Where Did I Put My Glasses?

Patients often wonder if they are mentally ‘losing it.’ They will forget why they have walked into a room or wonder what it was they were supposed to buy at the market. The overwhelming fear is developing dementia.

The thirty second test for dementia: it’s not remembering where you put your keys, but rather looking at the keys and wondering what they are for. It’s not quite a simple as that but physicians do have tools to assess cognitive function. When assessing a patient it’s important to take into account the underlying intelligence – the proxy for this is years of education. We expect better test scores from a Ph.D than from a grade school graduate. Also, patients who don’t feel well or who are in an unfamiliar environment may not score well.

Even patients who score well on a cognitive assessment panel may have difficulty with everyday tasks such as handling money or finding their way around familiar streets. Information from family or friends is helpful, particularly when determining fitness to drive. Such collateral history may be needed in judging executive function. The inability to self-regulate and plan may be a clue to specific underlying brain disorders.

One cannot do a cognitive self assessment: the people around the patient will notice a problem. Since medical problems may present as cognitive decline, it’s important to obtain a complete medical evaluation. 

A special report from Johns Hopkins Press.

The Flu - Once Again

Most of the country is now experiencing flu – the levels are similar to peak levels in moderately severe seasons in the past. Nationally, the levels of hospitalization for influenza and pneumonia are just below the epidemic threshold. So far, Connecticut has been spared the burden of disease, but we are surrounded and it’s only a matter of weeks (or days) before our levels increase. The rate of infection for children younger than age 4 is increasing far faster than for the other age groups.

There is plenty of flu vaccine available and the shot can be obtained as a walk-in in many pharmacies. Immunization is important for anyone with a chronic medical condition, including those who are very obese (body mass index greater than 40). Children younger than 5 and adults older than 50 are considered high risk for complications and should be immunized.

There is a high-dose flu shot for people older than 65. Human immune defenses become weaker with age, which places older people at greater risk of severe illness from influenza. Also, aging decreases the body's ability to have a good immune response after getting influenza vaccine. A higher dose of antigen in the vaccine is supposed to give older people a better immune response and therefore better protection against flu.

To learn more: flu.gov

Happy New Year

My New Year’s resolution last year was “less but better.” I like it enough to use it again this year.

A good friend of mine gives wise advice on how to eat an elephant: one bite at a time. I would add my two cents – don’t make the bite so large that you choke. Take baby steps when making a change for the better. Smoke one less cigarette. Have only one scoop of ice cream. Park at the far end of the row and walk to the store. Looking at the big picture can be too overwhelming. Don’t worry about the forest, just look at the tree standing in front of you.

Don’t beat yourself up over what has already happened. Move forward. Try not to make the same mistake again, but if you do, move on. Sometimes it just takes a while to catch on.

I wish everyone a healthy and happy new year. 

When Drinking is a Problem

It’s the season of celebrating and many people will usher in the new year with the pop of a champagne cork or a glass of wine with dinner. Before long, we will be watching the bowl games with a beer in hand. Alcohol can be a fun part of celebrating but can be a problem for many people.

Alcohol intake is a problem when it affects one’s personal or professional life. If someone has told you that you drink too much, you probably do. Alcohol use and dependence runs in families. Problem drinking can affect women and men of all ages and backgrounds but it’s more common among men. Alcohol abuse is common over the age of 65 and causes many fall-related injuries. Alcohol also interacts with medications.

Over the long term, alcoholics can develop diseases of the liver, pancreas, brain and heart. Alcohol can destroy families and careers.

One drink is 12 oz of beer, 9 oz of malt liquor, 5 oz of wine or 1.5 oz of 80 proof liquor. Moderate drinking is less than 2 drinks per day for men and less than one drink per day for women or anyone older than 65 years. Binge drinking is more than 4 drinks for women or 5 drinks for men at a single occasion.

If you think that alcohol is a problem in your life or a problem for someone you love, there is effective treatment. The gold standard is Alcoholics Anonymous for the drinker and Al-Anon for those suffering collateral damage.

More information:

Rethinking Drinking

For students (and their parents) 

Could I have a problem?

A Public Health Crisis

It is time to change the Constitution and abolish the Second Amendment. I cannot think of even one reason for an ordinary citizen to own a gun, let alone an assault weapon.

Injuries and death from weapons is a public health crisis. Petty arguments are being settled with gunfire. Casual owners are not sharpshooters and are more likely to injure/kill bystanders than hit their intended target. Domestic disturbances turn deadly when there is a weapon in the house. There is no need to defend one’s castle with artillery – exactly what do you possess that is so valuable?

Drive-by shootings is an important subset of this problem, leading to both injury and death. The shooter is often inexperienced in handling a gun and the intended or unintended victims may be slow to react to an unanticipated attack.

Our standards of behavior have changed since the eighteenth century. It is no longer acceptable to use religious slurs or exhibit other hateful behavior. One can no longer own another human being.

Our laws codify accepted standards of behavior. Stop at the red light. Don’t take things that don’t belong to you. It’s time to stop owning weapons.

The Dark Side of the Sun

As the number of hours of sunlight dwindle, few people are thinking about the damage that the sun can inflict upon the skin. Truth be told, we need to worry about sun even in the winter. The incidence of melanoma of the skin, the most commonly fatal form of skin cancer, is increasing faster than any other potentially preventable cancer in the United States. Five-year survival rates for people with melanoma depend upon the stage of the disease at the time of diagnosis. Survival rates decline steadily as the tumor thickness and disease stage increase. Most people with thin stage I lesions can expect prolonged disease-free survival and even cure, while those with thicker, later stage lesions (eg, >2.0 mm) are more likely to die from metastatic disease.

Practice Safe Sun is the message of Mollie Fund, an organization dedicated to increasing melanoma prevention. The excellent website has tips on self-examination, a video on the “Dark Side of the Sun” as well as a link for iPhone and Android.