What is Leaky Brain? Solutions to fix it

You probably have heard about “leaky Gut”, right? It is a gastrointestinal condition that your Gut can be punctured, which then impacts how well you digest your food and absorb the nutrients, how sensitive you are to possible allergens, and how much inflammation your food may cause. You may have heard of leaky Gut in terms of “intestinal permeability”, which might make it seem like your gut shouldn’t be so permeable. But the truth is that your gut is naturally and selectively permeable, allowing helpful compounds like nutrients to pass into the body while keeping harmful toxins and pathogens out. When this process fails, and the membrane of your GI tract becomes more permeable than it should be, it’s called leaky gut.

But today we will talk about “leaky brain”, which has a lot in common with leaky Gut. Just like yourgastrointestinal (GI) tract has a protective barrier protecting it from its surroundings, your brain has its own casing that protects it from your body and bloodstream. It’s called the blood-brain barrier (BBB).

 

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The Blood-Brain Barrier (BBB)

Leaky brain issues are just as common because your blood-brain barrier is also semi-permeable. Your brain needs things like glucose, amino acids, fat-soluble nutrients, and ketones to function properly, and gets them through the semi-permeable blood vessels that shuttle them into your noggin. Your brain also needs the BBB to keep harmful toxins, infectious pathogens, and errant immune cells out.  And, when the barrier is compromised, the floodgates open to all manner of nasty invaders, which can cause brain fog, depression, anxiety, and a host of neurodegenerative diseases, like dementia, Parkinson’s, and Alzheimer’s. So basically, when the blood-brain barrier is punctured, ruptured, or loosened, things like heavy metals, toxins, molds, fungi, and chemicals produced by our post-industrial world seep in and wreak havoc.

The blood-brain barrier, at its most basic and well-recognized level, is formed by brain capillary endothelial cells (simple squamous (flat) cells that line the inside walls of blood and lymphatic vessels). It includes anatomical, physicochemical, and biochemical mechanismsthat control the exchange of materials between blood, brain, and cerebrospinal fluid, which makes it the main physical barrier through which nutrients, hormones, and various chemicals pass from your brain to your blood system, and vice versa. Caffeine, for example, crosses the barrier quite easily, and, as you’ll learn, is actually potently beneficial for it.

The barrier maintains the extracellular environment of the central nervous system and brain through three main lines of defense:

  1. The physical barrier itself between blood and brain,
  2. Transporters that mediate the flow of compounds from the brain to the blood, and,
  3. An enzymatic barrier that contains neurotransmitter and toxin metabolizing enzymes in the endothelial and epithelial cells of the brain and blood, respectively.

Most of the research on the BBB in the 20th and 21st centuries, however, has focused on the first layer, the physical barrier, usually in order to learn how to deliver drugs more effectively to the central nervous system. This is the part of the BBB I’m going to cover here.

The endothelial cells lining blood vessels are only one layer thick. Some of the largest vessels, the arteries and the veins, are also surrounded by thick walls of connective tissue and layers upon layers of smooth muscle cells; but the vessel walls themselves are lined by a thin, single sheet of cells. This ultra-thin sheet determines the passage of every substance from the blood to the rest of the body — including the brain. So when it gets damaged, things escalate fast.

Like every other cell type in your body, endothelial cells can divide and repair damages in the sheet wall of a given blood vessel. If left to themselves, they’ll live out a cell lifetime that ranges from a couple months (liver endothelium) to several years (brain endothelium). But when they’re exposed to detrimental compounds and physiological circumstances, they can die prematurely and will need to divide quickly to repair the vessel wall. And when the vessel wall is exposed to this state without break, the BBB will be weakened overall, which can lead to all kinds of problems, including the leakage of plasma proteins into certain regions of the brain. This can cause exacerbated inflammation in the brain, and long-term, chronic inflammation in the brain can only cause problems.


What weakens the blood-brain-barrier?

1. Sleep Deprivation

Your body needs you to sleep appropriate amounts of each sleep phase, in order to properly regulate the functions and integrity of the BBB. In particular, loss of REM (rapid eye movement) sleep damages much of this function.

If you’re sleeping less than, in most cases, the recommended 7 to 9h per 24h, your brain will suffer. A group of researchers studied the effects of chronic sleep restriction (CSR) on mice in a test designed to mimic a common pattern of human sleep loss. They found CSR not only diminished endothelial and inducible nitric oxide synthase, endothelin1, and glucose transporter expression in brain microvessels of the BBB, it also decreased 2-deoxy-glucose uptake by the brain, a sugar needed to maintain proper electrical signaling and membrane potentials. This all coincided with an increase of paracellular permeability of the BBB, leaving the brain more vulnerable to invasion.

2. Excessive Alcohol Intake

Another cause that was already mentioned is excessive alcohol intake. Studies in the past have indicated that long-term alcohol abuse can lead to massive functional and morphological changes in the CNS, including neurodegeneration that ranges from minor dendritic and synaptic changes to full-on cell death. This occurs through oxidative stress on neural cells. The alcohol you drink is essentially ethanol (EtOH), which, among other things, enhances reactive oxygen species (ROS) that damage brain cells. Chronic exposure to alcohol also increases the expression of CYPE1, the enzyme that turns EtOH into ROS and acetaldehyde (the substance that causes the feeling of hangover). And, both EtOH and its metabolite acetaldehyde decrease the tightness of the BBB, which is exactly what should be avoided.

3. High-Blood Pressure

One study observed rats and found that the BBB dysfunction present in the rats was quite clearly related to the combined effects of elevated blood pressure and cerebral vasodilation (the widening of blood vessels in the brain). And, unfortunately for all of us, high-blood pressure is caused by a number of things, including stress (from anywhere), poor breathing, poor diet, lack of sleep, and more. Considering one in every three adults in the U.S. has high blood pressure, this should be taken seriously.


How to fix a leaky Blood-Brain-Barrier

1) Sleep

Before you do anything else, you need to sleep more. The first sleep study mentioned above also found that at the end of a 6-day period of sleep deprivation, the permeability of the BBB was restored to baseline after just 24 hours of recovery sleep. Sleep loss is known to impair the immune system, while simultaneously increasing levels of pro-inflammatory mediators. It also increases sympathetic nervous system activity and causes endothelial dysfunction. So to maintain homeostasis, the general health of your body, and the health of your BBB in particular, you need to get more sleep each day, between 7 and 9h per 24h period.

2) Limit Alcohol

As you learned above, this one is huge. While a glass of wine a day can cause low doses of ethanol to migrate across the barrier and trigger good endorphins and relaxing neurotransmitter receptors, higher amounts of alcohol can, obviously, cause high-doses of ethanol, along with acetaldehyde, to damage brain neurons.

3) Control Blood Pressure

Both acute and chronic hypertension increase blood-brain barrier permeability. Dark chocolate, high-dose garlic, magnesium, potassium, and even hand-grip training can all help to lower blood pressure. And luckily, you don’t have to eat an entire bowl of elephant garlic to reap the benefits. There’s a form of garlic extract called allicin, which is the main active component of garlic, that’s a far more efficient way to get the brain-boosting benefits of this common ingredient. As far as grip devices go, you can take a hand-grip strengthener with you in the car or airplane or train, and just keep squeezing it. There’s even a commercial device called Zona that’s been clinically approved for treating blood pressure. It even digitally walks you through a squeeze-and-relax regimen.

4) Caution With High-Fat Diets

Rodents that were given a 40% saturated fat diet (from cocoa butter) experienced elevated blood-brain barrier permeability, but adding in either aged garlic extract, alpha-lipoic acid (ALA), niacin, or nicotinamide completely eliminated this elevation. Phytonutrient-rich plants and spices such as curcumin (from turmeric), astragalus root, cruciferous veggies like broccoli, brussels sprouts, and cabbage produce a similar healing effect. Fiber-rich plants are also beneficial. They allow you to consume high amounts of fat while minimizing some of its effects. Make sure you also start including lots of dark, leafy greens in your meals, like kale, spinach, or collard greens.

5) Drink Coffee and/or Tea

Caffeine is a noted protector of blood-brain barrier integrity, and may even help inhibit BBB disruption as a means of preventing Alzheimer’s disease.

6) Supplementation

Alpha-GPC, a type of choline that readily crosses the blood-brain barrier, is known to improve endothelial dysfunction. Inositol from egg yolks improves BBB integrity, berberine reduces its permeability and increases resistance to brain damage following head trauma, and vitamins B12, 6, and 9 restore it to equilibrium.

7) Magnesium

As mentioned, high magnesium intake can attenuate BBB permeability, even in test subjects who have been injected with an agent to induce leaky blood-brain barriers. You can get it into your system by taking it orally, or applying it topically either as a lotion or spray on the back of your neck and head.

8) Stimulate Your Vagus Nerve

Stimulating the vagus nerve with practices like singing, chanting, meditating, deep breathing, cold showers and even electronic stimulation, and a host of other lifestyle practices and biohacks can all decrease BBB permeability.

9) Limit Snacking

Ghrelin, a hunger-stimulating hormone that tells you it’s time to eat, can also improve BBB integrity. Specifically, it can reduce BBB breakdown after traumatic head injury. By avoiding frequent snacking and grazing, practicing intermittent fasting, and reaching to point of hunger, you get better BBB function.

10) Nourish Your Gut

One study observed the effects of a transplant of gut microbiota from healthy mice with perfect BBB integrity to unhealthy mice with a leaky barrier, and found that it did, in fact, restore the integrity of the damaged barriers. Luckily, you don’t have to get such transplants from other people — you can get the same results by eating more prebiotic fiber, taking quality probiotics, and eating fermented foods on a regular basis.

11) Cryotherapy

The final tip is simply… cold showers. This will affect everything from your appetite to your vagus nerve connection between the gut and brain, to temperature fluctuations that will cause a release of blood and nitric oxide in your brain, all of which will improve BBB integrity by overall suppressing mechanisms of BBB degeneration. Cold soaks, cold shower, splashing cold water on your face, it’s that simple.

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Everything You MUST Know About Alzheimer’s Disease

Most people today know someone who has been affected by Alzheimer’s disease. It is the most common cause of dementia, accounting for about 60 to 80% of all dementia cases. People who have dementia lose memory and cognitive (thinking) abilities, and can also experience altered speech and perception. These losses make it difficult for people with Alzheimer’s to function on their own in daily life.

National estimates suggest that about 5.7 million people in the U.S. are living with Alzheimer’s disease, a number that’s projected to soar to 14 million by 2050, according to the Alzheimer’s Association. Aging is the most common risk factor, but Alzheimer’s can begin in middle age, too. Approximately 200,000 people in the United States have early onset Alzheimer’s disease, which begins before age 65.

Alzheimer’s also impacts the friends and family of those who have it. Friends and family provide 83% of care for older adults in the U.S., and nearly half of them provide care for someone with Alzheimer’s or another form of dementia.

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Early Signs and Symptoms of Alzheimer’s Disease

Applying the word “Alzheimer’s” to someone close to you can be uncomfortable, even if the signs, or symptoms, have been apparent for some time. It’s much easier to gloss over strange behavior: “Oh, Mom’s just getting older,” or to rationalize: “Well, we all forget things sometimes.”

Only a qualified physician can conclude with high certainty that a living person has Alzheimer’s disease. But the following eight symptoms are strongly associated with the disease. If your loved one is displaying these symptoms, it would be wise to seek medical evaluation.

1. Memory Lapses

  • Does the person ask repetitive questions or retell stories within minutes of the first mention?
  • Are memory lapses growing progressively worse (such as affecting information that was previously very well known)?
  • Are the lapses happening more frequently (several times a day or within short periods of time)?
  •  Is this forgetfulness unusual for the person (for example, sudden memory lapses in someone who took pride in never needing grocery lists or an address book)?
  • Does the person ask repetitive questions or retell stories within minutes of the first mention?

Everyone forgets some things sometimes. But your loved one may have Alzheimer’s disease if you notice these more significant memory lapses.

Having problems with memory is the first and foremost symptom noticed. It’s a typical Alzheimer’s symptom to forget things learned recently (such as the answer to a question, an intention to do something or a new acquaintance) but to still be able to remember things from the remote past (such as events or people from childhood —  sometimes with explicit detail). In time, even long-term memories will be affected. But by that point, other Alzheimer’s symptoms will have appeared.

2. Confusion Over Words

  • Does the person have difficulty finding the “right” word when he or she is speaking?
  • Does the person forget or substitute words for everyday things (such as “the cooking thing” for a cooking pot or “hair fixer” for comb)?

Of course it’s normal for anyone to occasionally “blank” on a word, especially words not often used. But it’s considered a red flag for Alzheimer’s if this happens with growing frequency and if the needed words are simple or commonplace ones.

This can be a very frustrating experience for the speaker. He or she might stall during a conversation, fixating on finding a particular word, or replace the right word with another word. This substitute could be similar enough that you could guess at the meaning (“hair dryer” instead of “hairdresser”), especially early on in the disease process. Or it could be completely different (“bank” instead of “hairdresser”) or nonsensical (“hairydoo”).

3. Marked Changes in Mood or Personality

  • Has the person who’s usually assertive become more subdued (or vice versa)? Has the person who’s reserved become less inhibited (or vice versa)?
  • Does he or she withdraw, even from family and friends, perhaps in response to problems with memory or communication?
  • Has the person developed mood swings, anxiety, or frustration, especially in connection with embarrassing memory lapses or noticeable communication problems?
  • Has he or she developed uncharacteristic fears of new or unknown environments or situations, or developed a distrust of others, whether strangers or familiar people?
  • Do you see signs of depression (including changes in sleep, appetite, mood)?

Mood shifts are a difficult sign to link definitively to Alzheimer’s because age and any medical condition may spark changes in someone’s mood, personality or behavior. But in combination with other Alzheimer’s symptoms, mood changes such as those described above may contribute to a suspicion of the disease.

A person with Alzheimer’s may also become restless and/or aggressive, but usually in later stages of the disease.

4. Trouble with Abstract Thinking

  • How well does the person handle relatively simple mathematical tasks, such as balancing a checkbook?
  • Does the person have trouble paying bills or keeping finances in order, tasks he or she previously had no problem completing?
  • Does he or she have trouble following along with a discussion, understanding an explanation, or following instructions?

Abstract thinking becomes increasingly challenging for someone with Alzheimer’s, especially if the topic is complex or if the reasoning is sequential or related to cause and effect.

5. Difficulty Completing Familiar Activities

  • Has the person begun to have trouble preparing meals?
  • Is the person less engaged in a hobby that once absorbed her (bridge, painting, crossword puzzles)?
  • Does he or she stop in the middle of a project, such as baking or making a repair, and fail to complete it?
  • Has the person stopped using a particular talent or skill that once gave her pleasure (sewing, singing, playing the piano)?

Activities with various different steps, however routine and familiar, can become difficult to complete for a person with Alzheimer’s. Your loved one might become distracted or lose track of where he or she is in the process, feeling confused. Or the person might just lose interest altogether and leave a project unfinished.

Alzheimer’s or some other form of dementia is especially suspect when the difficult or abandoned activity is something the person formerly delighted in and excelled at, or used to engage in frequently.

6. Disorientation

  • Has the person begun to be disoriented in new or unfamiliar environments (such as a hospital or airport), asking where he or she is, how he or she got there, or how to get back to a place that’s recognizable?
  • Has the person become disoriented in an environment she knows well?
  • Does the person wander off and get lost in public (or get lost when driving or after parking)?
  • Does he or she lose track of the time, day, month, or year? For example, after being reminded about a future doctor’s appointment over the phone, she may start getting ready for the appointment right away. Or they may have trouble keeping appointments and remembering other events or commitments.

These examples of disorientation are all typical Alzheimer’s symptoms, more so in later stages of the disease but sometimes early on as well.

7. Misplacing Items

  • Does the person “lose” items often?
  • Do these items turn up in unusual places (such as finding a wallet in the freezer)?

Losing track of glasses, keys, and papers happens to most adults sometimes, whether due to age or just a busy lifestyle. However, it may be a symptom of Alzheimer’s if this behavior escalates and if items are sometimes stored in inappropriate or unusual places, and the person doesn’t remember having put them there.

8. Poor or Impaired Judgment

  • Has the person recently made questionable decisions about money management?
  • Has he or she made odd choices regarding self-care (such as dressing inappropriately for the weather or neglecting to bathe)?
  • Is it hard for the person to plan ahead (for example, figuring out what groceries are needed or where to spend a holiday)?

Difficulty with decision-making can be related to other possible symptoms of Alzheimer’s, such as lapses in memory, personality changes, and trouble with abstract thinking. Inappropriate choices are an especially worrisome sign, as your loved one may make unsound decisions about his safety, health or finances.

Many of these Alzheimer’s symptoms go unnoticed for a long time. That’s because they’re often subtle or well concealed by the person (or a spouse), who may be understandably freaked out by the changes he’s noticing in behavior. Some patterns of behavior take time to become obvious.

If you suspect Alzheimer’s, keep track of what you’re noticing. Ask others who know your loved one what they think. Encourage the person to see a doctor.


Steps to Diagnosing Alzheimer’s Disease

If an aging loved one has started to show signs of Alzheimer’s disease, you may feel overwhelmed and unsure what to do. Your most important priority is to get a diagnosis. The earlier you can put a name to the problem, the easier it is to organize a care plan. Here are 6 steps you should take to get the right diagnosis.

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1. Create a Record

There’s no single test for Alzheimer’s disease or most other dementias. In fact, a definitive diagnosis can only be made after death, by examining brain tissue for telltale changes. But doctors can make a probable diagnosis of Alzheimer’s with as much as 90 percent certainty.

It’s almost always family members, more than physicians, who spot the first signs of Alzheimer’s disease. Start by writing down observations that you and others make of the person you’re concerned about. You’ll be better able to notice patterns or changes in the frequency of certain behaviors than if you just keep a mental record. This evidence is incredibly useful when you speak with medical professionals and may even help when discussing the topic with family and friends.

This same notebook can also serve as your “playbook” throughout your family’s journey, a central source of all the information that will be needed not only to make a diagnosis but to formulate an ongoing care plan. Having all the information you need in one place can be a valuable shortcut for families.

What to record:

  • His or her general medical history: current and past medical problems and conditions
  • Current medications and their dosages
  • Other family members’ histories of illnesses (including Alzheimer’s disease and other types of dementia)
  • Contact information for doctors and pharmacists
  • A record of who has been consulted and when
  • Symptoms

Part of the determination about the condition will have to do with how much the person has changed or how much you think he or she isn’t “acting like himself or herself.” Be sure to note when you first noticed a particular change in behavior, physical ability or mental ability (or about how long the change has been occurring); how frequently it occurs; if it has worsened and how different or “abnormal” it is for him or her.

Try to include as much information as you can about the person’s condition — not just things that you think are typically associated with Alzheimer’s. Other medical issues or unexpected changes (such as falling or incontinence) can be related to the disease.

2. Educate Yourself

As soon as you suspect Alzheimer’s, invest a little time in familiarizing yourself with the disease. There are lots of myths about it and plenty of confusion. Having a basic understanding allows you to ask doctors more informed questions and recognize the signs to watch out for.

  • Do not to jump to conclusions. Various types of dementia, as well as other illnesses or situations, may result in changes that mimic signs or symptoms of Alzheimer’s disease (such as disorientation and mood swings or personality changes), so you’ll need to consult with a qualified physician before determining that it’s Alzheimer’s. An early diagnosis means that the right medications and lifestyle changes can be made to slow the disease’s progress and help preserve independence as long as is practical.
  • Take the Alzheimer’s Association Brain Tour and learn how the brain works and how Alzheimer’s affects it.

3. Find and Talk with a Qualified Doctor

With the observations you’ve made of the person you’re concerned about and a basic foundation of knowledge about Alzheimer’s, you’re ready to consult with a medical professional.

  • Start with the person’s regular primary care doctor. This professional is optimal because he or she has observed your family member over time. But if the doctor doesn’t seem particularly knowledgeable about dementia or doesn’t seem to be taking your concerns seriously, it’s probably time to see another doctor, ideally someone who’s experienced in treating dementia. Seeing a geriatrician (a doctor who specializes in treating older adults) may be especially helpful.
  • Go with your loved one to the office visit. Even if you don’t have a history of attending medical appointments with them, try to arrange to be at this one. You might say, “I’ve been worried about you. Let’s make sure everything is all right or see if the doctor can help with that memory problem. I’ll come with you because you know they say it’s a good idea for more than one adult to be at all kinds of medical appointments. That way, between the two of us, we’ll keep track of everything the doctor says.”
  • Be prepared for the appointment. Bring your notebook of observations, including a list of the medications he or she is currently taking and a list of questions you’d like to ask, as well as the person’s medical history if it’s a new doctor. Be sure to include a request for referrals to specialists (if necessary) in your list of questions.
  • Arrange for some assistance. If you live far away and can’t be there for the appointment yourself, try to make sure that someone you all trust accompanies your loved one. Ask your loved one to sign a release permitting you to discuss their medical records and care with the doctor so you can call the doctor directly with follow-up questions.

4. Get a Thorough Medical Workup

The doctor will use evidence from a careful exam and a process of elimination to arrive at a diagnosis. A combination of diagnostic tools enables doctors to screen for conditions that may be affecting your loved one. Here’s a quick breakdown:

  • A medical history. The doctor will ask a series of questions about medical conditions and illnesses your loved one has had in the past, any current medical symptoms or medications, and information about other family members’ health. The doctor may ask about other topics as well, such as diet and exercise.
  • A physical exam. As in a regular checkup, the doctor will check the person’s vital signs — blood pressure, pulse and temperature — and also listen to the patient’s heart and lungs and check other physical characteristics.
  • Diagnostic tests. The doctor will order urine and blood tests to check for certain infections or disorders that may be causing symptoms. Blood testing may be used to search for genes known to make Alzheimer’s more likely.
  • A mental status assessment. Your loved one will be asked to answer a series of questions and perform some activities in order to evaluate memory loss, disorientation, trouble with following directions or completing basic tasks, problem-solving ability, communication skills, and awareness of the problems he or she experiences. The doctor may also ask questions to assess for depression, anxiety, and other possible psychiatric problems.
  • A neurological or neuropsychological evaluation. The doctor may test his or her physical coordination, reflexes, balance and speech, among other indicators of neurological health.
  • A brain scan. It’s likely that the doctor will either order a CT (computerized tomography) scan or an MRI (magnetic resonance imaging) scan to visually examine the condition of the person’s brain, including possible damage due to Alzheimer’s disease, trauma or strokes.
  • Additional tests. The doctor may also order other tests or scans, such as a spinal tap, a chest X-ray, an electroencephalogram (EEG, to examine brain function by the electrical activity it generates), or a positron emission tomography scan (a PET scan, to examine the function of internal organs).

5. See a Specialist

When Alzheimer’s disease is suspected or diagnosed, the doctor may recommend seeing a specialist, such as a neurologist, psychiatrist or geriatrician. This specialist will help confirm the primary diagnosis and advise you on Alzheimer’s care. He or she can also answer specific questions you may have about disease, its treatment and caregiving, and may be able to direct you to other helpful resources and support groups.

6. Consider a Second Opinion

It’s often advisable to seek a second opinion about your family member’s condition (whether the diagnosis is probable Alzheimer’s or not), especially if you or the doctor is uncertain about it. Another experienced, skilled physician can review the findings of the tests and evaluations the person has already undergone.

After the Diagnosis: What Lies Ahead

  • Assemble a team. If the diagnosis is probable Alzheimer’s, the next step is to start putting together an Alzheimer’s care team. Alzheimer’s care works best when it’s a shared responsibility — and when good resources and sources of support are available to the primary caregiver.
  • Don’t forget your own concerns. In addition to powwowing with your family about options for your loved one’s care, be sure to start thinking about support for yourself (or the person who will be the primary caregiver). Financial, emotional, and physical stresses often build over time.

There’s no single timetable for how the disease progresses, and your loved one may have many satisfying years ahead. Do what you can to ease the symptoms, to prolong his or her independence and dignity.


The Stages of Alzheimer’s: What to Expect

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Alzheimer’s disease is a degenerative condition marked by a progressive decline in cognitive functioning. This decline, often coupled with emotional apathy, affects the person’s behavior and mood. People sometimes mistake forgetfulness or absent-mindedness in seniors for early signs of Alzheimer’s, but some memory loss is actually considered a normal effect of aging.

You may have heard the terms “early, mid- and late-stage Alzheimer’s.” These are general terms that were used until the development of a more detailed framework with seven separate stages that measure progression of the disease. The system is known as the Functional Staging Assessment or FAST scale, developed by Dr. Barry Reisberg, director of the Zachary and Elizabeth M. Fisher Alzheimer’s Disease Education and Research Program at New York University Langone Health.

Below, we’ll examine the seven stages of Alzheimer’s disease, distinguishing between the normal aging process and the signs and symptoms of Alzheimer’s.

What is normal during the aging process?

As we age, some memory loss is considered normal, especially if it is not progressive. For example, an aging senior who does not have Alzheimer’s may:

  • Be concerned about memory loss but be able to provide significant detail regarding specific incidents of forgetfulness.
  • Have trouble finding the right word, but remember it later.
  • Forget the day of the week or where he or she is going, usually remembering later.
  • Need to pause to remember his or her way, even in familiar territory.
  • Misplace keys or a wallet temporarily.
  • Feel sad or moody occasionally, but be able to recover from it.
  • Avoid work or social obligations, but show no decline in interpersonal skills.

The FAST scale measures the decline of people with Alzheimer’s. Although each stage is distinct, due to a steady decline in cognitive function, there is still some overlap among stages. It can be helpful to view the scale as a spectrum, with the condition progressing as the person’s symptoms gradually increase and worsen.

Stage 1: Normal Adult

In this first stage, there is no obvious memory impairment. Clinical tests also show no measurable deficit.

Stage 2: Normal Older Adult

A person in Stage 2 shows very mild cognitive decline, usually showing some personal awareness of the change. This may include the person worrying that he or she is becoming more forgetful, although it is not obvious to a health care professional, family or friends. The person may forget names and temporarily misplace commonly used objects like keys or a wallet.

Stage 3: Early Alzheimer’s Disease

During this stage, the individual may have difficulty concentrating on certain tasks and may falter during a conversation. He or she may also have difficulty retaining information that was just read or heard. Forgetting names and words becomes more frequent. Misplacing objects of value may occur. Some degree of confusion is common.

Stage 4: Mild Alzheimer’s Disease

By Stage 4, friends and family members will have begun to notice changes in the person with Alzheimer’s, in addition to the symptoms mentioned above. These observations could include the person:

  • Forgetting people he or she has recently met
  • Losing interest in social or work situations
  • Being uncharacteristically disorganized
  • Showing a decreased ability to perform common tasks such as planning dinner, paying bills or managing finances

Stage 5: Moderate Alzheimer’s Disease

At Stage 5, the person is no longer able to function independently. Typically, the person will remember his or her own name as well as the names of a spouse and children, but may be unable to recall a home address or phone number. Forgetfulness increases, and disorientation is common, with people in this stage often being confused about time, place, date, day of the week and season. Other signifiers may include the senior:

  • Being unable to make proper clothing choices (for instance, selecting a sundress during the winter).
  • Forgetting personal history, such as where he or she went to school.
  • Withdrawing from social or challenging situations.

Stage 6: Moderately Severe Alzheimer’s Disease

By this time, a person with Alzheimer’s will exhibit major gaps in memory and a significant decline in cognitive function. Personality changes may begin to emerge as well. A person in Stage 6 may be unable to distinguish familiar people, including a spouse or children, from those he or she doesn’t know. The individual may require help with daily activities such as eating and toileting. Incontinence is common. In addition, the person may:

  • Forget the name of his or her spouse, even if the spouse is their primary caregiver
  • Wander and become lost
  • Experience hallucinations, interacting with people or things that are not there
  • Exhibit delusional and/or paranoid behavior

Stage 7: Severe Alzheimer’s Disease

In the final stage of Alzheimer’s disease, most individuals have lost the ability to communicate verbally, although some may retain a few words. A severe physical decline is apparent.

The person with Alzheimer’s will experience a progressive loss of basic physical abilities, including sitting, walking and even swallowing. Muscles become rigid from lack of use, and reflexes are abnormal. There is a disruption in the person’s circadian rhythm, which can upset sleeping patterns and contribute to disorientation and fatigue.

While the cause of Alzheimer’s remains unknown, research shows that many factors can play a part in the development of the disease. Understanding normal aging patterns will help you distinguish them from the warning signs of Alzheimer’s. If you are uncertain, talk to your loved one’s doctor about getting a definitive diagnosis.


Ways to Slow Down the Progression of Alzheimer’s Disease

The memory loss and other cognitive changes that are characteristic of Alzheimer’s disease and most other forms of dementia can’t be reversed. But there are some proven ways to delay further decline, at least over the short term.

The Rush Memory and Aging Project is a large ongoing longitudinal study looking at common chronic conditions of aging with an emphasis on decline in cognitive and motor function and risk for Alzheimer’s. A continuously updated list of scholarly publications featuring research conducted by study investigators can be found on the Rush University Medical Center website.

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1. Stimulate Mental Activity

A growing body of research indicates that stimulating the brain has the power to slow the progress of Alzheimer’s, particularly in the early stages. More frequent cognitive activity across someone’s life span is linked to slower cognitive decline later in life.

What you can do:

  • Encourage the person in your care to participate in activities he or she finds pleasurable, especially those that engage the mind: reading, writing, playing the piano, working crosswords or puzzle books, playing games such as chess, or even learning a new language. Make sure the person has fresh materials or plenty of opportunities.
  • Local senior centers and adult day care programs are more than just a way to “pass the time.” They often excel at providing stimulating activities, including group storytelling, music, arts projects and games.

Some research suggests that activities are especially protective when they involve interacting with others. Arrange for help around the home, if possible, but avoid relieving your loved one of all of his or her normal responsibilities. Participating in daily chores can be a type of mental workout, too.

The catch with mental stimulation:

It’s important that someone with dementia find the activity pleasurable. If the person finds studying Spanish or learning to use a computer frustrating because of existing cognitive declines, don’t push it.

Also avoid formal mental “exercises” or memory drills. They may stress your loved one, causing symptoms to worsen.

Too much social activity can also be stressful. Outings are best when low-key (think small dinners as opposed to big parties) and under two hours.

2. Make Daily Life Modifications

Simplifying the living environment and providing the tools to assist your loved one’s existing memory can help him or her maintain independence longer. This has the benefit of reducing stress and slowing further decline.

What you can do:

Find ways to minimize any tasks the person may worry about. For example, you could arrange electronic bill paying, hire a lawn service, enlist a young neighbor to handle the laundry or cancel subscriptions to magazines that are no longer read. Help keep the person’s home free of piled-up newspapers, old mail and other clutter. Look into electronic reminder systems, note-keeping systems, or commercially available tools that can help to prop up a faulty memory.

The catch with daily life modifications:

Be sure to make changes gradually. Too many abrupt changes — removing all the clutter from a messy home in one sweep, for example — can be disorienting and stressful to someone with Alzheimer’s or other forms of dementia and hasten the person’s decline rather than slowing it.

3. Keep Up Routines

The stimulation of fresh ideas can have positive effects, but too many changes can be confusing and disorienting. Familiarity is very important to someone with Alzheimer’s disease or other forms of dementia. The stress of having to cope with sudden or significant change can make symptoms worse. (Note: Stress doesn’t cause Alzheimer’s, but it has been shown to worsen symptoms in those already affected.)

What you can do:

Try to establish a regular daily rhythm for the person, with meals, sleep, outings, and bathing happening at about the same times each day. Schedule all doctors’ appointments at roughly the same time if you can, such as first thing in the morning or right after lunch. It’s not unlike the way a new parent organizes the day around a baby’s sleep-wake cycle.

The catch with routines:

A good routine is one that’s healthy to begin with. Examples of negative routines worth trying to change: If the person is staying awake later and later and rising later, or if he or she has dropped all former social connections and rarely sees anyone.

4. Incorporate Vitamins and Herbs

Scientists are investigating several different dietary additions for people with Alzheimer’s and other types of dementia. Two of the most promising areas:

Vitamins

A clinical trial showed that vitamin E helps slow down mental impairment in people with Alzheimer’s. Vitamin E is an antioxidant that helps protect cells against damage. It has also been researched in conjunction with B vitamins.

A large 2005 study found that healthy people who consumed more than 400 micrograms (the recommended daily amount for adults) of folate, a B vitamin that occurs naturally in many foods, cut their risk of developing Alzheimer’s in half. This slowing of cognitive decline is being studied to see if it’s also true once decline has started.

Ginkgo Biloba

This herb, traditionally used in Chinese medicine, comes from the dried leaves of the gingko (maidenhair) tree. It’s sometimes called the “memory herb,” after findings that it appears to help slow down cognitive decline for some people in the early stages of Alzheimer’s disease.

To date, research studies making this claim have been criticized, however, and a randomized clinical trial sponsored in part by the National Institute on Aging and the National Center for Complementary and Alternative Medicine found the herb to be ineffective in reducing the development of dementia and Alzheimer’s disease in older people.

What you can do:

Encourage the person in your care to inform her primary-care doctor about any supplements and herbs he or she has been taking and their dosages, and do so yourself if the person doesn’t. Bring the bottle, so the doctor can see exactly what’s being taken. Too much vitamin E, for example, can cause gastrointestinal problems and other side effects, and can be fatal to people with heart disease.

In general, the best way to get important vitamins and minerals is to consume them from their natural food sources. One study in 2007 found that people with Alzheimer’s who most closely followed a Mediterranean-style diet (high in vegetables, legumes, cereals, fruit, fish, poultry, dairy, and monounstaturated fats — and low in saturated fats) lived an average of 1.3 years longer than those who consumed a Western diet (higher in saturated fats and meats, lower in vegetables).

Try to make sure that your loved one is eating a diet low in saturated fats and rich in vitamins E, C and B. Older people’s diets often lack fresh fruits and vegetables (such as citrus, berries and leafy green vegetables), legumes (beans), whole-wheat or fortified bread, and nuts and seeds.

Take a close look at the person’s eating habits. People with memory problems often slack off on cooking because even the familiar steps, as well as managing cutlery, become too challenging.

The catch with vitamins and herbs:

The one thing scientists agree on concerning memory loss and supplements is that more research is needed. No single “magic bullet” has been found to stop memory decline in its tracks, and no supplements should be taken by people with Alzheimer’s or other forms of dementia without medical supervision.

5. Medications

Five FDA-approved drugs are used to delay the symptoms of Alzheimer’s disease or prevent them from worsening for a limited time.

What you can do:

Talk to your loved one’s doctor about which drugs might be appropriate. For mild to moderate Alzheimer’s, cholinesterase inhibitors — such as Aricept (donepezil), Exelon (rivastigmine) and Razadyne (galantamine), formerly called Reminyl — may be prescribed. These medications help keep the enzyme acetylcholinesterase from reducing acetylcholine, which affects mental capabilities and muscle control. The drug Cognex (tacrine hydrochloride) was prescribed in the past, but is no longer recommended.

For moderate to severe stages of Alzheimer’s, the drug Namenda (memantine) is also used. This drug is an N-methyl-D-aspartate (NMDA) receptor antagonist, which regulates glutamate (a chemical messenger in the brain that’s associated with learning and memory).

The catch with medications:

Not every drug works for all patients. And each involves possible side effects and interactions with other drugs the person in your care may be taking. Talk to the person’s doctor about whether any of these medications would be a good fit.


Life Expectancy for Someone with Alzheimer’s

Knowing the life expectancy of someone with Alzheimer’s can help your family prepare for the gradually increasing amounts of caregiving that eventually will be needed. Someone in the final stages of the disease, for example, requires constant hands-on care. Estimating life expectancy can help you and your family plan ahead for all the practical and financial issues you’ll face.

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What’s the average life expectancy of someone with Alzheimer’s?

The general rule of thumb is that a person diagnosed with Alzheimer’s can expect to live half as long as a peer who doesn’t have the disease. For example, the average 75-year-old can expect to live another 12 years. A 75-year-old with Alzheimer’s, in contrast, would be expected to live for six more years.

It’s hard to gauge an individual’s life expectancy based solely on the stage of Alzheimer’s. That’s partly because the length of each stage (early/middle/late) can vary greatly from person to person. Some people live 15 or more years after diagnosis, including many years with relatively mild impairment, while others decline rapidly and die within a few years of being diagnosed.

In general, someone who’s just beginning to show symptoms can be expected to live longer than someone of the same age with end-stage Alzheimer’s.

What Influences Alzheimer’s Longevity?

Scientists have a growing understanding of which Alzheimer’s patients are more likely to outlive their peers with the disease. In 2014, a UK study identified several factors that appear to influence life expectancy:

High Blood Pressure

In the study, participants diagnosed with Alzheimer’s who also had arterial hypertension, or high blood pressure, were found to live for a shorter period of time after diagnosis than those without high blood pressure.

Family History of Alzheimer’s

Study participants with at least one first-degree relative (a parent, sibling or child) with Alzheimer’s were found to live longer on average than study participants without a family history of the disease.

MMSE Score

In a 2004 Washington University study, participants who scored worst on a commonly used memory and cognition (thinking skills) test, the Mini-Mental State Exam (MMSE), were found to have shorter survival rates.This test asks subjects to do a series of simple tasks, including answering questions about the date and place, remembering three objects, and counting backward by increments.

An MMSE score refers to the number of correct answers given out of a total of 30. A five-point drop in score over the course of a year was linked to decreased survival rates among patients in the study.

However, simply scoring poorly doesn’t mean a person doesn’t have long to live. Sometimes a poor MMSE score is the first indication of cognitive trouble, which may indicate the very start of Alzheimer’s and therefore a longer life expectancy than predicted for someone who’s had memory problems for years.

Note: There are multiple factors that can influence an MMSE score. The test is not an Alzheimer’s diagnostic test — in fact, no such test exists.

Other Health Problems

In the 2004 study, survival was also poorest among those aged 85 and older who had a history of diabetes or congestive heart failure or those who’d had a heart attack.

What often happens in people with Alzheimer’s disease is that their general health suffers when, in the late stages, they forget or find it difficult to eat, don’t sleep properly, lose motor skills and develop bedsores. This sets the stage for infection, such as pneumonia, or the worsening of other chronic ailments. It’s those factors, not the Alzheimer’s disease itself, that ultimately result in most deaths.

Bear in mind that the statistics above represent group averages. Your loved one, of course, is an individual with a unique health history. And Alzheimer’s is a disease whose pace can vary widely from person to person. Still, having even a rough sense of what to expect can provide a glimmer of useful light at a difficult time.


When Alzheimer’s Disease Turns Violent

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Among the many difficult behaviors Alzheimer’s caregivers must cope with, verbal and physical aggression may be one of the most upsetting. Aggressive behavior isn’t uncommon among people with dementia, and we include it here because this is a real consideration as Alzheimer’s disease progresses through the later stages.

Geriatric psychiatrist Dr. Gary Moak, author of “Beat Depression to Stay Healthier and Live Longer,” says verbal and physical aggression affects as many as 90 percent of people with dementia at some point during the course of the illness.

“When surroundings and situations that should be familiar instead feel strange and bewildering, people with dementia may become emotionally overwhelmed, and they may lose control,” Moak says. “They may not understand that their caregivers are trying to help them, instead reacting as if they are under attack.”

Causes and Triggers of Aggression for People with Alzheimer’s

Experts say common triggers for physical aggression in those with Alzheimer’s include fear, confusion and an inability to communicate verbally, leading to frustration and anger. Some aggression may be the result of other medical problems, such as poorly managed diabetes or urinary tract infections, Moak says.

He notes that any change in routine can trigger disturbed behavior in people with dementia, including violence. Difficulty with mundane processes that no longer make sense can also prompt a feeling of a loss of control, which can then lead to aggression.

“Television programs that the person with dementia cannot understand, kitchen appliances they no longer know how to work, or family conversations they are unable to follow, also can lead to trouble,” Moak says.

Likewise, if a person with dementia senses that someone around them is anxious, tense or irritable, it can also trigger aggression, he says.

Understanding what triggers your loved one’s outbursts can help you react appropriately and possibly prevent physical aggression.

How to Respond to Physical Aggression

If your loved one with dementia does lash out physically, there are a number of things you can do to help keep you both safe. Moak recommends the following when a violent outburst due to dementia occurs.

  • Back off, if possible, and avoid acting defensively or angrily yourself
  • Use a calm, soothing voice
  • Resist the urge to convince your loved one that their reasons for aggression are wrong
  • Go along with the person, if necessary, as long as it’s safe to do so. (For example, if your loved one demands to be taken home when they’re already home, offer to take her home, but find a good excuse to delay doing so. If she still insists, take her for a drive around the neighborhood and return home).

The doctor notes that side effects from some medications may also contribute to aggressive behavior in people with dementia. He advises having your loved one evaluated by a healthcare professional with expertise in dementia management for possible treatments.

According to Moak, the best treatment for aggressive behavior may be in the caregiver’s hands. By changing their behavior or style, they may be able to create a less stressful environment for their loved one.

“This involves adopting a calm, lighthearted demeanor, learning to adjust [your] style of interacting with the demented person, and learning specific behavioral approaches for troublesome behavior,” he says.

 

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5 types of Brain medication that affect memory

At work, I am often questioned by patients about memory changes with age. They also state: “But you know, nothing much that can be done at my age”.

Wrong. In fact, there is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.

First among them: identify medications that make brain function worse.

This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice.

And the expert authors of the National Academy of Medicine report on Cognitive Aging agree: in their Action Guide for Individuals and Families, they list “Manage your medications” among their “Top 3 actions you can take to help protect your cognitive health as you age.”

Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.

Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.

And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.

You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.

Below, I share the most commonly used drugs that you should look out for if you are worried about memory problems.

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The Four Most Commonly Used Types of Medications That Dampen Brain Function

1. Benzodiazepines

This class of medication is often prescribed to help people sleep, or to help with anxiety. They do work well for this purpose, but they are habit-forming and have been associated with developing dementia.

  • Commonly prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively).
  • Benzodiazepines act on the same brain receptors as alcohol, and they almost always keep people with dementia from thinking at their best level.
  • Note that it can be dangerous to stop benzodiazepines suddenly. These drugs should always be tapered, under medical supervision.
  • Alternatives to consider:
    • For insomnia, there is no easy and fast alternative. Just about all sedatives — many are listed in this post — dampen brain function. Many people can learn to sleep without drugs, but it usually takes a comprehensive effort over weeks or even months. This may involve cognitive-behavioral therapy, as well as increased exercise and other lifestyle changes. You can learn more about comprehensive insomnia treatment by getting the Insomnia Workbook (often available at the library!) or something similar.
    • For anxiety, there is also no easy replacement. However, there are some drug options that affect brain function less, such as SSRIs (e.g. sertraline and citalopram, brand names Zoloft and Celexa). Cognitive behavioral therapy and mindfulness therapy also helps, if sustained.
    • Even if it’s not possible to entirely stop a benzodiazepine, tapering to a lower dose will likely help brain function in the short-term.
  • Other risks in seniors:
    • Benzodiazepines increase fall risk.
    • These drugs sometimes are abused, especially in people with a history of substance abuse.
  • Other things to keep in mind:
    • If a person does develop dementia, it becomes much harder to stop these drugs. That’s because everyone has to endure some increased anxiety, agitation, and/or insomnia while the senior adjusts to tapering these drugs, and the more cognitively impaired the senior is, the harder it is on everyone. So it’s much better to find non-benzo ways to deal with anxiety and insomnia sooner, rather than later. (Don’t kick that can down the road!)

 2. Non-benzodiazepine prescription sedatives

By far the most commonly used are the “z-drugs” which include zolpidem, zaleplon, and eszopiclone (brand names Ambien, Sonata, and Lunesta, respectively). These have been shown in clinical studies to impair thinking — and balance! — in the short-term.

  • Some studies have linked these drugs to dementia. However we also know that developing dementia is associated with sleep problems, so the cause-effect relationship remains a little murky.
  • For alternatives, see the section about insomnia above.
  • Occasionally, geriatricians will try trazodone (25-50mg) as a sleep aid. It is thought to be less risky than the z-drugs or benzodiazepines. Of course, it seems to have less of a strong effect on insomnia as well.
  • Other risks in seniors:
    • These drugs worsen balance and increase fall risk.

3. Anticholinergics

This group covers most over-the-counter sleeping aids, as well as a variety of other prescription drugs. These medications have the chemical property of blocking the neurotransmitter acetylcholine. This means they have the opposite effect of an Alzheimer’s drug like donepezil (brand name Aricept), which is a cholinesterase inhibitor, meaning it inhibits the enzyme that breaks down acetylcholine. A 2015 study found that greater use of these drugs was linked to a higher chance of developing Alzheimer’s.

Drugs vary in how strong their anticholinergic activity is. Focus your energies on spotting the ones that have “high” anticholinergic activity. For a good list that classifies drugs as high or low anticholinergic activity, see here.

Briefly, drugs of this type to look out for include:

  • Sedating antihistamines, such as diphenhydramine (brand name Benadryl).
  • The “PM” versions of over-the-counter analgesics (e.g. Nyquil, Tylenol PM); the “PM” ingredient is usually a sedating antihistamine.
  • Medications for overactive bladder, such as the bladder relaxants oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively).
    • Note that medications that relax the urethra, such as tamsulosin or terazosin (Flomax and Hytrin, respectively) are NOT anticholinergic. So they’re not risky in the same way, although they can cause orthostatic hypotension and other problems in older adults. Medications that shrink the prostate, such as finasteride (Proscar) aren’t anticholinergic either.
  • Medications for vertigo, motion sickness, or nausea, such as meclizine, scopolamine, or promethazine (brand names Antivert, Scopace, and Phenergan).
  • Medications for itching, such as hydroxyzine and diphenhydramine (brand names Vistaril and Benadryl).
  • Muscle relaxants, such as cyclobenzaprine (brand name Flexeril).
  • “Tricyclic” antidepressants, which are an older type of antidepressant which is now mainly prescribed for nerve pain, and includes amitryptiline and nortriptyline (brand names Elavil and Pamelor).

For help spotting other anticholinergics, ask a pharmacist or the doctor, or review the list.

Alternatives to these drugs really depend on what they are being prescribed for. Often non-drug alternatives are available, but they may not be offered unless you ask. For example, an oral medication for itching can be replaced by a topical cream. Or the right kind of stretching can help with tight muscles.

Aside from affecting thinking, these drugs can potentially worsen balance. They also are known to cause dry mouth, dry eyes, and can worsen constipation. (Acetylcholine helps the gut keep things moving.)

4. Antipsychotics and mood-stabilizers 

In older adults, these are usually prescribed to manage difficult behaviors related to Alzheimer’s and other dementias. (In a minority of seniors, they are prescribed for serious mental illness such as schizophrenia. Mood-stabilizing drugs are also used to treat seizures.) For dementia behaviors, these drugs are often inappropriately prescribed, as in this recent NYT story. All antipsychotics and mood-stabilizers are sedating and dampen brain function. In older people with dementia, they’ve also been linked to a higher chance of dying.

  • Commonly prescribed antipsychotics are mainly “second-generation” and include risperidone, quetiapine, olanzapine, and aripiprazole (Risperdal, Seroquel, Zyprexa, and Abilify, respectively).
  • The first-generation antipsychotic haloperidol (Haldol) is still sometimes used.
  • Valproate (brand name Depakote) is a commonly used mood-stabilizer.
  • Alternatives to consider:
    • Alternatives to these drugs should always be explored. Generally you need to start by properly assessing what’s causing the agitation, and trying to manage that. A number of behavioral approaches can also help with difficult behaviors. For more, see this nice NPR story from March 2015.
    • For medication alternatives, there is some scientific evidence suggesting that the SSRI citalopram may help, that cholinesterase inhibitors such as donepezil may help, and that the dementia drug memantine may help. These are usually well-tolerated so it’s often reasonable to give them a try.
  • If an antipsychotics or mood-stabilizer is used, it should be as a last resort and at the lowest effective dose. This means starting with a teeny dose. However, many non-geriatrician clinicians start at much higher doses than I would.
  • Other risks in seniors:
    • Antipsychotics have been associated with falls. There is also increased risk of death, as above.
  • Caveat regarding discontinuing antipsychotics in people with dementia: Research has found that there is a fair risk of “relapse” (meaning agitation or psychotic symptoms getting worse) after  antipsychotics are discontinued. A 2016 study of nursing home residents with dementia concluded that antipsychotic discontinuation is most likely to succeed if it’s combined with adding more social interventions and also exercise.

5. Opiate pain medications

Unlike the other drugs mentioned above, opiates (other than tramadol) are not on the Beer’s list of medications that older adults should avoid. That said, they do seem to dampen thinking abilities a bit, even in long-term users. (With time and regular use, people develop tolerance so they are less drowsy, but seems there can still be an effect on thinking). As far as I know, opiates are not thought to accelerate long-term cognitive decline.

  • Commonly prescribed opiates include hydrocodone, oxycodone, morphine, codeine, methadone, hydromorphone, and fentanyl. (Brand names depend on the formulation and on whether the drug is mixed with acetaminophen.)
  • Tramadol (brand name Ultram) is a weaker opiate with weaker prescribing controls.
    • Many geriatricians consider it more problematic than the classic Schedule II opiates listed above, as it interacts with a lot of medications and still affects brain function. It’s a “dirty drug,” as one of my friends likes to say.
  • Alternatives depend on what type of pain is present. Generally, if people are taking opiates then they have pain that needs to be treated. However, a thoughtful holistic approach to pain often enables a person to get by with less medication, which can improve thinking abilities.
  • For people who have moderate or severe dementia, it’s important to know that untreated pain can worsen their thinking. So sometimes a low dose of opiate medication does end up improving their thinking.
  • Other risks in seniors:
    • There is some risk of developing a problematic addiction, although that’s uncommon unless there’s a prior history of substance abuse. In my experience, having someone else — usually younger — steal or use the drugs is a more likely problem.

Where to Learn About Other Drugs That Affect Brain Function

Many other drugs that affect brain function, but they are either not used as often as the ones above, or seem to affect a minority of older adults.

Notably, there has been a lot of concern in the media about statins, but a meta-analysis published in a respectful journal could not confirm an association between statin use and increased cognitive impairment. In fact, a 2016 study found that statin use was associated with a lower risk of developing Alzheimer’s disease.

This is not to say that statins aren’t overprescribed or riskier than we used to think. And it’s also quite possible that some people do have their thinking affected by statins. But if you are trying to eliminate medications that dampen brain function, I would recommend you focus on the ones I listed above first.

What to Do if You or Your Relative Is On These Medications

So what should you do if you discover that your older relative — or you yourself — are taking some of these medications?

You should discuss any insomnia or sleep problems with your doctors — it’s important to rule out pain and serious medical problems as a cause of insomnia — but be careful: many of them will prescribe a sleeping pill, because they haven’t trained in geriatrics and they under-estimate the risks of these drugs.

If one or more of the medications above has been prescribed, don’t stop without first consulting with a health professional. You’ll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.

Remember, when it comes to maintaining independence and quality of life, nothing is more important than optimizing brain function.

We can’t turn back the clock and not all brain changes are reversible. But by spotting problem medications and reducing them whenever possible, we can help older adults think their best.

Now go check out those medication bottles, and let me know what you find!

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What is Brain Fog?

Brain fog is caused by a lack of blood flow to your brain. This lack of blood flow is called hypoperfusion and this condition triggers a domino effect of negative impacts on the brain.

Hypoperfusion causes inflammation in the brain which then causes damage to the cells of the brain. This damage to the cells causes the production of antibodies to get rid of the damaged cells in the brain. This then triggers the autoimmune mechanism in the brain to begin killing off brain cells.

This happens subtly over time and goes on for years and years, causing a great deal of damage to your brain.

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How Does Brain Fog Feel?

Brain fog slows your reflexes and it slows your processing time. You may feel like you can’t focus and everything in life is dulled. It is the difference between bleached and washed out colors and bright Caribbean colors. Brain fog can feel like you are “stuck in the mud” of life.

Is Brain Fog a Sign of Anxiety or Depression?

Brain fog is connected with anxiety and depression. The vast majority of people suffering from anxiety and depression have hypoperfusion in the frontal lobes of the brain. Hypoperfusion is lack of blood flow into your brain.

Does Brain Fog Naturally Occur with Age?

No. It’s not normal, BUT it’s unfortunately very common. There is no reason, no physiological reason why people can’t learn new things such as languages in their 80’s. Here is a great example, Professor Michael Marsh, the Godfather of Celiac Diagnosis, retired at 74. After he retired, he went back and got two Ph.Ds from Oxford University over the next six years.

Can Prescription Medication Cause Brain Fog?

Many medications can have a negative impact on your brain. You have to
be an advocate for yourself, take a look at what you’re taking and how it’s affecting your brain and talk with your doctor. See if there are different ways to handle things.

3 Day Kickstart Brain Fog Elimination Plan

The following 3-day Kickstart is designed to “stop throwing gasoline on the fire”, for a few days and provide the “kickstart” to better brain health and changes you will notice immediately.

Getting Started

►  Take the time to read over the instructions below and have each of the following ready to go and find a 3 day window in your calendar to fully commit to the kickstart protocol. Being prepared is the key to a successful kickstart.

►  After you have completed your 3 day kickstart, gauge your improvement. You will notice a difference.

►  Commit to these lifestyle modifications for continued benefits to your brain function and health.

Flourishing-center

1) Food – eliminate all wheat products from your diet

►  Why is it that people get brain fog after they eat wheat? It’s not a day later, it’s very shortly afterward. The most common reason is hypoperfusion, which is a lack of blood flow into the brain.

►  Swap out your wheat with alternatives such as gluten-free bread made with flours from ingredients such as buckwheat, chickpea, corn/maize, millet, potato, rice and tapioca.

►  Beware wheat can hide in unusual places, such as pre-made sauces and soups, condiments, alcohol, deli meats, and more. Always read those labels!

As the saying goes, “You can’t be a little pregnant.” you can’t have just a little wheat. It is important to commit to eliminating ALL wheat product from your diet.

►  Remove dairy and excess sugar from your diet. Sugar and dairy are ingredients that many people eat every day, so avoiding them for 3 days can seem like an impossible goal. Here are a few tips for success:

►  Include healthy fats with each meal. Examples include nuts, extra virgin olive oil, fatty fish, avocados and eggs.

►  Enjoy fresh organic fruits, especially those with powerful antioxidants, to curb the sugar craving. Examples include strawberries, blueberries and blackberries.

2) Exercise

► Add exercise and movement into your daily routine. So your goal will depend on your age and current fitness level. If you are in your 20s you may want to try to hit the gym and take in a cardio class and if you are in your 70s it could be a power walk around the neighborhood. The goal is to be active and “kick it up a notch”.

3) Hydrate

► Proper hydration is required for your brain to function optimally. Dehydrationcan impair short-term memory function and the recall of long-term memory.

How much water do you need each day?

The calculation is – half ounce per pound of body weight. So, if you weigh 120 pounds, that would mean you would need to drink 60 ounces of water per day.

Start the day with two big glasses first thing in the morning and spread the rest of your water intake throughout the day.

4) EMFS

► Electromagnetic field (EMF) pollution disturbs immune function through stimulation of various allergic and inflammatory responses, as well as by affecting the body’s tissue repair process. Today EMF pollution is everywhere from cell phones to computers to wireless baby monitors and more.

Our goal will be for 3 days to eliminate EMF pollution in the bedroom which is a room you spend a good portion of time each day.

To do this, remove any alarm devices, whether they be a digital clock or your cell phone from your bedroom.

If removing them all together is not possible, move them to the far side of the room as far away from your head as possible.

Next, in the evening turn off your wifi before going to bed.

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The 4 most important ways to optimize Brain Health

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Early signs of cognitive decline are often missed until it’s too late. Symptoms such as forgetfulness, confusion, unpredictable moods, lack of energy and poor sleeping habits are often overlooked or attributed to stress. Ignoring these key warning signs can lead to difficulty maintaining an active, independent lifestyle and decrease quality of life.

 

DISCOVER PRACTICAL INSIGHTS TO HELP YOU DEVELOP DAILY STRATEGIES FOR OPTIMIZING YOUR BRAIN FUNCTION AND OVER ALL HEALTH AND WELL-BEING.

 

1) Eliminate Toxic Exposure

Environmental toxins, pesticides, and heavy metals can impact metabolism, nutrient absorption, detoxification, organ function and cognition. Reducing your daily exposure to common household toxicants may decrease the occurrence of various health issues.

Choose an organic, whole-food diet that is free of pesticides, glyphosate, and GMO crops. Drink clean, filtered water and eliminate plastic water bottles, aluminum foil, and non-stick cookware. Avoid personal hygiene products and cleaning supplies that contain aluminum, phthalates, parabens, and synthetic fragrances. Check your home for leaks, water damage, and toxic mold growth.

2) Create a Sleep Sanctuary

Maintaining balanced circadian rhythm is vital for optimal health. Your pineal gland produces melatonin in the presence of darkness, causing you to feel drowsy and fall asleep. In contrast, exposure to bright light and the absence of darkness at bedtime inhibits the release of melatonin into the blood stream, resulting in less sleep and poor sleep quality.

Avoid blue-light exposure from electronic devices two hours prior to bedtime. Turn off your smartphone, tablet, or other electrical devices and choose a battery-powered alarm clock to reduce overnight EMF exposure. Ensure that your bedroom is dark, with little to no ambient light.

3) Nourish Cell Membranes and Support Acetylcholine Production

Each cell in your body is surrounded by a semi-permeable cell membrane that is made of a phospholipid complex called phosphatidylcholine. The cell membrane protects the cell from its environment and regulates the transport of nutrients and other substances into and out of the cell. Phosphatidylcholine is also a precursor to acetylcholine, the neurotransmitter linked to memory, cognition and movement. Nourishing your cell membranes with supplemental phosphatidylcholine may enhance optimal immune and neurological health.

4) Support Mental Acuity

What is mental acuity? It is the speed and accuracy at which your brain processes information. Steady focus, accurate recall of information and quick decision-making skills are key indicators that your mental acuity is intact. Enhance your cognition and memory with cognitive exercises and lots of reading. Include Ginkgo leaves (Ginkgo biloba), Rosemary (Rosmarinus officinalis) and Bacopa (Bacopa monnieri) extracts into your diet. These three herbs have been used historically to enhance mental acuity, promote circulation and contain antioxidant properties that support overall brain health.

 

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Could Wearing a Face Mask Be a COVID-19 Game Changer?

— Augmenting protection during a global pandemic

A young man and woman wearing masks sit on a wall while social distancing

While it may not be evidence-based in the rigid scientific sense, wearing a basic face mask in the community setting to augment our protection against SARS-CoV-2, the virus that causes COVID-19, is biologically plausible, and potentially impactful.

The basic or standard surgical mask, also referred to as a fluid-resistant surgical mask, is designed to serve as a “barrier to splashes and droplets impacting on the wearer’s nose, mouth and respiratory tract.” Recommendations from authorities discouraging the use of a face mask by the general public may have been optimal earlier, when there was generally no or low community spread of the virus in the U.S., and given the critical shortage of face masks for use in the healthcare setting.

But those recommendations may be changing now that there is exponential community spread of the virus in the U.S., the current epicenter of the pandemic, particularly New York City, not to mention, we now know that the virus is highly contagious and virulent with potential asymptomatic and pre-symptomatic spread.

Moreover, with the increasing threat posed by this virus, the public is more likely to comply with wearing a face mask than the other non-pharmaceutical interventions, particularly social distancing and staying at home. Wearing a face mask appropriately could prove a more cost-effective risk-reduction strategy, and in view of the critical shortage, a homemade mask made from common household materials could be an acceptable substitute.

In one study, homemade cotton face masks, while not as effective as the disposable surgical mask, “significantly reduced the number of microorganisms expelled by volunteers” with influenza. The study concluded that “a homemade mask should only be considered as a last resort to prevent droplet transmission from infected individuals, but it would be better than no protection.”

George Gao, director-general of the Chinese Center for Disease Control and Prevention recently noted that: “The big mistake in the U.S. and Europe, in my opinion, is that people aren’t wearing masks.” Notably, China was the initial epicenter of this pandemic, but the spread is now under control and rapidly abating. According to the World Health Organization (WHO), SARS-CoV-2 is transmitted directly between people through respiratory droplets, and indirectly from contaminated surfaces, and objects (also known as fomites). Specifically, droplet transmission occurs when a person is within about three feet from someone who has respiratory symptoms, such as coughing and sneezing. Hence the social distancing guideline of six feet of separation from others is considered sound as a protective measure, but compliance remains a major challenge.

In addition, a recent controlled laboratory study reported that aerosol transmission of SARS-CoV-2 is plausible “since the virus can remain viable and infectious in aerosols for hours,” suggesting that “people may acquire the virus through the air”. Aerosols result from the evaporation of droplets, and are therefore much smaller and contain the virus. These aerosols “may remain in the air for long periods of time” and be transmitted to others over distances greater than one meter or approximately three feet. Indeed, “coughing and sneezing can generate aerosol particles as well as droplets.”

While COVID-19 is not currently classified as an airborne disease, airborne transmission of the virus may be possible when certain medical procedures are performed. Amidst this evolving historic public health crisis, let’s not forget the scientific value of good logic and reasonable inference, as we seek to reduce the risk of infection to the general public.

Rossi A. Hassad, PhD, MPH, is an epidemiologist and professor at Mercy College, in Dobbs Ferry, New York. He is a member of the American College of Epidemiology and a fellow and chartered statistician of Britain’s Royal Statistical Society.

Source: Medpage Today 

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Is life in the 21st century giving you a headache?

headaches in the 21st century

Headaches during work, or keeping you awake at night, robbing you of rest and relaxation can be real frustrations. If on top of a stressful or tiring day you can’t get to sleep, you can feel like a limp rag the next day. Not only does it impact on you, but also your immediate family and friends.

Of course, an occasional headache is no big deal. But frequent bad headaches and migraines with any symptom to do with your nerves or muscles or movement warrant a thorough checkup from a physiotherapist.

Accurate diagnosis is important to guide the correct treatment and management of headache disorders. Head pain can have many causes, not just a migraine. Correctly identifying the cause will lead to better treatment.

Most headaches aren’t deadly but they can be very difficult to work around. They are commonly caused by irritation of the nerves or muscles around the brain and head.

If your headaches are due to emotional tension, learn to identify people or situations which are stressing your health. Just reviewing your life can help you take control and calm your mind. You may need to make lifestyle changes.

Headaches that are caused by disorders of the neck or physical tension can be successfully treated with physiotherapy.

Does the pain radiate from the back to the front of your head?

Do you feel dizzy or light-headed?

Is your headache brought on or worsened by neck movement or staying in the same position for a long time?

Is your headache eased by pressure to the base of your skull? If so, give us a call on (480) 335 2747 and make an appointment. Our physiotherapists can identify the cause of your headaches and lay out an effective treatment plan.

 


Laugh your way to better health!

Laughter makes the world go around! But if it’s yourself you’re laughing at, be prepared for the world to join you.

More seriously, laughing has been proven to be a marker of several important life markers, including:

  • A longer life with less chance of fatal heart disease, dementia, high blood sugar or pressure, and cancer.
  • A happy social network.
  • Higher ability to bear pain or distraction from pain – sick people reported that watching a comedy or laughing heartily at funny jokes worked much better at deflecting pain than painkillers.
  • Stress relief and a healthier heart rate, blood pressure and blood vessel tone.

So laugh as often and as heartily as you can. You’ll enjoy life and health all the better for it!

 


Quick tip

Try having one evening per week where you resolve not to turn the television on. Go for a walk, read a book or go meet friends instead. Chances are you won’t really miss your TV that much. If you’re game, also ditch your smartphone, laptop or tablet during your personal time.

 


Inspiration

I’m not out there sweating for three hours every day just to find out what it feels like to sweat.

~ Michael Jordan

 

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The lazy person’s way to fitness

We’ve all been there: Often we’re busy, but sometimes we’re just plain lazy. In this post we look at how you can get exercise and make fitness a part of your life, even with Netflix calling.

Please share this post with a family member or friend who may find it interesting. We hope this information helps you or someone you know to achieve and maintain the best health potential.

giphy

The mantra today is fitness. But does that mean heavy weight lifting and endless crunches? What if you happen to be the kind of person who turns pale at the very word “gym”? Is a workout indispensable for fitness?

Fortunately, no. Witness the generations past who preserved a slim figure, had lasting muscle and stamina, lived healthy to past 90 and remained active till their last days – before gyms were invented!

Many studies show that fifty-somethings who were fit had a significantly reduced risk of various diseases which leave most sufferers crippled after 65, including stroke, Alzheimer’s disease, heart and kidney disease, and various cancers. Those guys are on to something!

Start with a good diet

There are countless articles online about what makes a good diet, but it’s really simple. Eat fresh, balanced and in moderation. Avoid processed foods. If it comes packaged off a production line, chances are it is processed.

Drink enough water. It goes without saying.

Start moving more

If you’re too lazy to work out, start by getting more movement into your day. Our ancestors hardly sat around! Washing your windows or merely wiping them sparkling clean, vacuuming your carpet and under the sofa, shopping and bringing in your groceries, decluttering your cabinet, scrubbing down your bathroom walls and tub, raking your yard, mowing your lawn, cleaning your kitchen sink and counters, rough-housing with your kids, planting a few new flowers – just move more. It will all add up.

If you like your TV, simply make it a rule to walk around the room during the ads. Get off the elevator early and take the stairs for last 2 floors. Park your car a block away. Walk your children to and from school… See what works for you and build on it; it doesn’t need to be a daunting exercise regimen!

But when you are ready for more structured exercise, start a few basic exercises at a time. Later you can work up to a low-medium intensity exercise at 15-minutes three times a week. Regularity is important. Speak with us at Vick Physiotherapy International to organize an exercise plan to suit your needs.

So take heart and start moving without “exercise”. Watch what you eat, how much you eat, when and why you sit and take tiny steps to build active habits. Before you grow tired of it you’ll be on the lazy person’s road to fitness!

 


Health benefits of swimming

Swimming is one of the most all-round physical activities you will find. Swimming can be either an aerobic or anaerobic exercise depending on a variety of factors. Your fitness, the intensity of your workout and the duration of your swim can affect whether your body utilizes oxygen, which is the main difference. Aerobic and anaerobic workouts have their perks, but understanding each and the correct way to utilize them will benefit your fitness.

Water’s density produces a floating effect that decreases the load on your joints. Your body weight reduces by about half when you’re waist-deep in water. This makes exercise easier for people with joint problems.

Swimming lengthens your body and drives your arms and legs through greater range of motion, increasing your flexibility. Interval training through swimming is a wonderful way to gain uniform muscle strength and tone up your whole body.

Due to the increased water resistance, every arm and leg stroke takes more energy. You could burn serious calories and awaken the muscles you never knew you had.

Swimming can also help asthma sufferers, since it teaches you how to breathe properly, as well as increasing your lung volume.

Of course, like any exercise, swimming increases the efficiency of your heart function and releases numerous brain chemicals which elevate your moods.

So why wait? Let’s get into the pool!

 


Quick tip

Make sure you stretch daily. Stretching relieves tension from your muscles, improves circulation, increases flexibility, improves balance, and more.

Inspiration

Self-delusion is pulling in your stomach when you step on the scales.

~ Paul Sweeney

Funny thought of the day

The alphabet was the very first thing put in alphabetical order.

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5 TEDTalks to Inspire Rehab Therapists

As an avid watcher of TEDTalks, I have selected 5 of the most inspiring lectures about physical rehabilitation and therapy. I hope you enjoy them as much as I do, and that can provide some insight and knowledge for you to improve and refine your practice!

1. How to Have a Good Conversation – Celeste Headlee

If you knew exactly what your patients were thinking, I’m guessing it’d make your job as a therapist a whole lot easier. After all, a patient’s thoughts and perceptions can have a huge impact on his or her therapy success. But unless you have telepathic abilities, that’s much easier said than done. However, you can learn a lot about a person just by taking the time to listen—I mean, really listen—to what he or she is saying.

Being a good listener is the cornerstone of building rapport with anyone. Unfortunately, worrying about the good-listener qualities we’re taught (e.g., making eye contact, repeating back what you heard, etc.) can sometimes distract us from actually listening. (Talk about a contradiction!) This is the argument journalist Celeste Headlee makes, anyway. Fortunately, she also provides us with great advice on how to be a better conversationalist based on what she’s learned through her years of work in public radio.

2. The Physical Activity Paradox – Arto Pesola

It’s no surprise that way too many people spend the vast majority of their day sitting down. As experts in physiology, PTs are well aware of the detriments of physical inactivity. In this TEDx Talk, author and exercise physiology researcher Arto Pesola discusses the way modern culture praises health and fitness while simultaneously discouraging folks from improving their health in whatever way they can—and how we can combat that way of thinking.

3. A Doctor’s Touch – Abraham Verghese

Physical therapists have the benefit of being a very physical discipline. As an often hands-on care type, physical therapy is at an advantage over other disciplines that require less physical contact. However, technology—while enabling providers to deliver a higher level of care—can often shift the focus off of the patient and onto data points on a screen, and PTs aren’t immune to this trend. In this TEDTalk, Dr. Abraham Verghese shares his experience with retaining a more physical element to examination and discusses the impact it has on his patients.

4. A Portrait of the Patient Experience – Ted Meyer

At a young age, Ted Meyer was diagnosed with a rare genetic disease, which inspired his artistic motivations. Now, he communicates the patient experience of pain, frustration, and adversity through his art and advocates for people who have undergone physical trauma.

5. Health Care Should Be a Team Sport – Eric Dishman

Collaborative care networks aren’t a unique concept. In fact, we’ve talked quite a bit about the importance of establishing connected care teams. And it’s not just a matter of convenience—it’s a matter of safety. As medical tech specialist Eric Dishman explains during this TEDTalk, 80% of medical errors are caused by miscommunication and a lack of coordination among healthcare providers. Dishman also uses his own experience as a patient as a basis for his ideas on how to better connect providers across disciplines.


Feeling inspired? I hope so! If you feel like sharing your thoughts or have some favorite TEDTalks of your own, drop a line in the comment section below.

 

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Is your computer a sitting death trap?

Even though you may be using it to earn a living, with the long hours of sitting, repetitive movements, poor posture and a badly set up workstation, your computer might well be your death warrant! You could find, too late, that you have damaged the nerves and muscles in your fingers, hands, wrists, arms, shoulders and neck – causing stiffness and pain. You may gain weight, develop carpal tunnel syndrome and chronic back pain. Your eyes could be dry and red as you blink less and strain to make out the screen or see in uneven lighting. As your circulation slows, your blood vessels can get clogged. So pay attention early to any pain, tingling, weakness of grip or numbness in your upper limbs if you use a computer a lot.

your computer is a death trap

So if you’ll be using the computer for more than a couple of hours at a time, set it up right!

Your worktable needs to be at elbow height; ensure you have space for all the materials you will need now, and leg room.

Place the monitor at arm’s length. When you sit upright or at a very slight slant backward, its center should be just a little below straight eye level. Prevent glare by turning it at suitable angles any bright light, or curtaining a window.

Set the height of your chair so you can sit with shoulders hanging loose but reach the keyboard with wrists straight. Don’t clutch the mouse either. Let your hands float over keyboard and mouse when you’re using them. Keep elbows bent at above 90 degrees to allow free circulation. Flexing the wrist too much over the mouse causes a stiff painful wrist “mouse arm” or “carpal tunnel syndrome” – due to wrist tendons becoming swollen and compressing the nerves, in a narrow wrist space bound by ligaments and bones.

Adjust your chair’s backrest to support your lower spine. If you can’t reach the ground easily, use a footrest. Armrests are out.

Sit up! Slouching tightens up your chest muscles and rounds your back. The shoulder muscles at the back weaken. This imbalance gives you a hunch – and also a headache, and pain in the neck, shoulder or back.

Change hip and foot position every now and then. This ensures you don’t tire out your muscles – called “sitting fatigue.” Quietness reduces stress and relaxes muscles. Soft classical music to mask outside noise can help.

Our physiotherapists at Vick Physiotherapy International are trained to spot these non-ergonomic workplace habits and correct them. We offer a variety of services for pain relief; more importantly, we help you prevent such issues in the future by mobilising and strengthening your joints, and correcting your posture.

Take rest and exercise breaks. Every 30 minutes, stand up, walk around, get a glass of water and do some stretches for few minutes. Shrug your shoulders; get the blood moving. Let tired muscles relax, while inactive muscles come into action. This keeps your bones and muscles healthy at a computer. The extra activity boosts overall health too.

We would love to help you work productively and without pain. Call now on +1 (480) 335 2747 to make an appointment. You’ll be amazed how much we can change your life!


Quick tip

Use breathing exercises to help tighten those stomach muscles. Breathe in air as strong as you can and tuck your stomach at the same time as much as you can. Hold it for a few seconds and then slowly let it out. Don’t let it out so fast that your belly flops out. Try to breathe like this whenever you think about it, about few dozen times a day is ideal.


Inspiration

If I’d known I was going to live this long, I’d have taken better care of myself.

~ Eubie Blake

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