Monday, June 28, 2010

Don't be a Donor-cyclist!

What's a "donor-cyclist"? Anyone who rides a bike- motorcycle or 10-speed- WITHOUT a helmet. Everyone in medicine, especially ER staff, all refer to these as "donor-cycles" because without a helmet to protect their heads, these folks become organ donors after major accidents. Last week, there were two serious auto-bicycle accidents in my Austin neighborhood. Yesterday, while driving in Houston, I saw a man sprawled on the ground in front of a car, his motorcycle tossed to the side (and ambulance fast-approaching.) The most recent statistics (from 2008) showed that there were over 52,000 traffic accidents involving pedaling cyclists, and 716 deaths. Add motorized bikes and the numbers skyrocket.

I am not writing to discourage people from riding- quite the contrary. I simply want to reiterate that HELMETS save BRAINS and save LIVES. PLEASE WEAR THEM! Bikers- wear reflective or at least brightly colored shirts. Be aware that drivers have more distractions than ever as they zip down the road. If you are driving, put away that cell phone and watch out for our fellow travelers on two wheels. They can easily slip in and out of our blind spots, especially at dawn and dusk.

BOTTOM LINE: If you're riding on two wheels, make sure a helmet is protecting your head!

Monday, June 21, 2010

Medications, medications, medications!

Okay, it's obviously a play off of "location...location", but hey, if it gets your attention, then I've done my job! I want to say a few words about medications. First of all, to physicians. Many times we need to prescribe multiple medications for our patients. One is daily, another twice a day, and yet another may be before meals and bedtime. Before you know it, our patient is supposed to take a half a dozen pills per day (and then we wonder why they are "noncompliant"!)

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.
Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

Saturday, June 19, 2010

Dangers of Internet Drugs

The FDA recently issued a warning about a flu medication- Tamiflu- that was being sold online. It was marketed as "generic Tamiflu", but really had a PENICILLIN derivative (cloxacillin) instead of the anti-viral drug. Can you imagine what would happen if you are severely allergic to penicillin and took this drug to combat flu symptoms? You could potentially send yourself to the emergency room (or die on the way there from anaphylaxis) because you were trying to save money and time by self-diagnosing and ordering medications on line.
While this is an extreme example, it points out yet another danger of the internet. Many drugs are available online at discounted rates, but there is less supervision about the content and quality of these drugs. In addition, self-diagnosing frequently leads to incorrect treatment. I'm not saying every medical issue is challenging, by the way. A simple cold, strep throat or a sprained ankle are typically straight-forward. However, few medical challenges occur in isolation, and with the poly-pharmacy that most Americans choose these days, a few years of medical education come in handy to sort out interactions.
BOTTOM LINE: Buyer beware! Internet "specials" on drugs may not be such a great deal.

Monday, June 14, 2010

Recharge your battery!

What do I do to recharge my battery? My favorite vacation is summer or fall in Colorado. I believe our children summed it up beautifully when one of them said, "Mom, how can ANYONE be bored here?" Nature provides all the entertainment I could ever desire. Hiking, biking, kayaking, and rafting are ever-present. Want a slower pace? Grab your camera and shoot pictures of all the beauty.

Yesterday I took an amazing bike ride up here in Crested Butte. The views alone are enough to lighten my spirits, but the heart pounding you get at 9000 feet above sea level riding a bike will clearly up your adrenaline and pump up those "happy neurotransmitters" in your brain!

Remember that thirty minutes a day of aerobic activity (anything that significantly raises your heart-rate- you don't have to travel to Colorado!) is equivalent to taking a low dose of an anti-depressant.

BOTTOM LINE: Jump on your bike, go for a walk, or pick your favorite exercise and recharge your battery!

Thursday, June 10, 2010

Prevent Accidents: Hang up the Phone!

This week a perspective in the New England Journal of Medicine encouraged doctors to ask their patients about driving habits- and not simply about driving home after having wine with dinner. The issue here is all about texting or talking on cell phones while you are driving. Oh sure, you ONLY check your texts/emails when you are stopped at a light, right? Well, maybe if the traffic is really slow…What about simply talking on the phone- is that really a problem?

We know that driving while distracted by a phone conversation or texting is similar to driving while intoxicated. Both situations can cause you to react more slowly when an unexpected driving hazard emerges, or perhaps to never see the hazard until it’s too late. More and more studies are showing the dangers inherent with this distraction, and the hands-free phones do not appear to offer much (if any) improvement. There are more document accidents from talking on the phone than from texting, but this is likely due to the widespread use of cell phones (compared with texting.)

When teens are learning to drive, they are encouraged to put their phones in their backpacks or purses, and then place those items in the back seat. I believe we should all follow that advice. Move it to the trunk if you need to, but remove the temptation!
BOTTOM LINE: To quote a rude but accurate bumper sticker, “Shut up and DRIVE!”

Tuesday, June 8, 2010

How 'Bout a Cookie?

It's tough to say goodbye and leave your kids at camp- and you KNOW they are going to have a blast, make new friends and have wonderful new experiences. How much more difficult is it to move your parent into a senior community? Regardless of whether or not your parent is moving into a "senior retirement community" or assisted living, or even skilled nursing, you worry about them much like sending your child to kindergarten or summer camp. Who will they sit with at meals? Will the others be kind to them? Will they participate in activities?

I pray for patience, love and kindness in the heart of every person who works with our elderly. I hope they look at each resident and picture their own mom or dad in that situation.

When your parent has dementia, there is the extra pain that each day may bring a fresh volley of questions- when am I going "home"? Where am I? And the separation begins anew each time.

I wish I had many words of wisdom to impart about how to make this easier. What worked with my Mom (who had Alzheimer's) does not necessarily work with my Dad (who has Parkinson's dementia.) I do know that engaging your parent in a simple activity that still captures their attention- perhaps a Seinfeld episode, an old musical DVD, enjoying a favorite snack, or perhaps dialing an old friend for a short conversation- creates a pleasant diversion when it is time for you to leave. Most staff in memory units are skilled in these diversions. Ask them for help!

BOTTOM LINE: Just as you might with a child, be creative with diversions at the end of visits with your memory-challenged parent.

Wednesday, June 2, 2010

What's YOUR Status?

A friend shared a story today that I have heard many times before, and it bears repeating. My friend's father lives in another town. Family members have realized that he has been repeating himself a great deal, forgetting significant dates (birthdays, appointments), not paying bills and generally letting his house fall into disrepair. The family is worried about his memory. These forgetful behaviors are all new- totally out of character for this man. He went to see his doctor, and took the "mini-mental status" test, scoring nearly perfect, and so was reassured that there is no problem.

So what is the problem? The problem is that you can have fairly advanced dementia (memory loss) and STILL randomly score well on this quick memory test. Sadly, I remember that with our mom, she was still only missing a couple points when she no longer recognized that I was her daughter. The mini-mental status exam is a quick tool that is often used in the primary care setting to help us asses a patient's mental awareness and simple memory and calculating tools. If you score poorly on it, that is a huge red flag and catches our attention. The challenge for the physician is that we need to remember that this test does NOT RULE OUT dementia.

If a family is concerned and gives specific examples such as those listed above, we need to pursue further testing. In my office, that means lab work in our office a referral for full neuro-psychiatric testing.

BOTTOM LINE: A "normal" mini-mental status exam does NOT mean your memory is okay. Look at the big picture and give your doctor specific examples (write them down ahead of time) so he/she can better evaluate the seriousness of the problem.

Want to see the Mini-Mental Status test?

Tuesday, June 1, 2010 the corner of my...what was that word ?

Okay, have you ever had trouble finding a word? Or how about a name? Why did you walk in the room, anyway? Were you supposed to be checking e-mail, or did you sit down to look at your calendar? And, by the way, where the heck are the keys/remote/charger/phone??
Many of us have what we jokingly refer to as "senior moments". Something basic simply slips out of the grasp of our mind for the moment. Is it dementia? Do we have early onset Alzheimer's disease?

Let me reassure you that MOST of us do NOT. Sadly, there are a few that do. In fact, when my own Mom told me tearfully (when she was a mere 61 years old) that she and my father were concerned that she had Alzheimer's disease- I laughed. Seriously. I laughed, when indeed, I perhaps should have cried.

The truth is that my mother had several medical conditions that all could cause memory loss- and all were correctible. She had thyroid issues, B-12 deficiency, took a medication that caused memory loss and was a bit depressed. ALL of those conditions in and of themselves CAN cause memory loss sufficient enough to look like Alzheimer's disease.

The frustrating thing was that with my Mom, we were able to correct all of those issues, and yet the memory loss progressed.
If YOU have memory loss, PLEASE talk to your doctor about your symptoms. Have a physical and check blood work. Chances are good that you may simply have a medication side effect or a correctible metabolic issue. If, however, you DO have early dementia (such as Alzheimer's), starting medications sooner rather than later will absolutely slow the progression of your disease.

BOTTOM LINE: If you are having trouble with your memory, REMEMBER to schedule an appointment with your doctor TODAY!!

PS. It's the FIRST of the month! REMEMBER to change those AIR FILTERS!!!