Thursday, April 26, 2012
APRIL 26, 2012 WHERE DID I PUT MY KEYS?
"Married couples who love each each other tell each other a thousand things without talking."
- Chinese proverb
When it comes to patient care, finding an appropriate balance between emphasizing the need for follow-up and causing unnecessary alarm can be difficult. I see many couples who have been married for greater than fifty years. The quote reminds me of a couple, Lilian and Joseph who sat side by side receiving intravenous supplements or across from me in my office for years. When Lilian died 3 years ago, Joseph lost his best friend- his wife. He has never been the same. His memory is failing, his walking stride has slowed, and his 'will' to live or flame is no longer burning. I miss the old Joe. I certainly miss Lilian. I know the longer I practice (this is the beginning of my 19th year) I will begin to lose my elder population. It is sad, as my older patients have put their trust in me. Despite both conventional and integrative therapies, Joe's memory is worsening. I did not want to cause him alarm but gently discussed the situation with his daughter.
We all misplace our keys. We all sometimes walk in a room and forget why we even went in the room. I find the more stress an individual is undergoing, the more forgetful he/she will get. I encourage my older patients to do word retrieval games, seek the word games, math problem solving and basic jigsaw puzzles. I also want a central bowl when you walk in the door to place all your pocket belongings- your keys, Metrocard, change, bills et al.
Recent studies have shown that patients on the conventional drug, Aricept (Donepezil) scored higher on the Mini Mental State Examiantion than did patients who discontinued the drug. In addition those taking Aricepot scored lower on the Activities of Daily Living Scale which means they had less impairment. I use this drug in combination with herbs/supplements. I do find that older patients sometimes get gastrointestinal upset from Aricept. This is why I utilize an integrative approach to memory loss.
It is not easy to find studies on botanicals for memory loss. It is easier to find studies of vitamin/supplements like acetyl L carnitine, phosphotidylserine, phosphotidylcholine and omega 3, 6 9 fish oils.
Culpepper referred to this plant as 'a great binder' In older times, herbalists used to believe that the planets of our solar system governed the plants. Periwinkle (Vinca major and Vinca minor) were said to be governed by the planet Venus. Both have similar herbal properties. These plants have helped cancer patients with two medicines, vinblastine and vincristine. One of the other major uses of vinpocetine is for memory. According to Matthew Wood in Earthwise Herbal, Lord Bacon believed that a cramp in the leg could be cured by wrapping periwinkle vine around the leg. I have seen herbalists use periwinkle for heavy menstrual bleeding, ulcers, skin disorders, and even vertigo. I have not used Periwinkle species as much as I should with the exception of the substance vinpocetine being present in many memory formulas. I use 20mg capsules twice a day.
The other herbs in Memory formulas include ginkgo, garlic and huperzine.
Even the glowing jellyfish has a substance called Prevagen which has gained popularity in helping memory.