SSRI's Part one- Audio podcast

Link to this podcast on SSRI's http://limbicdoc.podbean.com/ (click listen now) once you are taken to the link or click on the podcast in the left hand margin to listen,

Radio Tour for book- WSVA 550AM Harrisonburg,VA and WOND AM 1400, Linwood,NJ

I have a couple more radio stops for the pre-publication radio tour for book-When Can I Go Home?
Will be on Barbara Altman show on WOND 1400AM in Linwood, NJ- (Atlantic City area) on Tuesday March 23 at 11:15 am EST. http://www.wond1400am.com , I think you can listen live to that program from anywhere on the web.

Also on WSVA 550AM Harrisonburg,VA Mike Schikman show on Friday March 26 at 3:10 PM EST. http://www.wsvaonline.com/joomla, I don't know if the have live web streaming.

Wisconsin Public Radio had fantastic callers, it validates my suspicions that everyone has a special and unique Alzheimer's story and so deerly and desperately need to be heard.

Listen Live on the internet

Monday 3/15/10 at 8am CST, I will be discussing Alzheimer's disease and my book When Can I Go Home? on the Wisconsin Public Radio Network. The Network has a live stream on the web. Here is the link

http://www.wpr.org/webcasting/live.cfm

Grieving the Living

I would like to thank Dr. Sivak for the invitation to become a guest blogger. I dearly appreciate it! In January of 2010 we moved my father, 71, in to a memory care home. Dad has dementia, either the vascular type or the Alzheimer's type or both. About three weeks later my mother joined him in the memory care home. This was unexpected but necessary. My mother, 70, has a long history of mental illness and prescription drug addiction. Some combination of the two has led her to have memory problems herself and specifically what I would call amnesia both anterograde and retrograde. These amnesia and memory problems have been coming on very slowly over the last several months and have become a lot worse in the last few weeks. This, obviously, has eliminated my mother as an adequate caregiver for my father. Hence, the move to memory care for both of them.

One of the things that has struck me has been the fact that I am having to grieve the loss of my parents despite the fact they are still alive. This will be the focus of this blog entry. I never like to view myself as a victim but in this situation I have had a great deal to cope with emotionally and logistically. I am my parent's only living child. My sister committed suicide almost ten years ago at the age of 40. Now that they are where they are, they have ceased to be parental figures for me, rather, we have now switched roles. The way I view it, my parents have died though not physically. I am grieving this loss, everyday. And, I think it helps to view it that way. I can still connect with them both emotionally when we visit, we can still talk about shared long-term memories but the relationship I had with them in the past has ended. The impact of this loss hit me square in the face last week. I had surgery on March 5th to have my gall bladder removed. Mom and dad were of course not there and we decided to not tell them about the surgery. There was no reason to, it would just confuse them and/or bring them short-term anxiety. It was the first time in my life that I experienced something scary/difficult and my parents were not there. My faith in God really helped me however and right up until surgery and after I felt very calm and at peace about the whole thing. My two uncles (mother's brothers) both showed up at the hospital and my wife and daughter were there to greet me after surgery. God is good. Throughout this process I have leaned every resource I can find: friends, family, God, and other professionals. It is the combination of it all that has allowed me to not only survive but in some respects thrive. I choose to fight! On my last visit with my folks, on March 4th, 2010, all of the complexities of their situation were in play and my need to grieve and let things go was fully tested. My father was quite agitated and angry with me during the visit. On some level he knows that I am the one responsible for him being there. At one point he told me that he never wanted me to visit again. I am to the point where I am not taking that kind of stuff personally but I would still rather not have to hear it. By the end of my visit however, my father was hugging me and telling his nurse, "this is my baby." I have decided when at all possible, I am going to take my 3 year old daughter with me on visits, her cuteness and beauty tend to distract both my parents and deflect some of the pressure off of me! Plus, she needs to see her grandma and grandpa often anyway. During this same visit on March 4th, I was reminded again how severe my mother's amnesia has become. Eleven months ago my maternal grandmother passed away at the age of 94. We were extremely close and she lived next door to my parents. My mother was the person that called me to tell me my grandmother had died, we had a funeral, settled her estate, cleaned out her house and we all still miss her dearly. However, my mother now has no recollection of my grandmother's death (her mother). She now speaks of my grandmother in the present tense and still thinks she is alive. It is really tough for me to wrap my mind around that. The only thing we can do is play along, we tell mom that grandmother is doing fine. No need to tell her otherwise.

Both before and during this process I secured the services of a geriatric consultant. Nancy Kriseman, LCSW has been a wonderful resource to both my parents and my folks. I don't know what we would have done without her. Recently, after things had calmed down, she wrote me a note. In the note she said "remember to take care of yourself as well as you have taken care of your parents." I think about that almost everyday. In closing, another way I have dealt with my grief is through writing, the article about my father that Dr. Sivak mentioned was part of that. Writing seems to help me organize, express and process my feelings. Thanks to Dr. Sivak for giving me another opportunity to both write and heal. And thanks be to God.

John H. Pruett, Jr., MS, EdS, NCC, LPC

Founder & Owner

Georgia Professional Counseling Center, Inc.

http://www.georgiaprofessionalcounselingcenter.com/

http://www.linkedin.com/in/johnhpruettjr

http://twitter.com/CounselorGA

Guest Blogger and Radio Interview and other stuff.

I seem to get a lot of queries about SSRI's so I am going to try and technologically advance and do an audio podcast on them over the next week or two. I don't know how it will go, so bear with me.

I will be on Wisconsin Public Radio this coming Monday 3/15/10 at 8am CST, talking about Alzheimer's and When can I Go Home? So if you are the neighborhood of Milwaukee, or Madison, or north of Chicago, or East of the Twin Cities, tune into your local WPR affiliate.

Now I have had this blog up for maybe 7 months. I am sure you are as tired of listening to me as I am, so it is time to move into a new realm. The realm of guest bloggers. I will have my first one coming on in a few days.

His name is John H. Pruett Jr. He is a therapist and counselor down in Georgia. His father has Alzheimer's. Not so long ago, I had the honor and pleasure to be able to read a little story/tribute he wrote about his Dad. I don't want to sound too cliche' but it was pretty moving and just a really decent, honorable little piece. The bottom line is John writes from the heart, he respects and cherishes that father-son bond, a bond that is now painted but not broken by Alzheimer's. The bond of the parent-child really resonates with me, so anyways I asked him to come on the blog. I told him he can write about whatever he wants, but it does not matter, he's a good, decent guy and a good, decent son. It should be fun.

ALZHEIMER'S IN THE NEWS

Major news outlets buzzing about report released by the Alzheimer's Association today. It all comes from a press release from the Alz Assoc. It is always good and important to keep this in conscious awareness. Data comes from a Federal Survey, not sure who conducted by, but the just of it is that African-Americans are at twice the risk of whites, and Hispanics 1.5 times greater risk than whites at developing the disease. It does point out the relative under-diagnosis in these racial groups. I think the point is that part of the rise in these numbers, is that fact that it is now being diagnosed more often in these racial groups.

Alzheimer's does cut across all socio-economic groups races and religions. It will be important to see how this new report affects research funding, I certainly hope it does in a significant way.

It is still underfunded, relative to other diseases, and still profoundly ignored.

Its an awesome press release and the Association is doing their job at raising awareness. I wish it made the nightly new every night. It is impossible to over-publicize this problem and health epidemic. A sound bite from someone on the news called it the "Silver Tsunami" in terms of the continuous increasing numbers, and projections over the next 20 years.

Not a coincidence of this release today is the fact that tonight the National Alzheimer's Gala at the National Building Museum in Washington DC is tonight. Tickets are $500 a person.

press release.

http://www.alz.org/documents_custom/FINAL_F-F_2010_General_Release.pdf

Dementia-agitation, treatment

Now one of the biggest stressors for family members is what do you do if your loved one with Alzheimer's is agitated and lashing out, or agitated and wandering off at night. What if they are moving about and wandering and confused? Are they more likely to fall and get hurt? Sometimes. This is typically a problem in the later stages of Alzheimer's and not all people in the later stages of Alzheimer's get agitated. Some do, they may even get violent. Remember this is the disease and not your loved one.

Yes it is true that there are people who have a history of violence and anger and agitation well before they develop Alzheimer's. Think of the violent or antisocial or sociopath. In my world as a psychiatrist those problems are all too common, but for the sake of those reading this blog, violent, dangerous people are the exception and really not that common in society. Yes violent dangerous sociopaths are people too, and I as a physician get to treat them with compassion, dignity and human respect, no matter how much I disagree with their values and the choices they have made. Another profoundly stressful thing at times which goes with being a professional and a physician. Another fact that is overlooked and very taboo and considered maybe even unprofessional to even admit, but yet very, very true. By the way as another aside, most people with mental illness are not violent or dangerous, especially schizophrenics, another fact commonly overlooked. enough digression and back to dementia.

Lets assume your loved one with AD was once a decent citizen, with no history of violence or agitation or any history of ever hurting other people. Now they are physically lashing out. Remember it is not them it is the disease, it seems to change personality, remember. Uncharacteristic behaviors emerge. Maybe your loved one is now taking their clothes of or making becoming hypersexual and inappropriate in that area. Remember it is the disease not your loved one.

Hypersexuality, wandering, violent aggression. It does not happen to everyone in the later stages of AD, but it does happen and it happens a lot. It is awful, it feels indignant and it is humiliating to live through as a loved one. It is something that many face and it probably is not addressed enough, because it is such an uncomfortable topic. Typically it is seen in the nursing home setting, when caring for the loved one at home has just gotten to be too unsafe. And yes there are people with AD living at home in the later stages who for whatever reasons, financial, guilt, emotional exhaustion, lack of resources, isolation or whatever just can't or won't place their loved one in a nursing home or assisted living. Every situation is unique and can't be judged either way. Entering a nursing home is a terribly emotional and painful situation for a family and a person with dementia. Sadly it is quite inevitable for many, if only for safety reasons, which is a big reason.

so what do you do to treat these problems of aggression or wandering or hypersexuality? Obviously you have to help the person calm down. There are basically three ways to do this. The most humane which does not always work is environment. A soothing calming relaxing environment. Soft calming music, maybe from your loved ones era. Reasonable lighting, enough light but not overpowering. Activities, attention, calmly talking to and with your loved one. Decent nutrition, some nursing home and assisted living facilities are better at this than others. Like anything else, some are great and some not, most claim to be, and if the environment, is the best thing to treat the agitating behaviors. Sadly it does not always work. Another problem often overlooked is when you take a person out of their home environment after 40 or 50 years, because it is just not safe, the new and foreign environment can sometimes lead to or make agitation worse. Why wouldn't it? Sometimes it settles down with time and sometimes not.

The second way to deal with aggression or lashing out, is physical restraint.

The posey, that thing that looks like a net that fits across the torso of a person and keeps them belted if you will in a chair. nobody wants to see this. It feels indignant and inhumane. We get angry at the doctor, the staff, and everyone else. The alternative is wandering, falling, assaulting other staff or residents. It is awful. There are various rules and laws regarding this, but when it is considered unsafe, sometimes the facility has to resort to this. some may use it more than others, that depends on the rest of the environment and your loved ones symptoms they are displaying. It is profoundly painful for loved ones to see this, it stirs up every raw ugly painful emotion associated with the diabolical disease.

The third way to treat violence and aggression or wandering is chemical sedation/restraint. Now the obvious problem usually overlooked but faced by thousands every single day, is that fact that calming your loved one down with meds can mentally slow them down more. They can become too sedated and sluggish making the Alzheimer's seem much worse. Obviously ideally a balance has to be struck. calm but not sedated is the goal. Right? This lead to the common dynamics of the meds actually becoming more of a villain. Throw in the fact that the doctor only seems to spend a couple minutes with the patient and does not see them that often and you have lots of high emotion and tension. some docs are way better than others, but I promise you no matter how much time the doctor spends with you, is kind, caring and compassionate, it can never be enough. That is the nature of the disease. remember most docs may have ten or twenty of fifty other families going through the same thing. A good doc will never ever say I have more patients to get to. In medicine, unlike anything else, patients are not customers, they are patients, and moreover they are people. That is regardless of the fact that the health care system seems to be moving in a most negligible direction, with the doctor patient relationship, continuously being placed as the lowest priority, regardless of what anyone tells you. I could digress into that issue all day, but suffice to say despite all the realities of our society and the health care debacle most docs went into medicine to help people like your loved one, some are way better than others at conveying compassion and empathy, it is a fit or a chemistry, and you know when you have a good one. Remember just about every issue in the geopolitical world, demands the doctor to be this way, and presents an environment and situation where it is becoming almost inhumanely possible to do this. The good docs don't make excuses. Back to the meds, there are many that are used to calm, sedate, and yes chemically restrain persons with AD. I have previously written about SSRI's and touched on antipsychotics. They have there own host of problems and warnings in dementia patients. It creates another quandary. What to do, no perfect med or situation, regardless of what anyone tells you, each situation is unique, sometimes the meds work wonders, not cognitively clouding the patient yet treating the aggression or wandering or hypersexuality quite effectively. sometimes not. Sometimes the meds increase the likelihood of taking a fall. Sometimes they decrease wandering and the likelihood of taking a fall.

The meds to treat AD specifically, aricept, exelon, namenda etc, sometimes help these symptoms and sometimes can make the aggression worse. There are several classes of meds used, and each person responds slightly differently. In future posts I will try to cover the salient features of the common meds and classes of meds used in people with AD.

what are Antipsychotics?

Antipsychotics are a group of medications used to treat a whole host of disorders and symptomatology. Generally speaking they are terribly misunderstood, dreaded and the subject of much hatred and controversy. They stir up a lot more emotion than say an anti-hypertensive to treat high blood pressure or an oral hypoglycemic to treat type II diabetes. They are also responsible for saving many lives. They are also responsible for helping many chronically mentally ill people live and function outside of a state mental facility.

they have been around for a long time, the original developed in the early 1950's and that was Thorazine. A whole host of medications followed, the so-called typical antipsychotics or first generation antipsychotics. more common ones still frequently used (but not as much as 10 years ago) in psychiatry are Haldol, Prolixin, Navane, Stelazine, Loxapine, Mellaril. They treat psychotics symptoms such as hallucinations, (seeing things that are not there, or hearing voices of people that are not there) and delusions, false beliefs not grounded in reality (eg. the NSA planted a micochip in my brain and is monitoring me or I have a special power in that I can predict the future, or I am Jesus Christ) Delusions can be different types, paranoid or grandiose for example. Some people act on there delusions or hallucinations. Sometimes hallucinations tell people to hurt or kill themselves or hurt other people. The antipsychotics attenuate and sometimes take these symptoms away completely.These kind of symptoms are seen in people suffering from schizophrenia, schizoaffective disorder, and sometimes severe bipolar disorder or severe unipolar depression.

The first generation antipsychotics also have a host of potential side effects.

The most severe one in the sense of it being permanent even if you stop the medicine is called tardive dyskinesia. This is a movement disorder, that involves repetitive stereotypical movements, that are not controllable. Such as lip smacking, crossing and uncrossing ones legs, or finger tapping. The movement disorder doe not keep the person from sleeping and often it is more distressing to watch than for the person afflicted with it.

A second generation of meds was developed in the late 1980's and through current day. That is the so called atypical antipsychotics or second generation antipsychotics, these meds are much less likely and virtually some not at all likely to cause tardive dyskinesia.

They are generally much better tolerated by a person than first generation meds. They tend to cause much less apathy and bluntedness. In fact they often improve those symptoms which are seen in people suffering with schizophrenia. So you see another problem with the first generation meds was that some of the side effects, sluggishness, apathy for example were also symptoms of the illness of schizophrenia.

The second generation meds, main problem which class action law firms have jumped on suing the drug companies for is the association of these meds with the possible development of type II diabetes. That becomes a hotbed of political and economic controversy. It is often poorly understood by other areas of medical specialties outside of psychiatry.The second generation antipsychotics are Clozaril, Risperidone, Zyprexa, Seroquel, Abilify, Invega, and most recently Saphris. They were considered antipsychotics but most of them have been approved and indicated by the FDA for various phases of bipolar disorders. So they are not just considered second generation antipsychotics anymore.

The government body the FDA puts out a warning on these meds but does not pull them off the market, the warning is called an ASSOCIATION of these meds with the possible development of diabetes. Accordingly proper periodic blood monitoring is required, to check a fasting blood glucose for example. Its a quandary because type Ii diabetes is growing so fast (on or off these meds), but it has created much opportunity for some lawyers. It is sort of like suing McDonald's for spilling there hot coffee on yourself and burning yourself, or suing the fats food chain because you got fat and developed diabetes from eating french fries. It would be easy if these meds clearly caused diabetes and were considered unsafe then the government could just pull them off the market. The truth of the matter is these meds no matter how much we hate them or hate psychiatry have helped a lot of people and saved many lives. That part gets missed. And no it is not as simple as money changing hands with the government or the drug companies and there profits. If it was that simple things would be easier. and no doctors do not get kickbacks to prescribe. It is amazing how many people assume that. Don't you think with how vilified physicians actually are in society it would be a little more apparent if it was that simple?

The truth of the matter is at this point these types of meds are the best we have right now, and most doctors that prescribe them are not doing it for fun or experimenting, they are actually trying to help their patients. How does that point constantly get missed? i know why it does but it would take a book to write about it.