the "long goodbye". Alzheimers and health care

http://www.theglobeandmail.com/life/health/new-health/health-news/canadians-missing-out-on-early-alzheimers-diagnosis-study-finds/article2290607/

Mary Schulz, national education director of the Alzheimer Society, said that early diagnosis is helpful on several levels. Drugs can slow symptoms of the degenerative brain illness, although they don’t work for everyone. More importantly, people with Alzheimer’s and their families can plan for future care – financially, legally and practically.

Yet a new survey shows that many Canadians who experience symptoms like memory loss, disorientation and personality changes – typical warning signs of dementia – wait a long time before seeking medical help.

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D - half waited a year, and a few even waited 2 years.

D - the first time I was consciously exposed to Alzheimers was in a West Wing episode called the Long Goodbye.

Plot

C. J. Cregg goes home to Dayton—and finds herself in the middle of an achingly sad family crisis—in this poignant change-of-pace episode. She's making the trip to speak at her 20th high-school reunion, but when she arrives at her father's house, she discovers that his new wife (her old English teacher) has left him. That is troublesome enough, but the fact that her father has Alzheimer's makes it almost unbearably heartbreaking. C.J. does find a soulmate at Dayton's airport, though, a classmate named Marco, who was a punk rocker in high school and now repairs watches.

http://www.squidoo.com/the-long-goodbye

D - why it is called The Long Goodbye:

Alzheimer's is truly "The Long Goodbye". You watch your loved one slip away a little more each day until there is finally nothing left of the person you spent so many years with, whether it was a spouse or parent. You are forced to be a witness to the deterioration of an intelligent and vital human being. By the end, and yes, Alzheimer's is a terminal disease, the person you knew has long since ceased to exist. Alzheimer's Disease is a cruel insult to anyone who suffers its indignity, leaving many "victims" almost lifeless, yet unable to die with the dignity and peace they deserve. As the disease progresses it is important to treasure every connection that you still can spark, because even when the disease progresses to the point where the patient can't speak, or even recognize you, they can still feel your love.

D - nobody wants to go out that way. From what I've read, one can maintain brain fitness by using that brain. Cross-word puzzles. Learn a musical instrument. Pick up a new language. (I learn a language a year for kicks. And can, self-taught, play Coldplay "The Scientist" now.)
Now I'd like to add a caveat now. I hope you are sitting down. You are gonna die. In fact, we are all gonna die. Of something. The trick is to rig the odds so you die of something more instead of less palatable. A nice, fast, painless death. Or at least quick - dying with your boots on, so to speak. Or quietly, in bed.

Like the Chris Rock lyrics to "No Sex in the Champagne Room" go:
Here's a horoscope for everyone:
Aquarius: You're gonna die
Capricorn: You're gonna die
Gemini: You're gonna die TWICE
Leo: You're gonna die
Scorpio: You're gonna die f****g.

D - Dementia and associated conditions tie up both intensive care beds and permanent retirement facility spots. And nobody, neither that old person (typically) or the taxpayer who funds a (poorly laid out) health care system wants that.
So, with these cold calculations, we juggle the odds. Just live past cancer long enough, and likely a cardiovascular failure will eventually get you. The trick is to make sure it's a heart attack and not your brain dribbling out your ears.
Check out sciencedaily - the ONLY science site for me - it is sooo good. Sure, old folks forget where they put their keys and fish for a name longer. But they can maintain high level functioning (particularly with planning) and have a # of effective coping strategies.
So nobody wants to die (after an excruciatingly slow and inexorable mental decline) of dementia or Alzheimers. BTW, fast-onset dementia is about as lethal as breaking a hip for old folks. Still takes years, though.

So what to do? Juggle the odds. Take my above advice to stave off dementia. Don't wait once you manifest symptoms -they'll only get worse, and faster, without medication.
Regarding cancer (another unpleasant- and very expensive way to go), well, we ALL already know. Fruits 'n vegis. Don't smoke. Drink moderately (I use targeted anti-oxidants for the liver.) Watch those sun burns and funny looking moles. All strictly duh-stupid stuff that you gotta do NOW to plan for LATER. Don't say I didn't tell you so.

As an aside, at 40 you should get tested for glaucoma if you drive. It's easy to treat early on, and can stealthily reduce your peripheral vision, impairing your driving.

To prevent Alzheimers (other than genetic-based early onset form):
Maintaining a healthy heart and avoiding high blood pressure, heart disease, stroke, diabetes, and high cholesterol can decrease the risk of Alzheimer’s. Watch your weight, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and mind.

D - all that stuff you've been ignoring when your doctor says it. Basically, a lifestyle that evades obesity and metabolic syndrome.

WHO
The World Health Organization criteria (1999) require presence of one of:
Diabetes mellitus,
Impaired glucose tolerance,
Impaired fasting glucose or
Insulin resistance;
AND two of the following:
Blood pressure: ≥ 140/90 mmHg
Dyslipidemia: triglycerides (TG): ≥ 1.695 mmol/L and high-density lipoprotein cholesterol (HDL-C) ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female), or body mass index > 30 kg/m2
Microalbuminuria: urinary albumin excretion ratio ≥ 20 µg/min or albumin:creatinine ratio ≥ 30 mg/g

http://helpguide.org/elder/alzheimers_disease_symptoms_stages.htm

D - here is a useful 'senior moment' vs 'dementia symptom' chart.

D - well that is about all you need to know about ageing well. Now onto...
GOVERNMENT POLICY. Morbid stuff, but gov't should be tailoring food and culture policy to result in a "good death" and not a very slow unpleasant and EXPENSIVE 1.
This includes a policy of cultural engagement and increasing the value of lifelong learning - and not just formal education either.
Our federal gov's seems incapable of reining in the food industry. Take their abject failure on salt reduction.
http://www.hc-sc.gc.ca/fn-an/nutrition/sodium/strateg/index-eng.php
Yup- a non-binding 'consensual' industry initiative. I've seen industry use too many such moves to just hedge for time, with no intention of meaningful change.


http://www.canadaandtheworld.com/highsaltcontent.html

Those who eat a bowl of Kellogg’s All Bran for breakfast may think they are doing something that’s good for their body. In the United States that might be true; in Canada, not so much.
According to World Action on Salt and Health (WASH) the All Bran cereal “contains 2.15g of salt per 100g in Canada, but only 0.65g of salt per 100g just over the border in the United States, less than a third of the Canadian level.”

D- we are laying the foundation for a continuing epidemic of strokes.

http://www.heartandstroke.com/site/apps/nlnet/content2.aspx?c=ikIQLcMWJtE&b=3485819&ct=11514719

It is estimated that one in seven deaths from stroke and one in 11 deaths from coronary heart disease could be prevented if Canadians reduced their sodium intake by 1,840 mg per day (roughly ¾ tsp).[i]
On average, Canadians consume too much sodium. Our levels well exceed what is recommended by international agencies and Health Canada. The average Canadian consumes about 3,400 mg of sodium a day, the vast majority of which is contained in processed foods.

D - not to mention, diabetes.

http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=117&morg_id=0&gsec_id=3086&item_id=4085&utility_link_id=3086

“Given this linear growth in the prevalence of diabetes, more than ten per cent of the adult population of Ontario will be diagnosed with diabetes before 2010,” said Dr. Lipscombe.
“If similar trends are occurring throughout the developed world, then the magnitude of the emerging diabetes epidemic is far greater than we anticipated.”

D - so why don't we have a 'food sin tax'? Here's a wacky idea. Base the following on one portion size- 1 meal serving - or 1 snack - with actual standards about what constitutes a portion size. (I recall comparing 2 salad dressings - the no-name had HALF the suggested portion size...). Let's assume most folks eat 3 meals of 1 serving apiece per day. So 100% of your daily limit distributed over 3 meals is 33% per meal. Any indicator of salt, sugar or saturated fat that exceeds 33% results in a 1 cent 'food sin tax'. Take, for example, the cheap no-name oriental noodles I like to warm up at work. The daily sodium is 43%. Ergo, a 10 cent sin tax. Suddenly these 'cheap' junky meals begin to reflect the very real health care costs incurred by them. Though that same packet suggests it contains TWO servings. I was shocked to realize I had just eaten 86% of my daily sodium in the side dish to my sandwich! Eek.

D - my bro-in-law suggested a carrot v.s. stick approach. At your annual doctor medical checkup, if you are in your BMI, you get a $1000 tax break. After all, the economics still work out for gov't spending. I quite like this too, though it it ignores that there are unhealthy thin and healthy fat people.
Though I am plenty concerned about what I've referred to as "the fat-fu**-ification of society". For the record, I'm 5' 10", 175 pounds and can bang out 50 perfect pushups, as well as run across town if I felt so inclined. At age 40.