Weekly Wellness

Alzheimer’s Nursing Homes and Psychotropcis: There has been some press regarding off label use of anti psychotic medications in the elderly, especially older persons with Alzheimer’s disease. AD is a progressive, debilitating, brain illness. Basically the brain degenerates. Tissue actually dies and on a SPEC or PET scan one can see black spaces where brain matter should be. For whatever reason, some patients with dementia have significant behavioral problems. [Well, it actually makes sense in the same way that people who have brain trauma and lose brain matter often act out]. Sometimes in the AD cases, the behavior is related to an acute illness, like a delirium. Many times persons not familiar with geriatrics mistake these acute symptoms for a progression of the Alzheimer’s or even a chronic Alzheimer’s feature. There are actually so many things that can be happening which do lead Assisted Living Facilities or Nursing Homes to bring these residents to the ER. I say all this because I was one of the people on a multidisciplinary psychiatry in patient team who sought to stabilize these people. Our role was to manage their symptoms and return them to long term care. It was often a fight to return them to the SAME facility. It is absolutely not as simple as some consumer groups would have us think. I whole heartedly agree that zyprexa, risperdal, haldol, abilify and the like should NOT be used. I argue that acute illness be ruled out first, upon examination, i.e. bowel and bladder disturbance, renal disease, and blood sugar extremes. Just because an 80 year old has a diagnosis of dementia does not mean they don’t have a urinary tract infection. I fully support efforts to change the environment in the facilities as well. Add staff to redirect wandering, excitable, confused and scared persons. Yes, more staff. Another problem is that hospitals and facilities are scared to death of falls and thus a medicated person who won’t get up is a lot better on so many levels than a frail walking un medicated one. But I digress. That kind of hands on, low resident to staff ratio seldom occurs, in doesn’t occur in Medicare Medicaid facilities. In the hospital, physicians are pressured to get the patient out as soon as possible and the long term care facilities won’t take an aggressive restless person back so the only solution is overmedication. Family members often agree to the meds because they have no other choice for “placement” as they call it. Thus now you know, it is NOT that simple. What is simple is this. Dementia is NOT a normal part of aging.

Fish – Fish OIL: Ironically, the health benefits associated with the Omega 3s in fish include heart and brain health. The question is yet unanswered as to if the fish oil capsules are as protective as the fish itself. A recent study still leaves room for doubt. It is very important again that one read beyond the headline. The study involved a small group, two groups, of women. Less than 30 people total and that is too small to allow for any type of population generalization. Any way. One group took capsules while the other got the same mg of Omega 3s in actual fish. Afterwards both groups had the same blood level concentration of Omega 3s. That does not answer the question, “ Is the effect the same?” A long term study would be needed for that and frankly; you don’t have time to wait for that. Eat your fish. They contain additional elements, protein, minerals, and yeah, well ok, a little mercury, cadmium…….. Oops.

SWEET! Oh I like this study from a place called Kaleida Health in Buffalo NY. Actually more than one study and the results are also more suggestive than causal. Oxidative stress and inflammation occur often in our bodies. Bad things like smoking cause it. But good things like exercise also cause it as do necessary things like eating. There appears to be an inflammation process to all cellular activity and free radical release. The accumulation of free radicals is quite harmful and inflammation in the blood (c reactive protein, homocystiene) can be a marker of heart disease. We also have a built in clean up effect, the antioxidant process which can be enhanced when we eat foods like blue berries and fruits and vegetables. Obese persons generally have more inflammation and high fat foods themselves increase oxidative stress, acutely. A healthy, active person of normal weight may still have an oxidative response when they eat, but it abates quickly. The researchers found that normal vs. obese subjects who ate the same high fat high calorie (1800) meal [meal? That is what I eat in a DAY] had the same spike but it lasted much longer in the obese group. That will increase their already higher risk of heart disease, and heart attack. However, there was also a study in which the same 1800 calories was in high fruit and high fiber and there was NO SPIKE. I don’t recall if that included both normal and overweight persons.

Radiation: It has been said that X-rays should not be used with reckless abandon as radiation exposure can change cells and damage DNA which is one way cancer can initiate. Now there is a concern about warning people who have been given radiopharmaceuticals. This would be chemotherapy as well as perhaps dyes used in bone scans. Apparently it leaves the patient a little radioactive themselves. Enough so that days and months later the person will set off an alarm at the airport. Doctors are being asked to warn persons of this possibility. Geez.