A California neurologist, Dr. William Rodman Shankle M.D., is reported to be using the drug Exelon to successfully treat patients diagnosed with early stage Alzheimer disease. The FDA approved Exelon in 2000, and it reportedly stops the breakdown of a chemical transmitter in the brain. According to the Orange County register, Dr. Shankle believes that early detection is the key to halting the disease’s progression.

The article describes Dr. Shankle’s treatment of retired obstetrician Dr. Marvin Sando, M.D. Marvin (pictured to the right) retired in 1999. A few years into retirement, his wife noticed some strange changes in her husband. Marvin, who once added rows of numbers in his head, struggled with calculations. An avid reader who juggled five or six books at a time, he could no longer follow when he turned to his place in a book.

"It was frustrating as the devil," Sando recalls. "(Before) I might begin a book and pick it up three months later, and after one or two sentences know exactly where I was." He also found himself forgetting who people in his life were.

In 2002, he saw Dr. Shankle (pictured here with Marvin), who, after testing, diagnosed him with AZ. Dr. Shankle put him on a regimen of medication, including Exelon, as well as lifestyle changes --mandatory daily walks, a glass of wine only on rare occasions, and Sudoku instead of crossword puzzles to give his mind a new challenge. Reportedly, within a few months, Sando's memory test score improved to 100 percent. A PET scan at five months revealed much more activity in the memory storage parts of his brain.

Nearly five years later, on a regimen of medication, he is virtually symptom-free, confirmed by his scores on memory tests, images in brain scans and the ease of his everyday life.

"Every day when I take that little pill, I think of how lucky I am to be here," says Marvin Sando. "I'm enjoying every day." "You can't get any more dramatic than completely reverting to normal," Shankle says.

Dr. Shankle says that most AZ patients aren't diagnosed early enough to fully benefit. Because early diagnosis of AZ is the key to the efficacy of this treatment, Dr. Shankle believes that everyone should have an annual memory test, starting at age 65, to screen for early signs of Alzheimer disease.

You can read the article by clicking here. If you or a family member have early stage Alzheimer’s, show the article to your family physician, and ask for a referral to a specialist who would be qualified to advise you on the best course of treatment.


Felicia Curran
www.ElderAdvocacyLaw.com

Do you know what a pressure ulcer is? I didn’t, until my mother acquired a Stage 4 pressure ulcer during a hospital stay ten years ago. I had no idea what they were, or how they were formed. I learned quickly, though, and helped my mother get appropriate care that got her back home with my Dad -- though only after a two-month stay at a convalescent hospital.

Pressure ulcers can be a red flag of poor care at a hospital or a nursing home. A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies. Also referred to as “wounds,” "bed sores” and “decubitus ulcers,” a pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater.

The most common places for pressure ulcers are over a bony prominence such as the shoulders, back of the head, elbows, sacrum, hips, heels, and ankles.

Residents of nursing homes who are immobile are at high risk for developing pressure ulcers because they may sit or lie for long periods of time in one place or position. They may be too weak or too ill to move themselves, and they are totally dependent on nursing home staff to help them reposition.

Pressure ulcers are preventable. For pressure relief, immobile individuals need to repositioned at least every two hours in bed, and at least every 15 minutes if they are sitting in a chair or wheelchair. The nursing home should use a written schedule, posted on the wall for verification, for systemically turning and repositioning the resident.

At poorly managed nursing homes and rest homes, residents develop pressure ulcers because they are left unattended sitting or lying in bed for long periods of time, due to staffing shortages or because staff are poorly trained.

Poorly trained nursing home staff may cause pressure ulcers by even dragging the resident’s body across the bed onto the chair, instead of using a lifting device, such as a trapeze, to move the resident. Shearing of the skin can occur when a resident is pulled up in bed, instead of using a technique such as placing a half sheet under the person’s torso to lift the resident up off of the bed.

Another red flag of poor care at a nursing home is when the pressure ulcer gets worse, and not better, or multiple ulcers develop in different locations. Signs that the ulcer is getting worse include:

the ulcer gets wider, deeper, longer;
the ulcer develops dead tissue (usually black);
the ulcer develops “undermining” (a thin lip of tissue around the edges of the wound);
the ulcer turns black (indicating dead tissue);
the ulcer has drainage (watch out for yellow, green, or grey drainage);
the ulcer has a foul odor.


Pressure ulcers are staged 1 to 4 according to the degree of tissue damage involved, with Stage four being the worst.

Stage 1: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.



Stage 2: The skin blisters or forms an open sore. The area around the sore may be red and irritated.

Progression of a pressure ulcer beyond Stage 2 most likely means that the nursing home or care home is not providing appropriate care, or that they have not fixed the problem that caused the pressure ulcer in the first place - for example, they are still dragging the person across the bed, or they leaving the person sitting in a chair all day.


Stage 3: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.







Stage 4: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.


If a pressure ulcer becomes infected, the infection can spread to the rest of the body and cause serious problems, including blood infection (sepsis) and bone infection (osteomyelitis). Either of these are life-threatening conditions.

A red flag of poorly trained staff at a nursing home is that the staff does not know the signs and symptoms of infection.

Signs of an infected ulcer include:

A foul odor from the ulcer
Yellow, green, or grayish discharge from the ulcer
Redness or tenderness around the ulcer
Skin close to the ulcer is warm and swollen

Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body.

The pressure ulcer that my Mom had was able to heal because, after two months of failed treatment at the convalescent hospital, we found out about a new technology, a vacuum pump, that helped draw the fluid out and close the wound up. She was able to go home with the pump, and her wound completely healed in another three weeks. Previously, the wound had been so deep that you could see her sacrum bone.

Don’t let pressure ulcers happen to your Mom or Dad. Educate yourself on the causes of pressure ulcers. If your loved one develops a pressure ulcer, be pro-active in getting appropriate treatment, and don't let them tell you that it can't be healed. A general guide to prevention from the National Pressure Ulcer Advisory Panel (NAPUAP) is available online, in PDF format.


Felicia Curran
www.ElderAdvocacyLaw.com

The New York Times ran an article this past week about how to tell if you’re having a heart attack. The article described how the popular image of a heart attack is all wrong.

"It's the Hollywood heart attack," said Dr. Eric Peterson, a cardiologist and heart disease researcher at Duke University. "That's the man clutching his chest, grimacing in pain and going down," Dr. Peterson said. "That's what people imagine a heart attack is like. What they don't imagine is that it's not so much pain as pressure, a feeling of heaviness, shortness of breath."

Dr. Elliott Antman, director of the coronary care unit at Brigham and Women's Hospital tells his patients, "Be alert to the possibility that you may be short of breath. Every day you walk down your driveway to go to your mailbox. If you discover one day that you can only walk halfway there, you are so fatigued that you can't walk another foot, I want to hear about that. You might be having a heart attack."

You may also have "discomfort in the chest that may, or may not, radiate into the arms or neck, the back, the jaw, or the stomach. Many also have nausea or shortness of breath. Or they break out in a cold sweat, or have a feeling of anxiety or impending doom, or have blue lips or hands or feet, or feel a sudden exhaustion."

Signs and symptoms in elders are often are less distinctive, especially in older women. "Their only sign may be a sudden feeling of exhaustion just walking across a room. Some say they broke out in a sweat. Afterward, they may recall a feeling of pressure in their chest or pain radiating from their chest but at the time, they say, they paid little attention."

Patients with diabetes "might have no obvious symptoms at all other than sudden, extreme fatigue."

Get into a hospital or call 911 if you are having these symptoms. Medical research shows that people have only about an hour to get their arteries open during a heart attack if they are to avoid permanent heart damage. During this "golden hour" you have a chance to save most of the heart muscle when an artery is blocked."

To read the complete New York Times article, click here.


Felicia Curran
www.ElderAdvocacyLaw.com

A study in the February 28 issue of the Archives of Internal Medicine reports that men who take daily doses of aspirin or of nonsteroidal anti-inflammatory drugs may increase their risk of high blood pressure by more than 33.33%. Researchers studied a group of 16,000 men, none of whom had high blood pressure at the start of the study. Men in that group who took either acetaminophen or anti-inflammatory drugs six or seven days a week were one-third more likely to develop high blood pressure.

Dr. Gary Curhan M.D., the senior author of the study, said that people who are at risk for heart disease should continue to take aspirin but that, "Those who are not at high-risk need to understand that there are potential risks in taking these medicines on a regular basis. What is causing you to take these medicines? Maybe there are other ways to reduce or eliminate your pain so that you don't have to take them."

Sounds like good advice.


Felicia Curran
www.ElderAdvocacyLaw.com