There are few conditions more frightening to my patients – and to me – than dementia. It’s easily the most common fear voiced in my office. One woman recently said, “I couldn’t think of her name and I’ve known her for years; I think I may have Alzheimer’s.” Another patient, a physician, half-jokingly asked, “How do I know if I’m losing it or have just misplaced it?” Behind his nervous attempt at humor was a deadly serious concern.
The most common form of dementia in the elderly is Alzheimer’s disease. According to the Alzheimer’s Association, it affects as many as 5.3 million Americans. Especially cruel is the twilight phase when patients can still understand what they are losing, when they can see the receding silhouette of their memories but cannot reclaim what they’ve lost. This was brought home to me very poignantly last year when I interviewed 65 year old Carol and her husband Mike about Carol’s Alzheimer’s. At one point, Carol could not remember how long she’d been married even though I had just reminded her two minutes earlier. At another point, Mike – a retired cop – broke down talking about his wife’s illness. All the words in the world cannot adequately describe the anguish conveyed by the looks on their faces, the tone of their voices.
Often forgotten in the tragedy of dementia are the caretakers, frequently family members whose lives are torpedoed by the devastating illness. In this week’s CBS Doc Dot Com, I speak with Gloria Signorini, an 80 year old woman with dementia and with her daughter, Joanne, who has put her life on hold to take care of her mother. Mrs. Signorini’s physician, Dr. Gayatri Devi, an expert in dementia at NYU Langone Medical Center, provides perspective about Alzheimer’s and other forms of dementia.
** Editor’s Note: Please click on this link to watch the video (I’m having technical difficulties embedding it here)**
This week’s episode of CBS DOC DOT COM took me to a college campus where I got schooled by two students about the widespread use of ADHD (Attention Deficit Hyperactivity Disorder) meds – by kids without a diagnosis of the condition – to study, stay attentive, and sometimes just to feel good. A 2005 Web survey found that 5% of US undergraduates reported having used stimulants over the previous year for non-medical reasons. But the real number may be much higher, especially if you listen to the students I interviewed with Dr. William Fisher, a psychiatrist at Columbia University Medical Center.
Features of ADHD include inattention, hyperactivity, and impulsiveness. A national survey in 2003 reported that about 4.4 million children in the US have been diagnosed with ADHD and 56 percent take medication to treat it. It’s estimated that about one to two thirds of the children with ADHD continue to have symptoms in adult life.
ADHD medication was in the news last week with a report that medication use in elementary school children improved math and reading scores. The gains – equal to about a fifth of a school year in math and a third of a school year in reading – still left the treated children lagging behind kids without the disorder. The study fans an ongoing debate on who should receive medications such as Adderall and Ritalin. These medications – along with behavioral/psychological therapy and educational interventions – help patients with ADHD; but they’re also being used by students and adults who have not been diagnosed with the disorder.
These drugs have potentially serious side-effects such as high blood pressure, irregular heart beat, and dependency. Doctors prescribing them for patients with ADHD should be carefully weighing the risks and benefits. People taking them on their own are rolling the dice with their health. No matter what you may feel philosophically about using these stimulants, the risk-benefit of their use in patients without ADHD has simply not been established.
I feel strongly that ADHD medications should only be used under the guidance of a physician. But that’s apparently often not the case. In today’s segment, we explore this issue further. Why do people without ADHD take stimulants? How do they start? How does it make them feel? Is society’s metronome pulsing so much faster today that people feel pressured to take drugs just to keep up? Click here for a fascinating related article which appeared recently in The New Yorker.
Yesterday I visited the Centers for Disease Control in Atlanta and was taken inside the command center, where almost 100 staffers have been working around the clock to monitor and stem the current outbreak of flu.
I first spoke to Toby Crafton, the manager of the command center, who oversees the day-to-day operations. He and his team have been preparing for a possible pandemic of flu or another infectious illness for years. I also spoke to Michael Shaw, PhD, who heads up the virology labs that are studying the H1N1 virus causing the current outbreak. He’s spent a career learning the laboratory techniques that are so urgently needed right now. The third person I spoke to was Dr. Richard Besser, Acting Director of the CDC, who has been working at the agency for 13 years and is an extensively published expert in infectious diseases.
I mentioned that last week I had received an email notification from the New York City Department of Health (NYCDOH) about how I should be managing my patients with flu-like symptoms. The advice was actually not intuitively obvious to me. For example, the Department of Health said that for patients with mild illness, treatment with anti-viral meds like Tamiflu and Relenza was only recommended for patients who also had underlying conditions that increased their risk for complications due to influenza. Dr. Besser pointed out that it was especially important right now for physicians to stay up to date with the recommendations being made by public health officials. Doctors can contact their local department of health and sign up for the same type of email notification that I received.
This brings us to the main point of today’s blog post. Many of us – patients and physicians alike – have been thinking about the influenza virus for about a week. Public health officials like the teams at the CDC and the NYCDOH have been thinking about it for years. Physicians, me included, are used to practicing medicine based on “clinical judgment.” We understand that medicine is an art and not a science, that there are many different ways to approach a problem, that there’s often no clear “right” or “wrong.” We are also used to doing things “our way”, whatever that way is. But this is not a time for doing things “our way” if it’s at significant odds with strong recommendations being made by public health officials. There are recommendations that may seem logical – like prescribing medication for somebody with mild flu symptoms “just in case” that nevertheless go against the judgment of people who have trained for years to think about how to deal with an epidemic.
What if you’re a physician who strongly disagrees with a suggestion of public officials? Then challenge that recommendation publicly. Bring the discussion to light; maybe you’re right. While this is no time to go rogue, doctors have an obligation to think carefully and independently and to challenge recommendations that seem illogical. But don’t silently do things your own way.
Due to popular demand, and the need for better public education about the swine flu outbreak, Dr. Jon LaPook will be offering the first ever live webcast at CBS tonight.
Check it out here (click on the link if video below doesn’t work at 7pm):
An assumption of my new web show, CBSDOC.COM, is that people are aching for mature discussions about health. This week I went to Central Park in New York City to talk to passersby about their sexuality, hoping to strike the right tone. I brought along two female gynecologists – Dr. Lori Warren and Dr. Rebecca Booth – experts who flew all the way from Louisville, Kentucky to help me out. Dr. Booth has written a book called “The Venus Week: Discover the Powerful Secret of Your Cycle At Any Age” that explains how hormones affect women from adolescence to menopause. Each has an active clinical practice and extensive experience talking to their patients about everything from memory loss following pregnancy (“my memory went out with the placenta”) to plummeting libido. And as luck would have it, total strangers we met at Columbus Circle talked to us quite openly about those very problems, eager to hear some practical advice. I hope we accomplished our goal of talking about a sensitive subject in a grown-up manner.
**Better Health readers: please let us know what you think of this new video series with Dr. LaPook. Leave a comment below. Thanks!**
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