Medicine- Day 5

Beth is sick today. I hope that she is feeling better soon. It must be uncomfortable to have one’s throat swollen shut and it’s probably not good for the baby to be sick. Poor Beth…..

I continued to follow up with 2 of my patients today and I took on an additional patient as well. Berny and I had a discussion about the different types of dementia, which I felt helpful. ( see FMI below for details) There is still quite a bit of work to be done in terms of learning to prioritize everything; nevertheless, I believe that hardwork can persevere through anything. I wrote a few notes to the GP last week regarding a few of the patient’s medications. Some of the changes were accepted and some of them were not. I guess that there is a disadvantage to note writing because I don’t usually hear back on the rationale behind accepting/refusing a recommendation.  I might try and talk to the GP by phone next time. Because most of the pt I worked up have GPs with special hospital privileges, I usually don’t get to see them face to face.

We submitted our ethics submission for our project over the weekend. The statistic portion is still alittle be vague, but at least we have most of the protocol done. Ivy and I will be meeting with the statistician some time soon to discussion how we can analysis the collected data.

FMI: types of Dementia from didactic discussion

Alzheimer’s disease – Alzheimer’s dementia is the most common type of dementia, and is caused by a loss of brain cells. It is at least partly a hereditary disease, in that it tends to run in families. (Just because a relative has Alzheimer disease, however, does not mean that another family member will have the disease.) In this disease, cells in the areas of the brain that control memory and mental functions are destroyed by abnormal protein deposits in the brain. People with Alzheimer disease also have lower-than-normal levels of brain chemicals called neurotransmitters that control important brain functions. Alzheimer disease is not reversible, and there is no known cure. There are, however, medications that can slow its progress.

Vascular dementias, including multi-infarct dementia – Vascular dementias is the next most common type of dementia, and is caused by poor circulation of blood to the brain. In multi-infarct dementia, lots of tiny strokes (or infarcts) occur which cut off the blood supply to part of the brain. The progression of vascular dementia can happen in recognised steps. With this type of dementia, good control of blood pressure, good diabetic control and avoiding cigarettes may help to slow the progress.

Parkinson disease – People with this disease typically have limb stiffness (which causes them to shuffle when they walk), speech problems, and tremor (shaking at rest). Dementia may develop late in the disease, but not everyone with Parkinson disease has dementia. Reasoning, memory, speech, and judgment are most likely to be affected.

Lewy body dementia – This is caused by abnormal microscopic deposits of protein in nerve cells, called Lewy bodies, which destroy the cells over time. These deposits can cause symptoms typical of Parkinson disease, such as tremor and muscle rigidity, as well as dementia similar to that of Alzheimer disease. Lewy body dementia is more likely, however, to affect thinking, attention, and concentration than memory and language. Like Alzheimer disease, Lewy body dementia is not reversible and has no known cure. The drugs used to treat Alzheimer disease also benefit some people with Lewy body disease.

Alcohol-related dementia – Brain damage can be caused by drinking too much alcohol. It is important that people with this type of dementia give up drinking alcohol completely to stop the disease progressing.

Pick disease (frontotemporal dementia) – Pick disease is another rare disorder that damages cells in the front part of the brain. Behavior and personality changes usually precede memory loss and language problems.