May 21st, 2009 by Jon LaPook, M.D. in Better Health Network, Video
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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)**
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May 3rd, 2009 by EvanFalchukJD in Better Health Network, True Stories
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My younger brother is an executive producer of the show “Nip/Tuck” and an executive producer of soon-to-air Fox show “Glee.“ Last year, he almost died.
It started when he woke up one day with numbness on one side of his body.
His doctor ordered an MRI. It found bad news: a tumor in his spinal cord, high up in his neck. He was referred to a neurosurgeon.
The plan was straightforward, but dangerous. First, radiation. Then, his spinal cord would be carefully cut open to remove the tumor. He was told he could end up paralyzed, or dead. Concerned, he called me, and we started a case at Best Doctors.
One of our nurses took a history, and we collected his records. Two internists spent hours reviewing them. The records noted our family history of a kind of malformed blood vessel. Our grandfather had hundreds of them in his brain when he died at 101, and our father has dozens of them in his. I have one in my brain, too. This was in my brother’s charts, but none of his doctors had mentioned it.
An expert in these malformations told us a special imaging study should be done to rule this out as a cause of the problem. Best Doctors gave that advice to my brother and his doctors. They agreed.
The test showed this was precisely what he had.
Quickly, the plan changed. He still needed surgery — if the malformation bled, it could also paralyze or kill him. But there would be no radiation, which might have caused the very bleeding we feared. Even if that didn’t happen, the surgeons were prepared to operate on a tumor. They would have been surprised to find a delicate malformation there instead.
In the end, his surgery went well. He is having a good recovery and is busy with his new show. But his case is a constant reminder of how important it is to have the right diagnosis, and how easy it is for things to go wrong.
Even in Hollywood.
April 26th, 2009 by Dr. Val Jones in True Stories
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A surgeon friend of mine recently told me a story about a little girl who wandered into the territory of some pit bulls. These dogs were tied up with leashes in the neighbor’s back yard – specifically because they couldn’t be trusted to run loose near children. Tragically, the two year old wandered within their grasp after slipping through a protective kiddie gate and out of the house.
The dogs attacked her viciously, dragging her deeper within their territory and attempted to eat her alive. They tore off both her ears and shredded her chest and limbs. By the time she was discovered she was near death. The girl was rushed to the nearest trauma center – where my friend took her to the OR immediately. He spent the entire night putting the pieces back together, as it were.
A couple of days later, my astute friend noticed her having problems turning her head towards her mothers’ spoon during meal times. That observation triggered him to test her vision – and low and behold the girl was completely blind. A brain CT confirmed the clinical team’s worst fears: at some point during her resuscitation, the girl had a massive stroke, and her entire occipital lobe (the back of the brain) was damaged.
Wondering if there was anything he could do to help the girl, and devastated by what he assumed was a grave prognosis (a lifetime of blindness), my friend called a neuro-ophthalmologist for advice. Much to his amazement, the neurologist told him that her visual deficits were likely to resolve completely, because her brain would simply adapt. Children at very young ages can recover from otherwise devastating strokes because of neuroplasticity – the ability of the brain to rewire itself, and recruit healthy neurons to take over for damaged tissue.
True to the neurologist’s predictions, the little girl regained her site within a year. Fortunately, her body healed extremely well too – and despite thousands of stitches, her scarring turned out to be quite minimal. Today it’s hard to tell that she’s had surgery at all.
This story holds special interest to me, as I too was mauled by a dog when I was a little girl. Although I was bitten in the face, and nearly lost my left eye, I can’t remember the last person who noticed my scars or asked about them. They simply faded with time.
The extraordinary healing powers of young tissue cannot be matched in adulthood. However, some degree of neuroplasticity lives on in each of us, offering hope for brain rehabilitation for everyone – from the forgetful to those with major impairments.
Whether you (or a loved one) have internal or external scars – healing is always possible.
April 16th, 2009 by eDocAmerica in Better Health Network
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Stroke is a major cause of disability and death in the U.S. and worldwide. Modern medicines like statins (and old ones like aspirin) are helpful in preventing both initial and secondary stroke in patients at risk. But, are there simple things you can do to lower risk?
Yes, you say! Well, indeed, you are correct. Twenty thousand men and women (age range, 40–79) without histories of stroke or heart attack were recently analysed in the U.K. for the effect of 4 simple behaviors: not smoking, regular physical activity, moderate alcohol intake (1–14 drinks weekly), and high fruit and vegetable intake .
Patients engaging in 3 or 4 of the activities were significantly less likely (2 times!) to suffer a stroke over the next decade. Patients who slipped up a bit and only did 1 or 2 of the activities did have significant stroke risk, though not quite as much as those who sat on the sideline and engaged none of the behaviors.
So, grab the baton and step up to prevent stroke. As always, questions and comments are welcome.
*This blog post was originally published by Jerome Ecker, MD at the eDocAmerica blog.*
April 13th, 2009 by Medgadget in Better Health Network
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Although scratching has been everyone’s favorite method of removing an itch for thousands if not millions of years, scientists have not been able to uncover the neurological mechanism of this action. Now a team of University of Minnesota researchers used the long-tailed macaques as subjects in an experiment that showed that the nerves being scratched send different signals to the spinal cord and then to the brain depending on whether there’s an itch in the area. In addition to being a peculiar finding, this may lead to the development of stimulation devices that address acute itching, pain, or other nociceptive phenomena.
From the abstract in Nature Neuroscience:
Spinothalamic tract (STT) neurons respond to itch-producing agents and transmit pruritic information to the brain. We observed that scratching the cutaneous receptive field of primate STT neurons produced inhibition during histamine-evoked activity but not during spontaneous activity or activity evoked by a painful stimulus, suggesting that scratching inhibits the transmission of itch in the spinal cord in a state-dependent manner.
Abstract in Nature Neuroscience: Relief of itch by scratching: state-dependent inhibition of primate spinothalamic tract neurons
Image: joyrex
(hat tip: AP)
*This blog post was originally published at Medgadget.com*
