Demystifying Medicine One Month at a Time

Tag: Dementia

The Madness of Donald Sterling

Like most Americans, I was appalled by the comments that Los Angeles Clippers owner Donald Sterling made about his discomfort with people of color. The National Basketball Association, the league to which his team belongs, quickly levied the harshest possible punishment upon him: a maximum fine and expulsion from the league (via a forced, or heavily pressured sale of the franchise).Azaleas

By now you may have heard that former Microsoft CEO Steven Ballmer has offered $2 billion for the Clippers. Pundits are thunderstruck at the offer, because Sterling purchased the team for a mere $12.5 million in 1981. The highest price ever paid for an NBA team is a bit more than $500 million, which makes Ballmer’s offer look especially outrageous.

As with all media-hyped frenzies, there are aspects of the Sterling saga about which I am curious:

  • Was Sterling baited?
  • Was mistress/girlfriend V. Stiviano paid off to record Sterling’s rant, or did she simply do it out of spite or a quest for justice?
  • What kind of name is “V.”?

Recent reports have indicated that Donald Sterling may have Alzheimer’s dementia. His estranged wife Shelly openly offered Barbara Walters this opinion in a televised interview. News reports from ‘unnamed sources’ indicate that Donald Sterling has been diagnosed by two neurologists as having ‘early’ dementia, and that he may have had it as long as 3-5 years.

Let’s assume that Donald Sterling does have dementia (the same news reports claim that he has been ‘declared mentally incapacitated’). This raises more questions:

  • Is Donald Sterling authentically racist, or were his comments made only from the throes of his affliction?
  • How accountable should Sterling be if his mind is playing tricks on him?
  • And again: Where is the threshold through which someone crosses into dementia?

Walking Improves Your Brain

I’ve previously blogged about the value of exercise. Just walking. Thirty minutes a day.

250px-Gray728Remember, you have 23 1/2 hours left in the day to sleep, eat, sit on your butt, and stare at a screen. Just that 30 minutes a day makes big differences in your physical and mental health.

Now: research suggests that walking improves memory, and lessens the likelihood of dementia. All this, and the researchers only looked at people walking for periods of forty-five minutes, three times a week.

The part of the brain controlling memory, the hippocampus, became larger in a single year when measured before and after in 60 volunteers in the “intervention,” (i.e. walking) group.

I’m taking the dog for a walk. Talk to you soon.

Beyond a Spoonful of Sugar

First there was that draconian immigration law.

Then came the news about the cash-strapped state cutting Medicaid funding for certain types of transplants.

[And of course now the horrible news about the shooting rampage in Tucson.]

The 48th State; cruel to some, kind to others.

Just when I thought Arizona would legislate itself into least-favored state status, there was this article by Pam Belluck in the NY Times.

The quick summary:

Beatitudes nursing home in Phoenix is an outlier in the care of patients with Alzheimer’s dementia, because the staff there are empowered to give the patients what they want. Really. Any time of day or night.

Chocolate? Check.

A nip of brandy? You betcha!

Grandma (Mom?) wants to play with dolls? God bless her…

This article, part of an ongoing Times series called “The Vanishing Mind,” carries the subtitle “Therapy Based on Comfort.”

Therapy based on comfort? I love this idea! Ultimately, what else is there?

I find myself asking this question more and more. Health care and hospital practice is all about sacrificing comfort in the name of answers: diagnosis and treatment answers.  [Hey! and let’s not forget prognosis answers…] When did medicine, like life, become “no pain, no gain?”

And this newfangled philosophy by Beatitudes is front page news! Literally.

Belluck’s article splashed across the front page the same month that the ever-crusty New England Journal of Medicine carried a piece titled “The Emerging Importance of Amenities in Hospital Care.”

What earth-shattering trend will the NEJM reveal to us next? “Shelter keeps people warm and dry?”

What’s interesting about the way this nursing home treats its patients is, well, the outcomes:

The patients eat more.

They’re less agitated. They wander less.

The nursing home has therefore cut way back on it’s use of sedative drugs and physical restraints.

This makes the families of these loved elders much happier.

The staff feel better about the care they’re delivering, since they’re empowered to try to negotiate their way out of challenging situations by giving the residents of the nursing home what they want, rather than telling the residents what they “must” do to comply with the home’s (and presumably state and federal) regulations.

Okay, you say, but this is an isolated example. A nice example of a defined population (Alzheimer’s patients) and a select environment (the nursing home).

But what prevents us, other than the inertia of old habits and institutional culture, from holding to these principles in other realms of health care?

Couldn’t we provide patients with comfort in hospital settings? Why does it always seem to be either/or?

We move vigorously to treat diseases, but when they become resistant or the treatments themselves too toxic, why only then do we switch to comfort mode? The article commented on here is only the tip of the iceberg in poking holes in that theory.

Remember that you heard it here first: The massive federal health care overhaul (coming to you full-fledged in 2014) will alter the landscape dramatically. Health care entities that offer value, convenience, service, knowledge, and above all comfort, will sip from the chalice of health care innovation and reward.

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