Visiting Someone with Memory Loss

Visiting a friend or relative with memory loss can be daunting. What will you say? What if she doesn't remember you? What if he is inappropriate? If you are taking your child, will she be nervous or scared around the other residents? What about the smell? There are so many potential barriers to a simple visit.
So, take a deep breath, and relax. PLEASE GO VISIT. Period. Perhaps I should change that- exclamation point is better- GO VISIT!! Or pick up the phone, and at least call, if they are able to talk on the phone. Ultimately, that friend or relative will have a better day if you visit. Whether they can carry on a full conversation with you about your high school high jinks together or they have no clue what you are talking about, they are human, complete with the full range of emotions that we all enjoy. Sadly, loneliness and boredom often occupy much of your time when you are suffering from memory loss. People treat you differently, talking to you as if you were less intelligent or perhaps deaf. Even if you don't catch a punch line, you can share a hearty belly laugh with someone.
So, here are a few suggestions for an easier visit:
1. Bring pictures, especially of you and your friend together.
2. Use technology- iPhones, iPads, and laptops are wonderful for sharing pictures or for finding images of special places and events (think the Grand Canyon or the Olympics) to chat about.
3. Music- again, the MP3 players are terrific for finding a tune or a snippit of a song.
4. Avoid food that requires utensils, but finger foods like french fries, or a small ice cream cone can be a delight to enjoy together if conversation is a challenge. (Obviously, check with your friend's caregiver for appropriate food choices.)
5. Consider a "Sunday drive". Often folks enjoy simply getting out and about for a short car ride. Pop on the radio or seasonal music and cruise around for a half hour. Yes, this is expensive in gas dollars, but often well worth the price for the sense of "escape" from the residence.
BOTTOM LINE: Visiting someone with memory loss (dementia) need not seem so stressful- relax, smile, hug, laugh...and your friend will, too. And hopefully, when we are the one with memory loss, our friends and families will return the favor.

Simvistatin (Zocor) Warning!

Are you one of over 2 MILLION Americans who are taking Simvistatin (Zocor) 80mg to lower your cholesterol? The FDA has issued a safety announcement regarding the highest recommended dose of simvistatin, trade name Zocor. The bottom line is that the 80mg dose, has been found to have an unacceptable rate of muscle damage, especially in the first year of use. The FDA no longer recommends STARTING patients on this high dose, even those patients who are tolerating the next highest dose (40mg) but need still better improvement in their cholesterol panel. If you have been on simvistatin for more than a year and you are doing well- low "bad" cholesterol numbers and no unexplained muscle aches- then you are exempt from this rule, and may continue taking the drug at this dose (but I'd suggest you have a conversation with your doctor at your next check up.)

In the last several years, we have switched many patients to simvistatin, because frankly, it became generic and was much less expensive than its name-brand counterparts. Doses are not equal among statins- they are apples and oranges. When you switch, for example, from Rosuvastatin (Crestor) to simvistatin (whether it's name brand Zocor or generic), you will need a much higher dose of simvistatin to achieve the same effects.

The cardiology gurus push us to get those cholesterol levels lower and lower to optimally reduce risk of heart attacks and strokes. In response, we push the dose of our cholesterol lowering medications higher and higher, which obviously increases the rates of side effects. In the case of statins, the most serious side effect comes when there is muscle breakdown (myopathy) so severe that it effectively clogs up the kidneys and can throw them into frank kidney failure. This potentially fatal process is called rhabdomyolysis, "rhabdomyo" meaning skeletal muscle, and "lysis" meaning breakdown. Rhabdomyolysis is a rare dangerous side effect of ALL statins- roughly 4-5 people out of 100,000 on these drugs will be hospitalized from this problem. Unfortunately, the 80mg dose of simvistatin carries the highest risk.

Statins help reduce heart attacks and strokes, but make sure you have optimized your diet and exercise so you can be on the lowest dose that your genetics allow. My pet peeve is seeing people blame medications for bad outcomes, when behavior modification might have prevented that person from ever NEEDING the drug to begin with!

BOTTOM LINE: If you are on a statin, especially simvistatin (ZOCOR), be aware of the warning signs of dangerous side effects (unexplained tender muscles), and take ownership of your part of the cardiovascular risks of high cholesterol by eating MORE fruits and vegetables and exercising daily!

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Another Reason to Enjoy Coffee!

Okay, before my patients have a HEART ATTACK, please note that I did not say a fully leaded cup of joe! Caffeine STILL causes headaches, fatigue, insomnia, heart burn, bladder irritation and breast tenderness, BUT...

A new study shows that men with high coffee use (6 or more cups per day) have a decreased chance of getting prostate cancer- specifically in this study of 48,000 health professionals, a 20% lower risk overall of developing prostate cancer, plus a 60% lower risk of developing advanced (lethal) prostate cancer. Happily, even those who averaged a more reasonable 1-3 cups of coffee per day had a 30% lower risk of the severe prostate cancer. For the record, it made NO DIFFERENCE whether or not the coffee was DECAF or regular.

Right now, 1 in 6 men will develop prostate cancer during their lives, with the average age at diagnosis being 71. Prostate cancer is the most common cancer in men, and the second leading cause of cancer death. As such, we are always looking for something that might prevent it! We know that diets high in lycopene (from TOMATOES) may help and that overly high calcium intake may increase risk. Other supplements or dietary modification may have an effect, but the jury is still out.

BOTTOM LINE: Men, if you are already a coffee drinker, enjoy a cup or two of decaf coffee each day with the knowledge that you may be reducing your risk of serious prostate cancer!

And yes, Eddie, apparently there is a Santa Claus...

Independence Day...and When to Give t Up

If you know an aging independent-living senior, most likely his or her greatest concern is maintaining that INDEPENDENCE. In a perfect world, we would all be able to mentally and physically care for ourselves as we age. Unfortunately, especially with all the advances in medicine that prolong our lives, that is too often NOT the case.

Driving is probably the hallmark of independence. As long as we can find our keys to GET to the car, we feel a strong sense of freedom. Getting groceries, heading to a doctor's appointment, visiting a friend or attending church is simple, because we simply get in the car whenever we feel like it. No one wants to give up driving, but here are some issues to consider:
Hearing
Vision
Limited neck mobility
Slowed reflexes/stiff muscles in arms

If you have trouble hearing, you may not hear that siren or warning honk, or even the loud motorcycle approaching.
Decreased vision (think cataracts and macular degeneration)- well, this seems obvious, but you can see cars with pretty poor vision. However, you need to be able to read SIGNS, too, as well as see colors of lights.
Stiff neck? You can't turn your head to check your blind spots.
Slow or stiff muscles- you can't manuever your car quickly enough to react to sudden changes.

Please check out an earlier blog on Driving Safely while Aging Gracefully.
BOTTOM LINE: There are many options to driving yourself that do NOT involve giving up your independence. Please do NOT wait to give up or limit your driving until you've hurt your car, yourself or another person.

TVs and TIRED KIDS (and Parents)

Televisions have become so commonplace that we often barely notice their presence. Many families leave the tv on for most of the day, more like background noise than anything else. A article recently published in PEDIATRICS addresses the use of television in preschool aged kids, 3-5 years old. The roughly 600 children in the study showed an increase in sleep problems associated with evening media use (television and computers), especially when that tv was located in the child's bedroom. Additionally, the study found that watching violent programs increased sleep problems, regardless of the time of day that the program was viewed.

Interestingly, the average reported screen daily screen time was a little over an hour, with roughly 14 minutes occurring in the evening. Remember that these were 3-5 year old preschoolers, and the information was obtained from parents filling out media diaries and sleep questionnaires. If this information was accurate, then please note that even kids watching LESS than the recommended maximum of two hours per day were still affected. Nearly one in five parents reported sleep disturbance in their child. (As an aside, please note, parents, that the medical community strongly recommends NO TELEVISIONS in kids' bedrooms!)

We are learning more and more about the impact of computer screens on our brains, and consistently finding that screen evening screen use impairs the quality of sleep. For children, adolescents and adults alike, we need to go back to "the good old days" of READING or relaxing in a warm bath before bed...but remember to read from a BOOK, not an electronic reader!

BOTTOM LINE: Media screen viewing, especially in the evenings before bed, impair your quality of sleep. If you have daytime fatigue, focus on LIMITING your screen time!

FDA's New Cigarette Labels- Wonderfully GROSS!

Let's hear it for the FDA! Cigarette boxes will no longer carry the simple boxed warning that smokers have come to ignore over the last couple decades. Instead of these simple printed words, now there will be nine different graphic images with accompanying appropriate messages. "WARNING: Smoking is addictive"- showing a man smoking from the hole in his tracheotomy (a hole in the neck surgically created for patients on ventilators long term), or "WARNING: Cigarettes cause fatal lung disease" with a picture of healthy pink lungs next to horribly diseased lungs. I think my favorite, though, is the one I posted above, with the yellowed teeth and cancer sore rotting on the lip.

I believe we need to address tobacco addiction at the age and interest level of the smoker. Teens rightly aren't terribly concerned with emphysema at age 60, nor lung cancers even as early as their 40s. They MIGHT listen, however, to concerns about bad breath and yellow teeth. An older smoker, however, may believe tooth whiteners and listerine will fix any transient problems, but the threat of stroke or heart attack from tobacco-related disease might hit home.

Whatever the age, I am pleased to see new marketing strategies put in place to shake up the routine. The FDA will be rotating pictures/messages to be sure that smokers are barraged with new warnings as they begin to be desensitized to the first batch.
Smoking is VERY addictive, and I have yet to meet a smoker over the age of 30 who doesn't wish they had never picked up that first cigarette- even those who steadfastly maintain they enjoy smoking and "don't care if it kills (them)".

BOTTOM LINE: If you still smoke, PLEASE talk to your doctor and find out what options you have to help you QUIT for LIFE.

Sunscreen Labeling Update from the FDA

Hooray! The FDA issued a press release this week that will only allow sunscreen products that protect against BOTH UVA & UVB rays to be labeled as "Broad Spectrum" and they must have SPF values of 15 or higher to state that they reduce the risk of skin cancer and early aging. Previously, SPF only addressed UVB rays, which are the primary cause of sunburn. Both UVA & UVB cause skin damage and skin cancers.

Earlier this month, I blogged about "which sunscreen is best", but let me review a couple key issues. SPF- Sun Protection Factor- measures the amount of solar energy required to cause a sunburn on protected skin versus unprotected skin. While in general terms that means a sunscreen with an SPF of 30 should allow you to be in the sun for 30 times the sun exposure before causing damage, realize there are two major qualifying factors. One, the UV radiation is more intense at different times in the day. Fifteen minutes at noon may equal an hour early in the morning. Two, no sunscreen- even when applied correctly- stays fully effective more than a couple hours. What's correct application? A full OUNCE per person, applied thoroughly and reapplied every two hours. Of course, altitude, latitude, cloud coverage and skin type all factor into the degree of solar intensity required to cause damage as well. With this in mind, the FDA is additionally proposing to limit the maximum SFP to "50+" as there is no evidence to show that products with SPF's higher than 50 provide any additional protection beyond those labeled as 50.

What does all this mean for the average consumer? For now, keep reading sunscreen labels more closely, making sure that the product you are choosing protects against BOTH UVA and UVB radiation. Typically, if you look at the active ingredients and see zinc or titanium dioxide along with several other chemicals, you've got the right product. The new labeling wont be obvious on the shelves till next summer, so while this announcement is a step in the right direction, don't assume products labeled "broad spectrum" this year are truly that. Also, please don't forget about hats and protective clothing, especially if you are going to have extended time outdoors.

BOTTOM LINE: Double check your sunscreen to be sure you are protecting your skin from BOTH types of UV radiation- UVA & UVB- because they BOTH cause skin damage that can lead to skin cancers.