Blood tests for neurological disorders

The hunt for biomarkers in the blood that can be used to screen for neurological disorders such as schizophrenia and dementia seems to be making headway. Two groups of researchers report about promising tests using biomarkers. Let us take a look at their discoveries.

Predicting Alzheimer’s

Researchers from the Institute of Psychiatry at King’s College London report that they may have develop an early test for Alzheimer’s disease – a test that can predict its onset up to ten years before the symptoms appear.

The biomarker used for the test is a protein called clusterin which surrounds the brain plaque characteristics of the disease. High clusterin levels were found to be closely linked to brain shrinkage and rapid memory loss. Clusterin is easily and reliably detectable in the blood. As a biomarker for Alzheimer’s, clusterin seems very promising.

According to lead author Dr Madhav Thambisetty:

“We are very enthusiastic about these results because they identify a strong signal in blood from clusterin protein that appears to be relevant to both pathology and symptoms in patients with Alzheimer’s disease, adding further evidence to the role of clusterin in Alzheimer’s disease… A primary goal in Alzheimer’s research is to develop an inexpensive, easily administered test to accurately detect and track the progression of this devastating disease.  Identifying clusterin as a blood biomarker that may be relevant to both the pathology and symptoms of the disease may bring us closer to this goal.”

Detecting schizophrenia

Researchers from Cambridge University report about another potential blood test – this time a test for diagnosing schizophrenia. Currently schizophrenia is diagnosed by psychiatrists based on patient interviews, a method which is not necessarily accurate, sensitive and objective.

The researchers discovered a set of 51 biomarkers with linked to schizophrenia. These biomarkers are detectable in a blood sample and can be used as a diagnostic tool complementary to the patient interview-based method. The test is called VeriPsych

According to Professor Sabine Bahn, Director of the Cambridge Centre for Neuropsychiatric Research, who developed VeriPsych together with his collaborators at Psynova Neurotech and Rules-Based Medicine:

“Schizophrenia is a complicated and challenging disease, yet current diagnostic approaches continue to be based on patient interviews and a subjective assessment of clinical symptoms. We expect VeriPsych to be used as an aid to this current process, and we hope it will provide the psychiatrist with additional confidence in their evaluation, as well as speed up the process.”

Is skin cancer on the rise?

The incidence of skin cancer is increasing. And this increase is not only due to better screening and diagnostic techniques. The threat is real and not just an artefact of better technology, according to researchers at the Stanford University Medical Center in California.

This rise of skin cancer incidence has been reported both in the US and Europe. In the US, the increase is on average, 3.1% each year, from 1992 to 2004.

The Stanford researchers argue that improved screening methods will detect more skin tumors which are thinner and most likely to be benign, the kind that were easily missed before the new methods were introduced. However,

“after assessing 70,596 previously documented cases of cancer diagnosed between 1992 and 2004 in the United States, they found that there were significantly more cases of tumours of all thicknesses”.

Another indication of skin cancer increase is the fact that the rise is evident in all socioeconomic groups, not only among those who belong to higher income groups in the US and therefore have better access to health care and insurance coverage.

The findings of the two studies indicate that skin cancer is indeed on the rise.

Skin cancer incidence reports are quite controversial, because the disease is closely associated to exposure to the sun. In recent years, there is a rapid increase in vitamin D deficiency the world over because people tend to avoid sun exposure for fear of skin cancer. However, vitamin D deficiency has been linked to a variety to chronic conditions, including cardiovascular problems, osteoporosis, neurodegenerative disorders, as well as pregnancy complications.

According to lead researcher Eleni Linos

“Over the past 100 years, people are really changing the amount of time they spend in the sun, the clothes they wear, and whether their hobbies and work are indoor or outdoor.” This has been confounded by the thinning of the ozone layer which led to “increased exposure to ultraviolet light or a longer-term increase in the genetic susceptibility to cancer.”

According to the Medline Medical Encyclopedia,

Skin cancer is the most common form of cancer in the United States. The two most common types are basal cell cancer and squamous cell cancer. They usually form on the head, face, neck, hands and arms. Another type of skin cancer, melanoma, is more dangerous but less common.

• skin cancer commonly occurs in people who
• have light-colored skin, hair and eyes
• are older than 50 years old
• family history of skin cancer
• spend a lot of time outdoors in the sun.

Photo credit: stock. xchng

Know your heart conditions: diastolic dysfunction

Resource post for January

About 80 million adult Americans suffer from at least one type of cardiovascular disorder. This is equivalent to 1 in every 3 adults. Diastolic dysfunction is a commonly used term nowadays in connection with diagnosis of heart disease. This term, however, is fairly new, and the dysfunction has only been identified with improved diagnostic techniques.

What is diastolic dysfunction?

Before we can understand this disorder, we first have to understand how our heart works.

“Lub-dub” This is the sound that our heart makes with each and every heartbeat. And with every beat, the heart contracts and relaxes. The contraction phase when the ventricles contract to pump blood out of the heart is called the systole. The relaxation phase when the ventricles relax and get filled with blood pumped from above by the atria is the called diastole. The “lub-dub” sound is actually made by the heart’s valves as they close and open during the contraction – relaxation cycle.

Our heart has 4 valves, namely:

• The tricuspid valve divides the right atrium from the right ventricle.
• The mitral valve divides the left atrium from the left ventricle.
• The pulmonary valve separates the right ventricle from the pulmonary artery, the big blood vessel that brings blood to the lungs.
• The aortic valve is separates the left ventricle from the aorta, the big artery that carries blood from the heart to the body.

The soft “lub” is the sound that the mitral and tricuspid valves make when they close at the start of the systole or contraction phase. The louder “dub” is the sound that the aortic and pulmonary valves make when they close at the start of the diastole or relaxation phase.

Diastolic dysfunction occurs when the relaxation or diastolic phase of the heart does not proceed normally. This has something to do with “stiff” heart muscles leading to the failure of the ventricle to relax normally. This inability of the ventricle to completely relax results in:

• the pressure in the ventricle to increase above normal.
• difficulty for the blood to enter the ventricle in the next heartbeat.

According to the American Heart Association (AHA), when not managed properly, diastolic dysfunction leads to inefficient pumping of the heart and “can cause increased pressure and fluid in the blood vessels of the lungs (pulmonary congestion). It can also cause increased pressure and fluid in the blood vessels coming back to the heart (systemic congestion).” This can eventually lead to diastolic heart failure.

According to this article in the American Academy of Family Physicians (AAFP) site

“diastolic heart failure is defined as a condition caused by increased resistance to the filling of one or both ventricles; this leads to symptoms of congestion from the inappropriate upward shift of the diastolic pressure-volume relation.”

A condition called systolic dysfunction also exists.

What causes diastolic dysfunction?

The disorder seems to be especially common in elderly women, even among those not previously diagnosed with heart disease. The following cardiovascular conditions can lead to the stiffening of the ventricles and thus diastolic dysfunction:

• aortic stenosis
• chronic hypertension
• coronary artery disease
• some forms of cardiomyopathy, e.g. hypertrophic and restrictive cardiomyopathy

How is diastolic dysfunction detected and diagnosed?

In its early stages, diastolic dysfunction does not manifest in obvious symptoms. Perhaps the earliest noticeable symptom would be dyspnea or shortness of breath. However, since this is a very common symptom for many kinds of diseases and disorders, diastolic dysfunction is often “missed” during routine medical check ups. Thus, “diastolic dysfunction may be present for several years before it is clinically evident.”

It its advanced stage, when diastolic dysfunction has progressed to the point of causing diastolic heart failure, the following symptoms and related conditions may be evident:

• Abnormal heart rhythms such as atrial fibrillation
• Periodic increase in blood pressure
• Decreased tolerance to physical exercise
• Severe breathlessness even without exertion
• Edema or accumulation of fluids in the feet and ankles
• Acute pulmonary congestion

A standard electrocardiogram or ECG unfortunately cannot easily distinguish between systolic and diastolic dysfunction. The most reliable but rather invasive diagnostic method is cardiac catheterization. As a less invasive alternative, a two-dimensional echocardiography with Doppler function can be used, although the physician must be well-trained in evaluating “the characteristics of diastolic transmitral and pulmonary venous flow pattern” in order to diagnose diastolic dysfunction.

How is diastolic dysfunction managed?

As in almost every disease, early diagnosis and treatment of diastolic dysfunction is important to prevent irreversible damage to the heart.

There is no easy way to treat diastolic dysfunction. However it can be effectively managed through treatment and management of the underlying conditions, namely:

High blood pressure. Management of hypertension is essential in the management of diastolic dysfunction. The AHA gives a comprehensive review of hypertension, including online tools to check for risk factors and blood pressure monitoring.

Coronary artery disease. CAD on its own requires aggressive management strategies to prevent heart attacks. This animation on the AHA site explains clearly how CAD develops.

Aortic valve stenosis. The aortic valve can also become stiff or is misformed at birth, resulting in aortic stenosis, a condition which puts a strain on the left ventricle. Usually, this condition is relieved by surgical interventions.

Arrhythmia. Abnormal heart rhythms such as atrial fibrillation need to be managed effectively to avoid further complications. The AHA site also gives a useful animation on atrial fibrillation. More information about arrhythmias can be found here.

Currently, there is a scarcity of conclusive data on therapies specifically for diastolic heart dysfunction and failure. However, the American College of Cardiology and the American Heart Association have jointly come up with guidelines which “recommend that physicians address blood pressure control, heart rate control, central blood volume reduction, and alleviation of myocardial ischemia when treating patients with diastolic heart failure. These guidelines target underlying causes and are likely to improve left ventricular function and optimize hemodynamics.” Medications used for the management of diastolic heart failure are summarized in this AAFP article (Table 4).

Can diastolic dysfunction be prevented?

Like many heart disorders, diastolic dysfunction and heart failure are preventable.

“Primary prevention of diastolic heart failure includes smoking cessation and aggressive control of hypertension, hypercholesterolemia, and coronary artery disease. Lifestyle modifications such as weight loss, smoking cessation, dietary changes, limiting alcohol intake, and exercise are equally effective in preventing diastolic and systolic heart failure.”

Photo credits: stock.xchng

Do you know your risk for heart disease?

Do you have an undiagnosed risk for developing cardiovascular disease (CVD)? You think it’s highly unlikely? Well, think again.

According to a British study, one in three people with high cardiovascular risk over the next years are unaware of their risk, and neither are their health care providers. In other words, it is very often that the risk remains undiagnosed until it manifests in overt symptoms. This oversight in risk assessment is especially strongest in middle-aged men.

The study conducted by Oxford University researchers in a mobile clinic looked at 71,037 men and women aged 18 and older all over England, Wales and Scotland. Tests were performed and questionnaires were filled in. The results do not look good.

• 20% of all male study participants and 6% of female participants have high likelihood of developing CVD in the next 10 years.
• CVD risk is highest in the 50 plus age group compared to others. 75% of men and 45% of women in this age group have CVD, diabetes, and are taking anti-cholesterol or anti-hypertension drugs.

Based on the results, the participants were classified as having high, medium, or low risk profiles.

People were defined as high risk if they had more than a 20 per cent chance of developing CVD over the next 10 years. This criterion is in line with the Joint British Societies Guidelines on Prevention of Cardiovascular Disease in Clinical Practice, which were issued in 2005 and endorsed by the UK’s National Institute of Health and Clinical Excellence in 2006.  

Based on their risk profiles, the participants were then given appropriate medical advice. High risk individuals were advised to see their doctor, together with their tests. Those with medium risk profiles were given verbal as well as written advice as to how to reduce the risk.

In the UK alone, almost 8 million people have been diagnosed with CVD or have recognized high risk for CVD. However, it is estimated that there are almost 4 million people out there whose risk are undiagnosed and are therefore unaware of this risk. Because of this, they do not concern about preventive measures, lifestyle changes, professional advice or early treatment. Of these, 2.8 million are male and 900,000 are females. If these figures were to be extrapolated on a global scale, the numbers are staggeringly big. There is clearly a need for more awareness of CVD risks and risk factors on the part of patients and health care providers alike.

The most common risk factors for CVD are:

• Obesity
• Lack of exercise
• Bad nutrition
• Smoking
• Genetics

So don’t think you are exempt from CVD risk. Check your lifestyle. Check with your doctor. Remember: early detection means early prevention.

Photo credit: fishmonk at stock.xchng

CVD News Watch for the Weekend 29 August

CVD treatment watch

New hope for stroke patients

3 hours max. That’s how long a stroke patient has before major brain damage and death occur. If treated within 3 hours, the patient has very high chances of survival and full recovery. After 3 hours, the brain becomes irreversibly damaged.

Anti-nogo, a new experimental approach can give new hope to patients with high risk for stroke. It can potentially restore brain function weeks or even months after the stroke has occurred. The technique disables the nogo protein which inhibits the growth of nerve fibers. In doing so, Anti-nogo stimulates the growth of nerve fibers, thereby compensating for those damaged by stroke.

 

CVD test watch

Hearts a flutter as exam includes audio portion for first time

It’s something every medical student in the US has to go through – the 3-part medical test. However, this autumn brings new angle (and sound) to the test – cardiac auscultation or listening to the heart. However, the students will not listen to a real patient’s heart beats but audios specially develop for this test. According to one medical professor, many medical students lack the skills to identify heart conditions using a stethoscope and instead depend mostly on very expensive tests for diagnosis. With the audio tests, it hoped that the students get proper training to know the difference between a healthy and a diseased heart by simply listening.

CVD weight watch

Not all fat is created equal

If you are obese, chances are your fat cells are “sick. Researchers at Temple University in Philadelphia report differences in fat cells between obese and non-obese individuals.

“The fat cells we found in our obese patients were deficient in several areas…They showed significant stress on the endoplasmic reticulum, and the tissue itself was more inflamed than in our lean patients.“, according to one study author.

 

CVD treatment watch

Olive leaf extract may help reduce blood pressure

An article in Phythotherapy Research reported that olive leaf extract at a dose of 1000 mg per day can lower blood pressure in humans. However, large-scale tests are needed to confirm these results.

 

CVD diagnostics watch

FDA Clears Test to Help Doctors Manage Heart Transplant Patients

The US FDA has approved the marketing of AlloMap, an in vitro diagnostic assay that can determine potential organ rejection among heart transplant patients.

“AlloMap measures genetic information contained in the white blood cells (cells of the immune system that defend the body against invading viruses, bacteria or other foreign material) from a patient’s blood sample.”

AlloMap has been developed by the California biotech company XDx Inc.

New Prostate Cancer Screening Recommendations

Yesterday the U.S. Preventative Services Task Force (USPSTF) released its recommendations regarding prostate cancer screening.

Summary of Recommendations:

• USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.
• The USPSTF recommends against screening for prostate cancer in men age 75 years or older.

What is the USPSTF?

“The U.S. Preventive Services Task Force (USPSTF) , first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the “gold standard” for clinical preventive services.”

More on Prostate Cancer:

Prostate cancer is the most common cancer in men after lung cancer, affecting one in six men in the U.S.

Prostate cancer rarely affects men under the age of 40. Diagnosis is usually over made after 50 and in fact two-thirds of all cases are diagnosed in men over 65.

60 to 61% of the time it is diagnosed in an African American male.

A male is twice as likely to be diagnosed with prostate cancer if he has/had a father or brother with the disease. There is also an inherited gene for prostate cancer, affecting 5 to 10 % of all diagnosed cases. While research into genetic testing is promising, it is not yet available.

Current American Cancer Society Guidelines recommendations for screening:

Both the prostate-specific antigen (PSA) blood test and digital rectal examination (DRE) should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy.

Screening will begin with:

• Digital Rectal Exam-part of a regular yearly physical to exam the gland for changes.
• PSA-Prostate Specific Antigen blood test-higher than normal levels may indicate a problem.

And may proceed to the following if your DRE and PSA indicate the need.

• Ultrasound-A small probe inserted into the rectum will take pictures of the gland using sound waves.
• Biopsy-Tissue samples examined by a pathologist to determine the staging of a cancer diagnosis.

Prevention:

The Mayo Clinic recommends a diet low in fat and rich in lycopene and regular exercise.

Treatment:

Treatment may include surgery, radiation, chemotherapy and hormone therapy.

The Prostate Calculator offers disease forecasts based on real patients and artificial intelligence

More articles on the screening recommendations of the U.S. Preventative Services Task Force (USPSTF):

The Wall Street Journal: Prostate Cancer Screening: Making Decisions Without Evidence

Forbes . Com: Do You Need a Prostate Cancer Screening?

Carcinoid Cancer

Carcinoid Cancer as defined by the American Cancer Society: “carcinoid tumors or carcinoids: tumors that develop from neuroendocrine cells, usually in the digestive tract, lung, or ovary. The cancer cells from these tumors release certain hormones into the bloodstream. In about 10% of people, the hormone levels are high enough to cause facial flushing, wheezing, diarrhea, a fast heartbeat, and other symptoms throughout the body.” These symptoms are referred to as Carcinoid Syndrome.

The causes of carcinoid cancer are unclear. This type of cancer is very slow growing and has no early signs or symptoms. It is often detected while evaluating other unrelated symptoms.

Risk Factors per the Mayo Clinic:

Sex: Affect women more often than men.

Family history: Children who have a parent with carcinoid tumors or a family history of multiple endocrine neoplasia type 1 (MEN 1) syndrome.

Smoking: Linked to some atypical lung carcinoids.

Other medical conditions. Those that affect the stomach’s ability to produce acid may be linked to some gastrointestinal carcinoids.

Diagnosis can be difficult and is usually done through:

• A blood test evaluating for high levels of the protein chromogranin A.
• A urine test for the presence of 5-HIAA.
• A CT scan
• A fine needle biopsy

Treatment is truly individualized depending on the location and staging. If the tumor has not metastasized, surgery may be the treatment option.

Other treatment options:

• Chemotherapy
• Radiofrequency Ablation
• Injections of Sandostatin to slow tumor growth
• Hepatic Artery Embolization-cutting off the blood supply to the tumor

Resources:

The Carcinoid Cancer Foundation offers not only information on carcinoid cancer but online discussion groups and seek to increase awareness.

Together We Make a Difference

Carcinoid. com is the Novartis website which offers information on carcinoid cancer and managment of the symptoms of Carcinoid Syndrome.

Carcinoid Cancer Awareness Network: CCAN.: A non-profit organization whose mission is to intensify awareness of carcinoid cancer and to assist support groups around the world in providing patients and caregivers access to important information about carcinoid disease.

Battling Books:

Carcinoid Cancer, Zebras and Stardust: My Sister’s Cancer Battle by Mary Girsch-Bock

(May 2008)

Thyroid Cancer Basics

Thyroid cancer is the single most common endocrine cancer and the most curable. If diagnosed before it spreads, thyroid cancer has a 97 % five year survival rate.

Per The American Cancer Society: 2008 about 37,340 new cases of thyroid cancer will be diagnosed in the United States. Of those, about 28,410 will occur in women, and 8,930 in men. A three to one ratio. AND…nearly 2 out of 3 cases are found in people between the ages of 20 and 55.

Read more

Pancreatic Cancer

The pancreas is considered a glandular organ. It is about 7 inches by 1.5 inches in size. It lies under the stomach and at the beginning of the small intestine, and functions as an exocrine organ by producing fluids for digesting food. It functions as an endocrine organ as it releases hormones. When released into the blood stream, these hormones regulate our glucose levels (insulin and glucagon).

Pancreatic cancer is a cancerous tumor that occurs in the tissues of this gland/organ.

Estimated new cases and deaths from pancreatic cancer in the United States in 2008 per the National Cancer Institute: New cases, 37,680 and deaths, 34,290.

This type of cancer typically spreads fast and is often not diagnosed in the early stages.

Per the Mayo Clinic, signs and symptoms of pancreatic cancer, which may not occur until the cancer is in the advanced stages:

• Upper abdominal pain that may radiate to your back
• Yellowing of your skin and the whites of your eyes
• Loss of appetite
• Weight loss
• Depression

There are two types of pancreatic cancer: exocrine and endocrine. Endocrine cancers are very rare. The American Cancer Society states that exocrine cancers are the most common and 95% of those diagnosed are adenocarcinomas.

Risk Factors for Exocrine (Pancreatic) Cancers:

• Smoking
• Obesity
• Gender-men have a slightly increased rate of occurrence
• Race-occurs more often in blacks than Caucasians
• Age-most people diagnosed are in their 70’s and 80’s
• Personal or family history of pancreatic cancer
• History of chronic pancreatitis
• Diabetes-occurs more often in diagnosed diabetics

The American Cancer Society site discusses risk factors that are uncertain or under research.

Diagnosis:

While there is no screening for pancreatic cancer you may undergo a CT, Ultrasound, and/or MRI if your physician suspects this disease.

Other diagnostic tests:

• Endoscopic retrograde cholangiopancreatography–ERCP-a dye is injected into your bile ducts and they are examined with a scope as air is blown into the ducts.
• Endoscopic Ultrasound-EUS–a scope with an ultrasound device is passed through the stomach into the duodenum to take pictures. It may also collect biopsy specimens.

• Percutaneous transhepatic cholangiography-PTC–a needle is inserted into the liver from outside the body and a tube is threaded into the bile ducts. Dye is injected into the ducts to detect blockages.

If a diagnosis confirms the cancer then further tests may be ordered to stage the disease and determine if it has spread. A CA19-19 blood test may be ordered to monitor your response to treatment.

Basic staging per the Mayo Clinic:

• Resectable. All the tumor nodules can be removed.
• Locally advanced. The tumor can no longer be removed with surgery because the cancer has spread to tissues around the pancreas or into the blood vessels.
• Metastatic. At this stage, the cancer has spread to distant organs, such as the lungs and liver.

For further staging information, including The American Joint Committee on Cancer TNM, numerical staging, see The American Cancer Society site.

Current Treatment for Exocrine (Pancreatic) Cancer:

• Surgery (resection)
• Chemotherapy
• Radiation therapy
• Targeted Gene Therapy

Battling Books:

100 Q & A About Pancreatic Cancer by Eileen O’Reilly M.D.

My Journey with Pancreatic Cancer by Calvin E. Rains Sr. (2006)

Pancreatic Cancer in the News:

ScienceDaily, January 9, 2008. Pancreatic Cancer: The smaller the tumor, the better your chances, study shows. “The odds of surviving cancer of the pancreas increase dramatically for patients whose tumors are smallest, according to a new study by researchers at Saint Louis University and the M.D. Anderson Cancer Center in Houston — the first study to specifically evaluate the link between tumor size and survival rates for one of the most common and deadly cancers.”

Resources:

The Pancreatica.org Clinical Trials Database is the largest resource of clinical trials for pancreatic cancer in the world.

PanCAN, the Pancreatic Cancer Action Network. “Working Together for a Cure”

The National Pancreas Foundation. Support, Education and Research.

CUPS

Cancer of Unknown Primary Site or CUP, Cancer of Unknown Primary is a tumor that is diagnosed at a metastatic site and the primary site is not known. Following additional testing many of these cancers are diagnosed with a primary site. Per the National Cancer Institute, 2% to 4% of these primary tumor site remain unknown.

The American Cancer institute ranks this as a “dangerous” cancer with an often poor prognosis due to these factors:

• Most are fast-spreading cancers.
• Because the exact type of cancer is not known, it is more difficult for doctors to know what treatment is most likely to help the patient.
• Because the cancer is usually widespread, it is rarely curable.

The next step in diagnosis is to classify the tumor in an effort to best treat the cancer.

As with any cancer, early diagnosis is the key. Have routine cancer related check-ups. See your doctor if you have symptoms that include:

• Shortness of breath
• Swollen lymph glands
• Abdominal tenderness and/or bloating
• Pain in the chest or abdomen
• Bone pain
• Skin tumors
• Weakness, fatigue, general malaise, weight loss

Diagnosis begins with:

• Physical exam, including a gynecological exam
• Blood tests, including tumor markers, tests for blood in stool and to evaluate kidney function
• Radiographic imaging, including, chest X-ray, mammogram, abdominal CT
• Biopsy and possible endoscopic exam

Special Lab Tests Used to Evaluate Biopsy Specimens:

• Immunohistochemistry, slices of tissue samples are treated with an antibody to rule out what type of cancer is not present
• Electron Microscopy, a microscope using beams of electrons to determine specific cell characteristics
• Polymerase Chain Reaction, this method may be able to detect abnormal DNA or RNA in a specimen
• Tissue Stains , specific stains such as Prostate-specific antigen, or Alpha-fetoprotien (for primary liver cancer).

Treatment is specific to the type of cancer that is suspected, or the subgroups of cancer that that is a probably diagnosis. Treatment is also determined according to staging and may include:

• Chemotherapy
• Radiation
• Surgery
• Hormone therapy

For more information on treatment options and staging please visit the American Cancer Institute site.

Resources and Support for CUP:

Cancer of Unknown Primary Foundation, “Making the Unknown Known.” A UK organization that provides support, information and advocacy.

CancerCare ,”a national nonprofit organization that provides free, professional support services for anyone affected by cancer. ”

Battling Books: The Following are Clinical Books on the Topic.

Metastatic Carcinomas of Unknown Origin by Mark R. Wick (2008)

Carcinomas of Unknown Primary Site by Karim Fizazi

To Tell or Not to Tell

This post discusses the merits of telling (or not telling) the affected person that he or she has Alzheimer’s disease.

Once Alzheimer’s disease is officially diagnosed, the primary caregiver and close family members have a decision to make.

Do you tell the affected person or not? There are valid arguments on both sides.  Let’s explore some of them.

Yes, tell the affected person what the diagnosis is and what it means.

Advantages of sharing the diagnosis

Knowing sometimes brings relief.  Although the person may not be able to articulate all that is going on, they know that something is awry.

Knowing takes away all need to lie and hide.  Often people in the earlier stages of Alzheimer’s disease make up excuses for their behavior and attempt to cover up mistakes.

Knowing may encourage the affected person to plan for the future.  Unfortunately, the prognosis for Alzheimer’s disease is quite certain.  The patient will know what is coming down the pike and can participate in long-term planning.

Knowing provides opportunity for cooperation on the affected person’s part–Eating a balanced diet, taking medications (which we’ll talk about in detail in an upcoming post), exercising the body and brain can possibly retard the progression of the disease.

Advantages of not sharing the diagnosis

Not knowing allows a sense of “normalcy.”  Denial is a coping mechanism that helps some people to make it through difficult times.

Not knowing may avoid some of the grief associated with reality of facing a terminal illness.

Not knowing may keep anxiety levels low.  For years, even doctors have advocated not causing further stress on already stressed individuals by not disclosing the diagnosis of Alzheimer’s disease.

Not knowing may enable the affected person to keep fighting instead of giving up.  Alzheimer’s is a cruel disease.  Sometimes knowing the future is just too much information for some individuals to handle.

What do the experts say?

According to an article in the March 2008 edition of the Journal of American Geriatrics Society, there may actually be many benefits to telling patients that they  have Alzheimer’s disease.  In addition, the study indicates, that at least in the short run, knowing brings a level of relief.

“Overall, patients told of their diagnosis did not experience an uncontrollable surge in depression or anxiety. Rather, most were relieved to have an explanation for their symptoms. They were also glad to have the opportunity to participate in planning for their futures, and relieved that help was at hand.”

“One reason an Alzheimer’s diagnosis can be comforting to both family members and patients, Dr. Carpenter suggests, is that it provides an explanation for what’s been going on with the patient. Caregivers, he notes, are often quick to attribute symptoms of dementia to the person, rather than the disease, and patients wonder if they are going “crazy.” This study confirms that most patients, regardless of their degree of impairment, tend to experience a sense of relief after getting their diagnosis.”  (see below)

In the end, to tell or not to tell is a very personal decision.  I did tell my mom she had Alzheimer’s disease, but it was long after we received the diagnosis.  I doubt that she understood.  She just looked at me with a blank stare.  I do wish that I had told  her earlier, like when I packed up her belongings and moved her 500 miles.  Maybe, it would have made the transition a little easier, but hindsight is always 20/20.

What’s do you think?  Did you tell?  Would you make the same decision again?

Note:  Kudos to the Fisher Center for Alzheimer’s Research Foundation and their great site, Alzinfo.org for access to this research.  Click here to read more of the article.

Source: Brian D. Carpenter, PhD, Chengjie Xiong, PhD, Emily K. Porensky, MA, et al: “Reaction to a Dementia Diagnosis in Individuals with Alzheimer’s Disease and Mild Cognitive Impairment,” Journal of the American Geriatrics Society, March 2008, pages 405–412.

Cervical Cancer

Cervical cancer will be diagnosed in more than 11,000 women in the U.S. in 2008 and more than 3,000 women will die of the disease this year.

Worldwide it is third leading cause of cancer death in women.

What is the cervix?

The cervix is the lower portion of the uterus. It connects the uterus to the birth canal (vagina) and is the area of the uterus where a fetus will grow and develop.

There are two types of cervical cancer:

• squamous cell carcinoma
• adenocarcinoma
  

Per the American Cancer Society, 80 to 90 percent of all diagnosed cases of cervical cancer are squamous cell carcinoma.
A diagnosis of cervical ‘pre-cancerous tissue’ is treated the same as cancer, though these abnormal cells do not always become cancerous. This is because often the symptoms of cervical cancer are silent until the cancer is at advanced stages.

The HPV and Cervical Cancer Connection:

Human Pappillomavirus is connected to 90% of all diagnosed cervical cancer cases. Many people have this common virus which is passed to another person during sex. A healthy immune system generally protects the HPV virus from doing any harm. However in some women it can cause pre-cancerous cellular changes that may continue to slowly change the cells to cancerous tissue.

The HPV vaccine will protect women from 4 types of human papillomavirus. Per the CDC: “If you are 11–26 years old, you can help prevent cervical cancer by getting the HPV vaccine. It protects against the types of HPV that most often cause cervical, vaginal, and vulvar cancers, and is given in a series of three shots.”

For detailed information on the HPV virus see the Mayo Clinic site.

Risk Factors:

• HPV infection (early sex, unprotected sex)
• Smoking
• Multiple full-term pregnancies
• Immune suppression diseases
• Birth control pills
• Other sexually transmitted diseases
• Family history
• Diets low in fruits and vegetables
• Socio-economic (no access to health care and regular PAP screenings)
• Age-most often occurs in women over the age of 40

These risk factors are discussed in more detail at the American Cancer Institute site.

Symptoms:

Cervical cancer begins on the cellular level which causes silent symptoms. Symptoms such as pelvic pain, bloody discharge or pain during intercourse may not appear until the cancer is no longer in the early stages.

Prevention:

• Reduce risk factors as appropriate
• Ask your physician if the HPV vaccine is right for you
• Schedule regular PAP tests

What is a PAP test?

The name PAP comes from one of the inventors George Papanikolaou.

A PAP test is done during your routine gynecological pelvic exam. Cell scrapings of the cervix are put on slides which are then examined for cellular changes or abnormalities.

Detailed information on PAP screenings can be found in the National Cancer Institute fact sheet.

Diagnosis and Treatment:

Diagnosis begins with a physical exam and history. The level of diagnostic testing will be determined by the stage of your disease. 78% of all cervical cancer cases are diagnosed in the early stage.

If it is suspected that the cancer is not in the early stage, your physician may order detailed testing to check the lymph nodes, urinary system, rectal and vaginal areas for spread of the disease. Detailed testing information can be found at the The M.D. Anderson Cancer Center site.

Treatment may include, surgery, chemotherapy and radiation. Per The M.D. Anderson Cancer Center, treatment options also include the following:

• The stage of the cancer
• The size of the tumor
• The patient’s desire to have children
• The patient’s overall health and age

Terminology for diagnosis and/or treatment:

Cone biopsy: a surgical procedure where a cone shaped piece of tissue is removed from the cervix.

Cryosurgery: a surgical procedure that uses an instrument to freeze and destroy precancerous tissue.

LEEP : Loop Electrical Excision Procedure- treatment done under local anesthesia, an electrical current passed through a thin wire hook to remove abnormal tissue.

Laser surgery: a surgical procedure that uses a laser beam to remove surface lesions.

Resources:

For more detailed information on cervical cancer, the CDC (Center for Disease Control) offers a downloadable pdf fact sheet and a cervical cancer podcast.

Eyes on the Prize.org offers support and information for gynecological cancer.

Women’s Health Cancer Centres (Canada) is a huge network of resources.

Battling Books:

100 Questions & Answers About Cervical Cancer by Don S., M.D. Dizon (2008).

Women at risk: The HPV epidemic and Your Cervical Health by Gregory Henderson M.D. Ph.D and Batya Swift Yasgur (2002).

Liver Cancer Facts

The liver is the largest internal human organ. If the liver completely shut down, we would die within 24 hours. This is because the liver has so many vital functions in human life.

Functions of the liver:

• Convert, store and release glucose as needed
• Breakdown fat and produce cholesterol
• Remove ammonia from your body
• Produce blood proteins, including clotting factors
• Detoxify drugs and alcohol
• Produce bile (the role of bile is to break down fat)
• Cleanse the body of cell debris and damaged red blood cells

The National Cancer Institute defines liver cancer as: “Primary liver cancer is cancer that forms in the tissues of the liver. Secondary liver cancer is cancer that spreads to the liver from another part of the body. ” The NCI estimates there will be 21,370 cases and 18,410 deaths from liver cancer and intrahepatic bile duct cancer in the U.S. this year.

Types of Primary Tumors of the Liver:

Hepatocellular : The most common type of liver cancer in adults. Three out of four diagnoses of liver cancer will be hepatocellular. This cancer may present as spots on the liver, a single tumor or various patterns.

Cholangiocarcinoma: This type of liver cancer starts in the bile duct and often has the same treatment plan as hepatocellular liver cancer.

Fibrolamellar carcinoma:A subtype of hepatocellular cancer, this is a rare form with a better prognosis than other types of liver cancer.

Hepatoblastoma:A very rare liver cancer found in children younger than 4, with a good prognosis if diagnosed early.

Angiosarcoma and Hemangiosarcoma: These rare forms of liver cancer begin in the blood vessels, grow quickly and have a very poor prognosis.

Symptoms of liver cancer may include:

• Lack of appetite and weight loss
• Abdominal discomfort
• Nausea and vomiting
• General weakness and fatigue
• An enlarged and tender liver
• Swollen abdomen
• Jaundice of the skin and eyes

Some of the Risk Factors Associated with Liver Cancer:

• Liver infections such as hepatitis
• Diabetes
• Cirrhosis of the liver
• Sex-Males are twice as likely to develop the disease
• Age-In the U.S and Europe the average age is 60
• Smoking tobacco
• Obesity
• Bile duct disease
• Consumption of foods contaminated with aflatoxins (a mold). This is a problem in Asia and Africa.

Diagnosis and Treatment:

• Diagnosis may include a physical exam, blood tests for liver function, CT, ultrasound, angiogram, MRI and biopsy.
• Note that people at risk may be checked routinely for early tumor development using an AFP (alpha-fetoprotein) blood test which detects a protein present in many liver cancers.
• Staging-see the Mayo Clinic site for information on staging types.
• Treatment depends on staging and the individual diagnosis and may include surgery, chemotherapy and or radiation. Ablation is a treatment used to treat tumors that cannot be removed by surgery locally. Embolization is a treatment used to cut off blood supply to the tumor. See the American Cancer Society site for detailed information on treatment options including complementary and alternative treatment.

Resources and News:

American Liver Foundation

M.D. Anderson, Adult Liver Cancer Support, includes networks, support groups and message boards.

DG Dispatch, March 12, 2008. Guidelines Support Ablation Techniques for Unresectable Liver Cancer: Presented at NCCN “Tumour ablation techniques should play a major role in treating tumours of the liver that are not suitable for resection, according to updated treatment guidelines for hepatocellular carcinoma …”

Battling Books:

100 Q&A About Liver Cancer by Ghassan K. Abou-Alfa (2005)

The Liver Book: A Comprehensive Guide to Diagnosis, Treatment and Recovery by Sanjiv Chopra ( 2001)

Endometrial Cancer

Endometrial cancer is the most common form of cancer affecting the female reproductive organs. The other types of female gynecologic cancers include cervical cancer and uterine sarcoma. Endometrial cancer is the fourth most common cancer in women.

What is the endometrium? The endometrium is the lining of the uterus.

Per the National Cancer Institute: Estimated new cases of endometrial cancer in the United States in 2008 are 40,000 and 7,470 deaths.

According to the American Cancer Society the chances of a woman getting this cancer in her lifetime are 1 in 41.

Endometrial cancer is a slow growing cancer that usually affects post menopausal women. Rarely does it reach an advanced stage with no symptoms.

Signs and symptoms:

Risks:

While it is not completely known why endometrial cells mutate, there are certain risk factors per the Mayo Clinic.

• Never being pregnant
• Irregular ovulation cycles
• A long history of menstruation (starting at an early age and ceasing at a later age)
• Obesity
• Diabetes
• Estrogen-only hormone replacement therapy
• Ovarian tumors (many increase estrogen levels)
• Age (over40)
• Race (more likely to be diagnoses in white women with a fatal outcome more likely in black women)
• History of breast cancer or ovarian cancer
• Tamoxifen treatment history
• Hereditary nonpolyposis colorectal cancer

Diagnosis:

Referral to a specialist may include the following tests:

• Pap test
• Biopsy
• D&C (dilation and curettage) allows scraping of uterine wall for tissue
• Hysteroscopy, which involves inserting a small telescope into the uterus
• Transvaginal ultrasound

Staging of Uterine Cancer:

Staging may be done after surgery, which may include a hysterectomy (removal of the uterus), bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries) and possible pelvic lymph node dissection.

For more detailed information on staging please visit the M.D. Anderson Cancer Center site.

Treatment for endometrial cancer, besides surgery may include chemotherapy, radiation and/or hormone therapy.

Resources:
Eyes on the Prize. org , Gynecologic Cancer Support and Information

Uterine Cancer Research Program at M.D. Anderson Cancer Center whose goal is to conduct innovative research in the prevention, early detection, treatment and basic biology of endometrial cancer. Visit the site to see current clinical trial in endometrial and uterine cancer.

Battling Books:

Mayo Clinic Guide to Women’s Cancers (2005)
Cancer Schmancer by Fran Drescher (2003)

The Facts: Breast Cancer In Men

Male Breast Cancer comprises 1% of all diagnosed cases of breast cancer.

While rare, breast cancer can occur in men at any age, though it is usually diagnosed in men over fifty, primarily in the 60-70 year age group.

Just like breast cancer in women, early detection is the key to beating male breast cancer.

The American Cancer Society estimates that in 2008 some 1,990 new cases of invasive breast cancer will be diagnosed among men in the United States. In 2008, about 450 men will die from breast cancer in the United States.

Male Breast Cancer Risk Factors:

• Exposure to radiation
• High levels of estrogen related to other disease entities
• A history of Klinefelter syndrome
• Hereditary altered gene factors (BRCA2 gene)
• Family members diagnosed with breast cancer
• Excess weight and excessive use of alcohol

Symptoms and Diagnosis:

Lumps or masses discovered in male breasts tend to be smaller than a female breast lump, though often more widespread, probably due to the fact that there is less breast tissue in males. Unfortunately men tend to ignore lumps, masses or redness, of the breast area, instead attributing it to other issues. Other symptoms of male breast cancer can include skin dimpling and nipple changes.

Initial diagnosis steps are the same as those for women and include a complete physical including breast exam, a mammogram and may include a biopsy.

Types of breast cancer found in men include:

• Infiltrating ductal carcinoma-The most common type of breast cancer which begins in the ducts of the breast and breaks through to breast tissue.
• Ductal carcinoma in situ-This type of cancer begins in the ducts and has not moved past the walls of the ducts. It is most often curable.
• Inflammatory breast cancer-An uncommon cancer that does not begin with a lump, caused by cancer cells blocking the lymph ducts.
• Paget disease of the nipple-A rare cancer that appears as a rash on one nipple, or areola area of the breast and may include an inverted nipple or nipple discharge.

Treatment and Recovery:

Treatment is determined after staging. Staging of breast cancer follows The American Joint Committee on Cancer TNM System.

Treatment options include:

• Surgery-lumpectomy, mastectomy, lymph node dissection
• Radiation-external beam, brachytherapy
• Chemotherapy-in conjunction with other treatments or alone
• Hormone therapy-most often utilized to prevent cancer from reoccurring
• Targeted therapy-clinical trials are utilizing laboratory created antibodies to block or kill cancer cells

More detailed information of breast cancer treatment options for men can be found at the National Cancer Institute site.

Further resources and support for Male Breast Cancer:

The New York Times, June 10, 2003, Surprise Role for Ex-Senator: Male Breast Cancer Patient. Former Massachusetts Senator, Edward W. Brooke, discusses his journey with breast cancer.

Male Care-Men fighting cancer together.

MDJunction.com hosts the Male Breast Cancer Online Support Group.

Brain Cancer Basics

The words brain cancer evoke a dark and often confusing image. What does it really mean?

Ah, we nod. Brain tumor.

Let’s examine this topic, so we can understand what’s going on behind this challenging diagnosis.

Primary and Secondary Brain Cancer

• Primary brain cancer is the term used when the cancer begins in the brain. The brain is the primary site.
• Secondary Brain cancer or metastatic brain cancer is the term used when the primary site is elsewhere.

About Malignant Tumors of the Brain

Most brain tumors fall into categories: glial cell and non glial cell. Glial cells help to support the cells of the central nervous system so they work properly.

Types of glial cell cancers or Gliomas:

According to the American Cancer Society 77% of all malignant brain tumors are gliomas.

• Astrocytoma-An astrocyte is a star-shaped type of glial cell. These tumors are graded 1 to 4. Grade 1-pilocytic astrocytoma, Grade 2-diffuse astrocytoma, Grade 3-anaplastic astrocytoma, Grade 4-glioblastoma multiforme. (The lower the grade, the slower the tumor growth.) About 35% of brain tumors are reported to be astrocytomas. This type of brain tumor is usually seen in the cerebrum.
• Oligodendroglioma-A rare tumor that starts in cells called oligodendrocytes. Usually these tumors cannot be completely removed by surgery. They consist of 4% of brain tumors.
• Ependymoma-This type of tumor is found in cell ventricles or in the spinal cord. These consist of 2% of brain tumors. Ependymomas are usually diagnosed in children and young adults.
• Brain stem glioma-This type of tumor is found in the brain stem. The brain stem connects the rest of the brain to the spinal cord. They consist of less than 1% of adult brain tumors, usually diagnosed in children and middle aged adults.
• Ganglioglioma-This very rare tumor has both neurons and glial cells and has a high cure rate.

Non Glial Cell Tumors of the Brain:

• Medullosblastoma-The most common childhood brain tumor. A tumor that begins in the neurons of the cerebellum. A fast growing tumor that is responsive to radiation.
• Schwannoma-These tumors begin in the Schwann cell of the cranial nerves. These cells form the myelin that protect the nerves. They are often non malignant. They affect cells of the 8th cranial nerve which impacts balance and hearing.
• Craniopharyngioma-This tumor grows near the pituitary gland. Often it impacts the pituitary gland and the optic nerve. This tumor is usually diagnosed in infants and children.
• Germ cell-This tumor of the brain begins in the germ cell. It is most often diagnosed in persons under the age of thirty. The most common of these tumors in a germinoma which is an uncommon tumor.
• Pineal region tumor-A rare brain tumor that is found near the pineal gland. They consist of less than 1% of all primary brain tumors. They may include germinomas.
• Chordoma-A reoccurring, slow growth tumor that starts at the base of the skull or the end of the spine. More common in young adults and middle-aged adults.
• Meningioma-This tumor occurs in the meninges (the membrane that covers and protects the brain and spinal cord) This accounts for 20% of all primary brain tumors and is more commonly seen in women. A slow growing tumor, 85% are benign and can be removed by surgery. Some are malignant and reoccur, spreading to other parts of the body.

Causes of Brain Cancer:

What causes the gene mutations that form a cancerous cell and finally a tumor in the regions of the brain is still unknown.

Symptoms and Diagnosis:

Symptoms of brain tumors depend on the size of the tumor and what part of the brain they may be affecting.

The National Cancer Institute lists these common, but not all inclusive, symptoms of brain tumors. Of course these symptoms may be indicative of other medical conditions as well.

• Headaches
• Nausea or vomiting
• Changes in speech, vision, or hearing
• Problems balancing or walking
• Changes in mood, personality, or ability to concentrate
• Problems with memory
• Muscle jerking or twitching, or seizures
• Numbness or tingling in the arms or legs

Diagnosis is completed following a physical exam, neurological exam, imaging study (MRI, CT, x-ray) and may include a biopsy and spinal tap.

Treatment includes surgery, chemotherapy and/or radiation therapy.

Resources for Brain Cancer:

The American Cancer Society

The National Cancer Institute: What You Need to Know About Brain Tumors.

The Brain Tumor Society: Brain Tumor Action Week is May 4-10, 2008. One of the goals of the Brain Tumor Society is to provide patients with better therapies and treatment options.

Read more

Testicular Cancer Awareness Week

Testicular Cancer Awareness Week

April 1-7, 2008

“There will be about 8,090 new cases of testicular cancer in the United States in 2008. About 380 men will die of the disease in 2008. A man’s lifetime chance of having testicular cancer is about 1 in 300. Because treatment is so successful, the risk of dying from this cancer is very low: about 1 in 5,000. Testicular cancer is one of the most curable forms of cancer. There are nearly 140,000 men who have survived testicular cancer in the United States.”

–Source: The American Cancer Society

The “Get a Grip” Campaign at the National Men’s Resource Center promotes the importance of young men and boys doing monthly self exams for early detection.

Testicular cancer forms in the testicles, the egg shaped glands located in the scrotum, that produce sperm and testosterone. According the American Cancer Society nine out of ten cases are diagnosed in men between age 20 and 54, however; it the disease can occur in infants or the elderly.

Symptoms include pain, swelling or unusual lumps in the testes or groin. Many times when lumps are discovered they are painless. Other symptoms may include breast enlargement or tenderness, a general malaise, a feeling of heaviness in the scrotum or an ache in the abdomen or groin.

The connection between risk factors and diagnosis is being studied but a cause for testicular cancer has not been determined.

Testicular Cancer risk factors:

• Undescended testicles or cryptorchidism. 10% of all cases occur in men with a history of cryptorchidism.
• Family history
• HIV infection may increase risk
• Race-white American men have a higher risk
• Age as mentioned

More detailed information on testicular cancer risk factors can be found at the American Cancer Society site.

Diagnosis:

Following a physical exam your physician may order blood tests (there are currently three tumor marker tests which screen for testicular cancer) and an ultrasound for a complete diagnosis.

Treatment Options:

• Surgery to remove the affected testicle. This may include lymph node removal.
• Radiation therapy, according to the type of cancer you have. Radiation is done after surgery.
• Chemotherapy in coordination with surgery

More Resources:

M.D. Anderson

NCI-Testicular Cancer Home Page

CancerBackUp-A U.K. site

Support:Male-Care: Men Fighting Cancer Together

TC-Care: Testicular Cancer Information and Support

The Genitourinary Cancer Message Boards at M.D. Anderson

LiveStrong: The Lance Armstrong Foundation

Events:

CancerBackUp 10K Fun Run-London, Sunday June 18, 2008. To raise awareness of male cancer.

Books:

Frequently asked Questions About Testicular Cancer by Paula Johnson (2007, Nonfiction)

It’s Not About the Bike: My Journey Back Into Life by Lance Armstrong (2001, Memoir)

Stages 3 and 4 Alzheimer’s Disease-Caregiver Response

Last week I talked about how to know if it’s Alzheimer’s disease and I ended the segment on Thursday with a discussion about stages one and two.  I promised that, for this week, I’d finish up the stages.

I thought it would be most helpful for you if I not only describe the stages, but also provide some information as to how, you as a caregiver, might prepare and respond in a particular stage. After all, as a caregiver, you want to know what is coming and how to deal with it.

Let’s just review quickly.  You can click on the link, Stages of Alzheimer’s-Caregiver’s Response to get more complete information.  But for now, you may remember that Stage one is really not a stage of Alzheimer’s, but rather a stage when no symptoms are present. Stage two there is very mild decline that may not be noticeable, except by the most astute observer.

For today, let’s talk about Stages three and four:

Stage 3-This is the stage where memory issues become much more obvious.  Even the friends and family members begin to notice changes.  The person may find it difficult to remember names, especially of people he or she hasn’t known for a long time.  If your loved one is still working or is involved in social activities like card playing, etc. associates may begin to notice that performance on the job or mental acuity in social settings is slipping.  You may also notice that planning or organizing tasks become more difficult.  Balancing the checkbook or following a recipe may take longer than before and may cause frustration.  Medical evaluation may or may not be able to confirm with a  high percentage of accuracy if the person has Alzheimer’s disease at this juncture.

Stage 4-I mentioned in an earlier post that although there are seven individual stages, the disease is also broken into larger categories.  This stage falls into the mild or early stage Alzheimer’s disease category.  It is characterized by obvious memory loss regarding current events and personal information, such as address, phone number and names of close family members.  By this stage, it’s tough for the affected person to plan a dinner party, pay bills, balance checkbook and keep tabs on person al finances. At this point, decline is obvious enough that friends and family members are sure that something is awry. Often, the disease can be diagnosed with a fairly high level of surety by this point.

Caregiver Response-At this stage in the game, as a caregiver, you need to swing into action.  If your loved one has not yet been evaluated; then make a doctor’s appointment and get that done right away.  You should also consider who will become the primary caregiver(s).  Getting Power of Attorney is very important so that you or someone is able to make important decisions on behalf of your loved one. Be sure to include health care responsibilities as well.  You will also want to have conversations with your loved one about taking over the finances, paying bills, etc.  Depending on the amount of assets your loved one has, you’ll want to see an elder law attorney to see how best to proceed to protect the assets of your loved one.  If your loved one will be on Medicare then you’ll need to complete the paperwork to get that process started.  In short, this is the time you will put systems in place to help you as the disease progresses.  Most of all though, try to understand how scary this is for your family member.  They have been living with the signs and not fully understanding what is happening for a long time now. Let them know that you will be there to help and support in any way you can. Allow them to express frustration and don’t take it personally.

Tomorrow, I’ll discuss stages five and six.

Alzheimer’s Disease-Testing and Diagnosis

This is the third post in a series looking at how do you know if its Alzheimer’s disease?  The first two posts, Symptoms of Alzheimer’s Disease and Alzheimer’s and Dementia-the Differences laid a foundation for the symptomology, characteristics and key definitions.  In this post, I’ll discuss how medical professionals actually get to a diagnosis of Alzheimer’s disease.

So, as our story continues, your suspicions have been verified.  Grandpa does indeed have dementia.  As we learned in yesterday’s post, the question now becomes, “what is the cause of the dementia?” Is it Alzheimer’s disease or some imposter?

Here is where it gets a little tricky, as there is no real test for Alzheimer’s disease.  Instead, medical professionals will begin the task of testing for certain conditions that cause dementia and as those conditions are ruled out, they become more and more certain that it is, in fact,  Alzheimer’s disease.  Dr. Eric Tangalos of the Mayo Clinic suggests that elderly with memory problems should be tested thoroughly to confirm, with as much accuracy as possible, that it’s Alzheimer’s disease.

Let’s look at some of the tests and procedures that might take place:

Medical history-The doctor should review past medical history carefully.  She’ll use this information to notice family patterns, prior Alzheimer’s, mini strokes or strokes, etc.  You should make a list of all medications, dosage and approximate time your loved one has been taking them. This will be of tremendous help to your doctor.

Mental Status Testing-The doctor will ask simple things like the date and time. Other questions will be asked to determine if the person is aware of his surroundings or recognizes familiar people.  As a part of mental status testing, the doctor will probably do what is called a Mini Mental State Exam (MMSE).   Your loved one may be asked to:

• Spell “world” backwards
• Count backwards by 7’s from 100
• Respond to questions regarding seasons and dates
• Follow instructions, usually sequential such as sit down, cross your legs and fold your arms.

Physical exam-This one is pretty obvious, but the physician will be checking for causes of dementia such as previous strokes, alcoholism, thyroid problems and a host of conditions that might mimick Alzheimer’s disease. They may do blood tests to rule out things like infection, severe anemia and or vitamin deficiencies, thyroid problems, diabetes, kidney or liver issues.

Neurological Exam-The doctor is looking for lapses in brain and or nervous system function.  Generally, the physician will test speech, ability of the eyes to move, balance/coordination, muscles and reflexes.

Imaging–This does not happen in all cases, but it is a valuable tool as technology makes it more and more easier to actually see the brain and what is going on.

It is important to note that one or more of these categories of tests may take place at one appointment and may not require a specialist. 

You now know the symptoms of Alzheimer’s disease, you understand the differences between Alzheimer’s and dementia and you know about testing and diagnosing Alzheimer’s disease.

Please be reminded that YOU are your own (and your loved one’s) best advocate.  Trisha Torrey has a great post, “Taking Responsibility For Health Care Decisions,” that is a serious reminder that ultimately, we are responsible for our health care decisions.  So, ask questions until you understand what the doctor is saying, do your own research and then ask more questions.  If you have any doubts, get a second opinion.

Tomorrow, I’ll discuss the stages of Alzheimer’s disease.

May I give you a virtual penny for your very real thoughts?  Please leave a comment or send a private message to:  battlingforhealth.com/contact

The Big FIVE-O

Time to start screening for colon/colorectal cancer. NOW!

The Facts:

March is National Colon/Colorectal Awareness Month.

The lifetime risk for being diagnosed with colorectal cancer is 1 in 19.

90% of all colon cancer diagnoses are in people age 50 or older.

It is the third leading cancer diagnosis in men and the fourth in women.

The disease strikes about 150, 000 people and causes approximately 50,000 deaths per year.

African-American’s are the highest racial or ethnic group at risk in the U.S.

The disease usually starts with a polyp.

The 5 year survival rate for those diagnosed early is 90%

Only 39% of those diagnosed are diagnosed early.

Read more

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