Alzheimers Disease - a special request

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I got an email this week from a man called Michael Ellenbogen. It's about Alzheimer's Disease which most of us have already heard about, but rarely think about unless it directly impacts our lives through a loved one or someone within tour immediate community. But listen to a little of what Michael has to say:

"Many people think Alzheimer’s disease affects our senior generation, but they are so wrong. I started having symptoms at age 39. They refer to people like me as having Young Onset Alzheimer’s Disease, or YOAD. Not many people are even aware of YOAD. My wife, who is in the medical field, was not even aware of this. The only people who seem to know about it are the caregivers and the people affected, who will most likely pass away within 8 – 10 years. A new person is diagnosed with Alzheimer’s every 68 seconds. By 2050, that number will be every 33 seconds. As of today, there is NO cure or any way to slow its progression. Even worse, this disease will bankrupt our health system if we do not act now." 

Michael went on to ask for help to spread the word, and to seek to get all of us to act before we too might become swallowed up in the "nothingness" that Alzheimer's Disease leads to.  There are no simple, immediate solutions, but without doubt there is an answer, or maybe several answers, "out there", and we need maintain the enthusiasm that already exists within the Medical Research Community if we are to find effective treatments within the lifetime of Michael and others like him.

So what can we do?

First and foremost - reduce your risks. Stay healthy, stay active and stay involved. Use your brain in as many ways as you can and surround yourself with people with similar aims as yourself - and here I think there is enormous potential for Social Media to play an ever increasing role for those who live more isolated lives.

Keep yourself informed. There are many interesting avenues of research and treatments being developed all the time and they need to be critically evaluated: don't be afraid of voicing your opinion because it might just be the missing link in a long chain of productive inquiry.

Become actively involved in raising awareness of the challenge before us all. Rattle the can or just donate to registered organizations that are already doing great work in this difficult field. And always be prepared to offer support to family or neighbours whose lives have been burdened by this most difficult of diseases.


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Croup - scary but rarely dangerous.

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Human Para-Influenza virus

With the change of seasons comes a spike in viral infections. Currently in Oz, especially in the West, we are seeing some significantly low temperatures heralding the real onset of the winter months: but being such a brilliant place, at least we know that we will still get some wonderful weather on most days!

But with winter come those infectious diseases that are "stirred up and spread around" in our schools, Kinders and child care centres, and then brought home to be shared with the rest of the family. One of those infections caused by the LTB virus (proper name of laryngo-tracheo-bronchitis virus) or a para-influenza virus can lead to sore throats, coughs and in little children, Croup!

Croup is one of those illnesses whose "bark is worse than it's bite", but in little children under five and even more so in babies, listening to them cough and wheeze can be very distressing and even frightening for both child and parent. We adults can have a sore throat and cough and easily put up with the swelling that results in our larynx without too many difficulties, but the smaller the patient the more significant that swelling becomes, and in tiny tots, small swelling can have big consequences.

The good news is that nearly all children with croup can be happily treated at home: all that's required are simple measures and lots of cuddles and reassurance. The onset is usually the same as with a normal cold - they're a "bit off" and then they feel hot and may complain of a sore throat. It's when the sun goes down that things can start to warm up with perhaps a spike in temperature and the onset of a barking cough. Paracetamol in the appropriate dosage can ease the temperature, help relieve the discomfort and might allow child and parent to get some sleep. During the day the child often "bounces back", but when the sun goes down again, the symptoms may recur. The body's immune system will deal with the infection and it will settle down of its own accord in 2 or 3 days.

For those with more severe symptoms, these children may require a Steroid Syrup to help reduce the swelling in the Larynx in order that they can breath more easily. Antibiotics will make no difference to the illness as antibiotics have no place in the treatment of viral infections. If your child has some of the following symptoms, then they should be seen by a Doctor:

• They make noisy, high-pitched sound when BREATHING IN (stridor)
• They drool or have difficulty swallowing
• They become irritable
• If they are obviously struggling to breathe
• If the skin goes blue/grey around the nose, mouth or fingernails
• Has a fever of 39.5 or higher

The treating Doctor will be able to make the diagnosis after examining your child and further investigations are not usually needed. If the Stridor is severe, they may admit the baby to give them humidified oxygen and medication until the swelling has settled, but most will be allowed home on medication.

Whilst the scientist haven't found any obvious benefit from "Humidifiers" at home, in my experience they do seem to make the child more comfortable - but do make sure that they are safe and away from little hands! But in the end it's Mums magic that is probably the best, with lots of cuddles and love: come to think of it, most Dads are pretty d*mned good at that too.
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It's a funny world.

We got up early and went for a jog through the forest this morning - pause for more information re the word "jog": for us it means lots of gasping, legs that often feel like they have 20kg weights attached to them, wondering whether to worry about that disturbing ache in the knee, or whether it might be easier to breathe if one stared ahead instead of at the ground! But here's the good bit: this "jog" is interspersed with moments where we stop, perhaps to cross a road where we often pray for a stream of passing traffic to appear, or just to marvel at the absolutely, awe-inspiring, gobsmackingly beautiful thing which we call nature. The trees have become a gorgeous umbrella of shade over tracks softened by leave mould, which is far kinder to older feet than concrete or tarmacked roads. Young deer are often seen staring at these two strange people people panting past, red squirrels scurry up trees (probably sniggering beneath their fur) to warn their friends of two wearied road warriors and rabbits hurry into the ascending undergrowth of ferns and briar. It gets me every time - the glory of the whole thing.

Then I sit and look at my lap top to "catch up" on events in medicine and the world at large: and it's depressing. There is such a huge gap between reality and our perception of it in urban society with all our needs and demands for "this and that". One thing nature teaches is that as well as the beauty of it, it's not always pretty, things can go badly wrong and it is fragile: and yet it is constantly changing and constantly renewing itself. Whilst in our "advanced" societies we seem to want to achieve a permanent state of perfection NOW and for pain to be banished for ever.

So my thought for the weekend is for all of you who can, go for a walk in the park/garden/forest/beach/desert and reflect on how much you have already and be thankful for it: accept that you can't hold onto "now"; that to fully engage in life means being flexible and that suffering happens and you will need to be ready to deal with it. Tough times will come - that's the way the world works - but it's how we respond to those tough times that marks us out as the genuine article ... a human being.

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Are older men wiser when it comes to sun protection?

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Apparently not much changes with men as we age: we still continue to believe that we're invincible! Well perhaps as far as looking after our skin, according to some recent research that I read today.

Older men are not good at protecting their skin from the sun and are at greater risk from developing skin cancer according to the report. The "Silver Surfers" reasoning goes like this: "I need a bit of sunshine and at my age, why bother with all this sun protection?". Well, I still vividly recall one of my first patients who was a melanoma sufferer and not all the gold in the world would get me to swap places with that poor guy! The good news is that early detection and treatment of melanomas - before they have spread to the lymph glands - has a 98% survival rate at 5 years, which in anyones book is pretty damned good!

So for all of those testosterone charged senior males who still know where their abdominal muscles are and love to flex them, here's a few tips.

Over the age of around 60 yrs you're going to lose subcutaneous fat and your skin is going to become more fragile; thus it needs all the help you can give it. Too much UV rays will damage the skin further and raise the real risks of developing sun related cancers. Think of your skin in the follwoing way: imagine a bucket, and once you've filled that bucket with water, it can't take any more. The skin is your "bucket" and the sun is the "water" and by the time you've got to 60 you will almost certainly have filled your "bucket" and you need to "turn the tap off", in other words avoid the sun's powerful rays.

So go outside and enjoy the great outdoors before 10am and after 4.00pm. If you have to go out in between those times make sure that you "cover up". Get into the habit of putting sunblock on exposed skin after you've brushed your teeth in the morning - summer and winter. Wear a hat with a wide brim: there are some really good ones around so take time to browse the shelves until you find one that makes you smile! Wear long sleeved skirts and slacks and if you're invited out during the day always try to find a good spot in the shade - you'll meet a lot of other interesting people there!

And if you notice something on your skin that has changed shape or colour, or bleeds easily, then please don't ignore it - get it checked by a professional and not your golfing buddy!

The sun is the most powerful structure in our planetary life and we should treat it with the greatest of respect - just like you'd like to be treated yourself!

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Driving me crazy!

Tweet I've just driven from the centre of Ireland to the city of Galway and back again to catch up with a friend of ours who has been doing an intensive English course there. And although I want to concentrate on posture in this article, I first must make a few observations of what I saw in that lovely city: 1. So many people were smoking that my heart sinks for their future health, because so many of these people are young people. 2. The number of seriously overweight people was remarkable. But as we know, this is not just an Irish problem, but a universal challenge. But yet again it was the number of young people who are literally carrying 40 to 50 kilos of extra fat around on a daily basis that must inevitably lead to serious health consequences. 3. Being a tourist area there is an added emphasis on alcohol, and yet again it's the young who are at the pointy end of the problem. In all these situations there are those who are putting in a huge effort to promote a healthier alternative, but to the average punter, they are not having the required impact. One obvious casue of these problems is the ease of availability of cigarettes, fast foods and alcohol. I do not advocate prohibition, but perhaps we should look at reducing the number of outlets for each of these products within each community. Naturally there would be a screetching outcry at such a suggestion, but tough decisions need ot be made if we are not to end up paying billions of dollars in the years ahead to combat the health and social impacts of the negative consrquences of these three challenges. Meanwhile, back to the problem of posture. Maybe I am deformed - a suitable pause for ribald comments - but at my age I find that the driving seats in cars eventually will cause me neck and shoulder pains. I find that they cause me to bend forward in the seat with rounded shoulders resulting in my cervical spine (neck) being in an uncomfortable position. Unless I force myself to constantly tighten my lower abdominal muscles to fix my lumbar spine in the correct position, to stick my chest out and push my shoulders back, then after an hour I find myself with tense shoulders and the onset of a mild headache. Perhaps all the creative geniuses out there who deal with ergonomics can give me some good advice!

Asthma prevention

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Asthma is caused by a combination of inflammation and irritation, and if the two arrive at the same time then an asthmatic can find themselves in serious trouble! So prevent, and be aware.

In asthmatics, the inflammation is to the inside of the airways within the lungs. As these airways get smaller and smaller, the effects of inflammation on the inner lining have a bigger and bigger impact.  Environmental irritation causes contraction of the muscles that control the "openess" of these tubes, and if the space is small in the first place then they're only going to get really tight once they've been irritated!

So if you have a tendency to suffer from asthma and you're heading out into the "Great Outdoors", PLEASE go well prepared because sometimes you just don't know what might trigger that asthma attack and you might be a long way away from support and help. Simple things like insect bites, smoke from a camp fire, a fruit bar with nut oil, or even just a change in the weather can trigger an episode.

Prevention is the key to good asthma control. Getting any inflammation under control and making sure that you can avoid "Triggers" where possible are both fundamental to preventing a potentially serious asthmatic attacks. According to Dr. James Sublett, chairman of the American College of Allergy, Asthma and Immunology Public Relations Committee,  "Planning ahead, seeing an allergist and knowing the causes of allergy and asthma, even those with the most sensitive noses and lungs can enjoy summer fun".

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Post menopausal bone fractures - some adivce

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Common things happen commonly and rare things happen ... rarely! People do get eaten by sharks, and it's terrifying and awful when it does happen, but shark attacks are sufficiently rare that they shouldn't stop people going for a dip in the sea. It's the same as riding a bike: we are actually encouraged to stop using our cars and take up cycling, but if you've ever fallen off your bike - which really isn't that un-common - then you might think twice about taking up cycling.

The reason I write about what might happen and what rarely happens is that I've just finished an article on Bisphosphinates. These are a group of medications that people, more commonly women, take in their later years to help prevent bone fractures. These medications have been around for 10 to 15 years now and were introduced to help reduce the fracture rate amongst post-menopausal women who are at greatest risk of breaking their bones. But obviously its far better to start a treatment before breaking a bone and the best way to do this is with Bone Densiometry, which is a tool used to literally measure how strong the bones are and to predict the relative risk for fractures. Each person is given a T score, and depending on that score, treatment might be offered.

Now here's the rub: Bisphosphinates do help those at highest risk in the first five years, but then the benefit seems to level off. Also, there are some rare - there's that word again - complications which aren't very nice: osteo-necrosis of the jaw bone - you don't want that - and "atypical" fractures in the femur - you don't want that either. But I emphasize that these are rare (think shark attacks) and overall Bisphosphinates do more good than harm - for those who genuinely need them.

Enter the FDA cautioning about long term usage of these class of drugs. So what does a good women do?

1. The long term ideal solution is prevention and this would take decades to have an impact. The ideal prevention is to strengthen bones from early adolescence and maintain that healthy bone with regular exercise, resistance training and good nutrition. If that were to be 100% successful, we would be in medical Nirvana!

2. For those at high risk - women with strong family histories of spinal and hip fractures; these ladies need to exercise appropriately and eat bone healthy meals. They also need to have bone densiometry to check their T score and if it's low then medication needs to be discussed and offered. Then they need to repeat their T scores from time to time to see if the treatment is actually effective for them: if not then they stop the medication!  

3. Those who have moderate or lower risk should also take regular, appropriate exercise and eat bone healthy food and get their T score checked as indicated by their monitoring physician.

4. This also applies to men with increased risk of bone fractures.

If your Doc suggests any treatment for any condition, probably the most important thing is to get a regular review and don't just carry on taking whatever it is without having some "review by date". Medicine is constantly changing and our level of knowledge and understanding of disease and treatments is also evolving, so what was a great idea 10 years ago might just be not quite so great now - or it might be even better than was realized before. But get a review and never be afraid to ask questions.
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Driving tired is mad and bad

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An elderly patient of mine has recently started showing signs of dementia. One of the more annoying elements of his disease is that he is losing his normal diurnal pattern, which means that he is waking up in the middle of the night and thinking that it's daytime. However recently he took things a step further when he woke in the night and decided to go for a drive. He still has a license, but this does raise the ethical dilemma of those people with early dementia and when to "hand in the license".


This is an unusual case of how accidents might happen to people with mental disorders and raises the question how far must we go to prevent such events happening. In this case, although the man still had his licence his wife had not allowed him to drive for several months because of the changes in his mental status. Now she has to increase the home security to make sure that this otherwise healthy and active man does not "escape" again. Studies have shown that "patients with dementia are 3 to 5 times more likely to be involved in a motor vehicle accident than age-matched control individuals".

But there are many people who continue to drive, most of them quite well, but who take very strong medications for their mental disorders and these medications do alter the patients level of alertness. Further studies have shown that "drowsy driving is associated with fatality rates and injury severity on par with that of alcohol-related crashes". But it's not just people on medication who may pose a risk, "shift workers or people who work long or uneven hours and those with sleep apnea or narcolepsy may also be unsafe driver" according to Christine Marchionni, MD, psychosomatic medicine fellow in the Department of Psychiatry and Human Behavior at the Thomas Jefferson University in Philadelphia

Having rules and regulations for "fitness to drive" are all well and good, but enacting them is a whole different ball game and often the burden of responsibility will fall on the family Doc to make a difficult call: after all, taking away a person/couples mobility will severely impact on their lives and making affect correct decision making.

But for medico-legal purposes, it is imperative that these situations should be openly discussed,  all the options fully explored and all the details fully documented.
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Staying flexible

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"Everything changes, nothing changes" is an old quote, but one that is so true! This morning sees new regimes installed in France and Greece with Europe appearing to be headed into new and challenging times: but then one just has to read the history of Europe to find out that this is "par for the course" for this part of the world.

And it's not just change "out there in the wider world" that happens, change inexorably happens in our own lives too. Usually it's slow and almost indiscernible, such as the greying of hair, the subtle loss of high frequency sounds and the gradual awareness that your back is bowing forward and your shoulders becoming round! But inside we still feel as young as ever even though it's more difficult to shake off that pall of tiredness that clings onto you throughout the day.

Change brings challenges, but often they are just variations on the same theme. In our physical life these are still based on good nutrition, appropriate exercise and avoidance of known toxins - such as smoking or too much booze. But Shakespeare gave us some useful insight when he wrote of the "Seven ages of man". What these ages demand of us is flexibility in our attitude and perhaps flexibility is one of the more under-rated facilities that we humans have. We tend to ossify in our attitudes and get set into routines and "beliefs" - and I don't just mean spiritual beliefs but all those certainties that we thought were true, like the tooth fairy and Santa when we were young, or that money can solve all life's problems when we're older!

So as our physical bodies get stiffer and we work harder on maintaining flexibility and function, lets also work on flexibility of mind and spirit too so that we can maximize our potential every day of our lives. Probably the best way to do that is to stay in close contact with young people who have all that energy that we wish we had, and they're usually brimming with ideas and confidence too. By interacting with them, we get a bit of what they have - energy and enthusiasm - and they get a bit of what we have - wisdom and experience! 

So let the theme for this week to be try to "Mix it with the kids": that should test our flexibility!
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Making the most of a healthy life

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Richard -Coeur de Lion

One of the delights of taking time out to travel is that you get to see so much; to experience other peoples cultures and, if you're lucky, to immerse yourself in a bit of history too! The young bride and I have just spent the week in the Loire valley in France, curtsey of a delightful couple - Marinette and Claude - who speak not a word of English but make up for that with hearts as big as trucks!

I mention all this because it has a tenuous link to health too and also explains why I lapsed into silence from blogging, as internet access is not always available when you want it!

On my return yesterday I went to check my very crowded inbox and also to check up on what had been happening in the health world: I was struck by the "cloistered" world that we seem to build up around ourselves even though we now claim to have made the world a smaller place through social media. By that I mean that health has become a means to an "end" - being 100% well - which is itself both fragile and finite. Whilst standing in an ancient Abbey and looking at the tomb of Richard the Lionheart, a childhood hero of mine, the thought struck me that he must have thought that he was "invincible" too and probably never doubted that he would live to "make old bones". And Elanor of Aquitaine also - she who was not only married to the King of France, but followed that up by marrying the King of England, which means that she must have been some "lady"! But even she lies in a gilded coffin.

My point is that, yes, we should maximize our health potential by adopting those things that we know will help us pursue our other goals in life, but health should not be the "new religion" that promises good health and long lives to one and all. The second point is that we need to put as much effort into our psychological/spiritual life as we do into our physical life in order that we get a more balanced perspective on life, and this means incorporating meditation/prayer into our daily rituals too. This is not something new for we humans but something that mankind has been naturally doing since they first stopped dragging their knuckles along the ground! It's just that it doesn't get mentioned much in the health and well-being literature these days!

So to all the Health Care Industry "out there", my suggestion is to take a well-deserved break and have a good look at the world around you, then sit down and reflect and maybe - just maybe - we'll start to see how hope can be a part of health at whatever end of the spectrum you might be.