Independence and Thinking). Persons in this program have a diagnosis of mild cognitive impairment or early stage Alzheimer’s disease. Many of these participants talked about the challenge of having their memory concerns validated and receiving a clear diagnosis. Fortunately, these folks were able to get a diagnosis early and are pro-actively taking steps to compensate for their impairment and possibly slow down decline.

I feel strongly that persons are empowered when they receive an early diagnosis. They begin to understand that the changes and challenges are likely part of a disease process – not a lack of effort, motivation, or sign of weakness. An early diagnosis offers the patient and their family time to arm themselves with knowledge and take full advantage of existing strengths. And early diagnosis allows for psychiatric symptoms such as depression to be identified and treated. I don’t want to imply that an early diagnosis provides individuals and families with rose colored glasses (nobody wishes for the diagnosis and the journey will not be easy), but instead it does help them with an understanding and a plan for whatever the future will bring.

If you’re concerned about memory changes in yourself or a loved one, the Alzheimer’s Association has a document that can be helpful to complete and take to your doctor. You can find the checklist on the Resources tab above, and a link to the Mayo Clinic memory training program. Free Medical Advice published By Dr Vivienne Balonwu.

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It was a conference that inspired hope and a sense of community. We learned how leading researchers are looking for ways to predict Alzheimer’s disease, improve diagnostic techniques, identify high-risk individuals, and ultimately develop preventative treatments and an eventual cure. There were breakout sessions, service vendors and advocacy opportunities.

The conference introduced us to the DeMoe family from North Dakota. The DeMoe family is made up of six children, five of whom carry a gene mutation that has resulted in younger-onset Alzheimer’s. Several members of the DeMoe family took the stage and while firmly interlocking hands, shared their journey. You may think that what we heard was a story of tragedy and heartache, but quite the contrary. What we heard and felt was a family in a place of acceptance and love. The family reminded me that none of us get to live this life without grief and loss. The DeMoe family understands this and lives each day with joy and purpose by participating in research, sharing their story, hugging any one who needs it, and with lots and lots of humor.

For me, the annual conference is like coming home after being away for a year. I see familiar faces dedicated to their work, I reconnect with families who I have met and supported over the years, and I stand proudly beside my colleagues who share my passion for making a difference in the lives of anyone impacted by dementia. I am certain the energy generated on this special day drenched us all with an undeniable feeling of community and oneness.

Until next year. Free Medical Advice published By Dr Vivienne Balonwu.

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Changes that occur over the course of Alzheimer’s disease make it almost certain that additional care, including residential care, will be needed. The decision is often heart-wrenching and met with uncertainly, fear and guilt on the part of the family or caregivers involved in the process.

Having said that, I can’t stress enough the importance of doing your homework as early as possible (well before your loved one needs long term care) so you can take time to understand the options available. Even if your loved one is in denial, family members can begin to investigate on their own. As the disease progresses and the time to move a loved one is near, it’s most often the family (children) that influence the decision the most.

So what exactly is long term care in the context of a person with dementia such as Alzheimer’s disease?  There are generally 2 types of residential care available: assisted living and nursing homes.

Assisted living is any group of residential programs not licensed as a nursing home. Definitions of assisted living and the specific regulations differ from state to state. The spectrum of assisted-living services includes options such as congregate housing, residential-care facilities including adult foster care homes and memory care assisted living. Assisted living residences generally provide 24-hour staff, recreational activities, meals, housekeeping, laundry and transportation. Memory care assisted living is essentially a step beyond basic assisted living. Residents are in a supervised, sometimes secured locked facility. Meals are provided; activities of daily living including medications are managed by care staff. Memory care assisted living is social, activity-based model of care (vs. medical model of care found in nursing homes). Most persons with dementia can live in a memory care assisted living facility throughout their disease unless there are medical conditions that require the skilled nursing services offered in nursing homes. Foster care or board and care homes provide meals and help with some daily activities (such as money management, scheduling transportation, reminders to take medication, laundry and housekeeping). Board and care homes may also be called adult foster care, elder care homes or residential care homes. Some foster homes are also dementia specific and will provide round the clock supervision, assistance with daily care and social activities.

Although some facilities accept state funding (Medicaid), assisted living is ordinarily paid for privately

Nursing homes provide a full range of skilled care needs, including acute care and long-term care. There are many persons with dementia who live in nursing homes because of coexisting medical conditions or due to insurance, proximity to family, or other logistical reasons. Some nursing homes offer alzheimer special care or memory care units to better meet the special needs of residents with dementia. Special care units are usually a floor or a unit inside a nursing home.

Currently 27 states have legislation requiring nursing homes and assisted living residences to tell exactly what specialized services including memory care they provide. This includes providing written information about trained staff, specialized activities, ability of staff to care for residents with behavioral needs, and what fees they charge.

What kind of care is best for you or your loved one? The Alzheimer’s Association CareFinder can be a useful tool and will walk you through the following:

what types of care are available how to recognize good care what the Alzheimer’s Association recommends how to decide what care you need how to make sure you’ve found good care

You can find a link to CareFinder on the Resources tab above.

Once again, there are no easy answers, but another valuable resource I must mention is a local support group. Support group participants can share their firsthand experiences with long term care and offer invaluable insight into their journey.  More importantly, they can provide the emotional support families need as they navigate this uncharted and unrequested territory. Free Medical Advice published By Dr Vivienne Balonwu.

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If using the ‘A’ word creates an obstacle with your parents, then changing your language may help to open up lines of communication. If you say, “Dad can we talk about your memory loss?” you may get less resistance than saying, “The doctor said you have Alzheimer’s disease.”

Overall, the goal is not to agree on what to call ‘it’ but to be pro-active in receiving treatment and planning for the future. That being said, the following are important discussion topics to have with your parents and/or other family members. Keep in mind that you don’t need to tackle them all in one conversation.

Medications are available that can help to maintain a better quality of life. Discuss these options with your doctor.Review and discuss legal documents and make sure healthcare wishes and assets are managed the way you like. We should all do this from time to time anyway, so it isn’t necessary to dwell upon the diagnosis as the reason for the conversation. In addition, consider meeting with an elder-law attorney. Know the resources in your area for help with services, support groups, online resources and other local programs for families. Begin to explore options for long-term care and memory care.

A common mantra we use in our support groups is “hope for the best, but plan for the worst.” One of the most tragic situations I see is when families wait too long to create a plan and consequently find themselves in some sort of catastrophic situation and feeling powerless. To the best of your ability and within the limitations of your situation, H.S., please intervene. Free Medical Advice published By Dr Vivienne Balonwu.

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The National Adult Day Association can also provide good information about what a day program can provide persons with a dementia such as Alzheimer’s and their care partner. The National Institute of Adult Day Care describes adult day care as a program of individualized services and therapeutic activities in a group setting for adults who are cognitively impaired, physically impaired, socially isolated, frail elderly, in need of assistance with activities of daily living and in need of supervision.

In addition to providing programming and social engagement for persons with dementia, caregivers receive a temporary break from the demands of caregiving – without respite caregivers are more susceptible to the effects of caregiver stress, such as depression, exhaustion and other health problems. Adult day services are worth checking out in your community.

In addition, many of the Alzheimer’s Association chapters offer as part of their core services care consultations. It’s a grouping of services to assist the person with Alzheimer’s or related dementias and/or their family care partners in planning for, and dealing with, all aspects of the illness experience. Individuals with dementia and their care partners receive one-on-one assistance that will enable them to better manage care and make more informed decisions regarding services and treatments. To request a consultation, call the Alzheimer’s Association helpline at 1-800-272-3900.

I know many of us feel guilty about asking friends or family for help, hiring help, or taking a break, but keep these points in mind:

You do many things in your life very well.

You are entitled to have a life of your own.

Your thoughts and feelings are normal.

Taking care of yourself is a gift to your loved one.

You can’t meet every demand. Remember, we feel guilty because we love.

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Influenza Suffer

Like a cold, influenza or flu means you have picked up a virus, which is passed on by coughing, sneezing or physical contact. In both cases you cannot treat or cure the infection itself, only its symptoms. Antibiotics will make no difference to flu unless you have a ‘secondary’ infection of the middle ear or chest.

A heavy cold can easily be mistaken for influenza, although flu is much less common and often spreads rapidly as an outbreak or, worse, an epidemic. The effects of flu, which infects the body’s breathing passages or respiratory tract, are more severe and can take longer to clear up than cold symptoms.

Flu is not normally dangerous, unless it strikes someone who is already ill or weak, or triggers off acute pneumonia – which is rare. If you are in a high-risk group you can arrange for an annual flu vaccination, which is around 70 per cent effective at preventing infection.

Catching one of the three main types of flu virus (A, B and C) will give you resistance to that particular virus in the future. Unfortunately, type B and (especially) type A produce new strains that your body’s natural defences cannot recognise or fight off – so you may get flu again and again.

How Do I Know If I Have Influenza?

Flu often comes on quite suddenly. The first symptoms are usually a fever, shivering, weakness, a headache, aching muscles and bones, tiredness and loss of appetite. A cough, sore throat and runny nose will normally follow.
After a couple of days your temperature will probably come down and the initial symptoms should be gone within a week. The cough, sore throat and runny nose will take longer, however, and you may feel tired and under the weather for a good two weeks.

What Can I Do Immediately To Make My Influenza better?

• Rest in bed and make sure your room is warm and well-ventilated.

• Soothe your throat and replace lost fluids by having plenty to drink. A hot drink made with honey and lemon or blackcurrant is preferable to tea or coffee.

• Do not smoke as this will make your symptoms worse.

• Try to eat a little, even if you do not feel up to it. If children are reluctant to eat, you could try extra drinks and semi-solid foods such as porridge or yoghurt.

• Treat your symptoms as you would those of a heavy cold – e.g., painkillers for a headache and fever, throat lozenges or gargling salt water for a sore throat, steam inhalations or cough medicines for a cough.

• Bring down a child’s temperature by sponging with lukewarm water.

• Remember to cover your mouth and nose when you sneeze, put your hand over your mouth when you cough and wash your hands regularly. This will help to avoid spreading infection.

• Do not rush back to work as soon as you feel better. Allow time for a full recovery.
What can I do generally to avoid catching flu?

• Steer clear of people who have the virus.

• Avoid places that are crowded or badly ventilated, particularly in winter when flu is more common.

• During the winter months, stay fit and healthy (and keep your body’s natural defences in shape) by eating and sleeping properly. Too much stress or a hectic lifestyle can lower your resistance to infection.

• Ask your doctor about having a flu vaccination if you are elderly and living in a nursing or residential home, over 80 years old, pregnant or have:

¤ a chronic respiratory disorder such as bronchitis, asthma, emphysema or cystic fibrosis
¤ a chronic heart condition
¤ diabetes
¤ kidney disease
¤ liver disease
¤ reduced resistance to infection, e.g., if you are having chemotherapy.

What Treatments Can I Buy Without A Prescription?

Your pharmacist will stock a variety of products for relieving the symptoms of flu, either separately or in combination. Some products, for example, contain a strong dose of painkiller together with ingredients for cough and a blocked or runny nose.
Ask your pharmacist which product is best for you and be careful not to mix products with the same ingredients in them. If your child has flu, get advice from your pharmacist on suitable medicines. Never give aspirin to a child under 12 years old.
For adults, paracetamol is useful for relieving a headache and bringing down a fever, while aching muscles and bones can be eased with soluble aspirin or ibuprofen every four to six hours (do not exceed the recommended doses).

When Do I Need To See A Doctor?

• If you are elderly or frail.
• If your temperature rises above 40°C.
• If your child’s temperature stays above 39°C for more than 24 hours.
• If your baby’s temperature is higher than 38.5°C.
• If you still have a fever after four days.
• If you are in a high-risk category (see above).
• If your symptoms get worse, you develop chest pain or are short of breath.
• If you are coughing up yellow or greenish phlegm.
• If you have severe earache.
• If you were recently in a country where there is a risk of malaria.
• If your baby or child is refusing to drink.
• If your child is sick and starts behaving strangely.

You Should Contact A Doctor Immediately If:

• Your child is weak.
• Your child is having problems breathing.
• Your child seems to find it painful breathing in.
• Your child has diarrhoea and is vomiting or refusing to drink.
• You, your child or baby show any signs of meningitis, e.g.

¤ a high temperature
¤ a persistent headache
¤ a stiff neck
¤ nausea or vomiting
¤ drowsiness or confusion
¤ dislike of bright light
¤ a red/blue skin rash

Babies

¤ a tight or bulging fontanelle (the soft spot on top of a baby’s head)
¤ listlessness
¤ a blank expression
¤ heavy or repeated vomiting
¤ refusal to feed
¤ high-pitched crying
¤ an arched back
¤ pale or blotchy skin with red or blue/black bruises

Note: Babies may display these symptoms without having a fever.

In Summary …

• Rest in bed and stay at home until you have fully recovered.
• Have plenty of fluids, particularly hot drinks to soothe your throat.
• Try to eat
• Treat your symptoms with home remedies or non-prescription medicines such as painkillers.
• Call a doctor if you develop worrying symptoms or are in an at-risk group.

By Peter Mansell, Edited by Dr Peter Stott. Published by Dr Vivienne Balonwu at Free Medical Advice Online.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Glaucoma

This is a disease of the eye, where the normal fluid pressure inside the eye gradually increases, leading to problems with vision or even blindness on occasions.

What Causes Glaucoma?

The basic problem in glaucoma is in the small space at the front of the eye, called the anterior chamber. There is normally a steady flow of clear eye fluid in and out of this chamber, bathing and nourishing the eye. For reasons which still remain unclear, in glaucoma this fluid begins to drain out too slowly and so the fluid pressure slowly builds up in the eye. This excess pressure causes damage to the optic nerve, which connects the light-sensitive retina at the back of the eye to the brain. It is the health of this optic nerve which is necessary for healthy vision and so progressive damage to it from glaucoma slowly damages the eyesight. Most people suffer from a form of glaucoma called ‘open-angle glaucoma’.

What Are Glaucoma Symptoms And Signs?

Initially there are no symptoms in open – angle glaucoma. There is no pain, and the vision is normal. However, if the glaucoma remains untreated, a person may notice that although they can see things directly in front of them clearly, anything to one side of their vision appears blurred or foggy. They may fail to see objects to one side of them, and feel as if they are ‘looking through a tunnel’. Over time, their vision may gradually disappear to nothing.

Will I Have Any Tests Or Investigations?

Specialized tests are vital for the diagnosis of glaucoma to be accurately made.

There are 4 main tests;

* 1. Visual acuity. This involves using the well-known ‘doctor’s eye chart’ with letters of different sizes on it to measure how well you see at various distances.

* 2. Visual field. This important test measures your side (peripheral) vision, the loss of which is an early sign of glaucoma.

* 3. Pupil dilation. Special drops are put into the eye to dilate the centre of it and allow for the optic nerve to be examined. This means you will have blurred vision for some hours until the drops wear off, and you should not drive in this time.

* 4. Tonometry.There are a number of different types of this test, all of which are designed to measure the fluid pressure inside the eye. A common type is the fair puff’ test which measures the resistance of the eye to a puff of air, and is quick and painless.

What Treatment Might I Need?

Glaucoma is readily treatable, although not curable. The usual treatment is medicines, either in the form of eyedrops or pills. Some of these help to drain excess fluid from inside the eye, and others cause less fluid to be produced in the first place. These have the disadvantage of having to be taken several times each day, and they may also become less effective with time. It is important that your doctor knows any other medicines you may be taking before starting such treatment in order to avoid drug reactions or side effects. Laser surgery is becoming an increasingly popular treatment option. In this case, a strong beam of light (the laser) is focused on the anterior chamber at the front of the eye. This is painless because the eye has been numbed first with anaesthetic eye drops.

You may see little flashes of red or green light, and the laser makes up to 100 evenly spaced burns around the anterior chamber. These allow fluid to drain more easily out of the chamber and so reduce the eye pressure. This is very effective at treating glaucoma, but pressure may slowly increase again after 1 -2 years in some patients. If medication and laser surgery have no effect, ‘conventional’ surgery is then an option and is performed at hospital. A new channel is created for fluid to drain away from the eye, and drops are needed for several weeks afterwards to prevent any swelling or infection. If the new drain in the eye closes up, a second operation is sometimes needed to re-open it again. This type of surgery works better if you have never had eye surgery before. It is always important to remember that the aim of glaucoma surgery is to save sight, not improve it and some people find that although their sight has been saved it is not quite as good as before they had their operation.

What Course Will The Illness Follow?

If untreated or unrecognised, the usual pattern is that the eyesight gradually deteriorates until vision is very poor or blindness occurs. Once treated, regular checks from eye professionals such as opticians and ophthalmologists are vital to make sure the eye pressure is steady and not increasing once more. If the pressure remains the same, the eyesight tends to stay the same also.

Can I Do Anything To Help Myself?

If you are aged over the age of 60, or have a strong family history of glaucoma, or are Afro-Caribbean in race then you should have annual eye checks, even if you are not aware of any eye problems or symptoms.

Tell Your Doctor

1. Do you think your eyesight is getting worse?
2. Can you see things in front of you better than to the side of you?
3. Do you have a family history of glaucoma or eye problems?
4. Have you ever had problems with eye tests in the past?
5. Have you had your glasses changed recently?

Ask Your Doctor

1. What are the side effects of treatment?
2. Am I allowed to drive with glaucoma?
3. What extra risk do my children have of developing glaucoma?
4. Can I go straight to laser surgery without needing to try medication?
5. Does eyestrain make glaucoma worse?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free medical advice on glaucoma is published by Dr Viv Balonwu.
For further information on glaucoma, visit International Glaucoma Association.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

A stroke is when a part of the brain suddenly becomes unable to function. This is due to a lack of oxygen, and so all strokes have the common factor of disease affecting the blood supply to the brain. This usually occurs with little or no warning, and causes weakness and paralysis of any part of the body depending on the part of the brain affected. In the United Kingdom, someone has a stroke every 5 minutes.

What Causes Stroke?

The main cause of a stroke is a blockage to the blood flow, or the bursting of an artery to the brain. When an artery is blocked, this is called a cerebral infarction. When there is bleeding into the brain, it is called a cerebral haemorrhage. There is a third kind of stroke, called an embolic stroke. This is where a blood clot travels through the body and blocks an artery in the brain to form a plug, or embolism.
The diseases which cause strokes to occur are similar to those which cause heart disease. Arteries in the brain may block due to them being furred up by fatty material in the same way that heart arteries become blocked and cause heart attacks. Blood clots can arise from heart diseases where the heart has an irregular rhythm, or where there is damage to the valves of the heart. When a cerebral haemorrhage occurs, the commonest cause is due to a weakness in the wall of an artery – called an aneurysm. These are sometimes present in people from birth as an inherited weakness, but more commonly are the result of high blood pressure.

What Are The Signs And Symptoms Of Stroke?

Any symptoms that occur after a stroke are immediate, and depend both on the area of the brain involved and the degree of damage caused. The commonest symptom is weakness or paralysis of one side of the body. There may be loss of sensation and movement of part of an arm or leg, or complete loss of any function along one side of the body. Speech is often affected, along with facial weakness and tingling or numbness of the face. If the stroke affects the base of the brain, there may be problems with swallowing, breathing and consciousness.
Some patients have a warning attack some time before a major stroke. This is often in the form of a short-lived weakness or numbness down one side, or a temporary problem with speaking. These are called TIAs – transient ischaemic attacks – and are usually completely better within 24 hours.

Will I Have Any Tests Or Investigations For Stroke?

The main test of use if a stroke is suspected is called a CT scan. This will not only rule out any other possible causes for a patients symptoms, but is also able to confirm whether a stroke is due to a clot or bleeding. If it is due to a clot, the heart will be tested for any source of these such as valve problems. It may also be necessary to perform a soundwave test called a carotid ultrasound, which looks at the arteries in the neck to see if there is any kind of blockage to the blood flow there. A neurologist – a doctor specialising in brain disorders – may assist in the diagnosis and management of stroke patients. The main care of patients who have had a stroke however remains good nursing care.

What Treatment Might I Need?

Initially, if the blood pressure is found to be high, this will be lowered by medication. If a clot is the cause, aspirin is started and if it is found there are problems with the heart valves, warfarin – a blood thinning drug – will be used. Any rise in the blood sugar level, which often occurs after a stroke, will be closely controlled, and oxygen may be needed in the early stages to try to minimise the brain damage.

What Course Will The Illness Follow?

This entirely depends on the severity of the stroke and how much damage it has caused. In the early stages there may be problems with swallowing, which in turn can lead to breathing difficulties or chest infections. Once a patient’s condition has settled however, attention is turned to maximising the function that remains. This involves intensive treatment by physiotherapists to improve mobility, occupational therapists (who use a wide variety of activities to help regain dexterity), and speech therapy. The aim is always for the patient to resume as many of their pre-stroke activities as possible, but a total return to their previous condition is the exception rather than the rule. Physical therapy may continue following discharge home, but some stroke patients cannot be cared for adequately at home and so need residential or nursing home care long-term.

Can I Do Anything To Help Myself?

The main factor is to identify and treat high blood pressure – this alone reduces the risk of stroke considerably. Just as important is stopping smoking since the furring up of arteries in the brain and neck is greatly speeded up by smoking. If there is any diabetes, a good control of the body’s sugar level is very important as is controlling the level of cholesterol in the blood, either by diet or tablets. Should the heart be beating irregularly, tablets such as digoxin should control this. This is often used in combination with aspirin or warfarin as blood thinning medicines to reduce the risk of any further strokes.

Tell Your Doctor

1. Did your symptoms occur suddenly?
2. Do you smoke?
3. Does anyone else in your family have similar problems?
4. Have you been treated for high blood pressure in the past?
5. Have you ever had what have seemed like stroke symptoms, but which have disappeared after 24 hours?

Ask Your Doctor

1. Am I at risk of a further stroke?
2. How often will I need my blood pressure checked?
3.What help can I get at home to help me with mobility and my daily activities?
4. If I am able to do them, will activity or exercise hurt me?
5. Will I need to stay on Aspirin or other tablets for life?

By Dr Roger Henderson, MB BS Lond., LMSSA Lond. Free Medical Advice Online, Published by Dr Vivienne Balonwu. Get advice, further information and help from The Stroke Association.

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A heart attack (sometimes called a coronary, a coronary thrombosis, or a myocardial infarction or ‘MI’) is when part of the heart muscle stops working because not enough oxygen is able to reach it through the heart’s blood supply – the coronary arteries. Any heart tissue that stops working during a heart attack is replaced by scar tissue that is unable to work again and will not heal. Therefore the more heart tissue that is starved of oxygen, the less well the heart can function after a heart attack.

What Are The Causes Of Heart Attack?

The blood supply to the heart is usually stopped by a blood clot in the coronary arteries, causing the heart attack. The arteries are narrowed in places due to ‘plaques’ – a build-up of the fatty substance cholesterol over many years. As this build-up of cholesterol increases, the arteries narrow – a process known as atherosclerosis. This process is speeded up by many other things, including smoking, high blood pressure, too much fat in the diet and diabetes. Being at risk of having a heart attack may also be passed down a family, as having parents or other relatives who have had a heart attack can incease the risk of having a heart attack. Most heart attacks occur in middle-aged men, and are rare under the age of 35. Women tend to have their heart attacks after their menopause.

What Are The Signs And Symptoms Of Heart Attack?

The main symptom is a dull, ‘heavy’ type of chest pain, usually in the centre of the chest. This is often described as a ‘pressure’ or ‘like someone sitting on my chest’ or an indigestion-like symptom. Pain may be felt in the jaw. There is usually some sweating and a feeling of being sick, or actual vomiting. The patient looks unwell, with a greyish colour and may be short of breath. However, up to a quarter of all heart attacks either have no symptoms – a ‘silent’ heart attack – or very mild symptoms which may be ignored by the patient. The most common time for heart attacks to occur is in the early morning, from 5 am to 10am.

Will I Have Any Tests Or Investigations?

The medical history and appearance of the patient will suggest to the doctor a diagnosis of a heart attack. This diagnosis is confirmed by an electrocardiogram (ECG) which shows the heart beat and electrical pattern of the heart. This shows up any non-working tissue in the heart as well as any heart muscle which is short of oxygen. A heart attack will produce very characteristic changes on an ECG tracing. If the ECG appears normal, or if the changes are only mild or borderline, then blood tests carried out some hours later can confirm whether there has been damage to the heart muscle or not. These tests pick up proteins which are released into the blood from heart muscle that has stopped working.

What Treatment Might I Need?

The aim of treatment is to restore the blood supply to the heart as quickly as possible this will stop a heart attack. The best way to do this is to dissolve the blood clot in the artery – a process called thrombolysis. The simplest way to do this is to give the person a dissolvable aspirin tablet under their tongue if they are conscious since this will begin thinning the blood immediately. Once in hospital, ‘clot-busting’ drugs can be given to continue this treatment, and these will open the majority of blocked blood vessels within 90 minutes.

These drugs are usually given on a coronary care ward which specialises in dealing with heart attacks. Speed is important here as most of the permanent muscle damage caused by a heart attack has taken place by 6 hours after the start of the attack. In specialised centres, patients may be given an angioplasty which is where a tiny balloon (known as a catheter) is pushed into the artery under X-ray guidance and to the site of the blockage before being inflated. This pushes the clot and plaque out of the way and so restores the circulation in the heart to normal again. Tablets may be given to prevent any complications. These include:

ß-blockers – which reduce the strain on the heart. These drugs may need to be taken for life.

ACE inhibitors – another class of drugs – which improve the heart muscle healing process.

What Course Will The Illness Follow?

Most patients admitted to a coronary care unit will spend several days there being monitored before being transferred to a general ward. They will be encouraged to begin walking around after a few days and will be monitored for any problems with the heart rhythm, shortness of breath or further chest pain. If a patient continues to suffer with any of the above problems, they may need further treatment, such as a change in medication, angioplasty or heart surgery. Provided there are no complications, most patients are allowed home after 5 to 8 days, and recovery is gradual. The time needed to return to normal activities depends on the size of the heart damage, with most patients being able to resume normal daily and sexual activity within 3-4 weeks. During this recovery period, vigorous exertion should be avoided such as heavy lifting or any work which causes sweating or shortness of breath.

Can I Do Anything To Help Myself?

As well as continuing to take regular medicines such as aspirin and ß-blockers, there are a number of ways to prevent the chances of a further heart attack:
1. The most important one is to stop smoking and never start again.
2. Losing weight reduces the strain on the heart, as does controlling any high blood pressure.
3. A low-fat diet will reduce the amount of cholesterol in the blood, and regular steady exercise will strengthen the heart muscle.
4. Try to reduce the amount of stress you may be under, which may mean taking a long look at your job and pace of life in general.

Tell Your Doctor

1. What symptoms do you have?
2. What type of pain is it?
3. When did the symptoms begin?
4. What were you doing at the time?
5. Does anyone in your family have heart problems?
6. Do you smoke?
7. Have you had any similar symptoms before?
8. Are your symptoms getting worse or better?

Ask Your Doctor

1. Is my heart beating regularly?
2. Will I recover normally?
3. Do I need to stay on treatment for life?
4. Are any of my family at increased risk of heart problems?
5. Will I be able to return to my usual work?

By Roger Henderson, MB BS, LMSSA

Free Online Medical Advice published by Viv Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.

Prostate Cancer

The prostate gland is not essential for life. It surrounds the outlet from the bladder and secretes a fluid into the semen that nourishes the sperms. It gradually enlarges with age and can block the passage of urine from the bladder.

Who Is At Risk Of Prostate Cancer?

The risk of prostate cancer increases with age and is doubled if a relative has the disease and is quadrupled if a father or brother has it. Latent or inactive cancer may be found in 50 per cent or more of 80-year-olds, but in them it is generally of no concern and is unlikely to require treatment.

What Are Prostate Cancer Symptoms?

It is uncommon for early cancer to produce urinary symptoms. However, symptoms may include urgent and frequent urination, getting up at night to urinate, or slowing of the urinary stream with difficulty starting or emptying. A urine infection or blood in the urine may occur. See your doctor if you experience any of these symptoms because they are more likely to be due to other problems.

How Is Prostate Cancer Diagnosed?

Sometimes prostate cancer is found incidentally after an operation for a benign (non-cancerous) enlargement of the prostate. It may be found during a routine check by your doctor, who examines the prostate gland with his/her finger in the rectum. This is called a digital rectal examination.

No blood test clearly shows whether you do or don’t have cancer. There is now a blood test which can help your doctor to manage prostate cancer. This is called PSA, as it tests for prostate specific antigens. The level of PSA in the blood can be raised by many infections and conditions, including a benign enlargement of the prostate, as well as prostate cancer. However, if a digital rectal examination is suspicious and/or the blood PSA is raised, your doctor may suggest a biopsy.

A biopsy involves taking a small piece of tissue from the prostate with a special needle so that it can be examined under a microscope by a pathologist. The needle is positioned in the prostate with the help of an ultrasound probe in the rectum.

If the biopsy is positive, the doctor may order a bone scan to ensure the disease hasn’t spread into the bones. If it has spread, different treatment may be needed to control the progress. If it hasn’t spread, you probably have an early cancer.

What Are Prostate Cancer Treatments?

For early prostate cancer, there are several options that you should discuss with your doctor.

* Watchful waiting

No immediate treatment may be needed in some men, especially those who have small, slowly growing tumours, or those with limited life expectancy. Your doctor will see you periodically to monitor your condition.

* Radiotherapy (treatment with X-rays)

This has been standard therapy for small, localised prostate cancer for many years. Radiotherapy involves daily outpatient treatment that lasts about 15-30 minutes each time, for up to seven weeks. Some patients can suffer irritation of the bowel or bladder, but this can usually be controlled by medication. Loss of erections (impotence) may be a problem.

* Radical prostatectomy

A biopsy of the lymph nodes takes place initially to see if the cancer has spread into them. If it hasn’t spread, the surgeon then removes the entire prostate gland (radical prostatectomy), preserving adjacent nerves where possible. If the cancer is confined to the prostate, the results of radical prostatectomy and radiotherapy are similar. The possible complications of this surgery include incontinence (usually mild), impotence and blockage of the urine flow.

* Hormone therapy

Hormone therapy involves eliminating the effects of the male hormone, testosterone – it is known that testosterone helps spread prostate cancer. Hormone therapy can be accomplished by removing the hormone-producing part of the testicles through a small incision in the scrotum. Alternatively, medications can be taken to stop the testicles from producing testosterone or to block the effects of the male hormone. This medication must be taken for life.
 
You should carefully discuss with your doctor the full implications of all these treatments, their side-effects and their impact on your working and family life.

Your doctor will arrange follow up blood tests, especially to determine the PSA level. A rise in PSA may mean the disease has returned. Careful monitoring means that any progress of the cancer can be treated early by hormone therapy.

What About Survival From Prostate Cancer?

If prostate cancer is diagnosed before it has spread, it may be treated with radiotherapy, hormones, radical prostatectomy or watchful waiting. Your survival depends upon the biological activity of the tumour and your general level of fitness. Men over 70 seldom benefit from radical surgery.

* If you have just been found to have prostate cancer, don’t panic.

* If you’re anxious that you may have a problem, ask your doctor to check you out.

* During treatment, try to eat well, stay active and keep track of your weight. And remember to follow your treatment program exactly as your doctor advises.

By Dr Mike Kirkby

Free medical advice is published by Vivienne Balonwu.

Quality Free Medical Advice Online by Vivienne Balonwu. A variety of general health advice and news online.