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Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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6:46 PM
September 1st, 2018

Alzheimer Disease – the Memory Thief

 

Alzheimer Disease– the Memory Thief

Alois Alzheimer

 

German psychiatrist and neurologist Alois Alzheimer received scant attention in 1906 when he published the case of a 51-year-old woman he had followed for five years until her death. The woman, he wrote, had trouble remembering her name, could not report what she was eating, could not write her husband’s name, and could not remember familiar objects after a few minutes. Alzheimer examined her brain after her death and presented the findings in this first reported case of Alzheimer Disease.

 

Prevalence

 

Alzheimer disease is the most common form of dementia. It affected over 6 million Americans in 2017. It was the sixth leading cause of death and produced an economic cost of $259 billion. Some studies suggest a higher incidence among women; however, some attribute this to women’s longer life expectancy. Medicare data suggest incidence of 11.5% among Hispanics, 9.4% among African-Americans, and 6.9% among Caucasians. Persons over 60 years of age constitute 90% of Alzheimer patients.

 

Causes

 

Physicians and scientists have no firm answers about the causes of Alzheimer, but do have some associations. As far back as 1906, Alois Alzheimer noted that the brain of his deceased patient contained irregularities known as amyloid plaques and neurofibrillary tangles. Although other aged people have these plaques and tangles, Alzheimer patients have them in increased

numbers and specific brain locations.

 

Risk Factors

 

Although science has not identified the causes of Alzheimer, it has identified certain risk factors. These are:

       Advancing age

       Family history

       Presence of certain genes

       Obesity

       Insulin resistance

       High blood pressure

       Down syndrome

       Traumatic brain injury

 

Symptoms

 

The symptoms of Alzheimer increase from the mild, through the moderate, and into the severe stages of the disease.

 

  • Mild stage symptoms include:
  •        Memory loss
  •        Confusion about location of familiar places
  •        Bad decisions
  •        Mood and personality changes

 

Moderate stage symptoms advance to:

  •        Short attention
  •        Difficulty recognizing friends and family
  •        Difficulty with language and numbers
  •        Inability to organize thoughts
  •        Difficulty coping with unexpected situations
  •        Loss of impulse control

 

Finally, severe stage symptoms culminate in:

  •        Weight loss
  •        Difficulty swallowing
  •        Lack of bowel and bladder control

 

Tests for Alzheimer

 

Currently, only autopsy or brain biopsy can make a definitive diagnosis of Alzheimer disease. Lumbar puncture, or spinal tap, can secure samples of spinal fluid for analysis; but this is helpful mostly in research. MRI and CT may be useful for ruling out other, potentially treatable diseases. Sometimes PET scanning helps to differentiate Alzheimer from other dementias.

 

Treatment

 

Available treatments for Alzheimer can only lessen the primary symptoms; they do not cure the disease or arrest its progress. Donepezil, rivastigmine, and galantamine are cholinesterase inhibitors. They work by slowing the breakdown of certain chemicals needed by nerve cells to function. Another drug, memantine, works by blocking brain cell absorption of a damaging chemical known as glutamate.

 

Other drugs simply alleviate secondary Alzheimer symptoms, such as depression, aggression, delusions, and sleep disorders.

 

Coping

    

Coping skills and strategies are central because Alzheimer is an incurable, progressive disease that extracts energy from both patient and caregivers.

Helpful coping tips are:

  •        Be realistic. Recognize that things will not be the same and that satisfactorymay take precedence over perfection.       
  •        Be clear, concise, and repetitious in communication.
  •        Use visual cues, such as gesturing, as well as verbal cues, in communication. 
  •        Reminisce about the past with photographs and videos.
  •        Be prepared to change, as measures that were effective at one stage may begin to fail as the disease progresses.

 

Conclusion

 

The conquest of Alzheimer disease will likely come slowly with progress on several fronts. These may consist of:

  •        Development of better coping strategies and education of caregivers in their use.
  •        Improved medications to lessen primary symptoms.
  •        Discovery of means to reduce the frequency of the disease.
  •        Development of methods to slow or arrest the progress of the disease.
  •        Invention of a biochemical cure for Alzheimer.
  •        Optimistically, but improbably, development of means to reverse damage done by the disease.

 

Success over Alzheimer will involve the mobilization of multiple resources, including, economic, sociological, political, educational, scientific, medical, and nursing. Moreover, it will involve the insightful proportioning of funds among these resources. Further, it will involve the proportioning of funds among many societal problems. In summary, the program against Alzheimer is far more than a medical commitment; it is a societal commitment.

 

Thomas Falasca, DO

Thomas Falasca, DO

 

References

 

Alzheimer Disease: Practice Essentials, Background, Anatomy. (2018, April 20). Retrieved from https://emedicine.medscape.com/article/1134817-overview

 

Coping Strategies for Alzheimer's Disease Caregivers. (n.d.). Retrieved from https://www.ucsfhealth.org/education/coping_strategies_for_alzheimers_disease_caregivers/

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Vaping and Lung Damage

Centers for Disease Control (CDC) and Food and Drug Administration (FDA) have warned  ...See More

Vaping and Lung Damage

 

Vaping and Lung Damage

 

On September 6, 2019, the Centers for Disease Control (CDC) and Food and Drug Administration (FDA) issued a clear warning about lung toxicity related to e cigarette use. They along with state and local health departments are investigating the cause or causes of this potentially life-threatening disease. The investigation stems from a study of 53 patients from the states of Illinois and Wisconsin who presented to the hospital with lung and gastrointestinal symptoms. A third of those patients required mechanical ventilation and one death were reported in this study. The median age was 19 years.

 

E-cigarette, or more colloquially vaping, usage especially among adolescents has increased exponentially. Recent studies from Monitoring the Future, a 44 year old study, show that the increased prevalence of vaping represents the largest increase in risky behaviors since the initiation of monitoring.  Although used as a means to transition from cigarettes, use of the nicotine still carries with it the risk of addiction.

 

Investigations into the cause of lung toxicity are ongoing, but there are several clues at this juncture. The presence of tetrahydrocannabinol (THC) usage by users and use of black market devices and flavorants appear to be the focus of current investigations. More information will be forthcoming. For now, despite the use as a means of tobacco cessation, it is wise to avoid vaping until investigators have clarified more clearly the cause or causes of lung toxicity. At the same time it is important to continue to remain tobacco-free given the heart, lung and stroke risks which are clearly present.

 

Jeff McGovern, MD

Jeffrey McGovern, MD, FCCP, FAASM

Hand Washing and Avoiding Infections

An ounce of prevention is worth a pound of antibiotics. Preventive hygiene is still the best way to avoid infectious ...See More

Hand Washing and Avoiding Infections

Hand Washing and Avoiding Infections 

 

 

In the past century, science and medicine have provided many weapons to use on infectious diseases. There are antibiotics for many bacterial diseases, antivirals for some viral diseases, antimycotics for many fungal diseases, and even surgery for localized infections. But, the best way to deal with an infectious disease is still not to have it. Prevention remains a tool against infectious disease, indeed, a most efficacious tool with few drawbacks except the modest energy needed to employ it. 

 

 

Hand Washing

We touch our hands to our faces, according to some studies, an average of 20 times per hour. But the mucous membranes of eyes, nose, and mouth provide easy access to the body for germs, especially for viruses because of virus’ small size. It would be best for us to keep our hands away from our faces, even when the hands appear clean. However, this is sometimes not practical. Consequently, hand washing is important.

 

According to the Centers for Disease Control (CDC), frequent hand washing in a community reduces diarrheal illnesses by 31% and respiratory illnesses by 21%.

             

 

How to Wash Your Hands

Hand washing is not always intuitive.

 

First, use plenty of warm, running water and sufficient soap. At faucet temperature, the warmth of the water is not sufficient to kill germs, However, it renders hand washing more comfortable and, therefore more likely to be maintained for a time sufficient to be more effective.

           

Second, use sufficient soap and rub hands together. The idea is not to kill germs, but to remove them. The soap loosens germs from the skin and the rubbing dislodges them for carrying away by the water. Be sure to wash front and back, all fingers, between the fingers, and under the nails for at least 20 seconds. Twenty seconds is about the time it takes to hum two repetitions of the Happy Birthday Song.

 

Third, for drying, cloth towels may transfer other people’s germs. Better are electric hand dryers as found in public restrooms. To further avoid transferring germs to your hands, press the dryer’s on-off switch with your elbow. Nevertheless, paper towels, although the least ecological hand-drying option, are the most hygienic. Be sure to use a dry paper towel to turn off the faucet and to touch the door handle when leaving a public restroom. If there is no used paper towel depository by the door, let the paper drop to the floor, the maintainers of the public restroom will get the message to provide a depository.

 

When to Wash Your Hands

Although frequent hand washing is important, there are times when it is essential, such as

 

Before 

  •      Touching your mouth, including eating, drinking, and tooth brushing.
  •      Helping a sick person.

 After

     Using the bathroom.

     Changing diapers.

      Touching high-hand contact surfaces such as doorknobs, elevator buttons, handrails, and poles and handles on busses, trains,             

          and subways.

     Helping a sick person.

     Blowing your nose.

     Touching an animal, animal feed, or animal waste.

     Touching garbage.

     Tying shoes.

 

Before and after

     Helping a sick person.

     Treating a cut or wound.

     Preparing food.

 

Unfortunately, in some investigations, only 31 percent of men and 65% of women washed their hands after using a public restroom.

 

Hand Sanitizer

Hand sanitizers are a potent hygienic weapon when hand washing is not available. However, while hand washing removes germs and harmful chemicals, hand sanitizers only inactivate some of the germs. Hand sanitizers are less effective when hands are visibly dirty or greasy as the dirt can protect the germs from best contact with the sanitizer. Further, it is senseless to use the sanitizer to smear dirt more widely!

 

As with hand washing, rub front and back of hands, all the fingers, between the finger, and under the nails. Rub until the hands are dry.

 

Sanitizers should contain at least 60% ethyl alcohol, which inactivates germs by denaturing the proteins of bacteria and viruses. This only takes about 15 seconds. Unfortunately, sanitizers do not work well against norovirus, which is the most common cause of gastrointestinal illness in the United States.

 

Children should use hand sanitizers only with adult supervision as swallowing hand sanitizers can cause alcohol poisoning. Children may be particularly likely to swallow hand sanitizers that are scented, brightly colored, or attractively packaged. Hand sanitizers should be stored out of the reach of young children.

 

Fingernails

Fingernails can provide a cozy place under which germs can hide. Fingernails should be kept short, and the undersides should be cleaned frequently with soap and water. Finally, keep any remaining germs away from the mucous membranes of the mouth by not biting fingernails.

 

Routine fingernail care should also be done hygienically. Before use, nail clippers and files should be properly cleaned, even sterilized, if used among a number of people, as in a nail salon. Also, cuticles act as barriers to infection; avoid cutting or disrupting them.

 

In the Kitchen

The kitchen sink can be a source of spread for many germs. The kitchen floor just in front of the sink often has more bacteria than the trash can. Washing chicken in the sink can transfer intestinal germs such as campylobacter or salmonella from hands to sponges and to faucet handles. The sink should be washed often with special attention to faucets. Wet sponges can be sterilized by placing in the microwave for two minutes.

 

In the Bathroom

Flushing a toilet can disperse bacteria into the air and contaminate anything within a three-foot radius. Because of this, it is important to close the lid before flushing and to keep toothbrushes away from this radius.

 

Sharing cosmetics may result in sharing bacteria. Sharing toothbrushes can pass on such blood-borne viruses as hepatitis B and C, and infectious mononucleosis. Sharing razors may share MRSA (methicillin-resistant staph aureus) as well as blood-borne viruses.

 

Since children, and some adults, may not be conscientious about bathroom hygiene, it is essential to frequently clean bathroom light switches and door handles.

 

At the Front Door

Taking off shoes on entering the home and leaving them at the door keeps the house cleaner and avoids tracking in allergens and germs.

 

Although entering the front door in winter conveys a sense of warmth and comfort, the truth is that when the cool air in the house is heated, even with a substantial humidifier, it becomes capable of absorbing more moisture. It thus dries out the mucous membranes of the home's inhabitants, increasing violation of the mucous membranes by germs.

 

Disinfectants

Bleach contains hypochlorous acid, which attacks proteins in bacteria and some viruses. It is a powerful disinfectant, said to be about 99% effective.

 

Vinegar, thanks to its content of 5% acetic acid, is a disinfectant said to be 90% effective against bacteria and 80% against viruses. It kills flu virus but not staph. Although less effective against bacteria than bleach, it is cheap, nontoxic, and biodegradable.

 

Electronic Devices

Electronic devices can be an unsuspected source for germ transfer. One research project found thousands of bacteria on an Amtrak touch screen in the train station. Cold and flu germs can live on such hard surfaces for up to 48 hours. Swine flu has been shown to survive in this environment for up to five days. Hand washing, or at least hand sanitizer use, is essential after use of public touch screens.

 

Even personal electronic devices can transfer germs. One study showed 16% of cell phones to be contaminated with intestinal bacteria. It is imperative to clean the phone regularly, especially after lending it to someone, and to be careful where laying it down.

 

On Airplanes

Despite the public perception that the major airplane exposure is breathing recirculated contaminated air, the air in a plane is well-protected by high-efficiency filters, which remove more than 90 percent of known particulate matter.

 

A bigger concern than recirculated germs is low cabin humidity, about 10% when flying at 30,000-35,000 feet. This dries the mucous membranes of the noses and throats of passengers. Consequently, the mucus becomes too thick for easy movement and it remains longer in the upper respiratory tract. This gives entrapped germs more time to penetrate the passengers’ mucous membranes.

 

The most significant airborne exposure on a plane comes from fellow passengers. The most dangerous neighbors on a plane are those sitting within a two-seat radius since bacteria and viruses from coughs and sneezes do not readily transmit more than six to eight feet.

 

Airborne exposures aside, the usual concerns about contact surfaces remain, also on a plane. The worst exposure is the airplane bathroom, which has the exposures of other bathrooms but complicated by smaller space. Other important contact exposures on an airplane are seat-back trays and aisle-seat handles.

 

In a Hotel

Hotels are in the hospitality business and usually try to present a clean appearance. Nevertheless, germs are frequently abundant on bedspreads due to the difficulty in cleaning them. Light switches and bathroom floors are often contaminated with intestinal bacteria. However, the dirtiest site in the hotel room is usually the TV remote control.

 

Meanwhile, in the hotel restaurant, menus are the biggest carriers of germs, followed closely by the pepper shakers.

 

At the Gym

Keeping any cuts or injuries fully covered is imperative when working out at the gym. It is also essential to use the solutions and towels provided to wipe down the equipment before using it.

 

Plantar warts virus and athlete’s foot fungus can easily infect those going barefoot on gym floors and locker rooms. Wearing shower shoes in the shower and locker room is critical.

 

For yoga aficionados, it is important to bring one’s own yoga mat and to wear socks when not on it. 

 

At Work

One of the most important rules to follow for work is not to go if you are contagious. This rule is becoming easier to follow now that there are increased opportunities to work from home.

 

If someone at work is coughing or sneezing, maintain a social distance; as mentioned, six to eight feet is usually sufficient.

 

Other precautions to observe at work are

  •      Covering coughs and sneezes.
  •      Washing hands frequently.
  •      Regular cleaning of often-touched surfaces.

 

Flu Shot

Since meticulously following all of these precautions is not always possible, it is important to get an annual flu shot. The flu virus spreads from person to person through droplets coming from the nose and mouth when a contagious person coughs, sneezes, or talks. The flu virus may also spread when someone touches a surface with flu virus on it, and then touch their eyes, nose, or mouth. An annual flu inoculation helps protect from these exposures.

 

Conclusion

Again, the best way to deal with an infectious disease is not to have it. Prevention is a most efficacious tool with few drawbacks except the modest energy needed to employ it. 

 

Thomas Falasca, DO

 

Sources and Recommended Reading

Centers for Disease Control and Prevention. https://www.cdc.gov.

Fox, B. (2015). Introduction to Infectious Diseases. Chantilly, VA: The Great Courses.

Handwashing: Clean Hands Save Lives. (2018, October 09). Retrieved from https://www.cdc.gov/handwashing/index.html

Water, Sanitation & Environmentally-related Hygiene. (2011, February 01). Retrieved from      

     https://www.cdc.gov/healthywater/hygiene/hand/handwashing.html

Water, Sanitation & Environmentally-related Hygiene. (2009, December 30). Retrieved from  

     https://www.cdc.gov/healthywater/hygiene/hand/nail_hygiene.html

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