Friday, March 26, 2010

Healthcare Reform


No matter which side of the fence you fall on, it is important to attempt to get some unbiased knowledge about just what health reform will mean. So much of what we hear in the media is distorted. With the important issue of obtaining health care for elderly loved ones, our families of all ages, and ourselves, it is absolutely necessary to find some objectivity and review the facts.



The Kaiser Family Foundation does a nice job of reporting information without inserting opinion. This type of resource is hard to locate regarding a topic which holds so much political charge. KFF also provides updates frequently so you may want to bookmark this site as well.






Wednesday, March 17, 2010

95 and Counting


We started the conversation talking about specific memories this elderly woman wanted to share. She prefaces our discussion with a statement that, in her mind, sums it up. With a high pitched voice, and rich Appalachian dialect Mary tells me, “Things just don’t come back to you like you’d think they would. Ain’t got much memory. I’ve about forgot it all.” Then she defies all she just said and remembers her story. Detailing life as a young woman, a wife, a mother, a farmer, she talks of days in her life before the nursing home, days before, as she says “my bones started to give out”. This petite elderly lady with long, wavy, barely gray hair holds the information of what life has been like for nearly a century. I am fortunate enough to get a slight glimpse into the mind of a woman who has experienced nearly a 100 years of change, and hear her talk about the transformation and the constant aspects of life over the years.


Mary tells me “I remember the milk cows, sheep, goats, hogs, a team of horses, and things like that. That is what took up my time. That is what I know. I knowed how to plant corn, potatoes, all kinds of little things in the garden. That is what took up your days.” She recalls more in-depth stories of tending her garden, helping her animals, herding them in to shelter when weather turned bad, and staying up into the midnight hours to make sure the baby animals, lambs in particular, were saved from the fate of freezing to death. She tells me of her childhood as an orphan, as her parents died and left 9 children, to “manage the best they could”, when Mary was not yet a teenager. She can’t recall her exact age, but tells me that she was pampered as she was not one of the oldest. Her face and words reveal shock when I tell her that average life expectancy in the United States is 77.7 years. Her family did not live this long and she feels like she is the exception.


Speaking easily of the days of past she recounts events in her life, but tells me that around the time her great-grandchildren came along there “must have been something happened to my mind”. She explains that currently, “It is hard to concentrate and sometimes I get scared because I am confused about where I am.” This happens most often when she wakes up at night, and she is able to “get straightened out” once she fully wakes. She regretfully tells me “If you’ll notice, I can’t tell you anything of benefit.” But what Mary fails to realize is that her presence, her story, the wisdom gained in her years are of benefit to us all.


What I see when talking to Mary is a person whose brain is in very good shape after 95 years of hard work, living, and thinking. She has normal age related memory change. Precise details are decreased, and the particulars of events happening in present day tend to fade more quickly. When I ask her to let me in on the secret to living such a long and fruitful life she explains how she took care of her body, working hard and walking a lot. I learn that they never called it exercise, as activity was just a way of life. I posed a question to Mary that required a bit of thought on her part, as it would for anyone. I wanted to know the best and worst thing about being a woman 95 years of age. The best, she tells me, is being able to “eat all you want because nobody pays attention if you need to trim up”. This statement, coming from the smallest woman I’ve ever met, reveals a great deal about how some components of our belief system and self image, deeply ingrained, carry throughout the span of our lives. The worst thing is a concept she can’t quite put her finger on. She simply states “I’ve lived through it all and there’s not much use to try and sort it all out, I am just here and that matters.”


Mary is very kind, beautiful, and grounded. When speaking of tomorrow she tells me in a quiet voice “The future will take care of itself. I like to be where I am and not waste the day with worrying about tomorrow.” This is how she has lived her 95 years. Her story is intact, the important parts, her ties to the past remain, but today is where she stays.


Cheers to Mary.

Sunday, March 14, 2010

Meds and Memory Improvement


A body of evidence exists discussing a positive secondary effect of antidepressant use. Hippocampus cell growth is the result which comes as a byproduct. The hippocampus is a structure within the brain which stores memories systematically. Typically examined in those with long term depression, studies show that with use of antidepressants over extended periods of time, hippocampus cells proliferate and increase in plasticity. If the hippocampus cells are generating, or even if the plasticity is allowing new information to be stored and retrieved, then implications could be profound.

The use of antidepressants can be very beneficial for the elderly and those with dementia, for decreasing depression, but perhaps there is an additional benefit. Wouldn’t it be amazing if we could kills two birds with one stone, or at least slow down the migrating flight of memory loss throughout the fragile brains of those with dementia, Alzheimer’s, or normal age related memory impairment.

Now I have to say that doctors do not prescribe antidepressants for this purpose, and research is virtually nonexistent in hippocampus volume increase with the population whose diagnosis is that of a memory disease such as Alzheimer’s. What’s available is the promise of clinical trials related to this concept. Here is a link to one such trial, and this site will provide a tool to find other trials as well that may benefit our patients and loved ones with dementia.
http://clinicaltrials.gov/ct2/show/NCT00702780?term=Alzheimer%27s+and+antidepressant&rank=12

More than a clinical trial, the promise or hope that perhaps a treatment we use for one symptom, depression, will change the brain with memory loss in a positive way may provide solace in the face of a very challenging disease.
Photo By: Tom Varco