Saturday, May 25, 2019

GUY’S GOTTA TALK ABOUT…Alzheimer’s #24 – “If I forget where I left my keys, do I have Alzheimer’s?”


Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

I know the question above sounds dumb, but…

If you have a parent, or spouse, or partner who has been diagnosed with Alzheimer’s or one of several dementias (Creutzfeldt-Jakob disease, dementia with Lewy bodies, frontotemporal dementia, Parkinson's disease, Huntington's disease, mixed dementia, and normal pressure hydrocephalus, and others as well), you may have started wondered if you were going to get the diagnosis someday, too.

If you haven’t, maybe you’d better START thinking about it. I’m pretty sure Mom and Dad never thought about it, so that when Dad was diagnosed by his doctor, he denied it. Vehemently. Violently. To the point that, honest to God, we thought MOM was crazy. We thought MOM was the one with dementia.

When I took over their medical matters – and managing dentist visits, drug regimens, checkups, and appointments – I found the words clearly written in a 2014 visit. Dad continued to deny it until…well, he continued to deny it until he was in a memory care unit. The only way we got him THERE was because when Mom reached her last days, the care facility they were living in offered hospice care (they offered it in ANY of the units, but we told Dad it was just downstairs). He moved in and ever after that, would talk about living in another room and wanting to go back there.

I out-and-out lied to him, telling him he and Mom had been in the unit from the beginning. Who knows, maybe that made the Alzheimer’s worse; I’ll never know.

There were lots of incidents and issues Dad had leading up to his death, but one of them was continually forgetting where he’d left things. His wallet was absolutely key there. He’d get frantic if he didn’t know where it was. When they lived in a townhouse, once he’d put his wallet in a half-used box of checks which was actually sitting on the ledge in the kitchen. But we searched for two days for that one. By the time he got to the memory care unit, there were only a few places he’d put it (the oddest being in his pillow case…) but there were times when it would “disappear” and I’d search for it until I’d pretty much turned the entire (tiny) apartment upside down. He’d always find it a couple days later. I SWEAR he was hiding it in his underwear!

Let’s come to me (because, you know, in caring for Alzheimer’s patients, even if you’re not actually DOING the care, “It’s all about ME!”). When I can’t remember where I left something or forgot to go to an appointment, or I KNOW I did something, but it’s clearly not been done, I think for a horrifying moment that I’ve finally reached the point where Alzheimer’s is about to claim another victim.

The “logical” me (and there’s a big part of me that IS…I’m a SCIENCE teacher!) knows that simple short term memory lapses are a part of the aging process. As the article referenced below asks: “When does an ordinary memory lapse indicate something more serious, like early Alzheimer’s disease or another form of dementia?”

Here are some things we can watch out for – with the help of spouse, family, friends, and co-workers:

“…forgetfulness and other symptoms may develop over a period of many years.

“Increasingly, research indicates that feeling you are forgetful may be cause for concern. A study conducted by Dr. Reisberg and colleagues found that seniors with subjective memory complaints are, over many years, 4.5 times more likely to develop mild cognitive impairment or dementia than those who do not have such memory complaints. That’s one reason why it’s important to pay attention for signs of being forgetful, and to seek medical attention about early signs of dementia and a possible dementia evaluation and work-up…it helps to consider some key symptoms of mild cognitive impairment and the early stages of dementia.

“Forgetting a friend’s name or not remembering a lunch date is something that most people without dementia do from time to time. Someone with early dementia, though, might repeatedly forget names or plans, and forget all about the incident soon afterward. Curiously, while someone with early dementia may forget something that happened the previous evening, they may recall in detail events that happened in the more distant past, last year, say, or during their childhood.

“At these early stages of dementia, family members, friends and colleagues may begin to notice that something seems wrong…Such situations may, understandably, trigger feelings of anger and defensiveness. They can also produce anxiety, which can in turn make anyone even more forgetful. The anxiety may be particularly pronounced in someone in the early stages of dementia.

“…those in the early stages of dementia may also have problems with judgment and planning. Someone with early dementia might, for example, become distracted in preparing a recipe or forget the rules of a card game…[or]…find it impossible to do everyday chores, like balancing a checkbook, that they used to find easy…Unusual changes in personality can also occur, like showing bursts of anger for no reason…and while many of us plop down on the couch to watch TV after a long day at work, someone with dementia may show little or no initiative in reaching out to friends and stare at the TV for hours or sleep all day.”

So far, I don’t THINK these have been happening to me, but it pays to be aware.  NOT paranoid, but aware, and above all, HONEST. I will NOT reach the point Dad did, denying that there’s any problem…


Saturday, May 18, 2019

ENCORE #109! – *AN UPDATE!!!* on HOLD ON THERE BABA LOUIE!” – Exercise “reduces cytokines in adipose tissue” might be PURE HYPE!


From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2012...

And now, the original post PLUS AN UPDATE, seven years later...

Doctors harp on exercise.

Despite the harping – or in my case, perversely because of it – I avoid exercise like the plague.

Even so, as I read more and more sites promoting the “exercise makes you better if you have breast cancer” meme, I found that almost none of them give any kind of evidence as to WHY exercise fights cancer and promotes healing.

So I dug into the sites and finally found some evidence supporting this wild, “Do this one weird thing…” kind of meme. This week, it’s number:


1)                  Increased levels of pro-inflammatory factors and decreased levels of anti-inflammatory factors have been linked with increased cancer risk. Physical activity might reduce systemic inflammation alone or in combination with reduction in body weight or composition through reducing inflammatory cytokines in adipose tissue.

What are pro and anti-inflammatory factors?

Let’s start with CYTOKINES and let me warn you, even researchers are still a bit fuzzy about these molecules, which explains the “might” in the paragraph above. We’ll take this subject as a “details at 11” kind of thing – it’s changing every day, but TODAY and to the best of our knowledge, we can say that we’re pretty sure that cytokines are small molecules that are given off by numerous cells and are used to communicate with each other. Cytokines are a large and diverse family of molecules with many jobs. One thing we are pretty sure they do to control the immune system – that collection of white blood cells and chemicals that spring to work when you’re hurt or sick and the body has to fight off an infection. The line between cytokines and hormones is also pretty blurry but PROBABLY, cytokines come from lots of places and there are only set amounts in the blood – though that amount can leap up during trauma or infection. Hormone levels are steady. Many cells produce cytokines. Most hormones come from specific glands (adrenal, pancreas, etc). Also, while usually specific, some cytokines act like hormones to have an effect on the entire body. Last of all, some cytokines act outside the immune system and affect the development of the human body.

As to breast cancer, at least one cytokine affects both the presence of and severity of breast cancer: “In a study published in the January 15th issue of Cancer Research…researchers showed that activation of the CXCR4 [cytokine] receptors [on the cancer cells] resulted in increased tumor growth and metastasis…and less dependent on estrogen for continued growth…to become metastatic and resistant to endocrine therapy…[in] A second study published in the current issue of Surgery…authors reported that all benign breast tissues had no detectable CXCR4 levels, whereas all 101 breast cancer patients showed at least some level of this cytokine receptor.  Of these breast cancer patients, 79 had low levels of CXCR4 and 22 had high levels of CXCR4.  These high CXCR4 levels were linked with increased breast cancer recurrence and worse chances of survival…overexpression of CXCR4 cytokine receptors is linked to worse breast cancer outcomes…blocking this pathway might become a valuable breast cancer treatment for patients overexpressing this cytokine receptor.”

The big “might” up above has given breast cancer, cytokines and exercise a high level of interest. The third reference below cites a study that, as of my referencing of it, was still recruiting participants.

So – I’m going to label THIS particular aspect of exercise and breast cancer as a big MAYBE, LET’S WAIT AND SEE. So don’t go spreading the word that exercise reduces cytokines and decreases breast cancer.

Nobody knows enough yet to say one way or the other.

Update: Not so fast!

Seven years later, there seems to be some evidence (in mouse research) that exercise can mitigate cytokine effects on cancer. I’ve condensed the abstract of the study referenced below. In essence it says, “Biological aging is associated with progressive damage accumulation, loss of organ reserves, and systemic inflammation…which [may lead to] a wide spectrum of chronic diseases, including several types of cancer. In contrast, aerobic exercise training (AET) reduces inflammation, lowers all-cause mortality, and enhances both health and lifespan…Lifelong, voluntary [mice who were trained to regular] wheel-running [experienced much less] age-related declines in…motor coordination…[and experienced]…partial protection against sarcopenia, dynapenia, testicular atrophy, and overall organ pathology…chronic elevation in…cytokines…was…[greatly reduced]…circulating SPARC [a protein in the body that,] when it accumulates, causes…“tissue fibrosis, nephropathy, retinopathy, and non-alcoholic fatty liver disease, while [when it’s removed] protects against the same…”…malignant tumours were also completely absent in [exercising mice], whereas they were present in the brain (pituitary), liver, spleen, and intestines of sedentary mice. Collectively, our results indicate that early-onset, lifelong running dampens inflammaging, protects against multiple cancer types, and extends healthspan of naturally-aged mice.”

So there you go. NOT A TREATMENT FOR HUMANS, but evidenced by the newest research.


Saturday, May 11, 2019

BREAST CANCER RESEARCH RIGHT NOW! #66: Surprising SUPER Star Spokeswoman!


From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Every month, I’ll be highlighting breast cancer research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today:

We’ve seen her in several favorite movies like Failure to Launch, The Blind Side, Midnight in Paris, in the big hit TV series lBig Bang Theory, as well as hearing her voice (albeit unknowingly) in Charlotte’s Web.

Actor Kathy Bates, I discovered today, is also a spokeswoman and lobbyist for the Lymphatic Education & Research Network (LE&RN.)

“Kathy Bates has successfully battled ovarian cancer since her diagnosis in 2003. In September 2012, she revealed via Twitter that she had been diagnosed with breast cancer two months earlier and had undergone a double mastectomy. In 2014, at the New York Walk for Lymphedema & Lymphatic Diseases, Bates announced via pre-recorded audio that, due to the double mastectomy, she has lymphedema in both arms. At that time, Bates became the National Spokesperson for the LE&RN and has been actively involved in lymphedema and lymphatic disease advocacy. On May 11, 2018, Bates led advocates in a Capitol Hill Lobby Day to garner Congressional support for research funding. The next day, May 12, Bates addressed supporters at the first-ever DC/VA Walk to Fight Lymphedema & Lymphatic Diseases at the Lincoln Memorial. She was awarded the 2018 WebMD Health Heroes ‘Game Changer’ award for her role in raising awareness of this chronic lymphatic disease.”

What does that mean, having a spokesperson? How can that make a difference?

In 2016, WBUR reporter Carey Goldberg interviewed Dr. Michele Berman, co-author of the book, "Reimagining Women's Cancers: The Celebrity Diagnosis Guide To Personalized Treatment and Prevention." She and her husband, Dr. Mark Boguski, run CelebrityDiagnosis.com. In that interview, after discussing the then-new Angelina Jolie diagnosis of a rare form of breast cancer and her double mastectomy, Goldberg asked,So ultimately, the moral of this Angelina effect story is...?”

 Dr. Berman said, “Celebrity stories are really double-edged swords. They can be very helpful. They can be very educational. But if the information given is just put out there on its own, without appropriate commentary by people who know what they're talking about, people can get wrong ideas. They can go looking for cures where there may not be any; they can go looking for testing where they may not need it.

“It's obvious these celebrities are not doing this to cause anyone harm. Their intentions are very good. But their story just doesn't always necessary translate to other people's stories. The message got out; people learned some more, which is a good thing. But the message didn't necessarily target the people who were most at risk.”

Honestly? I can’t add anything more to this. So there you go!


Saturday, May 4, 2019

ENCORE #108! – Neulasta – What’s It DO???? (Plus some new thoughts…)

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in November of 2011.

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

What’s “neulasta” and what does it do?

Chemically, “neulasta” is N-(3-hydroxypropyl)methionyl, 1-ether-alpha-methyl-omega-hydroxypoly(oxyethylene). Complex. Lots of chemicals.

But what’s it DO?

“Neulasta”, is a special protein that’s based on sugar (an oligo-saccharide, meaning that the molecule has only a few small units, in this case a sugar ) that’s attached to a protein to form a glycoprotein.

The glycoprotein is a very important part of a cell wall – the cells that are being targeted are white blood cells. The white blood cells are also called neutrophils, granulocytes and stem cells and are the main part of the blood that destroys microscopic body invaders like bacterial infections, viruses or other germs. The glycoproteins help the white blood cells recognize the germs.

Neulasta makes the marrow in bones produce more white blood cells to replace the ones killed by Cytoxan, Adriamycin and Taxotere (which I talked about esrlier) while they are busy killing cancer cells that are growing out of control.

The “colony” in the “colony stimulating factor” is the white blood cells in the bone marrow.

So – “neulasta” is injected just under the skin and gets into the bloodstream. It goes along until it reaches the bone marrow where it forces (also known as “stimulating”) the growth of new white blood cells to take the place of the older ones killed off by the chemicals in chemotherapy.

Side-effects? Sure. Any one of us who’s seen the Red Devil injected in his wife, mother or girlfriend knows what I’m talkin’ about here. With stuff like THAT going into a human body, to expect NO side-effects would be the crazy thing! There are “minor effects” – did any of the researchers experience any of these symptoms? If they had, would they have called the effects “minor”? – of the injection, things like hives; difficulty breathing; swelling (face, lips, tongue, or throat) as well as bone pain; pain in your arms or legs; or bruising, swelling, pain, redness, or a hard lump where the injection was given.

More serious side-effects (though according to the test trials, these rarely happened: sudden or severe pain in your left upper stomach spreading up to your shoulder; severe dizziness, skin rash, or flushing; rapid breathing or feeling short of breath; signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, mouth sores, or unusual weakness.

My wife didn’t seem to experience any of the side-effects. In fact, though we expected WORSE, the chemotherapy (while horrible in its own right) only threw us a few curves. Because of the neulasta injections, she didn’t seem to catch any sort of germ at all and stayed (on the chemotherapy scale of things in our “new normal” world) pretty healthy.

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There are other thoughts I’ve had about the use of neulasta (pegfilgrastim) and I might look at those soon. As for the use of the drug in conjunction with chemotherapy, as with all things produced by the “Big Pharma” industry, the price of an injection of neulasta while remaining roughly the same at roughly $6000, has stimulated (pardon the pun) some competition from a new product, Udenyca. It’s on the market currently and costs less as long as you use a “coupon” (can you “clip coupons” for your cancer treatment now?) reducing the cost of an injection to $4000…from a starting point of $20,651…) This competition MAY be explained by the experimental use of neulasta in treating arthritis…

Hmmm…