Friday, December 31, 2010

Happy New Year- National Alzheimer's Project Act

Well a Wish for a Healthy, Blessed and Happy and Safe New Year. God Bless All of you, Even the cool intellectual atheists, agnostics and everyone else that would have a hard time accepting the blessing.  I go to mass nearly every Sunday, I won't begin to tell you my Christmas Eve Mass Experience at Holy Rosary Cathedral In Duluth, MN. My God it makes me almost feel embarrasseabout being Catholic, the way some of these middle aged narcissisits and their offspring and their offspring's offspring, behave in church on the one day a year they actually go to mass. Makes it very miserable and difficult if you just want to pray in peace. Shameful and despicable, and I promise you I am not being vindictive. And we wonder why our children and each subsequent generation is so mean and disrespectful. I get tired of being surrounded by 45 year old adolescents sometimes.- But I guess that's what the world is amounting to.

Just a quick note on the business at hand since this is an Alzheimer's blog. So both houses of Congress passed the National Alzheimer's Project Act. So now the president has to sign it. It passed on December 15th the house and the senate, and was sent to the president Barrack Obama to sign. He has ten days to sign it and if he does not sign it, while congress is in session, it automatically becomes law in 10 days. However if congress adjourns before the 10 days, (they adjourned on December 22,) and the president does not sign it, then it is a pocket veto. Now, I am no lawyer, did not go to law school, so I am sure I am missing something in the constitution. Perhaps it is already signed by the president and no press release, doubt it. It creates more government control, basically by forming a committee, to find a cure and effective treatment for Alzheimer's. The committee consisting of lots of federal goverment officials, and private sector experts in the field, will help oversee funding alotments foer treatment and research in the field. The Act in no way alots funding for Alzhiemer's disease, jst oversees it. So with more government control and oversight, I would expect the president to sign it. On the other hand I can certinaly think of many reasons why he would not sign it. 
The head of  the consortium woul;d be the director of the health and human services, Kathryn Sebelius a lawyer, or her disignee. As you might imagine almost everyone who is affected by Alzheimer's disease, is behind this, because it brings attention to AD. That is a good thing. The Alzheimers association loves it, obviously it would or could give them the chance to maybe even move into an important and powerful role on the committee, Wonder who wants to be designee.

If Obama signs it, then it would illustrate his dedication to the elderly, the ignored and the downtrodden, those people and families  directly affected by the devastting disease. It would be counterintutitve if he did not sign it right?
I am very concerend about these congress and veto time constriants, I can't understand why the Alzhiemer's Association is not all over this, and the New York Times and everybody else. I must be missing something. These has to be some loophole, he must have lots of time to sign it right?

Thursday, December 9, 2010

Mr Joe Potocny's Book

I had the pleasure of receiving in the mail a signed copy of Mr Joe Potocny's book Living With Alzheimers' [A Conversation If You Will]. It is published by Xlibris and is 311 pages. It covers Joe's blog from September 2006 to Sept 2010. Joe has had almost 50,000 visitors to his blog and the book contains those blog entries and comments from readers over 4 years. There are hundreds of entries. It basically takes you through the life of Joe and chronicles the Alzheimer's he is living with. In addition it gives a little slice of his readers and what they are going through and how they relate to Joe's journey.  We are all fortunate that Joe put this together, as it needed to be detailed not just in the cyber web land but in good old fashioned book form. He has it available in hardbound and paperback and ebook and kindle.
It is very cool because you can pick it up and turn to any page and find a moving blog entry. Or you can read it from cover to cover or back to front. You will pick it up and get a real slice of the Alzheimer's world and learn something. And like I always say, you don't have to be affected by this or have a loved one affected to pick it up and learn something. Congratulations to Joe on a job well done. He continues to wage the war, fight the fight, and make us all aware.
Living with Alzhiemers': A Conversation If You Will

Wednesday, November 24, 2010

Thursday, November 18, 2010

Stream of Consciousness Blogging Random Musings and other useful stuff.

Tomorrow is set-up for festival of trees. We will have some helpful info from Local Chapter of Alzheimer's Association, thanks to Esther over at the Duluth office. We will also have Help info from the National Family Caregivers Association (0NFCA) thanks to Suzanne over there in the great state of Maryland. Yes I love the Crab Cakes over at Obrycki's. and the old water taxis to Fell's Point. Of course the state is not just a suburb of DC and the inner harbor, in fact the whole state is beautiful. I sure miss the crab especially since Brian Williams told us on the NBC news last night how filthy and carcinogenic the crab and all seafood is from Thailand and Viet Nam is, it makes me realize I could eat a lot more healthy in Baltimore than I could in Duluth. - probably more cheaply too.

Speaking of DC don't forget our president declared November 2010. From the White House:
Yes the President signed a proclamation.
Don't forget if I actually sell a book or two at the Duluth Junior League Festival of Trees this weekend, I will be donating some back to the NFCA.
If you actually take the time to read some of this blog over the last year, you know how skeptical I am of big government, big corporate entities, including those of all tax statuses such as no profits. (Did you ever notice how many non-profits are located in and around the beltway-why is that?)  However the NFCA really struck me as so important and meaningful and useful. It started with a real mission from real people and the beauty is, "it has not gotten to big for its britches", it really cares about a segment very often overlooked. that is the Caregiver. I very much respect them.
As far as the Alzheimer's Association, the real work still happens down at the local grassroots level and there are so many people working hard there with sometimes little day to day support and limited resources, but those local support groups make all the difference in the world. Those phone calls to the local chapter, offering information and support go so far. It is just good people working and caring down at the local chapter level. It is sort of where the "rubber meets the road". if you will.
My buddies Ken and Kathy Kollodge from the Kollodge have donated a Sunflower Photograph worth about $250 and a cubical art painting of a sunflower, (for your desk) which we will raffle off and give away Sunday to a lucky winner.
don't forget the sunflower is really important throughout history. The Aztecs sure liked it. It symbolizes many things including loyalty and wishes. I think which are extremely relevant things to the Caregiver.

In fact Ken is having an opening:
Ken Kollodge ice photographs at Art of Hair
from Duluth News Tribune:
"Ken Kollodge lived in Alaska for 30 years, and will be showing his photographs from the World Ice Art Championships in Fairbanks. Large blocks of ice were carved into sculptures, and Kollodge captured the patterns of light within the ice. They will be exhibited at the Art of Hair, 1427 London Road through December. The opening reception is 5-8 p.m. Friday."

The book tour writing blog continues. The diversity and individuality of people's blogs is quite amazing. Blogging is such a wonderful thing isn't it?

The Christmas City is the North Parade is Friday night, It is a big ole Duluth event. It is usually damn cold, but then again "the cold does not bother us" hmmm.
My little son, who is not little anymore, gets to march in the parade. He is playing sax, he generally only likes guitar and writing music, but the sax is okay. I encouraged him to take up Oboe, as I felt he needed a concert ssymphony instrument. He was okay at it, but generally ambivalent of it and suspicious as he was leery that is was too feminine of an instrument. Unfortunately the band teacher made him stay with it, as there is a paucity of oboe players in the concert band. However he has started Bassoon, which is more appealing it appears, and more masculine. with its tenor, tt is actually my favorite sounding instrument in many ways. In the end again his true love is first and only guitar.

I am still waitng for a copy of Joe Potocny's book, can't wait to read it, he is over at living with Alzheimer's blog.

Well enough stream of consciousness, if you are a caregiver, I hope you had time to read this mind idling stuff in this post and take your mind of your stress for only a couple minutes at least. I know the holidays are coming upon us and it is a particularly tough time for many caregivers, they still make me really sad in ways as I miss my parents even 25 years later.
If you are caregiving for a family member or loved one, or if you work in the caregiving world, God Bless you and as we used to say in 1974, Keep on Truckin baby.

Tuesday, November 9, 2010

Duluth Junior League Festival of Trees- Book Signing

I will be at the Junior League Annual Festival of Trees in Duluth, MN  on Saturday and Sunday November 20 and 21, all day, both days, at the DECC (Duluth Entertianment and Convention Center.) There will be a booth, with the publisher Niagara Press. There are hundreds of booths with vendors, selling everything from books to crafts and anything else might need for Christmas shopping ideas.
I will be signing and selling copies of "When Can I Go Home?"  on both days. A Portion of the proceeds will be from the book sales and will be donated to the National Family Caregivers Association. which is a very relevant organization. Check it out.
There will also be a drawing for a painting from the Kollodge Art Gallery in Duluth. Ken and Kathy are really cook people and owners of that gallery. They lived in Alaska for many years before coming down to Duluth, so they have many insights from their life experience and it shows in their work. Basically anyone that purchases a copy of "When can I Go Home?" will be entered into a free drawing to win the painting. The winner will be drawn Sunday towards the end of the Festival.
I will also have some other helpful information about Alzheimer's available at the booth from the Local Alzheimer's Association as well as the publisher Niagara Press.
There is also a On Line Auction for the Festival of Trees, with all kinds of donated items. I donated two copies of the book for this auction. The Junior League has been around for a long time and for many decades has been a leading organization in the realm of volunteerism and giving back to the community.

Sunday, October 31, 2010

Virtual Book Tour, Guest Blogging/ Author Interviews, Writer and Book Blogs

Here is a List of Writer and Book Blogs, (really cool blogs) where I will be guest blogging or interviewed  for Virtual Book Tour for "When Can I Go Home?"

1.       October 25 -
(Virtual Book Tour Cafe Feature Spotlight) Book Tour Cafe

2.       October 27 - Guest Blogging at
(Rhodes Review)

3.       November 2 - Guest Blogging at
(A Moment With Mystee)

4.       November 4 - Guest Blogging at
(Cindy Vine)

5.      November 6 - Author Interviewed at
(Written In Blood)

6.       November 8 - Author Interviewed at
(Brummet's Conscious Blog)

7.       November 10 - Guest Blogging at
(Writers Movement)

8.      November 16 - Guest Blogging at
(Ginger Simpson's "Dishin' It Out")

9.      November 18 - Guest Blogging at
(Arms of A Sister)

10.    November 22 - Author Interviewed at
(O'Neal Media Group Publicity News)

11.    November 24 - Guest Blogging at
(The writings & ramblings of a Philadelphian)

12.   November 26 - Author Interviewed at
(BK Walker's Musing of the Mind)

13.   November 30- Guest Blogging at
(Changing Face of Publishing)

14. December 2 - Guest Blogging at
(Ashley's Bookshelf)

Friday, October 29, 2010

Human Communication- Part 2 Cyber bullying, social media FB Twit Narcissist Haven?

The concept of anonymity was discussed. The lack of identity etc. You get to be whoever you want. The next major issue is how communication has changed, or lack of communication more precisely. Think about it, regardless of you religious affiliation, oh sorry Spirituality and beliefs I mean, you still have to consider human beings are mammals evolved animals. What sets us different? Opposable thumbs, of course and hence cutlery, and big old evolved brains. Huge brains with massive overgrown cerebral hemispheres, relative to everybody else in the animal kingdom. so what comes with that? Well verbal communication, It started out as eye contact then grunts and it evolved into words. Yeah we lost all the other cool senses and non-verbal communication that other animals still have with each other, instinct etc. (See "New Age Spirituality" of  the last 25 years Metaphysical or whatever it is called in 2010. you can work to get some of it back it is actually not a special gift for all the clairvoyants out there, it is actually something old humans lost hold of.)
Anyway so humans evolve, we loose our old instinctual communication, we grunt, we speak we make up languages, lots of them, based on where we are geographically, sort of still around, global neighborhood etc, based on who invaded who, I mean why don't the British speak French as primary language. (Rhetorical).
Then you throw in the opposable thumbs, and we start drawing on Cave walls and we get symbols and signs. We can draw. We start to draw lots of symbols and make up symbols for those grunts that are now words. Verbal and now written language. We communicate through it.
The original verbal language of humans was very intimate. It was all about eye contact and gestures, just slightly beyond the other animals.  you had to be in the same cave or vicinity to communicate. you knew where you stood.
The written stone tablets changed everything, you did not need to be in the vicinity of the person to communicate. Throw in ink and paper over the centuries, and finally the printing press. Communication became more massive, and less intimate. And nothing much went on for a few hundred years.
Then very recently, (relatively speaking to how long humans have been on earth)  just the last two centuries or so, all hell broke loose. The telegraph, early 1800's really brought out the immediacy of remote communication. Then of course the phone, TV and radio, in only the last century.
The telegraph brought in immediacy but not intimacy. no eye contact, no inflection. soon the phone brought even more immediacy and a strange new  pseudo-intimacy. Inflection, and voice but remoreness. No facial expression, no smells, no gestures. But lots of auditory.
TV really revolutionized the pseudo-intimacy. Now lots of one way communication, with two dimensional visual. and lots of sound. in your home no less, but still not real communication at least in a truly intimated two way human form. You can't bully someone through the TV, but you sure can demonstrate lots of it, even in high def now.
interestingly, people used to harass and beat the hell out of people over the phone, crank calls, etc. Just as the Internet, was taking off, some genius thought of caller ID and *69, and all of a sudden no more anonymous terroristic threats, people stopped playing games and harassing each other in that way.
Then emerged the Internet and simultaneously cell phones they sort of became the same thing as far as cyberbullying is concerned.
It was great we got rid of those clunky typewriters. Printers got better. We all learned how to type, if we hadn't in high school, except, the darn keyboard lingered as a remnant of the old typewriter. Now emerges the touch screens.  Smart boards etc. Thank God for modern technology right.
The anonymity is back with the Internet, you really have no idea whom you are talking to or listening to. Sorry but you don't. Of course now we have the crude innovation of skype, That of course will only get more perfected, but it will still only be two dimensional, no smell, no touch, until we can do molecular transport like Star Trek.
So now we communicate with the Internet. At work we email somebody across the hall. Parents and kids text each other in the next room. Why is that? Because it is a lot of work to communicate with someone face to face, and we as a society have started to develop a distinct anxiety about it.
Probably as a society the only thing we are more phobic about than direct face to face communication and intimacy. We are probably lazier than ever as a society. Think about it video-conferencing has taken off V-tel and all that, but it will never take off as it could have by now at least in the workplace.
We will always go for real life face to face meeting, if it involves excessive travel, why my God we can't do a video conference for that, we have to go for London for  five days for that one hour meeting. Because when you are traveling you get to get out of doing actual work, and still get to do all the self-aggrandizing- you know the type, always busy, gotta be somewhere. Check any airport.

The bottom line in communication is that it isn't what you say,  it's how you say it. Or at least that is 50% of human communication. At least that is what I have told students and anyone else who wants to know the art of developing an empathic connection with a patient.
Eye contact, inflection, volume, gestures, body posture that is 50% of human communication.pauses, facial expression. We call these non-verbal forms of communication but in reality human communication is one entity, and those are all components of it. Anything less than that is slightly less than human, say something like the Internet and social media for example.  We don't call it less than human communication though we call it virtual. But face it, when something is slightly less human isn't it easy to behave in a less than decent human fashion say cyberbullying?

Monday, October 18, 2010

Guest Blogger from Isabel at Enduring Care

Here is a post from my fellow blogger and Caregiver Isabel. She has a great blog called Enduring Care and knows firsthand about caring for a family member with AD. She is a excellent writer and captures the essence of all this stuff, you will see what I mean......

Living in the Age of Instant (Non)Medical Diagnoses
In the millennium, televised medicine is all the rage. Colonoscopies are performed before a live, gasping audience, staged for national television. Patients are being encouraged to second-guess our physicians. Everyone, it seems, is a wannabe physician.
The old, “everyone wants to be a comedian” should be updated in the millennium to: “Everyone is an unlicensed medical diagnostician.”
Even in the days of “Dr. Ben Casey’s” fictional character on television, tv “medicine” realistically took longer than today’s “Hollywood-style” camera-ready medical practice. Plastic surgery? No problem! Aging? “Fuhgged-about-it,” as my New York City Italian friends love to say.
Our millennial medical madness trend is evident to me in a number of areas, including Alzheimer’s and dementia lay-diagnoses. Lost your keys? Alzheimer’s! Tired and at a loss for words? Dementia! “Ask your doctor about Aricept” for the treatment of Alzheimer’s disease “symptoms,” is the overarching message of one long-running millennial tv commercial. Piece of cake diagnoses and medical treatment await you and me, should we be so na├»vely inclined.
In my younger years, I believe we called such thinking hypochondria. Back then, no reasonable person ever dared mention or conjure up chronic diseases, lest the individual were to tempt the universe to rain down illness in one’s life. Back then, hypochondriac thinking was frowned upon, or laughed out of town. In the millennium, we encourage and celebrate hypochondriac tendencies, more so about perceived or imagined Alzheimer’s and dementia symptoms. Some folks see Alzheimer’s at every turn – more so in the lives of others!
Dr. Sivak’s blog, Differences Between Delirium, Depression, Dementia, Delusions, Alzheimer’s, is a good read if any layperson feels a sudden urge to non-medically diagnose another individual’s “symptoms” as Alzheimer’s and/or dementia.
Cultural Perspectives on Alzheimer’s
I am part of the (Baby Boomer) generation that grew up accepting the generic use of the word “senility.” Back then, the word “senility” was used regularly by adults to define perceived “symptoms” of aging in some elders who displayed episodic or persistent memory loss, wandering behaviors, and, mental confusion such as currently associated with Alzheimer’s and dementia.
Oddly, although we were less medically enlightened in the 1960’s and 1970’s than we are today, many “senile” elders were not socially hidden by their families. Many families with “senile” elders revered their elders and taught their boomer offspring to do the same.
One of my childhood friend’s grandfather was “senile.” “Gramps” once walked half-mile, got on a bus, and wandered off – albeit in a kinder, gentler world. An entire community was on the lookout for “Gramps.”
“Gramps” was given a ride back home near dusk, when someone spotted him at the end of the bus line, confused, in a city more than 15 miles away. When “Gramps” was safely back at home, my friends and I asked him where he’d been. We listened to his sharing and laughed when he laughed. “Gramps” was physically fit, cheerful, otherwise seemed to be in good health, albeit cognitively lost quite often. Gramps died in his 90’s, in his adult daughter’s home, surrounded by his grandchildren, neighbors who’d looked out for him, and, other loved ones.
Medical Advances in Alzheimer’s Treatment and the Great Social Divide
Social progress is a funny thing. Are individuals who have been medically diagnosed with Alzheimer’s in the millennium, more, or less, socially visible than those in Gramps’ generation? You decide.
How far have we come in our public perceptions of Alzheimer’s?
·        Public education and awareness may be at all-time highs, yet, there are some communities that have yet to realize that Alzheimer’s disease is fatal. Might some individuals be in social denial?
·        Whether due to social over-simplification of symptoms or over-use of medical terminology by laypersons, there is some tunnel-vision in recognizing possible symptoms of Alzheimer’s and related brain diseases. Some individuals pounce at “senior moments” of lost keys or forgetting the day of the week as “evidence” of Alzheimer’s or dementia, while missing the medical forest for the laypersons’ trees.
·        Some may view the lack of a cure for Alzheimer’s as the final word. “Senility” happens, and there is no cure, so why bother, may be the prevailing thought for some individuals.
Regardless of how far we may have come, some individuals may still be circling the wagons.  Dr. Sivak’s blog says it all for me: “Lots of D’s to differentiate.” While we’re at the letter d, please talk to your doctor. This is not your grandfather’s generation. It’s the millennium.
There are medical treatments that have been proven to slow the progress of cognitive decline. Aren’t you the least bit interested in hearing?


Saturday, October 16, 2010

cyberbullying, social media, facebook, twitter, a haven for narcissists? part 1

So what is all this cyberbullying really about? Has it always been there, the concept of bullying that is and now there is just another really convenient outlet in social media? Is it getting worse? Have teenagers always been attempting and committing suicide because of the vile ways they are treated by other young adults? Are we just more aware of it? Is it just in our faces more because of the instantaneous virtual connection and immediacy of the Internet?
There are so many frameworks to understand it, yet it is still not understood well, we know it is bad, but we don't know how to really stop it as a society. There are maybe three things to think about in terms of this whole problem. The concept of anonymity, communication, and narcissism.
Think about it, you really have no idea on social media outlets,  on the Internet for that matter exactly whom you are communication with through the concept of electronic printed word, that's why it is called VIRTUAL. With the concept of true anonymity, anyone can be anything and anyone they want. It is amazing how many people lie about who they are and what they are, but that was happening long before the Internet, but I think it is safe to say the Internet really propelled that pathology forward by light years in just a couple decades. Why would someone do that?
Well we like to think a person just feels bad about themselves, low self-esteem, etc etc, yes that is true, that why people brag and boast. But it is deeper than the everpresent low self esteem. The reason the self esteem is low and the person is constantly lying trying to reinvent themselves, it isn't low self esteem, it is more that there is really nothing there on the inside at all, a big hole of emptiness in ones sense of self. The sense of self is a big lofty concept, but it also sounds quite simple. It is our sense of reality of ourselves and the world around us. It is our sense of who and how and what we are in the world and how the rest of the world (people) relates to us. That is our so called "ego-strength". The more developed ones ego strength the better they can cope relate and navigate through the world. Now when someones ego is developed in a healthy way, it gets really sophisticated in that when that is developed the next thing that develops is a sense of right and wrong, in reference to the world and others. Unless you have a true sense of self, a sense of right and wrong the so called "super-ego" can't really develop. How we relate to others in the world is our so called "object relations". Pretty much all these things start to develop and build upon one another from the time a person is coming out of the womb. an infant has no sense of self, they pretty much think the mother and they are the same thing for the first few months of life. no separation, no boundary. Pretty much everyone figures out they are a separate entity, right. To psychologically separate is a lot harder and a longer process through the early years.
What does all this have to do with the anonymity of the Internet and social media and cyberbullying and teens? Well the teenager struggles with their identity, their ego there sensee of self. They learn to think abstractly,  they have to figure out how to go from childhood to adulthood. The have to figure out how to use their super-ego (The sense of right and wrong) if they ever developed it ( comes FROM the PARENTS) to get through the world. Every teen struggles with identity and sense of self, it is a growing period. It is all based upon how things went in those first ten or twelve years of life.
We hear the old adage"he is she is basically a good kid- he or she just got into the wrong crowd" Well hears news, Every kid is basically a good kid, no one ever asked to be born right?
so since every teen struggle with their sense of self and identify, isn't it cool to have the Internet and facebook and YouTube and myspace and this and that and the other thing to help facilitate that? You can be whoever you want, who cares, it's really right? Well virtually anyway.
you could see how the anonymity and the flip side of the coin VIRTUAL INTIMACY and connection really helps the old psychological developmental process along in the teenage years.  Oh and it is really immediate and convenient too. But it is just you and your computer, or laptop of iPhone or whatever, and you are pretty much cut of from developing and sense of object relations or really how to get along or connect with other people when it is so important to refine in those developmentally turbulent adolescent years. Just the kid and his keyboard hmmm, sounds pretty powerful and omnipotent doesn't it. Well at least virtually. Hmm with that in place why would there not be cyberbullying? Throw in the communication issue, (the only form of human connection be it physical, spiritual, intellectual, or virtual communication it is connection, but what about virtual?

NB: when I use the term omnipotence or all powerful, (sitting at the keyboard), it may be derived from then anonymity, or that bubble or shell around the person, it is the same concept as why some people are outrageously aggressive people when they drive, Road rage etc. There is a false sense of power and security being in a car and as such the keyboard and the Internet.

Wednesday, October 13, 2010

antidepressants and suicide

Popular hype. do they increase risk of suicide? Not a new concept, been around since antidepressants were around. Yet some seem to find antidepressants more sinister than depression, schizophrenia, ptsd, hmmm they all have an increased risk of suicide right. Generally untreated mental illness can have a fatal outcome. Sometimes it is just really debilitating, and causes a lot of suffering.
so we have mixed reviews on antidepressants, some studies showing a slight increase in suicidal risk when on these meds.
Here is a fact, meds are not there to hurt people or make them worse or make somebody kill themselves.
There is very little data on if and how many lives antidepressants save. I mean think about it, how can we really research that.
Not to mention the fact that there is more media hype on the dangers of antidepressants than on the fact that alcohol is associated with most completed suicides.
So the meds prescribed by doctors to actually prevent suicide may increase the risk, even a little bit?
First of all if they were truly dangerous, would not your wonderful Federal Government that we all know love and trust pull them from the market??
Lets say you are a liberal and you love big government, you have a nice 401k and cheap or free health insurance, you have enough money to afford to be liberal, generally speaking, you by default hate doctors, are suspicious and mistrusting of them and perceived authority and you really groove on the concept of these meds being dangerous prescribed by mean non-caring doctors, okay fine, but you love government, and generally vote in the direction of bigger government. If that was the case, think about it, WOULDN'T THE GOVERNMENT PULL THESE MEDS OFF THE MARKET IF THEY WERE TRULY DANGEROUS???? oh sorry I forgot it is the big bad drug companies that are out of control, and the government just has to control them better?
Well you see all the political issues involved here.
Anyways, since the government put out stern warnings on suicide risk of these meds in people under say 24 years old, it scared the hell out of doctors and the teen suicide rate has been climbing ever since. SAD. Doctors afraid to treat, afraid of getting blamed and sued? Maybe who knows.
What is known clinically and generally still accepted is this, when you start and antidepressant the vegetative signs of depression improve before the cognitive signs. Generally in the first couple weeks.
This means a person with depression responding to antidepressants gets their energy back before there sad hopeless suicidal thinking improves. So they actually get enough energy in those first few weeks,  to kill themselves. A risky time. Not new, been around and clinically known like forever, The patient must be monitored closely in those first few weeks. Something your health care reform does not like much. The suicidal thinking does improve for many, if not most people that are depressed and get adequately treated. That is assuming you have the CORRECT diagnosis of major depression , the person is sober, and actually following a treatment plan prescribed, hopefully by a physician. It also helps for the person suffering to have a decent psychotherapist,  that does not have a chip on their shoulder about meds and psychiatry, and actually some understanding of the expectations and limitations of meds, and not just what they read on the internet or heard on TV. See my earlier blogs.
What if these meds really were meant to help people, actually saved some lives, and were prescribed by doctors who knew how to diagnose and treat and had their patients best interest at heart and were trying to help them because that was their profession and their vocation and that's what they do all day? That is just no fun to believe? Or we actually know better than that, cause we do.
I just wish we did not want to have are cake and eat it too. If we could just take these medications seriously for a minute, we devalue them, yet evetrybody wants to prescribe them with a minimal amount of training. So which is it? And yes we all know many terrible stories, of the bad med and the bad doctor and the terrible things that happened because of the meds. There are 100 of those stories to one, wear somone actually is allowed to speak out on how medicaiton actually helped them.
And no meds are not the panacea. no one is saying that. Frankly they have profound limitations but they actually do save lives whether we want to admit that part or not.

Friday, October 8, 2010

Some things you may not know about antidepressants.

Antidepressants have been around for fifty years. The first one was imipramine. How they work on the brain and central nervous system has not really evolved  much over the last fifty years. Our understanding of why and how they work has evolved, and the bottom line is we still don't know exactly why or how they work. They tend to effect neurotransmitters in the brain, that is the chemical connections between nerves. The three big neurotransmitter we know the most about are serotonin, norepinepherine and dopamine. The old and most of the newer antidepressants inhibit reuptake of these neurotransmitters into the pre-synaptic nerve. The original theory on why they work was related to the fact that you kept more serotonin or norepi around and this somehow helped treat depression.
Then in the 80's, 90's and into this century more attention was paid to the area on the nerve cell where these chemicals bind to. The so-called synaptic neuroreceptor.
For a long time it was felt that because you kept more of the neurochemcial around and it moved forward from the presynaptic to post synaptic nerve site, that somehow the neurorepceptors got desensitized or "downregulated".
Over the last 10 years the theory has evolved even more as to why these things work to treat depression and many anxiety disorders.
Now the science has led us to believe that the binding of the neurochemical (caused by keeping more of the chemical around) cause changes within nerve cell and somehow this affects the genetic coding of proteins within the cell, (remember RNA and DNA?) and somehow this causes an uptick or a positive swing in encoding for proteins within the cell that help protect the cell and treat the depression or anxiety problem.
The theory continues to evolve.
Some other facts- most antidepressants are prescribed by primary care physicians, internists, obgyns, and even pediatricians. Yes psychiatrists prescribe them all the time, but there are a lot less psychiatrists, and in terms of total volume of scripts, more come from primary care.
For many reasons, culturally speaking, it is much more socially acceptable to be depressed now. We are more open to talking about it and being aware of it. Depression is still debilitating and potentially fatal and we have a long way to go. Primary cares screen for it better now.
Within the demise and so called restructuring of the health care system in this country, there is much buzz and initiatives to screen earlier, treat and be aware of depression and its consequences.
The problem is now in screening for it, there is a tendancy to diagnose most mental health problems and simplify them simply into depression. The screenings will pick up symptoms of depression, but often not the specific and primary mental health problem. for examply Bipolar disorder (horribly misdiagnosed) and often missed and PTSD or post traumatic stress disorder, to name just a couple.
There are a whole host of antidepressants out there, the SSRI's which were developed back starting in the 80's with prozac, then in the 90's and into this century. Zoloft, Paxil, Luvox, Celexa and Lexapro.
The SNRI's which stands for selective noradrenergic serotinergic reuptak inhibitors, Effexor, Cymbalta, Pristiq. Basically these work pretty similarly to the old imipramines and elavils of the 60's and 70's, with a couple huge differences. The newer ones have way less side effects, and they are not so lethal alone in overdose. They are also felt to be more effective by many, compared to the old ones, -which may be a product of the fact that they are eaiser to take and tolerate and stay on since the side effects are better. The key to antidepressants working, is staying on the meds. They don't work if you don't take them.
Antidepressants have been used to treat chronic pain almost for thirty years. It was generally off label meaning the FDA did not approve or recognize these things in use for chronic pain. Then the popular media campaign came that "depression hurts" and cymbalta being approved for various pain problems a few years ago. Sometimes they really work well and sometimes not for chronic pain.
You do get more physical aches and pains and such if you are depressed. That is not new and has been known like forever in the medical world, well at least the psychiatric medical world.
Antidepressants are not there to hurt a patient or make them worse, and they do save lives. We are taught as a society to be afraid of them, suspicious of them and wary of them. Popular culture and media and the government regulation and subsequent media fiascos make this worse.
Conversely we are also taught and expect that these meds are a panacea, a cure a fix it all for all of our emotional and psyhoclogical pains. That simply isn't true. But with those two polar ends of the spectrum suspicion, fear,  and an attitude of this "should fix everything', you have the perfect storm.
There are many other antidepressants out there I did not mention, so that block certain receptor sites like Remeron and Serzone and Trazedone. They have also been around for years. Wellbitrin tends to block reuptake of dopamine and norepi. Some people generally like Wellbutrin becouse it does not affect weight gain like some of the others can. It sometimes does not work so well for anxiety symtoms often associated with depression.
There is a ton of information on antidepressants on the Internet. We tend to love the devaluation of them, and when we find a negative article on them we like to say "Aha I knew it" as if they are bad and there is some awful conspiracy. Some psychiatrists have even made a cool name for themselves in devaluing them. Very politically correct. We also tend to devalue them in this way:
Think about it: the average family doctor has a few weeks of training in psychiatry but they prescribe the most antidepressants.  Non-physicians prescribe them- nurses practicioners, in most states and also psychologists want to prescribe them and in a couple states they are actually legally allowed to.
 We convince ourselves that is all okay. It is not. This comes from the shortage of psychiatrists. Most doctors don't want to go into psychiatry. For a lot of reasons. It is very little pay compared to most medical specialties, with health care reform that will only get worse. Also people don't always get better, it takes a long time and a lot of psychiatric problems tend to be chronic and recurring.
so you will see more unqualified and marginally qualified people prescribing and treating psych disorders.
The sell-out blogs jump on the politically correct bandwagon of supporting psychologists and the so-called mid-level practitioners, prescribing, as well as non-psychiatric physician. With that comes an underlying devaluation of psychiatry in general. You are not allowed in this day and age to even consider that maybe a specialist in psychiatry should be treating many psych problems out there. That is so politically incorrect, you get lambasted and you are very unpopular, so most doctors can't even speak up any more. It is just the way the world is. But with the sort of disdainful reduced attitude towards psychiatry and mental health issues in general, and the lack of accurate information that is truly disseminated, it is easy to see why we are so wary of psych treatment.
Before I get hate mail yes there are good nurse practicioners out there, just like there are good physicians out there.
Generally the popular buzz is "doctors don't talk to their patients, but nurses do". I am sure that is true in some case, but we like to convince ourselves that this is the norm. It is probably going to get worse with health care reform.
Antidepressants are used in Alzheimer's, People with AD can get depressed, it make the AD worse. They often can't articulate it to us, becouse of the dementia, so it is often overlooked. You generally have to use much smalled doses of antidepressants in the elderly (like any med) sometimes if not carefully prescribed or prescribed wrong they can make things worse, and if diangosed right and carefully monitored they can help tremendously.
There is much more to talk about with antidepressants, the suicide issue (horribly misunderstood) side effects, target effects, (what they are actually supposed to do. All of the natural remedies, (chemicals also like the meds) they are a financial; boom to many and severly unregulated, but as a fairly uninformed society or shall I say misinformed, if we hear the world "Natural" we are profoundly reassured.  Stay tuned.

Friday, September 24, 2010

Differences Between Delirium, Depression Dementia, Delusions, Alzheimer's

Lots of D's to differentiate.
Alzheimer's disease is one form or type of dementia. The most common form or type of dementia. Dementia is the loss of cognitive ability. A global generic term. There are many other causes of dementia besides the most common Alzheimer's disease. Lewy body dementia, Vascular dementia, traumatic brain injury induced, to name a couple.
The different forms of dementia may look slightly different in their clinical symptoms and presentation and progression.
Dementia is a chronic problem it is typically slow and often progressive.
Delirium is way different. A delirium is an acute confusional state, or an encephalopathy. It generally comes in pretty quickly, hence the term "acute". There is always a cause for delirium. It may be a metabolic problem, eg. not enough oxygen to the brain or too much carbon dioxide, such as someone with really bad lung or heart disease, or a metabolic problem, someones sodium for example is too high or low, or a toxicity, such as illicit drugs or drug withdrawal, alcohol withdrawal is a common cause. A severe infection with for example a high fever is another cause.
Delirium is always a medical emergency. It can have a high death rate up to 25% or more, especially if not treated.  Usually it is very treatable, the issue is diagnosing it and finding the cause. 
Often it is mistaken for a psychiatric problem. A common symptom is visual hallucinations, seeing things, example bugs crawling on the wall. Sometimes there are tactile hallucinations, feeling things that are not there, such as bugs crawling on one's skin. These kind of hallucinations usually again indicate an "organic" or medical reason and problem.
A person can get extremely agitated in delirium, bizarre, violent aggressive behavior, it often gets worse at night and fluctuates over the course of the day. Sundowning is a term that has been associated with delirium.
A person with dementia can get agitated and worse at night. We also associate the term sundowning with Alzheimer's also, or more agitation at night. Wandering about etc.
A person with dementia can also develop a delirium on top of that. A common cause for example is a person that has Alzheimer's dementia and develops a urinary tract infection, or a metabolic imbalance.
That is where it gets more difficult to diagnose. Usually there is more of an acute change in the persons behavior, a significant worsening or change over hours or a few days.
One of the key things in telling the difference between delirium and dementia is that a person's level of consciousness fluctuates in delirium. They are in and out of consciousness, from awake and alert to sleepy somnolent, to hyperalert and agitated. Sometimes they are difficult to wake up, and may go from sound asleep and difficult to rouse to extremely agitated in a matter of seconds.
A person with dementia typically will not go in and out of consciousness so abruptly. They will be awake and alert, maybe completely impaired with memory, concentration, orientation, but they will be alert.
Another key thing is since delirium is a medical or organic problem, a person with have "autonomic fluctuations"  This means there vital signs will fluctuate a lot over the course of the day. Remember it is a medical problem. So their blood pressure may go up and down they may have fevers that come and go, pulse rate may fluctuate. In someone with dementia only, you would not see much fluctuation in vital signs on a daily basis. But if they are not checked you would not know.
It is something a doctor (or medical provider) really needs to diagnose and find the cause of and treat.
As I have stated ion previous blog posts auditory hallucinations are typically associated with a psychiatric disorder, that is "hearing voices" of people that are not there. Unfortunately visual versus auditory hallucinations are not always distinguished by medical people outside of the psychiatric realm of specialists. Hence you can see another reason why it gets confusing.
Delusions are a symptom of psychosis. They are false ideas or beliefs. They can be of different types. Paranoid- eg "aliens planted a computer in my brain" or Ssomatic (physical) there are snakes in my belly eating my insides" Delusions are typically asassociated with a psychiatric disorder, such as schizophrenia, they are fixed and ongoing, however they can also develop in someone with dementia. And in fact are not uncommon as Alzheimer's disease progresses.
Delusions can also be seen in a delirium, but there are so many other things going on when a person has a delirium a fixed delusional belief is usually not a paramount symptom, since the whole medical problem is quickly developing and acute.
The paranoia associtated with for example Alzheimer's is a little bit different say than someone with schizophrenia. The false beliefs in dementia, may be more variable, and less fixed and tend to come and go, more than in a functional psychiatric disease.
but the issue of delusional beliefs is one of those quandaries that makes everyone ask is Alzheimer's a medical or a psychiatric problem (see previous posts).
The delusional material is often treated with anti-psychotics, it may not completely go away, but the person tends to be much less obsessed concerned with or likely to act on their delusional beliefs if they are treated. We then run into all the problems and well publicized issues with antipsychoitcs and the warnings in the elderly etc. (see previous posts).
Hallucinations are also treated with antipsychotics, they are not quite so common in dementia but certainly can and do occur, maybe not as often as delusional beliefs though.
you would not want to start treating visual hallucinations without simultaneously find the cause of any delirium. Auditory again are more common in psychiatric disorders, and it is less likely to find a delirium or medical cause, so the hallucinations are treated there also, and often respond quite well to antipsychoitc meds.
Depression is a psychiatric disorder, that is now more openly talked about over the last 15 years or so, so it has made its way into the mainstream of primary care and is regularly more screened for in general medicine, It is much more socially acceptable to talk about depression. Depression can have a high morbidity- loss of job, divorce, substance abuse) and be fatal for example by suicide if it is not treated. 
Persons with dementia can also develop depression, but often unlike someone without dementia they can't necessarily tell us about it or how bad they fell because they are already cognitively impaired.
Here is where it gets even more tricky. Back in the day not so long ago, there used to be a common term called "pseudo-dementia". It was associated with depression. In fact it still is, but the term is no vogue anymore. Probably too confusing for everyone. Here's what it means- a person with depression has lots of symptoms- sad, hopeless, helpless, suicidal, insomnia, low energy, weight loss, for example to name a few, but a person suffering from major depression can also be cognitively slowed. They can be sluggish in memory and thinking. It can be mistaken for dementia,
As a person ages they are at increased risk for developing Alzheimer's, but if they are depressed and have absolutely no dementia, they may still have cognitive slowing from the depression and be misdiagnosed with dementia. IT HAPPENS A LOT. With the health care debacle it will happen even more as we will tend to want to diagnose ourselves or have our friends do it. This is why a medical work-up and psychiatric work up and evaluation is so important.
With health care rationing already here, I am very fearful that there will be many people misdiagnosed or simply not treated. People with Alzheimer's being misdiagnosed with depression and vice versa
Now one final problem, a person can have Alzheimer's disease brewing and depression at the same time. In fact depression can be the first sign of Alzheimer's. The diagnosis of one or both has to be made and differentiated by a medical professional. untreated depression can make the Alzheimer's worse.

Monday, September 20, 2010

The Double Whammy

Most of my posts in the past have been about my dad and his battle with dementia but today going to talk about my mom. We have known that my mother has been having some memory problems herself, dating back for the last 1.5 to 2 years, roughly. So, in August, we took my mom in for a neuropsychological evaluation. The results came back with a dementia diagnosis, significant cognitive impairment, likely Alzheimers type dementia. So, mom and dad, ages 70 and 72, both have dementia. The double whammy. We have now started mom on the same memory medications that my dad has been on, so hopefully that will slows things down. But the whole situation remains very difficult for me to wrap my mind around.

Another thing that has occurred to me recently is the number of head injuries my dad may have had during his lifetime. He played a lot of football during an era of thin leather helmets, and his occupation left him open to physical injuries. I can remember his head being cut or bloodied many times. He also rode motorcycles and for a while semi-pro, he once had a wreck in which his jaw was broken and his teeth had to be wired shut for several weeks. Leaves me wondering how much of this accumulated history may be impacting his current condition.

The other news is that we have moved my folks to a new assisted living/dementia care home. The place is significantly nicer and we hope that they will be much more comfortable there.

Thanks be to God....JP

Tuesday, September 14, 2010

As The Present Fades

I am still amazed at this point that I can still converse with you and tell you how things are going in my journey or battle if you will. In the beginning and still now i am prepared for the mental walkings and goings but I was never prepaired for the physical problems.  Walking with a swagger, actually kind of a stumble and hunched, feeling icky most of the time, getting exttermely upset around people and sweaty like a pig, shaking like i do, not able to hold things all the time, just not ready for this crap.

I find my world in fading in and out now. I recognize family and people and suddenly they start to become someone else. Same person standing there but my brain seems to switch off and step back and say who the fuck is that. I am finding this to be happening more and more, I feel like i am fading away from Joe and going somewhere and I cannot stop it anylonger. I really wish I would hear from others in this world of mine and what they are going through and how they feel. It is really a lonely place, yes I have people around me that care and help, not the same, they are not here with me, in my reality such as it is.

I must go now my mind is confused and i am getting very angry.

God Bless You & This Country of Ours!

PS.  Hi Doc, this is from my blog today, love you my friend.

Friday, September 10, 2010


Well it is back to school time. N Minnesota saw a really hot summer. On the Western Terminus of Lake Superior it gets hot a few times every summer, up around 90 degrees. But it only lasts a few days here and there. This summer it was hot in the 80's for days on end, sometimes for weeks at a time. By American standards that is not really much, considering how warm it gets in other parts of the country. Right after labor day, it was like instant fall. Now it gets cold for the next 10 months. The temperature correlates with peoples attitudes. I mean the cold grates on you, I don't know how Canadians do it. Yes you can always wear three coats, bu t it still wears you out spiritually. Most people that live in the cold, pretend it does not bother them, or they are not even aware how it affects them. We like to think about the daylight, and seasonal affective disorder, and the pineal gland and melatonin and all that fun stuff, that has modest scientific review. Yes it does exist, but nobody really considers the cold.
Well we will try avoiding using the furnace for as long as possible. Hopefully can get another month in.
Lots of unhappy anniversary dates in September. It is exactly 10 years ago September 10, since I ruptured my Achilles tendon, simply paying tennis. That seemed to take forever to get better. Then on September 12th it will be exactly one year ago since I broke my face in three places falling off a scooter. See old blogs, hard to believe this blog has been up for over a year already. My face still hurts. I still don't know how I went back to work in a week back then , if only out of necessity.
Then a few months ago in going through my mother's old scrap book, I found out it was September 10th 1933, when she was in a tragic car accident. She was 16 and sustained a fractured skull. Interestingly she was back to school in a couple week after being in a coma. See old blogs about head injuries and development of Alzheimer's.
Then of course we have 9/11 for all Americans, 9 years and we all remember what we were doing when we heard, I know I do.
On the good side of September we have the start of football season. Nice night for the Saints and the city of New Orleans last night and not too good for local fans around here as the Vikes take a hit.
Well as the seasons continue to fly by, take care of yourselves, as a caregiver you still get to be human. Remember the day is only 24 hours, unlike the legendary Alzheimer's book says, you will all make it. The days grow shorter now, except for our friends in Australia and N Zed. If you live in a place where the leaves change, get out and take a serious walk over the next month and enjoy it. If you can take your loved one with you safely, then go for it, or just go for a drive. Everyone likes to go for a ride. The kids, the dog, people with AD. Where I live interestingly it goes from green to white. In other words sometimes it snows before the maple trees even turn yellow and orange or think about loosing their leaves. But time keeps marching on.

Friday, September 3, 2010

Alzheimer's and old memories, memory loss, long term memory preservation

One of the important aspects about Alzheimer's disease and memory loss is the fact that the last part of the memory to decline is the long term memory. In other words your loved one will not remember very recent things,, from the here and now, what they ate for dinner four hours ago for example, but they will remember stuff from forty or fifty years ago quite clearly. Sometimes they can remember events from the 1950's or 60's like it was yesterday. There is trouble storing new and recent memories, but the old ones last a really long time in the disease process. It is just the nature of how the disease process works.
They might not know who the current president is, but they might remember some interesting things about JFK or the moon landing or even Pearl Harbor if they are old enough.
You might use this to connect with your loved one. Music is a wonderful area where long term memory is preserved, and it generally calms the mind and soul to hear music "from our time".
Old photographs also can sometimes stimulate mood, memory and the spirit.
It is a strange thing for people to see and observe sometimes, how can you not remember what day it is or what month, but you can tell me the name of your third grade teacher?
Ultimately the long term memories will also decline as the disease progresses, but use them while you have them. It is freeing and a wonderful way to connect. Don't worry if the old memories are not exactly accurate, just connect to your loved one through them.
You might even learn something historical and interesting that you never would have known had you not tried.

Sunday, August 22, 2010

The Author's Show- Tuesday August 24th all day

I will be on the Author's Show This Tuesday August 24th.
Interview with Don McCauly

Click on The Link Below to Listen:

The Author's Show Internet Radio Program

Sorry link works now.

Friday, August 20, 2010

Is Alzheimer's a mental illness ????

This seems to be such a common question and issue. Everyone wants to know the answer. I have blogged about this in the past, but the question still comes up all the time. If it is not a mental illness does that make it better? If it is a mental illness, well does that somehow make it worse? Does it make AD less real if it is a mental illness.

When my mother developed AD, it was so shocking, so furious, so heart-breaking, I don't remember ever really pondering that question, because I was so overwhelmed, so bewildered, my head was spinning. Being seventeen at the time, it felt like I had a million things on my mind already. The whole process was like a waking dream.

My book "When Can I Go Home?" speaks to that waking dream. It also speaks to the process of me becoming a doctor and a psychiatrist- much of that process happened while she was dying from the disease.
For me a related question is, did I ultimately choose psychiatry as a specialty, because my mother had AD, and she had it long before I was anywhere near going to medical school.

I mean I could have entered and specialty right? God knows my life would have been a lot different if I had. Life would have been a lot less of a financial struggle, I would not have faced so much disdain and prejudice, because of the horrible stigma we place on mental illness. That stigma is why the question of AD being a mental illness is so important and why we place so much emphasis on it.

People with mental illness face it every day. It is parallel in my world. Let me explain what it is like. For so many people there is something uncomfortable, disquieting, "icky" about being a psychiatrist and mental illness in general. When someone learns a person is a physician, it immediately conjures up biases, stereotypes, preconceived notions. People might think you are smart, hard working, or a weasel, that your are no better than them, and all the usual chip-on-the-shoulder things and biases we have about physicians. Some still respect you as a person more than if you were not a physician.

But as soon as you advise your are a psychiatrist, my God, do peoples' expressions change. Many people get that "icky" disquieting feeling. They are also let down in some fashion. The ideal of a physician and all the underpinnings is gone. "Not the same as a real doctor"

Why do we consider the whole concept of mental illness as something subhuman, something more related to morality than a clinical manifestation? In our prejudicial minds the leap between someone having mental illness and their questionable integrity and questionable character is not a leap, but a thin blurred line.

So if you are a good person with good character from a family of good and decent character and someone gets AD, does that mean somewhere along the lines there was a breech of character, someone did something wrong? If it is NOT a mental illness then no intergrity or character issues right? Sort of off the hook. Moreover if it is a mental illness, then on some level would that not mean it is less than real- at least in the sense that if the person tries harder, than maybe it will go away. If we just figure out what that character flaw is.
If you have mental illness you know what it is like to be treated a little bit less than human, to have your character called into question, that prejudice, that bias, that icky feeling and manner other people present to you because you have mental illness. If you don't have mental illness, imagine what it would be like to have to live with that bias. I mean real imagine it for a second.

So AD is not a mental illness or a "functional" illness in this way: You can see it, you can find the amyloid plaques, we are moving closer to being able to test for it- checking spinal fluid, biomarkers. Therefore it is legitimate. It is real. We have tests and we can tangibly SEE it. But here is the problem, this is why we want to know if it a mental illness. We as family members are in the twilight zone. A gray area:

The everyday CLINICAL world lags behind the RESEARCH world, by 10 or 15 years.
Right now you can't routinely see it on a blood test, or a really good MRI or CT, you can see non-specific atrophy of the brain consistent with it, but you can't really definitively see it, unless you look at brain tissue on an autopsy, after the person has died from it. At least in 2010, thats the everyday reality we are all faced with.

Here's how Alzheimer's is a mental illness is 2010. We can't really see it on an x-ray or any blood test that you or I or most Americans may have access to. Nor with the deterioration and reduction of health care delivery, non of us are going to have much access to the evolving sophisticated research anytime soon, the same research that politically helps legitimize Alzheimer's disease.

-Alzheimer's disease affects behavior, actions, thoughts feelings personality, cognition, a persons manner of relatedness to others, all those things we conventionally equate with "MENTAL ILLNESS.

My mother had changes in her personality, and behaviors, sometimes it was odd, sometimes bizarre, sometimes not, but there were changes. Most AD victims do have these at some point.  AD makes your brain deteriorate. You brain regulates behavior, personality, something has to do this and it is the brain. behavior and personality are not random or coincidental happenings.

A neurological disorder is so legitimate, a psychiatric disorder is not legitimized in our society.
The best answer to the question is "Alzheimer's disease is a progressive neurological disorder with overlapping psychiatric symptoms. Alzheimer's disease is a progressive deterioration of the brain. The brain regulates behavior and personality. In our society we have severe bias and prejudice toward mental illness and pass judgment harshly on psychiatric disorders but not neurological disorders."  That's how I would answer that right now. There just is not a perfect yes or no answer. The correct answer is both, the more correct answer is, it does not matter, If you say yes it is a mental illness, you would not be incorrect but it immediately changes our views of the disease, based on our biases. If you say NO it is not a mental illness, we all breath a sigh of relief. We feel a bit better in that disease is legitimate. 

In the end the question does become irrelevant as you or your family member struggles with the diabolical process. It does not really make the process easier to know it is not a mental illness. 

Remember people with mental illness are just people, they have feelings too, hopes, dreams, just like everyone else. People with mental illness can develop Alzheimer's disease, just like people who never had mental illness can also get Alzheimer's. The behavior and personality changes associated with Alzheimer's can be at times crazy, bizarre, strange weird, it is upsetting and disquieting. The person is not doing it on purpose, It is not a sign of character, or something we have done right or wrong in our lives. The same can be said for mental illness.

The health care world incidentally and ironically has some of the strongest and worst biases about mental illness. As a psychiatrist, I face it from other doctors, maybe not as much as from other non-physicians that work in the health care field, but it is there. There are also so many people in the Alzheimer's world- caregivers, health care workers, bureaucrats, that have this bias, it is so Hypocritical, two-faced and not very humane, but it is where we are at as a society. Something we don't like to talk about or admit, Alzheimer's=neurological, mental illness= uncomfortable, "icky".  Let's admit that prejudice and start growing up and working past it.

Until we start getting over ourselves and becoming truly humane towards all disease states, and people suffering from them, including mental illness, you are not going to see much true progress. towards treating the aging population with respect, dignity and honor. After all if it is easy to secretly judge people with mental illness, it is not easy for the fascist, intellectual, politically superior to exploit this?- to  place less value on the aging and the elderly and those with Alzheimer's disease?  Get it? We are talking out of both sides of our mouth when we distinguish Alzheimer's as not a mental illness.  It is easy to exploit that paradox, that is part of the reason why we have not advanced much in our society in our understanding of Alzheimer's, and we ponder the question of AD being a mental illness. It is a vicious circle. Throw in the health care debacle and limited resources, and you are one step away from the E word, euthanasia.
Hence cost savings- euthanasia. free thinking atheist, cool people with certain correct, political views= forward thinking know- it-alls? utilitarian,- grow up.- most people will get old some day, and all that youth driven narcissism won't really matter will it? "How many people under thirty years old, say "well if I ever get like that just shoot me!"
It's all our faults, it's how we are raising up our kids, generation after generation.

Here is an a paradoxical,  optimistic point, I believe the legitimacy of AD will be hammered in stone  (in other words the clinical world will catch up to the research world, and we will have everyday access to the legitimizing tests that unequivocally convince us that AD is a clinical disease) this will happen long before the stigma and prejudice toward mental illness is obsolete.

If I was a policy maker, or if I worked for a nice big non-profit and could lobby for AD all day, I would lobby that the question of Alzheimer's disease being a mental illness is irrelevant. I wouldn't spend all day working to draw that line ion the sand, that distinction for society. It Exacerbates the stigma, to argue the point.

So my mother's Alzheimer's disease was a factor probably in me going into psychiatry, but not THE factor. There was no one main factor. It certainly taught me about empathy, and emotional pain and loneliness, ands societal prejudice, something most psych patients deal with on a day to day basis. (and family members of an Ad victim.)  Yes its true I saw the emotional anguish the disease causes, I lived it. I thought psychiatry was the most humane of all medical specialties, some days I still think that, other days not. After all, a psychiatrist talks to their patients, understands there patients from a human aspect, not a disease aspect, or so most of us thought. That is why most went into it. It seemed to bridge the gap between the art and the science of medicine in so many ways, in ways that nobody cares about much anymore, in ways society places little value on- IE. humanity.  Cost-effectiveness supersedes humanity. that's the reality, throw in some power-drive economics and political correctness and well you have more bias and prejudice but yet we still convince ourselves everything is okay.

Friday, August 13, 2010


hmmmm call me old fashioned, call me a heretic. But will this really improve care? If I was one of those slick high tech cool medical bloggers, I would tell you how wonderful it is and how the art and the science of medicine will be so greatly advanced and how much this is going to help patients. Lots of people would read and retweet, the news media loves it and it will help patients.
Now lets talk about the realities nobody wants to blog about except me it seems.
First of all, how will it help patients. LESS ERRORS. This is good. How so? Handwriting errors, handwriting errors HANDWRITING ERRORS. Fantastic. Hmm is that an N or an H? I can't read the handwriting. EXCELLENT. No more of that ever. IT will probably save a few lives every year.
Think about it there are only so many ways for a prescription to get from your doctor to the Walgreen's in your neighborhood. 3 ways actually. The doctor phones it in to the pharmacy, the doctor faxes it to the pharmacy, or the doctor hands you a handwritten prescription to take down and hand to Kristen or Eli your ever pleasant pharmacy technician at the drugstore.
That's it that's how it works. No More. Electronic prescribing will be the law in the great progressive State of Minnesota at the end of 2010.
It will cut down on other errors too. Maybe. Theoretically You can have a more thorough list off all the meds you have ever been on. This should help on missed drug-drug interactions. Right. Sounds good.
Hows it work?
Well first off all most people that work in medicine are not doctors, they could never see electronic prescribing as being anything but good. These non medical people actually write most of the templates for the software for electronic prescribing. Big money to be made for these non medical- medical consultant experts. Licking their chops so to speak.
So you doctors office or somebody spends a lot of money to get the templates and then they can electronically prescribe. It gets sent to the pharmacy electronically, sort of to a clearing house over the Internet, I guess you could call it sort of an intranet, and it is about as secure as secure can be with lots of firewalls and things. I mean think about how secure your stored information is when you purchase something over the Internet. nice and secure, nobody could ever get in with all those firewalls.  
The software really is great, lots of drop down menus invented by non-physicians telling you exactly when where how much how often you get to prescribe something. Since these templates are generally written by non-medical people the art of medicine really shines. You doctor can't really personalize the treatment to you.It is rigidly standardized. Sure there is a little place at the end where you can attempt to put in specific instructions, often hard for the [pharmacist to find and extremely user UNfriendly for the doctor, to actually individualize the treatment to the patient. I mean we all fit into nice pigeon holes, right?
Then there is the issue of the fact that many non-physicians are going to be entering the prescription into the computer and hitting "send". Boy I hope they are not having a bad day or pissed off or something or having a bad home life that week and  don't make an error on the drop down menus. Its ok though because it will still be the doctors fault in the end.
Then there is the beauty of the fact that depending on the software and the clearing house, something you took for a week will still be showing up years later, like you broke you toe and went to the ER and got three lortabbs. That just will keep coming up or or you took amoxicillan for a strep throat five years ago for am week. Right there in your face, the dates and quantity may be a little less harder to find. Sort of got to look. Hopefully someone will mark it as not active but expired stuff still follows you around, thank you rich thoughtful computer software companies medical non-doctor consultants.
But here's the best part. Formulary restrictions, all a patients data is out there including insurance, behind lots of firewall encrypted safety devices of course.
In other words when a doctor tries to prescribe something and a patients insurance won't cover the med-BAM the clearing house will reject it. Nice hunh? You are not allowed to have that med. It is like that now, but at least we still have the old prior authorization,- that's where you doctor spends all day usually several, fighting with some private sector company employee of a corporation contracted with the federal government, sitting in some cubical in Solon or somewhere telling the doctor they are not allowed to prescribe the appropriate med and to use something else.
It will be a lot easy to avoid this, with e-prescribing and to really really start limiting and putting the clamps down on what meds you are allowed to have based on your payer.
And this part is even better than best-now we can truly monitor physicians prescribing habits and make lots of inferences and punitive actions against physicians who prescribe too many expensive meds. Way to really reign em in. Bout time right? Unless its your husband or wife. then shouldn't they have the best medication even if it is expensive? Nope and NOPE.
Anyways I guess it will cut down on forgery and prescription drug abuse too right? Maybe. Luckily criminals are not smart with computers and all that stored information on you and dangerous drugs out there in the electronic password encrypted firewall protected cyber world.
Call me old fashioned, I will get used to it. I must be getting old and set in my ways, I just don't think human beings and their treatment fit into drop down boxes and templates. It will be OK though, in all fairness a majority of hospitals have been using electronic entry of orders and meds for inpatient units for years. Why look how often we don;t have errors in those hospitals anymore.
Pretty soon we can have a robot hold your hand or talk to you instead of a human, technology-nice and healing but a human will still have to program and turn on the robot, chances are it won;t be a physician.
In more all fairness the Government Medicine Programs the VA and the DOJ (Federal Prisons) have excellent electronic prescribing and electronic records, that are prototypes and lead the way. I'm sure we can find lots of data on how errors have been decreased and patients helped and the care improved over at those venues. Right?
I know I got to do it. It just feels sort of bad to have something imposed on you, when you had a pretty good system and checks and balances set up to avoid errors, and now you have to change, you had something that worked and maybe the system you had actually helped patients and not hurt them, and now that system will be illegal in a few months. Sad Sad Sad.
By the way do you know how often I hear- "the doctor (half the time it is a nurse practitioner) never looked at me they just kept staring at the computer screen"
and  here's a good one "the doctor could not do anything, the server was down, they were having trouble with the computer"
I hear those quotes a lot more and more every year, I pray those are not said about me someday.
A final thought, I think we should be more cognizant of the CEO' salaries of these medical software companies and start scanning the benevolence factor of these companies- kind of like we do the drug companies, God knows there first priority is helping the patient.

Saturday, August 7, 2010

On medical blogging

I read so many blogs from doctors, the psychiatry ones like to discuss how psychiatry has been reduced to simply writing prescriptions. It is old news. Most psychiatrists did not go into psych to write scripts all day to see patients every ten minutes. Generally speaking most start out with the ideal of wanting to understand and help their fellow human being. Old news.
Then their are the usual blogs about bashing the pharmaceutical industry, nothing new, usual stuff, politically correct. Meds are bad, pharmaceutical companies sinister etc etc. Lots of bad doctors pandering to the drug companies. People love these blogs, safe politically correct targets to bash.
There seems to be more physicians blogging than ever before, but they may reflect more the fact that there are more people blogging than ever. Some are a bit more pithy than others, some walk a political line, hoping to stay ahead of things with electronic media preserving their place in the cosmos, as the current physician-patient relationship, the therapeutic alliance, what medicine was created on since the beginning of human-kind, continues to erode. It erodes because of economics and politics.
I hate it when some of these blogs stay on the right side of the line, stopping short of speaking what is really on their mind. You can feel it and smell it. They don't always speak with candor, they may be honest, but they don't say what people don't want to hear, because nobody would read them. Fortunately for the blogger it is a world where most people are on the outside looking in, so most would not know if they are candid or not.
The blogger feels good because they are honest, but generally there is a pervasive fear and a general need for self-preservation, that behooves the medical blogger to stop short of telling the whole story.
Some actually open up about their human side of things, but one must be very careful with that. It is a very ultra thin line as we still hold the medical profession in some sort of bizarre precarious inflated esteem.
We want and assume our doctors to be smart and flawless and the greatest healers, but we know and expect them to be money-grubbing, selfish crooks, who don't care about their patient. We almost expect it, and the system reinforces our negative perceptions.  We look and wait for any clue to reinforce it. Is it any wonder the most prolific medical bloggers stay on the safe side? What option to physicians have?
I always assumed that the physician was the primo patient advocate, but nowadays we must be wise consumers who bring people to advocate for the patient against the physician. Who truly made the system adversarial? FDR? LBJ? Managed Care? HMO's? the AMA?
Perhaps I idealize the past, maybe the system was always adversarial, maybe the old physician-patient alliance was always challenged and precarious. I have to admit though since I have been working for 17 or 18 years now, it seems that their is less and less opportunity to take care of your patient and much more paperwork, defensive work, fighting with insurance companies and so many things in the way of letting you care for your patient. That part I can see. The doctor is just not free to practice medicine anymore. Yet on some level in the end, we still want our doctor to be the best and do everything right.

Sunday, August 1, 2010


I have found a rather odd way to connect with my dad over the last month or so, I have started trimming his fingernails. And man, they do grow fast. At first he was really apprehensive about me doing it but has become OK with the idea. Today I trimmed his fingernails and toenails. It's really good for me and I think for him because when I am concentrating on it, it is something tangible I can do for him. It also distracts him and seems to calm him down. So instead of a manicure, I'm gonna call it a "Man-Cure."

His dementia is getting worse by my estimation though Dr. Sivak says these things ebb and flow and progress slowly over time. I get that but he's beginning to check out on us a little more. Ironically, his "worsening" has made it easier for me to visit him because he has forgotten, for the most part, that he was angry at me (for moving him out of his home). I have had 4 or 5 consecutive visits without him getting ugly or aggressive. It is such a huge relief. My 3 year old daughter and I visited today. We also visited last Sunday. Dad still knows me and her and we are thankful for that. He cannot read anymore and there are many words and things I mention that confuse him and I am having an increasingly hard time understanding what he is trying to say. Today I mentioned I had driven one of his classic cars, his 57' Chevy. He had no clue what it was, at all. The week before I showed him a picture of the Chevy, that he could connect with that but not the uttered words. When it comes to an emotional connection, that is still 100% there. He laughs and smiles and has a superb time with my daughter.

I have finished reading Dr. Sivak's book. It was wonderful, I plan to write a full review sometime soon. Thanks be to God. JP

Elder Rage Review

Here is a review I posted on Amazon for Elder Rage, Jacqueline Marcell's book about her struggle with her father's Alzheimer's:

-"As a Physician and a Caregiver for my mother diagnosed with Alzheimer's when I was a teen, I recommend this book to caregivers. Not only do I advise this book to be read by caregivers but by the general public at large. Alzheimer's is something we don't want to know about or hear about till it touches our own family. It's time we open our eyes. The book is thorough, gripping, and filled with insights that offer utility to caregivers of AD victims. No matter what age you are when a parent or loved one is affected, AD is a coming of age process. It makes people grow up, and dig down inside ones' spirit to find the courage to persevere. Jacqueline did something with this courage and fortitude and offers it to others in similar circumstance. I had the pleasure of appearing on the Author's Radio Show "Coping With Caregiving", and found her to be gracious and a Caregiver Advocate, filled with passion and zeal toward bringing this disease out of the darkness. It is a passion and insight that I rarely see in regard to this devastating"-
Joseph J. Sivak MD

Sunday, July 25, 2010

Alzheimer's Research

So it appears the thrust of research at the recent consortium is to take all the research that has gone on at various facilities and share and combine and put something together meaningful. The criteria for diagnosing and staging Alzheimer's and mild cognitive impairment is being reevaluated for the first time in years. When you think about it, this is crucial. There has been a certain way of diagnosing the disease definitely by looking at microscopic tissue under a microscope. That has not changed and we still can't do that on live human beings. However if there was a way to predict or even diagnose the disease much earlier, even before it starts to clinically show itself and manifest, this may have clinical implications for treatment, as well as prevention. Seemingly the earlier you can intervene or even prevent the better.
Hence emerges the concept of biomarkers. This is not a new phenomenon. The biomarkers we are talking about are more than testing for the genes that definitely predict who will get the disease.
The well known presenilin and APOE genes. The hereditary links are somewhat better understood, however the overall genetics are still not clear. There are very rare instances where there is a direct hereditary link, which account for a small number of AD cases, relative to all the cases.
But what about the vast majority of AD. Emerge biomarkers.
There are a couple that can be evaluated looking at CSF. CSF is cerebrospinal fluid. This is the fluid that baths the brain it runs down throughout the spinal cord. It is in the ventricles of the brain, Everyone has it.
Most people have heard of an LP or lumbar puncture or spinal tap.
A spinal tap is most commonly known as a diagnostic intervention for example when it is suspected that a person has meningitis. That is an inflamation of the tissues covering the brain and spinal cord. The CSF is sort of a purified version of fluid sort of like plasma but different. Sometimes you get an infection in there and you can look at the fluid , sort of like a blood test. You get the fluid through a needle in a spinal tap. Now meningitis or infection like that has nothing to do with AD. however you can do this spinal tap and look at fluid and analyze it, like a blood test.
It does appear people with Alzheimer;s have some proteins and chemicals in the spinal fluid which would be changed and possibly a good marker for AD.  Hence the biomarkers. It is possible some of these protein fragments are related to the Amyloid the develops in the brain of AD patients. now it may also be possible that these molecules that are too high or low in the CSF, indicative of AD, show up maybe much earlier than the cognitive and behavioral changes of AD. Not really totally clearly understood, but getting there.
Hence the consideration of new diagnostic criteria, and maybe someday the analysis of these biomarkers being used not in research but in everyday clinical practice.
Getting somebody to pay for this testing on an everyday basis is another story. Remember, since AD is fatal and it affects mostly older adults it is not a politically or economically popular thing to fund.
If some of this testing ever becomes more mainstream, it will be new cutting edge and therefore expensive. sort of like when a new electronic computer or phone type thing comes out.
but it is crucial because I think the research is on to something, we really have been trying to understand and treat or prevent it, once it is so full blown and that is probably way to late.
The research is fragmented, it does need to come together and share ideas, I still think it is misguided and stupid to have meetings in such elaborate places as Hawaii, but we somehow have to bring people together. The greatest minds working on this stuff. Remember in research, there is a ton of collaboration and collegiality. There is also a ton of competition. People fighting for grant money, for recognition, for the first to be published on something. Research has always been that way. It is just human beings. The motivations between altruism and notoriety get sometimes blurred.  Again something very real but taboo to discuss.
Some key thinking and thinkers coming together happened.
With the asinine health care climate in the everyday world, I hope and pray some of the forward thinker of the greatest research minds will trickle down to everyday mainstream clinical practice, and suffering families, who really don't give a damn about who gets published first, or the terrbile health care climate, they just want hope and treatments, preventions and cures.

Talking about the book with the Lake Superior wind....... a calm day