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Wise as Salamon/News Links

ssalamon_non_cg_2566Suzanne Salamon, MD is chief associate of clinical geriatrics at Beth Israel Deaconess Medical Center.   Email general questions to mdeery@brooklinema.gov or call Maureen: 617. 730. 2790.   These are excerpts. Read the full post in this month’s newsletter (link in right column)

AUGUST:  My mother is diagnosed with benign neurological syndrome due to tremors on her hands and vocal chords. Does it progress to Parkinson’s?  Tremors are caused by areas in the brain that control movement. Many cases of essential/action tremors are genetic, so if a family member has a tremor, there is a 50% chance this will be passed to the child. Other causes: overactive thyroid, stroke, brain injury, some medications, alcohol abuse, stress, caffeine, steroids, fatigue and amphetamines.  Resting tremors are often seen in Parkinson’s. There are medicines to treat the tremor and gait problems. Voice therapy can help with vocal problems. Overactive thyroid can be treated and familiar tremor can be calmed with certain blood pressure medications.

JULY: Lyme disease is a bacterial infection you get from deer ticks (not dog ticks). These tiny ticks are hard to see. They bite and stay on the skin. Symptoms may include fever, chills, sweats, fatigue, arthritis, headache and aches like the flu. Some develop a bullseye rash. If Lyme is treated early with antibiotics, it is curable. Prevent bites by spraying your clothes and skin with repellent, wearing long pants and socks. Check for ticks and rash after hiking and gardening.

JUNE:  Sciatica. Ow. The sciatic nerve runs from the lower back down each leg. It can be compressed by a bulging disc, arthritic and lumbar spinal stenosis. In addition to anti-inflammatory drugs like ibuprofen and naproxen, alternating heat and cold can help, along with deep muscle massage. Unrelenting pain can be treated with a steroid injection.

Shingles vaccine:  The first shingles vaccine was Zostavax. It is less effective for people over 80. The new one, Shingrix, is more effective regardless of age. It requires two shots 2-6 months apart. It is recommended for people over 50 even if you had shingles, got the older vaccine, or are not sure you’ve had chicken pox.

MAY:  Flowering trees and bushes are beautiful but my nose and eyes are watering. Is there anything I can do?  Pollen from grass, trees and flowers can cause allergies:  runny nose, sneezing, itchy eyes and sometimes, cough.  Allergies are not associated with fever, aches and pains. There is evidence we are seeing more allergies because we are becoming “too clean.” Antibiotic soap may wash away bacteria we need to develop antibodies. Try air purifiers and filters. After gardening, wash clothes and hands and remove shoes at the door. Newer antihistamines like Allegra and Claritin, over the counter, help symptoms with fewer side effects.

APRIL: What is diabetes and how can I prevent it?  It is a disease caused when sugar and fat that we eat cannot be absorbed and used for energy.  Instead they stay in the blood which causes blood sugar to rise, which leads to possible serious side effects.  Type 1 usually occurs in young people whose pancreas doesn’t produce insulin.  Type @ is more common and usually occurs in people who are overweight.  Risks: family history, overweight, some medications and older age.  Eating sugar does not cause diabetes.

MARCH:  What is TIA?  TIA stands for transient ischemic attack. Transient implies the symptoms last for a short time, less than one hour up to 24. Ischemic means not enough blood and oxygen are getting to the brain. Sometimes a TIA is called a mini stroke. While a TIA does not always cause lasting damage, it needs to be taken seriously because nearly 1/3 of people with a TIA will have a stroke in the near future.  Symptoms of a TIA and stroke may include: Face drooping, Arm weakness, Speech problems, Time to call 911 (FAST).  Timing is critical so if you experience any symptoms, get to the hospital.

FEBRUARY:  I have trouble sleeping. I hear that insomnia can lead to dementia. Is this true? Many people have trouble falling or staying asleep. Some studies have shown a connection between chronic insomnia and memory loss but this has not been proven for sure.  It is believed 7-8 hours of sleep can help us think more clearly and improve memory.  You can take a short nap before 5 pm. It is hard to sleep on a full stomach and if you are hungry. Spicy food may cause heartburn and milk products can affect the lactose intolerant. Alcohol can make you fall asleep faster but it can cause restlessness and wakening early.  Tea, turkey and tuna fish may help induce sleep. Exercise and relaxation techniques may help. It is common to have short periods when we have trouble sleeping but they usually pass.

JANUARY: What can you tell me about Parkinson’s disease? It is a disorder where the part of the brain called the substantia nigra stops producing dopamine. Dopamine is important in controlling movement. When dopamine levels are low, symptoms such as shaking or resting tremors, rigidity, slowing of movement and difficulty can occur. The most common initial symptom is a pill-rolling tremor of the thumb and index finger of one hand at rest in the lap. We don’t know what causes Parkinson’s but it often runs in families. It seems to occur in people with high exposure to pesticides and people who have had head injuries. There seems to be a lower risk in smokers and people who drink coffee and tea.

DECEMBER:  I have macular degeneration. It is the chief cause of loss of vision in the US, more than cataracts and glaucoma combined.  In “dry” MD there is no obvious loss of vision but the doctor can see yellow deposits called drusen. In “wet” MD there is noticeable loss of vision caused by bleeding into the eye.  Risk factors: family history, over 55, smoking, overweight, high blood pressure, heart disease, being Caucasian and unprotected sun exposure. Symptoms may include blurred vision, straight lines seeming wavy, or an empty area in the center of the visual field.  Early treatment can be critical to saving vision.

NOVEMBER:  I can’t sleep. I am tired when I go to bed but then I cannot sleep.  As we age, our usual sleep patterns may change. People may get sleepy earlier and wake up earlier in the morning.  The important question is whether you feel rested during the day or whether you feel tired. Try these: turn off the TV and computer one hour before bed. Read a book. Block out snoring with ear plugs. Get aerobic exercise: walk, dance golf. Talk to your doctor about melatonin (not sleeping pills). Short naps, less than one hour, are okay.

OCTOBER:  Breast Cancer Awareness Month.  In the US, about 330,000 women were diagnosed this year.  Possible risk factors:  age, radiation to the face or chest at a young age, being a white woman, being overweight, using hormone replacement pills, smoking and drinking more than 2-3 drinks/day.  Most cancers are picked up during mammograms. Women 45-54 should get them every year.  Women 55+ can go every two years or yearly.  Women over 75 typically get cancers that are slower growing and thought not to be as dangerous. Treatment is improving for early and advanced stages.  Get your screenings and report lumps, for both men and women, to your doctor.

SEPTEMBER:  What is the best way to take care of my feet?  The American Podiatric Medical Association estimates that the average American has walked 75,000 miles by the time they’re 50.  Foot problems may include decreased cushioning, dryness of skin and nails, heart disease and diabetes that can lead to poor circulation.  Wear shoes that don’t rub, cut nails straight across, keep feet clean and dry.  Read the column in its entirety in the newsletter.  See link on front page.

AUGUST:  Should I get the new shingles vaccine Shingrix? There are 5 vaccinations you need: flu vaccine every year, Prevnar 13 once, pneumonia vaccine once, Tdap once then every 10 years, shingles once. If you had Zostavax you should also get Shingrix.  It requires two shots given 2-6 months apart.  It is recommended for people over 50, even if you had shingles, got the older shingles vaccine or are not sure if you had chickenpox. Medicare Part D covers Shingrix but check with insurance about co pays.

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 New York Times, Huffington Post, New Yorker

  • For Diabetics, Health Risks Fall Sharply, by Sabrina Tavernise and Denise Grady, Times, April 16
    Progress Report
  • Younger Skin Through Exercise, by Gretchen Reynolds, Times, April 16
    Time Passes
  • A Number That May Not Add Up, by Jane E. Brody, Times, April 14
    Weight Matters
  • The Sixth Stage of Grief, by Joel Yanofsky, Times, April 11
    Buying a Puppy
  • Why a Brisk Walk Is Better, by Gretchen Reynolds, Times, December 4
    Pick up the pace
  • The Power of a Daily Bout of Exercise, by Gretchen Reynolds, Times, November 27
    Eat and run
  • In the End, It’s Not About the Food, by Corey Mintz, Times, November 26
    Just a little
  • Think Like a Doctor, by Lisa Sanders, MD, Times, October 3
    A Green Heart
  • A Youthful Glow, Radiating From Within, by Jane E. Brody, Times, September 30
    You look mahvelous
  • Manson Whitlock, Typewriter Repairman, Dies at 96, by Margalit Fox, Times, September 8
    Work works
  • Online Lessons in Dementia Management, by Judith Graham, Times, Sept 5
    Caring and Coping
  • On Becoming an ‘Orphan,’ by Paula Spahn, Times, July 1
    Profound Shift
  • When Aggression Follows Dementia, by Paula Spahn, Times, July 12
    Heart Breaker
  • When Exercise Stresses You Out, by Gretchen Reynolds, Times, March 13
    Hate it?
  • Eat Your Heart Out, by Gretchen Reynolds, Times, March 7
    Your Heart
  • The 20 Million, by Mark Bittman, Times, June 12
    Hardly eat
  • Gross Ingredients In Processed Foods , by Sarah Klein, Huff Post, May 14
    Eat no meat
  • We Could Be Heroes, by Mark Bittman, Times, May 15
    Eat less meat
  • The Disconnect: Why are so many Americans living by themselves?, by Nathan Heller, New Yorker, April 16
    Love story
  • Nutrition: Options Play a Role in Healthier Choices, by Nicholas Bakalar, The Times, February 13
    Food story
  • The Fat Trap, by Tara Parker-Pope, The Times, December 28
    Sad story
  • In the Body’s Shield Against Cancer, a Culprit in Aging May Lurk, by Nicholas Wade, The Times, Nov 21
    Old story
  • For Beginning Runners, Advice Can Be a Hurdle, by Gina Kolata, The Times, November 14
    Running story
  • What Boomers Do Best (and how you can prosper after 50), by Julia Moulden, Huffington Post, June 12
    Loud story
  • When the Roommate Has Four Legs, by Antoinette Martin, The Times, October 20
    Dog’s life
  • Redefining the Hot Dog, a Cart at a Time, by Jeff Gordinier, Times, August 9 “There are children in New York who have never eaten a hot dog.” Very sad story
  • When Are You Too Old to Exercise?, by Judith J. Wurtman, Huff Post, April 13
    Old story
  • The D Word, by Nora Ephron, Huff Post, 11/8/2010 “There are good divorces, where every­thing is civil, even friendly. . . In my next life I must get one of those divorces.” The D word