if they cant agree

IF THEY CANT AGREE
thats what i was thinking as i listened to several state
neurologists discuss alzheimers this week at an
alzheimers conference sponsored by the
texas health department

i am also on a subcommittee thats working on an algorithm
for evaluating someone with memory loss
based mainly on the pdf file and booklet
listed here
clinical best practices for early detection...

i am on the committee as a family doctor and as a patient
to give my view from these two perspectives
ive noticed without me there im afraid these two views
might not be looked at as closely as they should
after all
its the patient that we are talking about here
right

by the way if you have memory loss or have a loved one
who has it
this booklet will give you a good guide
for whether or not you or they are being or have been
worked up properly
its the standard for the workup of memory loss

its always sad to find someone with a treatable disease
months or years later
when earlier treatment would have cured them or improved
their memory
like thyroid issues poor control of diabetes
blood pressure cholesterol depression sleep problems
etc etc

on this committee and those who are making suggestions for
the committee its interesting that even the experts dont agree
on what to do
now the core part we all agree on
eg
some would not have treated me at the beginning while others
would have
now i knew the statistics and research that was used to base
my treatment
i understood and was willing to accept the limitations of treatment
and its side effects
my choices were not good otherwise
so
i went with treatment
maybe in 10 years they will say
yes you should begin treatment it seems to help to delay things
for several years
or
no it doesnt make no difference
so
i went with the yeses
i and others of us cant wait for answers to be found
i say definitely prove this doesnt work and ill not do it

the main speaker was from ucla and he mainly does research on
preventative stuff
now this stuff he discussed has been shown to help slow down
that decline graph as the disease progresses
eg
eating healthy controlling blood pressure and cholesterol
getting adequate sleep etc
may shift the graph so that the decline may not happen
for 2 years or 4 years
or
if one is lucky 10 years later

now i know and understand these things dont make alzheimers go away
since its  going to win its battle with us in the end
but
man on man wouldnt it be nice
to see a grandchild start kindergarten or graduate from high school
or
if we are lucky graduate from college get married have kids

thats what this is all about
extracting all we can so we can enjoy these things when they happen

i sat there watching these experts talk and discuss how  they manage
patients
and
i thought
they some of them really dont understand do they

we are willing to accept side effects extra costs even on things
that may later prove not to work
eg
do the study on coconut oil using placebo groups and treatment
groups on patients destined to get alzheimers disease
on patients with mci
on patients with early alzheimers disease
follow them long term
do the tests that need to be done like memory test scans to document
whether this works or not
if it doesnt then publish it so we can all quit taking it
this should have been done years ago
that folks is simple straight forward science

another example
is turmeric acid or curcumin the spice
many of us take it every day
again just do the dam study that shows definitely that it works
or doesnt
again this should have been done years ago
yes or no just give us the answer
its again simple to do

now resveratrol has been studied like this
the results will be out soon
i take it every day at a high dose based on the dose that
was used in the study
if it is shown to not have an effect on the progression of memory loss
then ill stop using it
and
will move on

now its been shown and research supports these
theyve done the studies
that
controlling blood pressure diabetes cholesterol obesity
eating a well balanced diet like the mediterranean diet
controlling anxiety and depression and sleep issues
meditating reducing stress
stop smoking
drinking in moderation
exercising your body and your mind and your spirit
maintaining normal vitamin b12 folate vitamin d homocysteine

these have all been scientifically been proven to make a difference
no doubt about it

now can you please start doing the studies on all the vitamin
and supplements that seem to maybe possibly could be helpful
just do the studies please
either they do or they dont
its not that hard to do the studies that need to be done

quit working on rats and mice
us humans are willing to be the guinea pigs for proving if
these things work
thousands are doing it anyway

so thats what i was thinking as i sat and listen to all those
folks
agree and not agree on what needs to be done

so
i am not changing what i am doing until its shown that the things
i do dont work

until they agree

the organicgreen doctor

tomato dreams

TOMATO DREAMS
so heres the deal
in central texas if you want tomatoes
you have to pick the right varieties
get them in the ground asap
since when the ground warms enough to plant
you are on the clock pushing those plants to make
fruit before the heat hits
since
once that heat hits here
those tomatoes are usually done for

if you delay the process any along the way
you may not get tomatoes

each year it seems something happens to throw
a wrench in the system
too much rain
hail storms
too little rain
late freezes this seems to happen every april
early summer now this one seems to hit us every year
infestation of pests

despite all this
we and most gardeners around here still plant those tomatoes
sometimes several times before we get a crop

if you can get them in the ground early
keep them from freezing
get them far enough along
before it starts to warm up
you might get a good crop

like last year
i planted them a month early
in a deep hole
covered it with a 5 gallon bucket
covered all that up with row cover and blankets
and
i had a fairly good crop

now i started this year tomatoes destined for the northern us
thinking i would put them in pots and move them in and out
of the greenhouse
ive never started them from seed before
i learned this year that i should have used a warmer under
my pots to speed things up
so far out of 10 pots i have just two plants that made it

they are called glacier
with a name like that they should do good in this weather
i plan to transplant them into my garden this week

so this year i spoke with a gardener who does this

she takes these candles i think they are prayer candles
maybe what you are suppose to do
is light them and start praying they wont freeze

she buries them in the ground to almost the top
lights it when its cold
puts a pot over it
the small cover over the hole is removed
air comes under the pot over the flames and out the top
like a chimney or tepee
in her 12 ft bed she uses about 3-4 of these

the bed is then covered with thick row cover
she gets her first tomatoes in early april
so
i tired it
in my large bed
after two nights of 28 degree weather my tomatoes froze
looked like someone sucked all the juice out of them
limp as could be

but
in my circular bed for some reason
the tomatoes i planted
a juliette and a sweet 100 tomato survived
and actually have doubled in size
i plan to plant the glacier there also
so maybe this method will work after all

the true test will be this am when i peak under
the layers of row covers to see if it works
after several days of freezing weather and
sleet and ice
oh by the way the candles will burn up to a week

now
i plan to replant that 12 ft bed
plant those tomatoes in the hole thats the depth of a
1 gallon pot
as it grows ill cover its trunk with dirt
during cold spells ill cover it with the 5 gallon bucket
but
i will light those candles again with the clay pot over them
then
cover it all with row covers
hoping
this time the big bed conglomeration will work
since
i want to get those tomatoes in asap
so
we can eat them asap

i can dream cant i

the organicgreen doctor

there you go again

THERE YOU GO AGAIN

president reagan said those famous words years ago
at a political debate
now
i think
elizabeth warren mutters it everyday

i think whether you are a democrat or republican or independent
or nothing
you need to like her
since
like ive said before she is on our side
she is watching out for our best interest
the not rich guys
no matter their political persuasion

we have to have someone like her up there
to be a thorn in the side of those who
got us in all that financial mess we were in

i think you will like her if you just focus on the things
she does to protect all of us
just forget about politics

now i realize she is too liberal on other issues to ever be
elected president
but
i wish we could get someone running that had
that fire in her belly that she does
someone who was really truly
on our side

i noticed her standing beside the president when he was
talking about excessive fees that many of you are paying
for your investments
not me my fees are the lowest there is
any move to decrease these are being met with resistance
and
big money is being put up to fight it
since those too big to fail folks
the ones we saved and it seems are set up to save again
if need be
are some of the ones set to fight it

derivatives that dirty word is back again
you go senator warren fight those things for us
our great grandkids will be paying for the last bailout
on those things
and
we i should say our great great grandkids will be on
the hook for the new derivatives
why cant we learn
oh thats right
follow the money where it flows
to both the democrats and republicans
thats why all this stuff happens
they work together to protect those with the money
and
we all have to pay for it

in sundays local paper i read this article on
low down payment mortgages at many loan places
now
these are the ones that started the mess that
almost destroyed our country financially
sending us down an abyss that we are still
trying to get out of

the freddie mac is allowing these 3% down loans
fixed rates to be done
lets see 3% on a $100,000 house
thats $3000
im sorry this doesnt feel right to me
makes me feel real uncomfortable

my thought is that
you dont have the money for a larger down payment
then
you just keep on renting your apartment or house
many folks are better off doing it this way anyway
you cant default on rent

lets dont put all of those folks at high risk of personal
financial collapse again

in the words of ronald and elizabeth
there you go again

just dont do it please

the organicgreen doctor

peach dreams

PEACH DREAMS
this is the time of year when i have those
peach dreams

country n peach dreams
those sweet juicy peaches
that
my wife she and i call
sink peaches
since
you have to hold the peach out over the sink
in the kitchen
bend at the waist
then
bite into that juicy peach
and
let all those juices
what you cannt get into your mouth
fall off you mouth and lips
drip down your chin
into the sink
even trying to catch some of the juices
in the other hand
to lick off when you finish eating the peach

if youve ever eaten sink peaches
then you know what i am talking about
ok i snuck in some tomatoes
in this picture since there are such things as
sink tomatoes also

now our peaches
they dont seem to produce a good crop of peaches every year
but when they do
it is ultimate peach bliss for a few weeks

i do whatever i can every year to make them grow better
this year i mulched around my peach trees with my
country n homemade compost
added some organic fertilizer
even ran a dripper that uses the runoff from my rainwater
tanks to keep extra moisture to them
then

come february 14 thats valentines day for those of you who
might have missed it this year
i trim my peach trees so they are easier to pick the peaches
thinning out limbs

then i am ready
hoping please ole please no late freezes
that will nip those buds just as they are ready
to burst out

sorry to say
that is yesterday and today as our temps dropped into
the upper 20s and the light rain and mist has covered
all our trees with a sheet of ice
got my fingers crossed
hoping that they make it

now we have this one tree thats on its last legs
its old
its now down to one or two branches
the main trunk of the tree is all twisted gnarly like
split open
looks like it should die
but
it seems to survive each year

now this peach tree makes the absolutely best
sink peaches that i have ever eaten
but
we only get them about every 3-5 years because
they bloom in early february every year
then get slammed with the freezes like we have now

so
this year i have scheduled an intervention

i covered it with two layers of row covers
tied at the bottom with bungy cords and clamps
then
covered that with a large tarp
then
inside the middle of the tree branches
i clamped one of those heat lamps used in chicken houses
and
plugged it into my bbq area
hoping
just hoping
that it will keep things warm enough to keep the buds
from freezing

so far before this weather we are having now
its survived two nights of upper 20s
without freezing of the new buds

im dreaming of
sink peaches from that tree

the organicgreen doctor

why still alice bothered me so much

WHY STILL ALICE BOTHERED ME SO MUCH
this weekend my wife she and i went to a special showing
of the still alice movie at the alamo drafthouse on south lamar
that was sponsored by the alzheimers association

a local neurologist the director of the alzheimers association
and i answered questions from the audience for over 30 minutes
afterwards
well i almost didnt make it through it all

what is the matter with me
i thought
as i started watching the movie
i figured i would tear up some
but
i started when the movie started
and
it never stopped all the way through the  movie

i thought theres no way im going to be able to make it through
that movie
then
get up in front of all those folks
and
answer questions about alzheimers disease
heck
i barely at times could see the screen for all the tears

i made my way to the front of the auditorium afterwards
still a little bleary eyed
started my 2 minute introduction
but
when i started talking about my mother my brother my dad
my older brother who fought and whose fighting the disease
i had to stop
and
discontinue talking

lets move on was said to some questions
i took a deep breath
thought i have to do this for them and myself
and
for those other people who wanted some answers
so
i sucked it up
finished my introduction
fielded the first question from a local newspaper reporter
and
did ok the rest of the way

i thought about all this later on my way home
why did it bother me so much to watch that movie
and
to get up and talk about my family and dealing with alzheimers

ive done it numerous times at multiple locations to groups of
all sizes without problems
granted
the first one i ever did after my diagnosis was to about 50 of
my fellow family practice doctors where i use to practice
the same thing happened
it was the first i had seen most of them after i had left there
a year before
i regained my composure then like i did this weekend
and
finished my presentation and fielded their questions

i realized that i had been thinking about my mother all week
and
about her fight with the disease
and
she would have been 93 on saturday
had she lived
had alzheimers not taken her away
almost exactly 8 years ago

seeing the movie
and
seeing those events still alice was experiencing
seeing her family and its dynamics
some accepting it some not
seeing her downfall
brought back strong memories
none of them good
wonder if flashbacks are like this
then
i thought a lot about my younger brother this week
since he had early onset alzheimers like still alice
now he didnt have the dominant gene kind like still alice did
but that doesnt really matter
since
the course and end result is all the same

then i thought about my older brother
just diagnosed over a  month ago
what he must be thinking
what he would feel if he watched this movie
its like a cancer diagnosis with no cure but maybe
a lot slower before it does its job

then
so much in the movie triggered things as i watched it
the memory test
brought back the memory of
sitting in the examiners office at the alzheimers center in dallas
being asked to name what those pictures were
five of the things i sat there staring like she did
knowing i knew what they were
but the words werent there for me to reach out
and grab to answer her questions

thats a you know that bird that flies on the beach and
eats fish
you know that thing you sit in on our deck
my wife she sits in it when she grades papers sometimes
i joke that if she grades in that thing they always get as

there were  more of those that day
and
i remember getting that stare
that sinking feeling she had that she showed on the screen
i remember feeling hot and sweaty
knowing what i knew about things
that
my moment had arrived
it changed my life and my familys life that day over four years ago

so thats why as i started watching the movie
i instantly teared up and didnt really clear up
until after i started answering questions

flashback and flashbacks were the answer i guess

so
i feel like all that was cathartic
even though i wasnt sure at the time
im glad i watched the movie
and
answered your questions

by the way so should you
watch the movie

i persevered to finish what i started that day
and
am feeling somewhat refreshed now
ready to move on
as
we all continue the fight against this terrible disease
alzheimers disease

congratulations to julianne moore for winning the oscar
there was no doubt that she would win

you and your older kids need to see it
just bring tissues

the organicgreen doctor

top questions you ask me

TOP QUESTIONS YOU ASKED ME
i am always asked a lot of questions about alzheimers
dementia memory loss
and
of course lots of gardening questions and rainwater collection ones
but
mostly today ill address the top three im asked about memory

should i be tested is asked at every presentation i do
i answer it this way

if you are having memory issues
you should seek an evaluation
there are a lot of things that causes memory issues that are treatable
like low thyroid low b12 abnormal electrolytes liver disease
kidney disease depression anxiety stress sleep disturbances
medication abuse of drugs and alcohol poor control of diabetes
blood pressure cholesterol
just to name a few

fix these and your memory might improve

before you go to the visit
if the memory is significant have a family member do
an online questionnaire on you like this one
fill it out and print it to take with you

also write out what memory issues you are having
take them in with you
take someone with you since many providers like to
interview family members also

make the appointment just for memory and nothing else

during the evaluation you should be asked lots of questions
labs should be done
a memory test should be done

if you have an in office one that doesnt take 20 minutes or so
to do then you did not have a good one
they are called mmse or moca tests
they may do one called a clock test or minicog as a quick screen
but on that one you have to be more advanced to flunk it

you may need a neuropsych test and an mri

here is the link to a pamphlet that is a gold standard
for evaluation of memory loss for providers to follow
the link is at the bottom of that page to the pdf file

it soon will be available in a quicker reduced form
you can look at this online pdf file to follow your workup
to make sure a complete evaluation is done

dont get ignored if you do go somewhere else for the evaluation

should i have genetic tests done
i would say no if you are not ready to accept what you find
if you are not ready physically mentally emotionally and
financially to get bad news

if a positive genetic test gets in your medical record
you will not get life insurance disability insurance
long term insurance possibly professional insurance like
malpractice insurance and in some cases health insurance
which thank goodness for obamacare most people could get
it even with a diagnosis

i have had relatives and friends get genetic tests done
that show the apoe4 double gene
if its positive and its in your record you will have problems
as above

the genes for alzheimers are rare
less than 1%
if its heavily in your family you could have it
if you have the gene you will get the disease

the apoe4 gene double version is the next bad one to have
your odds are increased 10-20 times you will get alzheimers
but it doesnt mean you will
even then it can be hard to digest and accept your risk

that said
i would want to know and i did want to know
so i got tested
granted this was after already being identified as having
memory loss
and
labeled as amnestic mild cognitive impairment
and
having been shown to have abnormal levels of beta amyloid
and tau in my spinal fluid

so as part of a total workup i had it done
probably without symptoms i would not
but
lucky for me i had all of my ducks in a row re insurances
when my diagnosis was made

that said
knowing you have this increased risk sure makes you more
aggressive in taking care of you health
which i think determines how this apoe4 gene will affect
your memory loss

how are you doing
i must say that compared to 4 years ago when i was diagnosed
and
took all my tests and did all those memory tests and
neuropsych tests
i am much better as evidenced by my scores now on those tests
and
based on what i feel and notice myself

i feel like that fog that was hoovering over me for a couple
of years seems lifted some

why
once all this happened i got very aggressive with my health
my blood pressure was always borderline high
it would come and go
so i gave in and got on a blood pressure medicine that keeps
it normal all the time now

my cholesterol was under pretty good control
but i have aggressively got my levels to those that someone
with heart disease or increased risk for heart disease should
have theirs at
specifically my ldl is less than 100 and my triglycerides are less than 100

i stay very active physically mentally socially as much probably
as when i was in practice if not more

i take aricept which could be part of the reason why im better

stop it and i will find out but im not willing to do that though
the problem with aricept is that it interferes with my sleep
i only get 5 hours a night
but
i compensate that with an afternoon nap
and
i now take a nightly herbal medicine that seems to get me back
my 1-2 hours i am loosing to the aricept
usually
but i do most of the time feel rested

that said the aricept causes a lack of energy and tiredness that
usually hits me in the afternoon
hopefully i dont demonstrate that tomorrow afternoon at the movie

luckily usually i am napping and have done most of what i
like to do in the morning

i take b12 supplements and vitamin d3 supplements since both of
these were low when i had blood tests for them

i eat a mostly vegetarian diet about 90%
i eat a morning egg and toast dried nuts and fruits
i do eat meat but its lean meat like turkey and range fed beef
some occasional chicken
i follow mostly a mediterranean diet
but if i go out to eat i eat what i want too

i am not depressed i dont feel stressed i feel happy and contented
i dont get angry it seems

then
i have been following the protocol from the
reversal of cognitive decline study from dr bredesen from ucla
most of which i was doing already

putting all that together
the answer is
i think i am doing better


still alice
the special showing of still alice  with the alzheimers association at 155pm which
will have a panel that includes me and two others to answer your questions
afterwards
is sold out

it is showing several other times that day and at other locations in austin
for you to see it
it is a must see movie for i think everyone
even young folks since i think they need to be thinking about this

for those who got tickets to the q&a session ill see you there

the organicgreen doctor

hope for the future

HOPE FOR THE FUTURE

these kids and their generation and the generation
just above them
are the hope for the future
for everything but especially for
a cure or preventative treatment for
alzheimers disease

i can see it like way over there in the horizon
like when you travel in the dessert in the early evening
or early dawn
way off in the distant you see those glittering lights
and those areas of green

hope is out there but its way out there

the cure and treatment will probably come too late
for my generation
but
it will be there for these little guys and their soul mates

a new study i read about this morning was done on women
who took multivitamins with minerals long term
they had a 35% decrease in their risk of dying from
heart disease

now i know from all my reading on alzheimers disease
that generally whats good for the heart is good for the brain

there right now are so many exciting potentially game changing
studies with different new drugs and treatments


the A4 study
folks will be given the new alzheimers vaccine  who
have positive scans that show they will probably get
alzheimers disease but have no symptoms
the vaccine will remove beta amyloid from the brain
thats the bad stuff that is thought to be the culprit in
alzheimers disease
if it works they wont get the disease or will slow down its
progression


the apoe4 studies
folks who have the double apoe4 gene like i have
which puts them at high risk for developing alzheimers disease
will be given the alzheimers vaccine

other folks will be  be given a bace inhibitor which stops
the brain from producing the bad stuff beta amyloid


colombian studies
folks who have the dominant gene for alzheimers disease
and all yes all of them will get it in their 30s to late 40s
and die from it
they will get the vaccine also

so using the vaccine and the bace inhibitor will be thoroughly
tested and we will know in 3-5 years if this approach will
work
if it does we will see this form of treatment get fast tracked
to folks who are early like me or who are at high risk
like
eg my siblings who arent affected yet
they can be screened with scans and spinal fluid analysis
if they are positive
then they could be started on a lifetime of treatment

so maybe this is the hope for the future we are looking for

of course if it doesnt work we are knocked back to ground zero
but
there are lots of other studies being done


the noble t-817ma study just got fast tracked some because of some
promising new studies showing it may help
basically this chemical promotes the new growth of new nerve cells
and
inhibits brain cell death


the sniff study just started one that i might get involved with
basically insulin is sprayed up the nose
goes up the smeller nerve thats the olfactory nerve to the
part of the brain where alzheimers disease starts
it increases glucose to the brain cells some damaged and some not
preliminary studies shows that folks who use this
have an improvement in memory

i expect this will work some and will become part of a
treatment regimen for folks

so these studies above are ongoing now
in humans
and will be available in 5-10 years if they help

some hope for the future

there are lots and lots of studies in animals usually rats or mice
that seem promising
like the stanford study studies on multiple older meds like
citalopram bexarotene etc


then
there is the reversal of cognitive study from ucla that was published
last year that use 36 points
half were healthy things like blood pressure cholesterol diabetes control
exercise diet sleep mental activity meditation for me thats gardening
and making sure your numbers are ok like thyroid b12 homocysteine
vitamin d hormones
then the rest was supplements based on human and animal studies
that showed promising results

he had 9 of 10 people with memory loss get better
the one that didnt had more advanced alzheimers disease
most had memory loss documented on memory tests
some had abnormal scans
when they went off the regimen they got worse again
so
theres something in what is in that 36 point study

maybe some it will be related to the new study referenced above in
women with lower heart disease rates who took multivitamins with minerals

so
in summary
there is hope for the future
for
we always have to have hope dont we


fyi
there are only 12 tickets left for the special showing of still alice
they are along the back row of the auditorium
thats actually where we always like to sit at the alamo drafthouse

the organicgreen doctor