COVID 19 is a nasty disease, in case you hadn’t noticed. It is SNEAKY: you can catch it from a person who has no symptoms.
It is UNPREDICTABLE: you may develop no symptoms or Die from it. It can affect any part of your body, including HEART and BRAIN.
And now we hear that it can DRAG ON. The outstanding infographic, “a multi-systems disease, which is intended for PRIMARY CARE PROVIDERS, has a lot to offer patients, who can do a lot to Care for themselves:
- –They can get a THERMOMETER and a PULSE OXIMETER to watch their own temperatures and oxygen saturations
- –They can monitor their own COMORBIDITIES, like Diabetes and HYPERTENSION, which are common with severe Covid. In patients who get very ill .
- –They can watch their GENERAL HEALTH, including SLEEP and DIET (the exercise part is relegated to DOCTORS recommendations).
You should also RESTRICT Alcohol, Caffeine and it goes without saying CIGARETTE SMOKING. Of course PREVENTION, with DISTANCING, MASKING and being Outside, coupled with SLEEP, DIET and EXERCISE is always best.
We ARE our brains. Reduce the function of any other organ, and we may be sick, but reduce the function of the brain, and WE have changed.
PROGRESSIVE LOSS of brain function is called DEMENTIA. A sudden, temporary (if the cause can be found) is called Delirium. A variety of bad things can cause dementia, such as infections (AIDS), toxins (lead, mercury), chemicals (alcohol), traumatic (CTE from football), diet deficiencies (B12, folic acid), Endocrine deficiencies (thyroid),Psychiatric problems (depression), drugs, and Vascular problems.
The Preceding article on dementia discussed APATHY, as opposed to the somewhat similar DEPRESSION, as a warning sign for SVD, or small blood-vessel disease. SVD is the most common VASCULAR cause of Dementia.
The most common overall cause of Dementia, especially in old age, is ALZHEIMER’S disease (AD). “Senior Moments” are so common as to be a cliche. But this problem is not limited to old age. My 3-year-old Grandson came crying to me that he lost his favorite toy. “Where was it when you last saw it”?, I asked. “It was in my hand” he answered.
He had laid it somewhere, unthinkingly. You can’t remember something unless you ENCODE it. You must be paying attention to, be “mindful” of an action if you are to remember that action.. You will not remember where you put your glasses if you wander around in “default mode”, daydreaming, preoccupied. Everybody occasionally forgets a name, or item which hangs on “the end of my tongue”.
These things, especially “short term memory” do DETERIORATE AS WE GET OLDER. It is common to wonder if we, or a loved one. are getting Alzheimer’s disease, as our mental powers wane.It is often difficult to distinguish the normal forgetfulness of age from DEMENTIA, including Alzheimer’s Disease (AD) It might be a source of REASSURANCE to realize that if you are worried about getting AD YOURSELF, you almost certainly don’t have it; It takes a lot of mental functioning to contemplate that possibility.
Most often, you will be wondering about the possibility in a loved one having AD. There are 2 ideas that I ran across in my reading that might help you do a little evaluation Yourself.
BCGuidelines.ca has a 21 item questionnaire that you can score yourself. 4 points or less is considered normal, so common is forgetfulness. 5-14 points suggests mild cognitive impairment. 15 or more points suggests Dementia, of which AD is the most common type.
The test I really liked was the “Clock Test”. In this test, you draw a large circle. You then ask your loved one to draw a clock, with all the numbers and hands that will indicate 10 minutes after 11. If it is drawn correctly, you can with reasonable certainty EXCLUDE Dementia.
If incorrect, further tests are warranted. I consulted with a Neurologist regarding a friend of mine who has marked memory loss, but is very sweet, is physically capable, takes care of herself personally, doesn’t wander around, has no apparent anxiety, depression or other psychological problems.
I asked if it was reasonable to just watch without any medical intervention. The neurologist said that she should have a blood test, a metabolic panel, TSH (thyroid), LFTs, folic acid and B12 tests, and a CT to rule out NPH (normal pressure hydrocephalus). It is rare to find anything treatable, but a shame to neglect it if present.
If you do see a doctor about a Spouse or Parent with possible dementia, you might request that they discuss the possibilities with you, but ask them not to write the diagnosis of “Alzheimer’s “ in the chart. Private Assisted Living Homes CHARGE A LOT MORE for that Diagnosis– locked facilities, more personnel and the like. BDNF- brain derived neurotrophic factor- can fend off Dementia.
That is the good news. The bad news is that it takes effort and discipline to increase your level od BDNF.; I’m sure medical science is hot on the trail of a pill. But until then, our old friends, Sleep, Diet and Exercise ride to the rescue. Sleep, both N3 and REM stages, increases BDNF. Dietary polyphenols and butyrate increase BDNF. exercise of all kinds will do it.
The BDNF gene codes for the BDNF protein, which promotes the survival, expansion, and differentiation of Neuronal stem cells, and promotes neuronal PLASTICITY, neuronal response to experience. Grit your teeth and develop the HABIT of exposing your Postmodern Body to 3 of the most ICONIC and NATURAL things mandated by Evolution, Treat your Body to the Health-giving Benefits of SLEEP, DIET and EXERCISE!
I have been having Heartburn for more than 40 years. The cause of Heartburn is leakage of acid from the stomach, where tissues have evolved to tolerate the highly acidic conditions, into the esophagus, where they haven’t.
The young body has an efficient, functional gate, or sphincter, keeping the food, once swallowed into the stomach, from coming back up. As you eat, you chew your food well to aid digestion. Your taste buds, sensing chemicals in the delicious food, activate saliva.
The salivary enzymes start the digestion of the carbohydrates in the food. If you eat slowly enough, you may be able to appreciate the digestion of tasteless starch, like in bread, into sweet sugar, right in your mouth.
You then swallow the food, which slips past another gate, called the epiglottis, diverting the bolus of food past your windpipe. This gate sometimes does not shut tight, and you choke on the food or drink. The food is then conducted into the highly acidic environment of the stomach.
The stomach evolved to be an acidic, “fiery pit”, inhospitable to any bacteria that came in with the food, thus protecting the stomach from infection. In the old days, there were a lot of bacteria, and the acidity of the stomach was useful, and evolutionarily conserved.
These days, the “fiery pit” tends to be a problem. As you get older, the gate that keeps food in the stomach gets more floppy and relaxed, and allows food to come back up into the esophagus, and sometimes, most often at night when you would rather be sleeping, all the way up to your throat, and is inhaled into your windpipe and lungs in what is called “gastroesophageal reflux”, or GERD.
Even if the food, and acid, doesn’t make it all the way up, and stops at the esophagus, which has not evolved to tolerate acid, you will have “heart burn”. Of course it is not the heart that is burning, but the esophagus, which runs right past the back of the heart as it goes all the way from the throat to the stomach.
When I first developed Heartburn, all that was available was the flavored chalk, Calcium Carbonate, sold as Tums. It works right away, and is a source of Calcium, but can cause trouble, like kidney stones, if you take too much. The relief didn’t last long enough for me, and I had to take more in the middle of the night.
My next medicine was Xantac, a medication that blocks histamine from stimulating acid production in the stomach. The H2 blockers have recently been recalled because of NDMA contamination. I sometimes used H2 blockers like Xantac when my patients would get a bad allergic reaction. In such cases BOTH an H1 blocker like Benadryl, and an H2 blocker are called for.
Zantac was not strong enough for me, and I soon graduated to Prilosec,which directly blocks the secretion of acid in the stomach.
Prilosec was then very expensive, but now is available as the inexpensive GENERIC Medication, Omeprazole. It seems that no medication is without side effects.
Omeprazole, by reducing stomach acid, makes stomach and GI infections more likely, and interferes with the absorption of B12, and Calcium.
If you have had a lot of heartburn over a long period of time, you should check with a Gastroenterologist, who may scope you to rule out Barritt’s esophagus, which can lead to Cancer.
It is interesting that the antacid Tums in excess can cause too MUCH Calcium in the body, and can cause kidney stones and other kidney problems like MAS, and Omeprazole, by interfering with absorption can cause too LITTLE absorption of Calcium, leading to OSTEOPOROSIS.
The best rule is to take as low a dose of ANY medication as possible, preferably none, to understand the possible side effects, and compensate for them if you can.
TELEMEDICINE is here to stay! With all its’ advantages Patients will demand It!
This video is one of the few to highlight WOMENS’ HEALTH as an appropriate field for Telehealth. A remote visit first may at least let the Doctor order some tests that will accelerate your care.
Urinary problems can also be appropriate for telemedicine; the MEDICAL HISTORY is such a VALUABLE DIAGNOSTIC TOOL!
Psychological and Psychiatric care could be completely remote, by telemedicine. The Doctor could save on expenses, and deliver care less expensively.
Distance disappears as a barrier to Consultations and second opinions. A University medical center or prestigious multi specialty Clinic are on your doorstep.
Of course, barriers remain in the form of regulations, litigation, bureaucracy, and Insurance, but these can be overcome, if the Will is there.
As I have aged, my skin has been more itchy. My allergy practice was loaded with Patients whose ECZEMA and HIVES itched. My favorite uncle developed intolerable itching (pruritis) in his 90’s, and died within a year of metastatic Prostate Cancer.
This gives you an idea of the Range of this annoying sensation. My emphasis here will be on CHRONIC ITCHING with DRY SKIN in otherwise HEALTHY PEOPLE without much rash or other skin condition. If you want extra discussion, look at Reference #1. If you are a Doctor, or a brute for punishment, see Ref.#2, a CME review.
Your skin is the largest organ in your body, and deserves respect right from birth. The skin of your child is wonderfly healthy in looks and self repair. EXCESSIVE SUN EXPOSURE is about the only thing you need to protect her from, and the only penalty is increased cancer risk in later life.
As your body ages, your skin looses some of its essential oils, and and becomes more dry (at least you don’t get acne any more). You become more sensitive to dry air, like in the winter, when the cold outside air (adiabatically) drops in relative humidity when warmed to inside temperature.
Do you notice the increase in static electricity shocks in the winter? If not, I’m sure that you do notice that your skin itches more. one treatment for the “winter itch” is to humidify the inside air. If you have a draughty old house like I do, it may be more convenient to use MOISTURIZING LOTIONS.
These were once mainstays of itch control in my former practice (before development of the effective modern medications). Eucerin and Cetaphil were very helpful. Maybe it is because of the name, but I now find myself using Curel “Itch Defense” all over my body twice daily,.
The itching is much less now, except for my EARS. My ear canals (they are skin too!) have recently been very dry and itchy, maybe because i listen to podcasts when walking or swimming.
Unwilling to give up my podcasts, I put some UNSCENTED Johnson’s baby oil with my little finger into my ear canals, as suggested by my ENT Doctor (I wanted to be sure i didn’t have a diagnosable condition like a fungal infection). If I have a small spot that itches a lot, I use some 1% Hydrocortisone cream, and I feel better.
Antihistamines don’t do much for me, but are effective if the itching is a real allergy (most of what people call allergy is not the IGE-MEDIATED, “real” variety). HISTAMINE is the quintessential provocateur of ITCH. Cetirizine (or atarax) is the strongest of available antihistamines, and diphenhydramine (benadryl) the old standby.
Chronic itching can be caused by a plethora of illnesses, as you will find if you choose to read the following papers.
– Dr. C
In my 88 years, I have had at least a dozen medical problems. Some have gone away on their own, some have been removed surgically, and a few have become CHRONIC, lasting for years, ultimately becoming a part of my life.
I have compiled a list of these and other SYMPTOMS & CONDITIONS I have seen as a physician. Over the next year, I will discuss them one by one, appending these vetted articles for further reading.
The ‘CHRONIC COUGH’ will be the first discussed.
As an Allergist, I was involved with coughing all of my adult life. If my patients did NOT have asthma, they usually coughed from mucus pouring down the back of their throat (post-nasal drip), from their allergic nasal condition (allergic rhinitis), or sometimes from the associated SINUSITIS drainage.
Asthma was a much more common cause of Chronic Cough for my Patients, sometimes theIr main problem. All asthmatic have a chronic inflammation of their breathing tubes(bronchi), and the resulting BRONCHITIS irritates the airway nerve endings, causing Cough.
Without enough narrowing of the airways to cause wheezing, this is called “cough equivalent asthma”. With the addition of airway narrowing (constriction) to the above situation, ASTHMA results.
There is added shortness of breath (dyspnea), and the cough becomes the “tight” wheezy cough of full-blown Asthma.
COPD (chronic obstructive pulmonary disease) may be a residue of long-term asthma, but commonly results from cigarette smoking. Where loss of alveolae (air sacs) predominates, dyspnea (shortness of breath) is more common.
Where bronchial tube inflammation is more prominent, mucus and cough result. This cough is useful in clearing the mucus; a USEFUL COUGH (although my Patients did not always appreciate their friend, which could be bad enough to cause hernias or incontinence).
Gastro-esophageal reflux is a chronic condition where stomach contents are not retained in the stomach by the G-E Sphincter ( a type of “purse-string” Gate), but spill(reflux) up, when not restrained by gravity, at NIGHT. The ACIDIC STOMACH CONTENTS burn the esophagus on the way up(heart burn), and are often aspirated into the airways during sleep, causing inflammation and COUGH.
There are many other less common CHRONIC LUNG ( pulmonary) DISEASES (conditions) such as sarcoidosis, bronchiectasis, interstitial pneumonitis, TB, and cancer, that can be diagnosed by imaging (X-Ray, etc.). Heart failure can also cause cough, as can blood pressure medication (ACE inhibitors).
Smoking is an obvious cause; chronic smoking, chronic cough. Smokers know what is causing their cough, and usually don’t bother coming to the Doctor unless they cough up some blood, or develop one of the myriads of diseases caused by their habit.
If you have a chronic cough, check with your Primary Care Doctor, who may refer you to an Allergist or Pulmonologist. The following article will be useful to your understanding of cough, and will provide a LIST OF QUESTIONS the DOCTOR will likely ask you.