Thursday, December 18, 2008

Trash talk

I was shopping one day a year or so ago and discovered that I could read food labels without my reading glasses if I squinted. Ah freedom, no longer dependent on glasses that are somewhere that I am not, I now scrunch my lids easily and often over the printed page.

So no problem today when my glasses again gave me the slip. Squinted and healed my way through the afternoon. As I threw a wad of exam table paper in the trash, I noticed the dark plastic ear piece of a pair of glasses poking up from under a discarded kleenex box (ah yes, threw that away late morning after a lady wept her way through her appointment). Well how about that, some hare-brained patient has thrown her glasses away, methought.

Need I say more?

Sunday, December 14, 2008

Stain or abstain: The coffee question

Here's a riff on a menopause moment of a different sort.

I've always been an early riser. Time it was that I'd rise and shine, as in hit the pavement for a walk, or throw on clothes and get to work early to catch up on charts. Now I rise and read, savoring hot, fresh coffee and the morning paper or a book before anyone else is up.

The operative words in my current, slower, menopausal mornings are 'savor' paired with 'hot, fresh coffee' and 'a book'. Coffee has been exonerated of any connection to pancreatic cancer or breast cancer. Its consumption is linked to decreased risk of diabetes, Alzheimer's disease, and cirrhosis of the liver. I actually don't entirely trust people who don't like coffee, and I am appalled by the number of my patients who declare with a certain virtuous smugness that they've given up coffee only to substitute diet pop.

But I am deeply dismayed by this advice from a New York cosmetic dentist as found in the September issue of Health Magazine:

I avoid stained teeth by drinking my coffee quickly. If you sip it over the course of an hour; it keeps coating and recoating.

Gad, don't want any of that coating and recoating business. Perhaps the good doctor takes hers intravenously?

Tuesday, December 2, 2008

Grounds for concern

Got the coffee ready early yesterday morning using the fancy Costa Rican beans that my daughter brought back from her recent trip. Flipped the switch, then headed upstairs for leisurely work on my hair and face before breakfast.

Alas, I stopped one task short of completion in the coffee-brewing business--forgot to put the carafe in place. After the basket filled with hot water (our model has a valve that prevents water flow out of the basket when the pot is removed), the overflow, complete with grounds, oozed over the top, onto the counter, under cannisters, dish drainer, toaster oven, Magic Bullet, and into the newspaper.

And my pleasant early morning routine? Grounded!

Saturday, November 22, 2008

No waisting these pants!

This is not a menopause moment in a brain freeze sort of sense, but only a woman of a certain age could carry off such an episode with such aplomb. Here's what happened to my patient Donna:

She arrived at the store early; the parking lot was virtually empty. The proprietor of the small store stood at the door, enjoying the unseasonably warm day. He flashed her a welcoming smile as she got out of the car and began to walk across the lot.

Donna is working on weight loss but not yet ready to buy new pants, so she pulled on a baggy old pair for this errand run. Alas, halfway to the store, the stretched-out sweats dropped to her ankles. The store owner quickly looked away, but darned if Donna didn't reach down, hitch up her britches, and tuck them into her underwear under her shirt. Then...she proceeded into the store to conduct her business; after all, who's got time to do these chores twice?

Sunday, November 2, 2008

Buy this woman a cold Flat Tire beer!

Cil writes about a trio of moments in celebration of one of those half-century+ birthdays:

First we welcomed a cold front. Overjoyed to have open windows again, it was dismaying for me to see the return of my night sweats.The bedroom thermometer said 64, a cold breeze wafted in, and I was lying there in bed with no covers on, sweating profusely. Ah, what a bittersweet moment.

Then I went to work, left school at the end of the day, and puzzled over the fact that my car keys could not be found in my purse, my pockets, my book bag. No, I thought to myself, I couldn't have done it. But I had. I found the keys in my ignition.

My hat trick concluded yesterday. You probably don't have to be menopausal to be clueless enough to get in a car and drive it several blocks before realizing you have a flat tire. But to have this happen on your 54th birthday just seems so poetic.

Sunday, October 26, 2008

Acetyl L-Carnitine

I discovered this product through Dr. Larry McCleary's book "The Brain Trust Program" (and I again recommend this book to you). There is certainly no shortage of supplements that purport to improve your cognitive functioning and protect it against age-related damage. Acetyl l-carnitine(ALC), along with Huperzine-A (both available at a very reasonable price through Swanson Health Products) has some decent science to back up such claims.

In order to keep your neurons in charge of memory functioning in touch with one another, you need to produce the neurotransmitter acetylcholine(ACH). And what better way to keep a supply of ACH on hand than to take ALC? ALC not only supplies acetyl to your neurons as aging diminishes ACH, but studies suggest that ALC improves verbal memory so you won't carry on like a newscaster casting about for the right word when you're trying to appear sharp and on-your-game in a world that increasingly demands these qualities. ALC also seems to promote the production of nerve growth factors integral in brain cell maintenance.

How will we know for sure it's working other than waking up in our 70's and 80's with brains intact? Coincident with or as a result of taking Swanson's ALC and huperzine A, my day-to-day verbal fluency and working memory capacity has improved. You might consider giving them a try.

Wednesday, October 22, 2008

Not so Level-headed

Let me tell you the story
Of a man named Charlie
On a tragic and fateful day
He put ten cents in his pocket,
Kissed his wife and family
Went to ride on the MTA

Did he ever return,
No he never returned
And his fate is still unlearn'd
He may ride forever
'neath the streets of Boston
He's the man who never returned.
---The Kingston Trio

I briefly considered the possibility this past Sunday that I would soon become the stuff of urban legend as the woman who never emerged from the Mall of America. I entered the "largest indoor mall in the USA" in the late afternoon with sensible shoes, orthotics, a light sweater, and 2 hours to kill. A regular modern day Gretel sans bread crumbs, I noted a Finish Line store by the entrance and signs for "Bubba Gump's Restaurant, Level 3." Check, find the Finish Line on Level 3 when I'm set to go and I'm outta here, I thought, though weird that Level 3 is street level.

2 hours later. Feet throbbing, visions of a dark and cold Minneapolis late afternoon outside but inside I'm sweating in this stupid sweater and I've toured the entire perimeter of Level 3, passed one Finish Line store and spotted one below on Level 2, but alas now I'm in a carpeted stretch of corrider and no carpeting anywhere else thus far.

I picked up a "Help Line" and held for help.

Do you know where I am based on where I'm calling from, I asked the male helper.


So how do I reach the exit for the hotel shuttles from here.

The other side of the mall, Level 1.

Well, of course, Level 1 signs invite Level 1 shoppers to visit Bubba Gump's on Level 3. No one, not even in Minnesota, starts on a mall on Level 3. I took the elevator to Level 1, limped through the horror of the indoor amusement park, and emerged like some sweaty mall rat blinking small pink eyes in the bright, sunny late afternoon air.

This per Nina Silverstein and company in their book "Dementia and Wandering Behavior":

Alzheimer's patients do not get lost because they have forgotten where they are going, they get lost because they cannot keep track of where they've been.

Thursday, October 16, 2008

Menopause and working memory

The classic menopause moment, of course, is when you hurry with great purpose into another room only to find that you're clueless once there. If you're a mother, it's a mommy moment. Fair-haired? A blond moment. On beyond menopause? A senior moment. All these short-term lapses represent a sudden and unexpected blackout in working memory. Let me explain.

You needn't be a neuroscientist to recognize that there is a difference between working and long-term memory. Here's what Swedish researcher Dr. Torkel Klingberg has to say on the subject:

[Working memory] refers to our ability to remember information for a limited period of time, usually a matter of seconds...[I]t might seem a simple function, but it is fundamental and vital to numerous mental tasks, from attention control to solving logical problems...One of the defining characteristics of working memory is its capacity limitation.

In contrast, again per Dr. Klingberg:

The amount of information that can be stored in long-term memory is virtually boundless. Long-term memory means that we can memorize something, direct our attention at something else for a few minutes or years, and then retrieve the first item again at will. This is not how working memory operates, for when information is being stored here, it is under the constant glare of attention.

In Klingberg's book "The Overflowing Brain" due for release in 2009, he explores the good, the bad, and the exasperating of our brains on information overload. This book is well-written (or well-translated from Swedish) and not for the faint of brain. He offers both animal and human evidence as well as imaging evidence from functional MRIs and PET scans that explain why it is that the overwhelmed, the inattentive, and the aged have trouble doing two things at once much less multi-tasking.

In brief, whereas memories are encoded into long-term and permanent storage through biochemical and cellular changes, short-term memory is a work in progress that depends on the continual activation of neurons in the front and sides of our brain. Interrupt the current current in these cells and poof! there goes your thought. In other words, if an unexpected stimulus such as the ping of a text message or your teenager calling on the back office line turns your attentional spotlight off your search for a report, you will find yourself in front of an open file drawer with no notion why.

Is information overload a bad thing? Interestingly, Dr. Klingberg presents evidence that we can expand our working memory capacity through the daily exercise of focused multi-tasking. He does note, however, that working memory 'bandwidth' narrows with age, and the mismatch of lowered working memory capacity with higher information load results in stress.

Well yeah. And menopause moments.

Sunday, October 12, 2008

Huperzine and the lack of menopause moments

My latest menopause moments include 1) Losing passwords when I cleared the cookies on my computer, but those passwords lost were chosen and entrusted to memory ages before I began work on my aging brain, and 2) Muddling our 2007 tax information back in early April shortly after my mom died, and only just discovering the mess now as the final tax form is due.

Other than that, I haven't worn toothpaste, dumped water on my head, misplaced my reading glasses (alright, I mean SERIOUSLY misplaced my glasses) or made any spelling gaffes in weeks. Coincident with or a result of using huperzine? I don't know, but brain seems to be working well these days.

Stay tuned for information from "The Overflowing Brain," the newest book on my nightstand.

Wednesday, October 8, 2008

Tossed my cookies!

Oh gad, what was I thinking? Deleted the cookies, and now I can't remember some of my passwords and user IDs. As Homer Simpson would say, "Dough!"

Saturday, October 4, 2008

Is there a brain in the House?

I was watching "House" this past week, my all-time favorite TV show. Actually, I was watching House, browsing through an amusing little tome called "Menopause: The State of the Art in Research and Management" AND racing downstairs during commercials to finish the dishes. Who says an aging doctor can't multi-task successfully on a Monday night?

Apparently I can't. No amusing gaffes here, just the realization at show's end that while I followed the main plot line, I didn't get the two sub-plots. All this education, and I can't even follow a couple of story threads through a prime time TV show, read a book, and clean up the kitchen. Too old to multi-task or just jammed tight in the bottleneck of my working memory?

Sunday, September 21, 2008

Huperzine A--the first week's report

I mentioned a couple of weeks ago that I was adding yet another supplement to my diet based on a recommendation form Dr. McCleary's book "The Brain Trust Program." Huperzine has a silly name, but apparently inhibits the breakdown of the memory-promoting neurotransmitter acetylcholine, keeps neurons from being excited to death through the influx of too much calcium, and has anti-oxidant and anti-inflammatory properties as well.

So, like an aging Alice in Wonderland, I opened the bottle and swallowed the pill. I fully expected to see no results for 20 some years when I would wake up one morning and not be demented. Whereas one pill made Alice larger and one pill made her small, this pill, completely unexpectedly, made me less anxious. I faced my day and my to-do list not with a tranquilized but rather a tranquil brain. The effect wears off by day's end, but per "The Brain Trust Program," this supplement is to be taken twice daily.

Hmm, this pill could be the new mother's little helper.

Friday, September 19, 2008

Wired for fashion

this honorary menopause moment from Edder:

Several years ago my girlfriend and I rode the bus to work downtown. She lived one bus stop before mine and would save me a seat in the morning. In those days I wore suits to work. One morning as I was making the 2 block walk to my stop I noticed people staring after me as I walked by. "I'm lookin' sharp!", I thought as I strode by in my suit, tie and trenchcoat with my bag slung jauntily over my shoulder. I boarded the bus and made my way down the aisle to my saved seat, but before I could sit down my girlfriend said "Wait" and then pulled a wire coat-hanger that was hooked on a belt loop on the back of my trenchcoat.

Tuesday, September 16, 2008

Honorary menopause moment

K. leads a crazy life as a single mother, cleaning our office in the early morning as well as managing another busy facility during the day. As she tossed our trash in the dumpster yesterday, she watched with a sinking heart as her 'smart key' (as in expensive, electronic key to new car) went twirling through space to the bottom of the bin. She donned rubber exam gloves a la crime scene investigation and clambered up a step stool to crawl into the dumpster after that key. Her sister arrived to help as the day began to grow light but ended up no help at all as she became helpless with laughter watching K emerge (with key) from dumpster, a blue shoe on one foot and a black one on the other.

Sunday, September 14, 2008

Muffed muffins

This from anonymous:

I was making bran muffins this weekend while thinking of everything else I had to do besides making bran muffins. The batter was pale and sort of runny but I thought that was because I used white flour instead of wheat. I filled the paper cups with batter and it got all over the muffin tin because it was so runny but I finally got them in the oven.

I walked back to the counter to clean up and noticed the bran cereal waiting to be added to the muffins. No wonder the batter was so runny--I'd forgotten to put the bran in. You should try to scrape batter out of paper cups sitting in a hot metal muffin tin. What a mess. I added the bran cereal and put them back in the oven, they turned out dry and hard. Yuck.

Wednesday, September 10, 2008

Polish off your breakfast!

This menopause moment from Cathy:

A couple years ago I was making breakfast and thought I was spraying PAM into the skillet. It was a yellow colored can just like PAM but I sprayed it with Pledge furniture polish. I never did figure out why the Pledge was on the kitchen counter.

Tuesday, September 9, 2008

In top condition!

I spent last night in a hotel en route to a speaking engagement in Cheyenne, Wyoming. After a long hot bath, I grabbed the tiny bottle of lotion supplied by the hotel. It was wonderfully scented with lemon but oddly slow to work into the skin. This morning as I packed up to leave, I noticed (finally had my reading glasses on) that I'd slathered my skin with hair conditioner.

Friday, September 5, 2008

Huperzine A

I am not (yet) a force in the world of medical information, but I may be a small-sized ripple.

I noted in another blog that the Northfield Harkins Theater in Denver had a dingy lobby and poorly located handicapped parking. Darned if I didn't get free passes and a nice note from their public relations people in Arizona (and p.s., their lobby now looks great!). The Yoga Toes people likewise sent their warm regards when I praised their product, but alas, no free toe contraptions followed.

Most recently, the front woman for The Brain Trust Program commented on a recent article I wrote on overactive bladders . The connection between bladders and brains, perhaps, is that attending to the frequent needs of the one can screw up the cognitive functioning of the other, at least in old people with poor sleep habits. With just a little hint from me, she sent me a free copy of this book for my review.

I pictured that I would speed read this book, order the supplements, implement the behavioral changes, and report back to you. All that is proceeding a bit slower than planned, but I would encourage those of you who have an active interest in preserving your brains to check out this book. At the very least, have a look at Dr. McCleary's web-site, where you can take an amusing but arduous quiz to assess your risk of dementia.

All of which is a long-winded introduction as to where I came across huperzine A, a chinese herb that combines the goodness of Aricept with the punch of Namenda plus a dash of anti-oxidant and anti-inflammatory activity. Now I haven't tried it yet (I already take so many supplements that I sometimes just have to lie down after dinner to accomodate the load of little tablets I've swallowed), but shoot, I'll try anything, just gotta' get around to ordering it.

This extract of chinese club moss is a proven and potent inhibitor of acetylcholinesterase, the enzyme that minces up acetylcholine (Ach). Ach is the neurotransmitter molecule that allows the cells in charge of memory formation in the front of your brain to talk to one another and thus form new memories. By slowing down the breakdown of this essential brain chemical, huperzine, like Aricept and Exelon, allows memory centers of the brain to motor on longer and stronger through the aging process.

In addition, huperzine limits the flow of calcium into nerve cells. Calcium influx is a good thing in terms of neuronal function, but too much calcium is toxic. Like Namenda (and Prevagen), huperzine allows in just enough calcium to hold the thought but not enough to strangle the thinker. And like melatonin, huperzine is also an anti-oxidant and a neuroprotective agent.

Now how good is that? Huperzine is currently in Phase II trials as a treatment for Alzheimer's Disease.

Saturday, August 23, 2008

Not-so-Goldilocks and the three nights sleep

Not-so-Goldilocks worked late after a long day, so she finally went upstairs. She lay down in the first bedroom recently vacated by her son who had left the previous day for college, but the bed was too hard. She was only able to sleep for 5 1/2 hours, and she felt like hell in the morning(1).

The next night, Not-so-Goldilocks was so tired she headed up to bed at 9 p.m. She lay in the second bedroom that still had her daughter's stuffed animals arranged on a flower spread, but the bed was too soft. She slept like the dead, unmoving, for 9 1/2 hours, and woke up with her head foggy and her back screaming(2).

On the third night, she dragged her sorry self all the way to the end of the upstairs hall to her own bedroom at her usual bedtime of 11 p.m. Then she flopped down on her pillow-top Sealy mattress, and it was just right. Not-so-Goldilocks fell asleep and awoke refreshed at 6 a.m., her mind clear and her eyes unpuffy. She bounded downstairs for breakfast and coffee, ready to wrestle the world to the ground.
(1) Researchers at the University of North Carolina's School of Public Health in Chapel Hill found that women who slept six hours or less were at 14 percent greater stroke risk than those who slept seven hours a night.
(2) This same study found that compared to postmenopausal women who slept seven hours, those who dozed nine hours or more had a 60-70 percent higher risk of ischemic stroke.
(3) The Chapel Hill investigators agreed; seven hours of sleep is just right!

Tuesday, August 19, 2008

Color her clueless

My medical partner showed up one day in a bright cotton outfit. The problem, however, was that the bright top and T-shirt had nothing whatsoever to do with the boldly printed slacks, at least in a color sense. We're not talking clash in a sassy, young-at-heart sort of way--that top, those pants, simply had nothing whatsoever to do with each other by anyone's standards.

There are worse gaffes, for sure, say travel knit paired with linen, or light-colored shoes with a dark pair of slacks. We all wondered in silence whether this was a 'who gives a fig about fashion' statement, or had she just dressed in the dark. And no one said a word to her.

The next day she arrived, fully coordinated, and aghast that no one had mentioned her mismatch. Turns out, she did indeed dress in the dark. How then to explain an entire day spent under bright fluorescent lights, clueless as to her 'glamor don't'?

Menopause moment, for sure.

Estrogen and memory function

A study conducted at the University of Southern California demonstrated that estrogen promotes the growth of those essential neurons in the brain's hippocampus that are critical to memory function. Scientists there created a hippocampal campus in a petri dish, inducing these cells from the memory center to set up housekeeping in the USC lab. They then squirted conjugated equine estrogens (CEEs or Premarin) on the nerve cell colonies and watched the results under a videomicroscope.

The cells literally bristled with excitement. The addition of estrogen juice significantly increased the number of dendrites or outgrowths of the cell membranes which are known to be cellular markers of memory formation. Dendrites hook-up with other neurons to form new connections, a process that promotes brain 'plasticity' or the ability to learn new material and make new associations. In other words, the same cellular events that occur in the hippocampus of the brain during memory formation happened in these brain cell cultures when estrogen was added.

When I see patients going through the menopausal transition, I not only inquire about hot flashes, night sweats, and the quality of their sleep, I also ask "How's your mood?" and "How's your memory?". The lack of estrogen affects women differently, some struggling far more than others in a brain function sense. I think the problems with verbal memory and executive functioning (starting a multi-step task and completing it successfully) along with the increase in anxiety and depression that can accompany falling estrogen levels are too often not addressed in women of age.

Monday, August 11, 2008

Don't mind your hot flashes...

...they may be good for your mind. A new theory suggests that these pesky little episodes may protect your brain through a phase when dwindling estrogen supplies leave central neurons susceptible to damage. As you read on, please remember that this is all strictly a theory.

Because our brains are unable to store nutrients, we rely on a steady supply of sugar delivered via the blood to keep our central nervous system ticking. One of estrogen's many useful functions is to promote the entrance of glucose into the brain--after all, can't have Cave Mom keeling over from low brain sugar! As estrogen levels drop during perimenopause, a condition called 'neuroglucopenia' follows which is a fancy name for a brain-fogging lack of readily available glucose.

Researchers theorize that low brain sugar may set off a hot flash which activates part of our involuntary nervous system, the same reaction involved in a 'fight or flight' response to danger. This may be why hot flashes tend to rip us out of a deep early a.m. sleep, hours after our last meal. The alpha-adrenergic surge that follows corrects the starving brain problem thus protecting vulnerable cells from the destructive effects of no sugar.

Perhaps then the women most at risk for losing brain cells to aging and oxidation in an Alzheimer's sort of way are those who 'sail' through menopause without hot flashes. Neuroglucopenia city in their heads, but no adrenal surges to correct the situation.

Or maybe not.

Tuesday, August 5, 2008

Meal curries no favor with patient

(or no brownie points for me!)

What a great lunch I'd had: green curry with jasmine rice (Tommy Thai's best!) followed by brownies courtesy of a drug rep. One-half hour later, I was in the exam room listening to my patient's update on her back pain. As she went on, I felt a soft blanket of carbohydrates roll over my brain. My eyelids grew heavy, but I struggled mightily to keep them open.

On average, patients don't notice my occasional post-prandial lapse, but this lady was a psychotherapist and, as such, a keen observer of human behavior. To my horror, she stopped abruptly, mid-sentence, and looked at me with alarm.

"Are you O.K.?" she inquired.

A burst of adrenalin cut through my fog, and we both had a good laugh over this doctor's inability to follow her own nutritional advice.

Wednesday, July 30, 2008

Giving the husband the brush-off

This from BearNaked:

One morning as I was brushing my teeth, I looked up in the bathroom mirror. What I saw was that I was using my husband's toothbrush. His is blue and mine is green; no reason whatsoever for the confusion.

I blamed it on my early morning rising and convinced myself that was the cause. I went out shopping that afternoon and bought new green and blue toothbrushes for the two of us.

Three days later I did the same thing all over again.

I now have a large stock of green and blue toothbrushes (just in case.)

And this is our little secret because I never told him about it.

Thursday, July 24, 2008

There's an awful latte coffee on your desk...

Thank heavens for drug reps and their coffee budgets. A few lattes from the local coffee shop is a great way to get past the front desk in my office, but I do promise you that I don't base my prescribing habits on free coffee.

That said, I was pretty pleased to see a full-leaded latte in the hands of a drug rep this morning. My medical partner got one too although, on average, she's not as prone to listen to their patter as I am. She spirited hers away to the bookshelf where we review prescription requests, and I carried mine off to the counter where we chart.

Several hours later, we are still carrying our cups from place to place. I finally land with my leftover dregs in my back office so I can polish it off while returning phone calls. Shortly thereafter, partner appears in office door.

"Did you take my latte?" she asks, surveying my desk.

"No," I answer without looking up, "This one's mine."

"What about the other one?" she demands.

I glance over by my left elbow where her latte and mine sit inches from one another right where I (who else could it be?) must have carried them in on two separate trips.

Wednesday, July 23, 2008

Imagine me and you...lost

Two women, one menopausal moment.

My friend R and I went to see The Turtles last night. A young fellow beckoned us left ("Easy in, easy out"), and we parked in a near empty lot cordoned off from a public lot by yellow string. Was it legal? Was it necessary to pay $10? Who cares, it's the Turtles! He pointed waaay up the hill to a distant traffic light. "Walk up to the light, then turn right to the concert." Good thing we were in high spirits and sensible shoes.

After two opening acts --we never did figure out who they were-- and Melanie (as in "I've got a brand new pair of roller skates") who might have been drunk or stoned and who definitely could no longer carry a tune, the old guys formerly known as The Turtles bounded onto the stage. Fabulous! We were giddy and singing at the top of our lungs.

Alas, the walk, the singing, the excitement, we were too tuckered to sit through more than one song from Jack Bruce of former Cream fame. R turned to me. "Did he really just say "I'll be with you 'til my seeds are dried up?" Yes he did and indeed, the old goat is here just as he promised.

We headed straight down the hill, renewed despite the oppressive heat by singing "Imagine me and you, I do, I dream about you day and night, it's only right." On and on through the gathering gloom, through the now dark office park...that we didn't walk through on our way into the concert.

"Uh, I think we're lost."

"No way."

"Yes, we are, don't you tell anyone about this."

"My feet are killing me, and my orthotics are all sweaty."

We collaborated on deciding which way was west, then turned east. A group of municipal dog catchers were gathered in a darkened lot--now what do you think that was about--and R got directions from them. "See that traffic light waaay up the hill there? Turn right when you get there, and the theater you parked at is about a half mile down the road."

Off we went. So happy together.

Monday, July 21, 2008

Tuesday, Tuesday, can't trust that day

E-mail exchange:

Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm we will cancel the Lunch & Learn that Dr. Paley was going to speak at (July 22) and reschedule Dr. Paley for Tuesday September 4 from 11:30-12:30.

Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

...I assume it's Tuesday the 2nd because the 4th, as mentioned in Menopausebrain's e-mail, is a Thursday...

Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

Tuesday Sept 2nd is the date.

Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

Oh yes, tuesday the 4th - so sorry!

Saturday, July 19, 2008

Listen, dear, who's playing our song?

Another momentary lapse from Wendy who proves that menopause moments are not just an American phenomenon:

I pulled into the gas station to fill up the car. Already late and impatient, I jumped out to fill it myself. The place was very busy - everyone wanted gas, and it was a Self-Serve - but I don't want to wait for the busy Attendant to get to me. So I squashed the hose, filled up my tank, and gave my money to the Attendant. Jumped back in the car and started negotiating my way around cars that were waiting for their turn.

Geez - this place is too full - let me outta here.
O.K. relax, go get a coffee.
"Please don't stop the music......." sang Rhianna or somebody, over the radio.
"Please don't stop the music..... the music.... the music......."
Oh, I like that song, I thought to myself as I waited for a break in the traffic to pull away from this busy place.

I turned the knob of my radio, so I could hear the song better. Nothing.
Meanwhile, I saw a break and focused my attention on pulling into the traffic. No time to glance down at the radio.
Hey - where did the music go? I turned the knob again - a little louder this time.

Oops - that wasn't my radio - my radio was turned off!! Somebody else must have pulled away from the station, taking my song with them!

Tuesday, July 15, 2008

I goofed, so Sioux me!

Occasionally, I note a slip so rich and humorous that I will post them here even if the slipper is not a menopausal woman. This fellow may as well be one so ditzy his deed.

The 'editorial obituaries' in the morning paper often include an amusing anecdote from the dearly departed's life. This fellow was billed as a 'kind and caring lawyer,' but the author notes that sometimes 'his mind whirled...too fast.'

Mr. T. was on his way to join his wife in Sioux Falls, S.D. for a family visit. He arrived at the airport way before flight time back in the days when those minutes to spare were not spent in security lines. He went up to the ticket counter to see if he could catch an earlier flight, then hurried off to board the plane.

While passing time during a layover in Lincoln, Neb., he wandered about the airport humming Sioux City Sue. That's when he realized that he would soon end up in Sioux City, Iowa per his newly purchased itinerary. When he landed in Iowa, he called his wife to hum her the wrong city/wrong state blues.

Sunday, July 13, 2008

Don't send me packing!

My husband asked me to bundle up some unwanted purchases for mailing back to the store. That's our unspoken deal; he finds good deals on the Internet, I package them up for return.

I took extra care today, filling out the return slips complete with reasons for return ('color is gross,' 'this denim looks stupid') and making copies for our files. I had a devil of a time with the cheap packing tape; I had to slice through it with a razor to get an end to unwind. By the time I was done, I'd taped my scissors shut and lost my fresh cut end twice. The kitchen where I worked was 82 degrees, hot flash city!

My husband strolled in as I was ready to put the return label on the box. He held the flap down as I applied the label, then I pulled my fresh strip of tape across the top. Across the top crookedly, alas, so that only a small portion of the top was secured.

"Oh, let me do that," he exploded impatiently, and he proceeded to expertly apply tape to box without securing his fingers underneath it nor sticking the tape to itself.

I was biting my tongue so as not to note aloud that he should've done the entire job himself when I noticed the return slip sitting on the counter. My husband is not fond of menopause moments, and I am not fond of conflict, so I slipped that errant slip into a drawer with plans to redo the operation later when he left the house in search of a good deal on motor oil.

Part II: A Package Deal

Two menopause moments for the price of one!

As soon as the house was quiet, I hauled the box back on the kitchen counter and expertly slit open the previous tape job. No problems with packing tape this time, I easily picked the cut end free and rolled it smoothly across the flaps. All done quickly, easily, with time to spare before my spouse came home.

I was sitting and reading awhile later when it occurred to me that I had--once again--failed to insert the return slip into the box prior to sealing it shut!

Saturday, July 12, 2008

Don't forget your blood pressure meds...

Because evidence suggests that you may then be at risk for forgetting just about everything.

Hypertension is a known risk factor for dementia and is associated with some of the same gummed-up brain changes also found in Alzheimer's disease (AD). Researchers evaluated the beleaguered brains of hypertensives and AD patients using proton magnetic resonance spectroscopy (don't ask, I have no idea). When compared to normal subjects, both those with dementia and the tension-filled had the same abnormalities in their brain composition. Furthermore, hypertension contributes to the changes in small blood vessels in the brain that lead to vascular dementia, another degenerative brain disease which can be indistinguishable from AD.

Research has shown that successful treatment of hypertension can decrease the risk of memory loss. A study of nearly 2,000 aging souls in Indiana over five years confirmed that the use of anti-hypertensive medication reduced the risk of dementia by 38%. Another trial known as the Systolic Hypertension in Europe (Syst-Eur) study was originally designed to investigate the protective effects of blood pressure treatment on risk of stroke. This portion of the trial was terminated early because the benefits of intervention were so clear with respect to decreasing incidence of stroke that researchers were compelled to offer the active-treatment to all participants. After that point, nearly 3,000 subjects, all now on medication, were followed for the occurrence of dementia. Blood pressure lowering therapy with a specific class of medications called dihydropyridines--Norvasc (amlodopine) and Plendil) reduced the incidence of such memory loss by 55%!

Syst-Eur investigators note that these drugs (also known as calcium channel blockers) seem to provide better protection against stroke compared to diuretics (Dyazide, HCTZ, Lasix) and beta-blockers (Toprol, atenolol, and others), and this advantage may also prevail in dementia prevention. Their results suggest that treating 1,000 hypertensive patients for five years with such meds can prevent 20 cases of dementia.

Saturday, July 5, 2008

Hot flashes and verbal memory

Interesting research from the University of Illinois in an upcoming issue of Menopause. Investigators there observed 29 hot, flashy women and determined that: 1) Women have more hot flashes than they think they do, and 2) The more hot flashes you have, the more addled your brain in a 'find the right word at the right time and use it in the right way' sort of way.

These long-suffering women agreed to wear skin conductance monitors that recorded when they broke out in a menopausal sort of sweat (do you think they got paid or did they just take one for the team?). The number of objective flashes averaged 19.5 per day per woman, but the number they reported was less than 40% of the actual episodes. Let's see, that means they perceived less than 11.7 flashes in 24 hours. I'd like to say I did that in my head, but mental arithmetic makes me sweat these days.

Then the group was invited down to the [hopefully] air-conditioned lab to perform verbal memory tests. The higher the flashes, the lower their scores. Wow, no surprise there. Dr. Pauline Maki sums it up for those of us too hot to put it in our own words: "In other words, the hot flash-memory relationship is not all in a woman's head. It's actually a physiological relationship that you can pick up on, if you measure hot flashes objectively with a monitor."

The researchers also found a relationship between hours slept, or rather hours tossed and turned, and defects in verbal memory. Certainly flashing by moonlight does not enhance sleep quality, but the Illinois doctors did not address whether it was the night sweats or night frets that caused the memory lapse.

Sunday, June 29, 2008

Misplaced modifiers

One sports bra and a pair of orthotics. Now how could such things go missing, it's not like they travel outside the home on their own.

Thursday, June 26, 2008

Smeared memories

I explained in detail why my patient did not need a Pap this year (over 30, low risk, no abnormal Paps for 10 years). She agreed, and we proceeded with her annual physical.

We chatted away about this and that through the exam. At visit's end, I reminded her that she would hear about her Pap in 1-2 weeks.

"Uh, but I didn't have a Pap."

"Of course you did," I answered after a moment's hesitation, "but we were talking and you probably just don't remember." And then I remembered that we'd talked about no Pap.

"Well, maybe I did, " she answered, "or did I?"

At this point, she and I had a spirited discussion about Pap or no, did she or didn't she. I checked in the back, and indeed she did. Whose menopause moment was this?

Tuesday, June 24, 2008

Minding the Gap

This isn't so much a story about a memory lapse as one of judgment. If I can't share a day of apparel peril with my menoposse*, where else can I tell the tale?

During my daughter's last visit home, she cleaned out several drawers. She unearthed a good-as-new, size 6 pair of khaki slacks from Gap and dropped them in the to-go pile. I tried them on (standing all the while), and they fit like a glove. New summer pants without the agony of a shopping trip! I spirited them away to my closet.

Yesterday was the day to show the world there's no such thing as a generation gap at my house--I can wear size 6 hand-me-downs from my daughter. The first inkling of trouble, however, was my first proper sitting experience clad in khaki as I drove to work. The pants felt like concrete casing about my legs and stomach. I wondered would they stretch like denim (they did not) and would the seams hold (they did). But on arrival at the office, I got compliments from my 20-something medical assistant and 50-something medical partner. A droopy, half-century+, back end packed into stretch-resistant khaki is apparently a thing of beauty.

I spend my days talking to patients while perched on a backless exam stool. The only way my half-century+ back can handle that is by leaning forward from the hips. I found out minute one with Patient One that leaning forward was not an option. One, I couldn't breathe if I did, and two, didn't want to test the zipper strength.

Patient One and I discussed back pain, and I allowed as how I had that too. "No wonder," she noted, "look how you're sitting." Legs wound tightly round one another and dropped to one side while I leaned back with one arm resting on a chair to my other side. I told her why, and she burst out laughing.

By day's end, I was suffering from back spasms every time I moved and dreaming of a pair of travel knit slacks. Two aspirin, a muscle relaxant, and a long walk in sweat pants set my back straight. The pants went straight back to the discard pile.

*This great word is courtesy of my brother. Thanks, Bob!

Friday, June 20, 2008

PET scans prove that neurons like estrogen

We now have several lines of evidence, from independent parts of the brain, that estrogen is actually protective in a manner that is related to aging and dementia.
---Daniel Silverman, MD, head of neuronuclear imaging at UCLA

Scads of research evidence already support this conclusion. Reports from brain cells in petri dishes, as well as testimonials from aging gerbils, mice, rats, and women attest to the beneficial effects of estrogen with respect to forming new memories, learning new tasks, finding the right word at the right time, and completing a multi-step task(1) from start to finish.

UCLA scientists used functional brain imaging to visualize how well postmenopausal brains worked with estrogen compared to their activity after estrogen is withdrawn(2). PET scanning involves administration of 'tagged glucose' molecules. When busy little neurons put on their thinking caps in your brain, they suck up and metabolize sugar at an accelerated rate. The labeled glucose glows like a light bulb on subsequent scanning, identifying those parts of the brain that are successively at work.

81 women considered to be at high risk for Alzheimer's disease (AD) based on family history or genetic testing entered the study. All were initially on estrogen for menopausal symptoms. Baseline PET scans were performed, then the subjects were randomly assigned to continue estrogen or go on placebo over 2 years of follow-up. Intial "findings from the first 25 women to undergo baseline and follow-up scans were highly consistent for a neuroprotective effect of estrogen," per Dr. Silverman.

The initial scans showed that the longer the woman had been exposed to her own estrogen (defined as years from onset of menstruation to the end of the line at menopause), the higher the metabolism in the precuneus area of the posterior medial cortex. Don't knock the precuneus area just because you--and me!--haven't a clue where or what it is. Significantly diminished blood flow to this area is one of the earliest signs of Alzeimer's disease.

By study's end, women on estrogen continued to light up brain regions known to be most affected by AD whereas lights were dimming for the estrogenless group. Activity in the right inferior parietal lobe decreased twice as fast for this befuddled group. Research suggests that the right IPL is involved in the "what" (...did I come for) and "where" (...did I put it) of working memory. In fact, again per Silverman: "In [some] women who stayed on estrogen, metabolic activity in the frontal part of the cortex actually increased."
(1)Such as walking from one room to another to get something, grabbing that something, and returning with it to the original room with the thought intact as to why you wanted that thing
(2)Silverman, D et al. Society of Nuclear Medicine 2008 Annual Meeting: Abstract 973. Presented June 16, 2008.

Monday, June 16, 2008

Someone cell me a brain!

A menopause moment from Jean.

Dialed the number and walked around looking for my cell phone. Asked if anyone had seen it. I am always setting it or our house phone down and forgetting where.

Announced to whomever would listen, "Next time I'm buying a bright pink one, then I'll see it."

Wayne looked at me, "Aren't you on your cell?"

Sure enough, there was the phone clutched in my hand.

Please send me menopause moments of your own for sharing. E-mail me at:

Sunday, June 15, 2008

Mad as a wet hen!

Oh right, I was a wet hen.

I always wear a shower cap in the bath to keep my hair dry. I grabbed the cap in hand, tested the water temp, and stepped into the tub while pulling hat over head. I vaguely registered that the cap felt unnaturally weighty but proceeded to swing it up over my head.

Water poured over my hair as the cap emptied its contents down my head and face. I'd held it under the running tap as I used my index finger to check out the bathwater.

Thursday, June 5, 2008

A pasty white woman

I drive my husband nuts with my inattention to details such as tightening the lids on jars. Sometimes, however, I am hoist by my own petard.

I'd spent the evening preparing a talk on blood vessel health. Turns out, one's vascular health depends a lot on one's dental health, so I ended the evening with an in-depth flossing. I wore my strongest reading glasses as I bent towards the mirror to get a really good look at the teeth. When I straightened up, I noticed white goo on the tips of my hair. I didn't much want to touch it, but a moment's investigation confirmed it was toothpaste. Indeed, my Pepsodent tube, cap askew, had oozed paste into a puddle on the counter top.

After rinsing paste from hair, I straightened up to inspect my floss job in the mirror. Hanging from the left earpiece of my readers was an enormous gob of toothpaste dripping from glasses across onto lens and down into hair and cheek. I have no idea how my toothpaste tube launched this surface to hair missile. Was my face white!

Wednesday, June 4, 2008

Verbal fluency and hormone therapy

Verbal fluency is defined as the ability to find the right word at the right time and use it with ease when appropriate. I wrote a post on it earlier this year on Doc of Ages, my other blog.

I got an interesting comment and question on the subject today. Verbal fluency (VF) is very much an estrogen-supported brain function. Out of estrogen and you may be out of luck with respect to having your say in an okay way. This lady writes:

In the last few years I have noticed what seems to me more VF problems than my friends. I am not as bothered by it when writing which I do a great deal.

I'm 73 and have taken Premarin, .625 mg daily, since I had a complete hysterectomy at age 54 (done for multiple non-malignant reasons). Some doctors lately say I should discontinue the Premarin because it increases my likelihood of getting cancer - uterine and breast - and major clots. (I had bilateral mastectomies in my 30s for major non-malignant breast changes and a high family cancer history). I am healthy otherwise (minor heart change, excellent bone density, some arthritis).

Two questions: Why the VF problem? Discontinue the Premarin? The answers I get are vague and don't satisfy me.

I answered:

While VF is sensitive to estrogen or the lack thereof, it also falls off with age. That said, you're not that old, and I never know what to make of this citation of age as a reason for anything; it seems that there must always be an underlying problem that perhaps worsens with age but not explained by age alone. As VF is a frontal lobe function, and the frontal lobe is more susceptible to stroke damage than other parts of the brain, I wonder if you should have an MRI to look for the tiny white spots that correlate with small vessel disease in the brain.

Premarin or no, here's my take on that. While estrogen is known to support frontal lobe function, oral estrogen supplements, and in particular Premarin taken orally, are known to cause some problems even as they may benefit brain function.

Once orally-ingested hormones are absorbed into the bloodstream, they head straight for the liver via the portal circulation. The liver gears up to break these foreign molecules down and, in doing so, produces some unwanted proteins such as angiotensinogen (which can raise blood pressure), C-reactive protein (which causes inflammation), clotting factors (which raise risk of clots and blood vessel inflammation) and triglycerides (which raise risk of heart disease and stroke).

If you haven't had a major clot from Premarin, you are unlikely to get one now unless you have to undergo major surgery such as a knee replacement. You don't have breasts or uterus to worry about cancer risk. But you do have to worry about stroke.

I would consider going off Premarin. But...estrogen supports frontal lobe function. You might consider replacing the Premarin with a transdermal estradiol patch such as Vivelle Dot. That way, the estrogen you take is not foreign (like the horse estrogens of Premarin) and it does not go through your liver (causing all the above troubles). It is known that transdermal estrogen does not raise clotting factors, C-reactive protein, or angiotensinogen. It has not been studied whether or not transdermal estrogen increases risk of stroke the way oral estrogen does, but logically it should not.

The only vague part of my information is whether or not you should change hormone delivery systems or go off it altogether. That is a weighted decision best made by yourself and your doctor.

Wednesday, May 28, 2008

Sleep apnea and memory

If your sleep is disrupted by an irregular breathing pattern known as sleep apnea, research suggests that as you snooze, you lose...brain cells that is. Sleep experts have long known that persons who are restless by night from sleep apnea are befuddled by day, and they assumed that such foggy-headedness resulted from fatigue. Investigators in Kentucky beg to differ, however, after they discovered that periodic lack of oxygen in rodents wreaks havoc on the brain's memory center called the hippocampus.

Dr. David Gozal and his colleagues studied ratty little brains and found that intermittent hypoxia (IH)--the episodic drop in blood oxygen levels that occurs during the prolonged respiratory pauses of sleep apnea--causes apoptosis or death of neurons involved in memory and learning. On the other hand, sustained low oxygen levels such as those that might occur in rats residing in Leadville, CO or in a Tibetan monastary, causes protective adaptive changes that spare these vital brain areas.

These research findings suggest that untreated and prolonged sleep apnea may lead to permanent changes in brain functioning. There is good news, however, from the Southern rodents. Those animals who agreed to undertake the rat-sized equivalent of a one hour daily walk in the park were protected against the destructive effects of IH on their brains.

Bad news, on the other hand, from an analysis of the effects of diet on rat brains exposed to IH. The rats who ate a high-fat, refined-carbohydrate diet (as in American convenience foods) were dazed in their mazes, and the inability to figure a route out was magnified if this lousy diet was paired with IH. The combined effect of IH and fast food on rats prompted Dr. Gozal to call such double trouble "a major disaster for the brain."

Tuesday, May 20, 2008

Is that your final diagnosis?

Guilty pleasures. Lying on the bedroom floor drinking a smoothie and watching reality TV (no, I won't say which show). During a commercial break, I caught a glance at myself in the mirror; dang, there's a bleeding cut across the bridge of my nose. Must've slammed the wire frames of my reading glasses into the skin, although you'd think I'd remember doing something like that. Well, it stung a little bit, but no sense messing with it until after the show.

Somewhat later, I inspect the wound, now wearing my reading glasses. Odd colored blood, more pink than red. As I wiped the area with a wet Kleenex, all the 'blood' disappears and there's no damage whatsoever to the skin. I can't imagine what it is, I'm not even sure I want to know. But not until I rinse out the smoothie glass do I figure out the mystery. While tipping back the cup to get the last dregs of crushed strawberry, I deposited bits of same on my nose from the far rim of the glass.

Thursday, May 15, 2008

You think what you eat

If Leftover Salmon means nothing more to you than a rollicking bluegrass band, your brain may be in jeopardy. Turn off the progressive rock station and forage instead in your 'frig for dinner remnants rich in omega-3 fatty acids. Fish dishes have long been known as "brain food." Here's why.

Investigators followed the menus and mentation of 1600 aging individuals over five years. The survey results, published in the January, 2004 issue of the journal Neurology, showed an inverse relationship between dietary intake of fish oils and cognitive impairment. In other words, those whose diets were high in marine omega-3 polyunsaturated fatty acids (EPA and DHA) were at a significantly lower risk of losing their marbles over time. They bested the befuddled fish-free folk during mental testing both with respect to accuracy and speed. On the other hand, the group that favored foods rich in cholesterol and saturated fat were more likely to develop memory problems and an inability to learn and apply new material.

The scientists from the Netherlands estimated that the effect of eating an additional 80 mg. more cholesterol each day was similar to the effect of being 3 years older. I don't know how they came to that particular conclusion, but just the disturbing trends here are enough to make me worry about the longterm effects of McD's on my brain.

Wednesday, May 14, 2008

Who's cee-ell-yoo less now?

A patient was in the other day with that which is going around. She sounded awful and looked worse, glassy-eyed and pale.

"So," she said after I looked her over, "do you think it's eff-ell-yoo?"

Hmm, I thought, eff-yoo-oh stands for fever of unknown origin. What's this fancy, new acronym about?

"What does eff-ell-yoo stand for?" I asked.

She looked at me dumbfounded. "Uh...Flu?"

Later, that day, another patient and I were talking about menopause moments. I told her this story, all the way through my clueless question. I paused, waiting for the laughter.

"So," she said with an expectant smile. "What does it stand for?"

Sunday, May 11, 2008

How do I get 'dis connected?

This from Beverly:

I recently got a new laptop that is equipped for wireless, and I have a router and all that.

I couldn't get it to work, so I called the company. The lady very patiently took me through everything...finally I looked and saw that I had not turned on the switch that connected it all. I felt rather dumb! I thanked the lady over and over. I did feel foolish.

Thursday, May 8, 2008

If you can't say anything nice...

don't have a menopause moment.

My family and I having lunch at a restaurant in a mountain resort. The service was indifferent at best, and by the end of the meal had deteriorated to appalling. The final straw occurred when our waitress set our desserts next to our uncleared dishes from the meal.

Son and husband left while daughter and I lingered over coffee. When the check came, I was too annoyed to tip the waitress. But in an uncharacteristic fit of incivility, I also left a note advising her to find another career as she was completely unsuited for the one she was in.

As we hurried out into the cool mountain air, I realized I'd left my favorite purple windbreaker behind at the table. Did I go back in and face the server's wrath, or slink away without a coat?

Tuesday, May 6, 2008

Cat's got your phone?

Here's a teenage moment to rival any lapse I've got to offer.

I was reading in the kitchen when a string of unprintable words issued from the teen as he traversed the back hallway. I squelched the maternal impulse to run and check out the situation, and, indeed, no need to get up, he soon ambled round the corner at a leisurely pace, shoulders slumped sadly.

"I can't believe it. I dropped my *#?# cell phone in the cat's water."

Well this got me to my feet. "You what? Good heavens, did you fish it out?"

"Are you kidding?" He looked at me as if I was the one who'd lost my mind. "And touch that water?"

I flew around the corner and rescued the cell phone which, amazingly, still worked. And the teenager wisely chose to still use it anyway, cat water bath and all, rather than have no phone at all.

Saturday, May 3, 2008


I never think about nutmeg except briefly at Thanksgiving to once again note that I have none on my shelf when it's time to make pumpkin pie. Thanks to recent research out of India, I need to rethink my nutmeg indifference so that I may continue to think at all.

First, a word or two about making memories, in a biochemical sense. Acetylcholine is a neurotransmitter which allows neurons in charge of memory functions to communicate with one another in order to both make 'em and keep 'em--memories that is. Acetylcholinesterase is the enzyme that breaks down acetylcholine, and the inhibitor of same allows acetylcholine to work longer in the gap between memory-preserving neurons(1).

That is how some current medications for Alzheimer's disease, including Aricept and Exelon, work. London pharmacologists screened a number of Indian herbs for this activity(2) and found that even weensy bits of nutmeg extract diminished the activity of acetylcholinesterase inhibitor by 50%(3).

I don't even know if I really like nutmeg between never having it in the cupboard and not having a very discerning palate. I think I could learn to like it, however, if it supports my aging brain!

But watch out, if a little is good, a lot is not better. This spice can be toxic; persons actually abuse it for its psychoactive properties including hallucinations and euphoria. But then really, how euphoric can you get after downing a tablespoon-plus of nutmeg?
(1)This is why anticholinergic medications like benadryl and other antihistamines (used for allergies and sleep), oxybutynin (used for bladder control), and amitryptilline (used for sleep and chronic pain control) can befuddle susceptible older persons and should not be used.

(2)Mukherjee, PK, et al. Screening of Indian medicinal plants for acetylcholinesterase inhibitory activity. Phytother Res. 2007 Dec;21(12):1142-5.

(3)Other winning herbs in a acetylcholinesterase inhibiting sort of way included Centella asiatica, Nardostachys jatamansi (more on this one in a later post), and Evalvulus alsinoides. They also inhibited the enzyme's activity by 50%. I googled them all; you can buy them as supplements.

I've flipped my lid!

Menopause moment from Wendy:

I was cold when I got home, so decided to warm up some milk and make hot chocolate. Opened a new tin of cocoa. I like to make my hot chocolate with honey and cocoa - the old fashioned way.

Took off the red plastic lid, peeled back the inner seal, spooned out some cocoa and then tried to put the lid back on. Didn't fit. I tried to screw it on. Wouldn't work. Tried to clip it on somehow - still didn't work. It just sat on top of the tin (actually cardboard) container of cocoa. I squished it on, only to spill a bunch of chocolate powder on my t-shirt.

O.K. - now I'm getting mad. What is wrong with these people! They can't even make a lid to fit - actually fit back on the container ?? Why do people have to make things so cheaply these days?? This is crazy. I'll just call the company.

I called the 1-800 number on the tin.
"How can I help you, ma'am?"
"I can't get this red plastic lid back on my cocoa. I've tried to screw it on, or clip it on, and I've only succeeded in spilling cocoa. This lid does not fit properly!"
"Oh, just a moment, I'll go and get a container and lid and see if I can help you solve this. Would you mind if I put you on hold?"
"Not at all. Thank you."

Thinking to myself: stupid cheap companies. If they think they can get away with lids that don't fit......
Hmm - what happens if I flip it over and put it on.

Click! Like magic the lid snapped into place.
I was mortified! Oh no - I had it on upside down!!! My fault entirely - and here I was blaming the company.
Should I wait for the customer service person to come back on the line?
No - I chickened out and quickly hung up.

Oh boy, he must think I'm the dumbest person alive. Maybe he even thought it was a crank call. Nobody would be that dumb!
The phone rang. Agggggg - don't tell me it's him, wanting to know why I hung up!

Whew - it was only my daughter. I was laughing when I answered the phone, so had to tell her of yet another "menopause moment."

Please send me menopause moments of your own for sharing. E-mail me at:

Monday, April 28, 2008

Hold that thought AND the box

I'd inched my way down the first step with a heavy box of books when I noticed that I felt off-balance on looking down. Ah, still had my reading glasses on. Set the books down on the landing with a heavy thump, pulled off the glasses, and scratched the tip of my nose. Gathered box and books back in my arms, and resumed my careful descent.

Dang, still dizzy. While my nose was no longer itchy, I was once again wearing the glasses.

Sunday, April 27, 2008

The benefits of progesterone

I woke up this morning, made coffee as usual, then sat down with the Sunday paper. I realized by page 10 that the smell of the ink (something I'd never noticed before) was grossing me out. I had to leave steaming coffee and paper or risk throwing up. Whoa, thought I, this feels like morning sickness.

Lying miserably in bed, I remembered that I was on the day 2 of the progesterone cycle of my combined hormone therapy. And, indeed, as morning sickness is probably caused by the high levels of progesterone in early pregnancy, this a.m.'s passing upset may well have been the menopausal equivalent.

I am not alone in my ambivalence towards progesterone; other women find they too are woozy and sleepy on natural progesterone. The research of Emory University's Dr. Donald Stein reassures me that progesterone is not without benefits to brain even if the acute effects include sedation and dizziness.

A major problem with head injuries is that not only does the part of the brain injured by the blow lose neurons, but the adjacent brain cells are also at risk of dying off as a wave of inflammation caused by the trauma spreads laterally. Dr. Stein and his colleagues in the Emory's Emergency Department, frustrated by their inability to prevent this devastating secondary injury to unharmed gray matter, set out to test whether or not progesterone could benefit traumatic brain injury (TBI) patients.

Until recently, the primary treatment for TBI was high dose steroids, but the evidence for the efficacy of this approach was sparse. In fact, a 2004 study compared the outcomes for thousands of head-injured patients, half treated with steroids and half not(1). The trial was abruptly terminated when it was found that 2 weeks after injury, the steroid-treated patients had a greatly increased risk of death.

Testing on both human and animal subjects suggest that memory, executive, and spatial functioning is best during mid-cycle (ovulation) when progesterone levels are highest. Animal models of TBI and stroke show that progesterone reduces brain swelling and greatly protects neurons surrounding the primary area of injury from dying. Stein and company found that rats treated at the time of injury had quicker and more complete recoveries of brain function. Initial trials on humans (and progesterone is a non-feminizing hormone that can be used in men who are more likely than women to experience TBI) suggested that the early use of progesterone after head trauma improved odds of being undead one month post-injury by more than 50% and those progesterone-treated survivors had a trend towards better functional recovery(2).

So why does progesterone lead to sedation and, in some, such a morning hangover? Stein notes that progesterone binds to GABA receptors in the brain --the same ones targeted by Valium, Xanax, and other such tranquilizers-- causing temporary sedation. These effects are passing, and the net effect of progesterone on brain is neuroprotective.
1. Sauerland, S, et al. 2004. A CRASH landing in severe head injury. Lancet. 2004 364: 1291-1292.
2. Stein, D, et al. ProTECT: a randomized clinical trial of progesterone for acute traumatic brain injury. Ann Emerg Med. 2007 Apr;49(4):391-402,

Thursday, April 24, 2008

Shady business

My patient was in today about her chronic insomnia. Like so many women, her sleep changed with the menopausal transition and never returned to the good old ways.

As we sat talking, she fiddled with her sunglasses in her lap. Midway through the appointment, she put them on. A puzzled look crossed her face for a moment as if she wondered, briefly, why the room had dimmed. She pulled them off, and we both had a laugh over that.

As we bent over her test results together, she opened her purse and got out her reading glasses. Not a minute later, she lifted the sunglasses and attempted to put them on over her readers.

Sleep deprivation or just a plain old menopause moment?

Tuesday, April 22, 2008

If you can't say anything right...

Don't say anything at all!

Shopping with spouse, he comparing the price per square foot of paper towels, me wondering if this outing is materially affecting the length of my remaining life.

Along comes a patient who greets me "Hi Dr. P!"

Argh, dig deep, it's a big leap from towels to names. The details of her last visit come up on the mental screen, but there's a hole where her name lives.

"Uh, hi....Irene." I smile uneasily. She hurries her cart and her partner out of the aisle.

Dang, I realize immediately that's Ilene. Perhaps she thinks she heard me wrong. Perhaps not.

Thursday, April 17, 2008

Losing my buttons!

I sat at my desk today, retrieving patient messages on my cell phone. One of those push 1 for this and 2 for that sort of voice mail systems. I pushed 2 to get the new message. Nothing. No beep, no response, nothing. So I pushed it again, harder! Nothing. Then I realized that I was pushing the 2 button on my desk top phone while holding my cell phone to my ear.

Monday, April 14, 2008

And you are...????

Ah, it' I'm always on my toes at the grocery store, ready to recognize and greet patients that I may have met only once in my life. I usually remember the faces and something personal, like where their children go to school, or where they work. But names? That's a problem mostly because new names seem to me like random tags without any associated memories to link them with a face.

What, however, of persons who can't recognize faces? This problem, dubbed prosopagnosia, can be so severe that these people have trouble identifying their nearest and dearest. Once thought to be rare as can be, researchers now believe that 2% of the general population have face blindness severe enough to affect their daily lives.

Are you in the facial know? Check out Faceblind for two little recognition quizzes. The first presents an array of famous faces that does require a certain visual knowledge of the famous and the infamous. During the second, you will have a small amount of time to familiarize yourself with twenty women, then will be asked to recognize them as they appear on your screen amonst the unknown. It's fun!

Saturday, April 12, 2008

DNA loves company

We can't change them into the happy, laughing life of the party, but we can keep them out of the coffin.
---Steve Cole, genomics researcher at UCLA

The chronically lonely are known to be more likely to suffer from ill health. A recent study suggests that this state of mind actually affects gene action in a way that decreases immune response and increases inflammation.

Dr. Cole and his colleagues set out to find the biological basis for the detrimental effects of loneliness on health. They studied the DNA of a group of 153 volunteers, looking for abnormal gene expression as related to the self-expressed degree of loneliness in their subjects.

The UCLA Loneliness Scale was used to determine just how isolated these folks felt. Then DNA gleaned from white blood cells of the 8 top lonely scorers was compared with the DNA from the 6 subjects most connected to others. The researchers found 209 genes abnormally expressed in the lonely genome, many involved in activation of the immune system and production of inflammation. The genes in charge of inflammation were overexpressed, and those that regulate the production of antibodies against bacteria and viruses were underexpressed.

These results may explain why isolation and loneliness increases vulnerability to infection and cardiovascular disease. Dr. Cole theorizes that strategies that decrease inflammation may promote better health amongst the isolated.

Saturday, April 5, 2008

Verbal fluency

Verbal fluency (VF) is defined as the ease with which a person can find the right word and use it at the right time. Verbal fluency tests generally involve a timed interval in which a person is asked to name as many animals (fruits, vegetables, words that start with Q, etc) as they can during that time.

I test my verbal fluency every day in the consultation room as I explain this, that, or the other medical condition to a patient with more or less ease. Progesterone definitely slows down my VF as does a lack of estrogen. Progesterone is known to have sedating effects on the brain, and my frontal lobe is clearly affected by my periodic use of Prometrium, a proprietary formulation of natural progesterone. A dose at bedtime gives me a great, dream-filled sleep but leaves me fumble-mouthed on the job the following day.

Likewise, estrogen has a strong influence on verbal memory, and some of my patients who choose to motor into menopause without HRT find their word-finding abilities seriously impaired. Estrogen supports the function of cholinergic neurons in the brain (those brain cells that communicate one to another via a neurotransmitter called acetylcholine). Cells in charge of verbal memory and executive functioning are cholinergic neurons and thus affected by lack of estrogen. Likewise, anticholinergic medication such as antihistamines (which are used as over-the-counter sleep aids) also can leave the user tongue-tied with respect to VF.

Not only does dementia cause decrease in verbal fluency, so often do head injuries (as the frontal lobe sitting just behind the forehead, is often first to hit the windshield in accidents), Parkinson's disease, schizophrenia, diabetes, and alcoholism. Persons with chronic lung disease are known to have cognitive troubles whether or not they're running short on oxygen levels. Ohio investigators found that 20 minute exercise sessions significantly increased verbal fluency scores on patients with COPD.

Thursday, March 27, 2008

Rats! It's Welch's!

The average rat lives for 24 months. A 19 month old rat, therefore, is getting on in months and may well be on its way to becoming a doddering old rodent. In an effort to see if rats could retain their marbles well into their second year, investigators at Tufts University encouraged an aging rattine* group to exclusively drink Concord grape juice from the age of 19 to 21 months. One group knocked back a 50% concoction, another a 10% brew, and a confused final group got no grapes at all.

The half-strength gang excelled at motor skills (the team reported that this group of elderly daredevils were able to hang onto a wire for two seconds longer than all the rest -- suspended perhaps above a pen of hungry cats?). The ten-percenters, on the other hand, mastered a Morris water maze with an ease that shamed their thrashing colleagues, and then they oozed far more dopamine from their striatal slices -- this after they no longer needed their brains to stay afloat -- in a manner not usually seen in aging vermin.

The implications for those of us humans attempting to hang onto our aging brains but not necessarily wires? Dr. John Folts of the University of Wisconsin concludes that "a good antioxidant might be helpful" to old neurons. I don't know about you, but I've switched to Welch's as my a.m. juice du jour.
*Just to prove you can find anything on the internet, check out the discussion on ratty adjectives at Ratty and rat rights.

Docosahexaenoic acid or DHA

DHA is an appealing PUFA (poly-unsaturated fatty acid) delivered by fish oil. French investigators theorize that this PUFA or omega-3 fatty acid becomes incorporated into the cell membranes of neurons. Once embedded in the cellular surface, DHA may protect against the injurious effects of beta-amyloid, the protein fragment that gums up the brainworks in Alzheimer's disease.

And in clinical news, a decade long study of Boston old fogies* showed a 48% decrease in the incidence of AD among those who had the highest levels of DHA from their regular intake of fatty fish.

Lead author, Tufts scientist Dr. Ernst Schaefer had this to say "These dramatic results show how older adults can play a significant role in their neurological health by increasing their intake of fish, fish oil or especially, DHA."
*Arch Neurol. 2006 Nov;63(11):1545-50.

Tuesday, March 18, 2008

Silent brain infarctions

...and no air through the airway means no oxygen to the brain!

Clinically identified stroke represents the tip of the iceberg in terms of cerebral vascular disease by at least an order of magnitude...It is hard to believe, however, that loss of brain tissue should go without consequences. The brain may reorganize functional networks to adapt to lesions and recover function. But with each subsequent stroke, the capacity to do so is diminished.
--Brian J. Murray, MD

Silent brain infarctions or SBIs occur when a small amount of brain tissue is lost due to a lack of oxygenated blood to the area caused by a blockage in its blood supply. While any one such event can pass unnoticed, the cumulative damage from many such events builds up over time until the loss is manifested by neurological symptoms such as confusion or unsteadiness with walking. Nursing homes are filled with old ladies who lost their independence piecemeal in just such a fashion.

Scary new news on SBIs--one-fourth of persons with obstructive sleep apnea (the bedmate who keeps you awake as you lie awake waiting for him to take his next breath) were found in a Japanese study to have evidence of extensive silent strokes on MRI imaging.

How do you know if you've got sleep apnea if no one is lying awake waiting for you to breathe, and then telling you about it in the morning? Excessive daytime sleepiness,* a high red blood cell count, hypertension, and a short, thick neck are often associated with this dangerous condition.
*As your oxygen levels drop off when you stop breathing, brain sensors rouse you to near consciousness to get you to make that big, annoying (to your bed partner) gasp for breath. While you may not be aware that you are waking up multiple times during the night, the lack of deep levels of sleep leaves you heavy-lidded by early afternoon.

Tuesday, March 11, 2008

Menopause morning

Moment, shmoment, this is turning into a day long lapse.

After looking frantically about for my cellphone, I called it to see if I could hear it ring somewhere in the house. No sooner did I hang up but the phone rang, my office manager calling to say the MIA phone was ringing on my office desk where I'd left it last night.

Then I rushed to exercise class, skidding into the lot at the last minute but, alas, no athletic shoes in the car. Between the moment I picked them up and the time I settled into the car, they vanished both from consciousness and arms.

When I arrived (late) to my dentist's office, I explained to his middle-aged receptionist the aggravating events of the day.

"Oh," she said in reference to the missing shoes, "I've done that. They're on your kitchen counter."

And so they were.

Monday, March 10, 2008

How can you tell if you've got memory problems?

Women who do too much classically suffer from CRS (can't remember you-know-what).

Overwhelmed and inattentive, we hurry with great purpose into the kitchen and arrive clueless as to why we're there. At what point, however, does distracted crossover to demented?

While people with age-associated memory deficits may have difficulty recalling names and retrieving information, their day-to-day functioning remains normal. Dr. Julie Fago of the Center for Aging at Dartmouth Medical School lists the following warning signs indicating when "brain freeze" may be progressing to Alzheimer's dementia.

* Inability to follow a complex train of thought, such as cooking a meal
* Trouble formulating problem-solving plans
* Difficulty finding the way in familiar places
* Increasing difficulty finding words or following conversations
* Increasing passive, unresponsive, irritable or suspicious behavior
* Misinterpretation of visual or auditory stimuli

So it's not a problem when patients forget they had an appointment with me (at least it's not a problem with respect to the long-term outlook for their brain). A cause for worry would be if they missed their follow-up visit because they couldn't find my office.

Saturday, March 8, 2008


Brain injuries, whether traumatic, toxic, or ischemic (lack of blood flow due to stroke or aneurysm), cause immediate cell death that is unavoidable. A secondary wave of death occurs, however, when cells adjacent to the damaged site basically commit molecular hari-kari. This secondary die-off is called apoptosis which means 'fading away,' an unfortunate event occurring in healthy neurons exposed to inflmmation.

Researchers have found in animal experiments that estrogen "dramatically" protects against this delayed cell death in brain injury. Neurobiologists at the University of Kentucky began the investigation by removing the ovaries of 100 rats, plummeting the unsuspecting rodents into menopause.

They then gave half the rats low doses of estrogen. After one week, the rats were subjected to an 'experimental stroke' as the researchers cut off blood flow through a cerebral artery. While estrogen did not protect against the initial cell death that occurred within hours of the stroke, it did markedly reduce the secondary damage.

Estrogen is known to have both direct and indirect benefits to brain cells. Scientists are working to develop 'non-feminizing' estrogens. In other words, such estrogen-like molecules would provide neurological benefits but would not occupy estrogen receptors in tissues like the breasts or uterine lining and, therefore, would not unfavorably stimulate these body parts in a cancer-causing sort of way.

Friday, March 7, 2008

Location, location, location

I gave my package addressed to Philadelphia, PA to the middle-aged clerk to weigh. She looked at the destination and smiled.

"I've been there," she said. "Alcatraz was fascinating."

That stopped me cold. Something not quite right about that statement.

"I loved the Golden Gate Bridge," she added.

Got it now. Right sights, wrong city.

"Oh, I think you mean San Francisco," I finally countered. She nodded in agreement and gestured to the package.

"I've been there too! Next I'd like to go to Niagara Falls."

That's in Florida, right?

Wednesday, March 5, 2008


Forget vitamins C and E. The unrecognized antioxidant hero of your molecular world may be melatonin. This hormone is produced by the pineal gland at the base of the brain particularly during the wee hours of the night. Melatonin levels are adversely affected both by light at night and aging, so if you're an aging insomniac, you should lie in bed and curse the darkness rather than light a single reading lamp.

Melatonin is a wonderfully efficient free radical scavenger. Free radicals are highly reactive oxygen- and nitrogen-based molecules in search of electrical stability. These unstable characters have such an immediate need for electrons that they will travel only an angstrom or two before exploding some important piece of your cellular machinery. The most effective antioxidant then is the one that's on site when these radical bad boys are produced.

Scientists call the area in which a toxic radical mutilates its neighbors the "reaction cage." Fat soluble vitamin E happily resides in the cell membrane, sopping up radicals in this reaction cage. Likewise, water soluble vitamin C works its magic in the water-based inner sea known as the cytosol. Not only does melatonin also work in these reaction cages, it is antioxidizing away in the mitochondria and the nucleus of the cell as well. In other words, melatonin is widely distributed throughout the cell, making it a scavenger extraordinaire, always in the right place at the right time.

Inexpensive, minimally toxic, and easily available in pure form (Consumer Labs tested 14 preparations and found them all to contain their advertised amounts of melatonin without contamination), melatonin has been lauded as a wonder treatment for the conditions that cause "feebleness in the elderly." In particular, melatonin prevents the secondary damage to brain cells caused by trauma, strokes, Alzheimer's disease, and Parkinsonism, effectively squashing the radical oxygen species produced as a result of these disorders.

If you've tried melatonin for sleep and found it wanting, consider coming back around on it in a higher dose, say 3 or 5 mg. This research suggests that you may want to take melatonin each night whether you need it to snooze or not.

Tuesday, March 4, 2008

Can't hold a thought. Period.

My forty-something patient and I chatted about her recent hysterectomy before we got started on the business of her annual exam. As we settled into her medical history, I ran through my usual questions about her energy level, sleep habits, diet, and exercise.

Moving on through the interview, I looked up and asked "So when was your last period?"

Monday, March 3, 2008

Estrogen and mood

Antidepressants are still first-line treatments for major depressive
disorder across the female life cycle, but when they fail, novel
approaches that integrate the use of estrogen are now being
investigated, including the use of estrogen by itself or in combination
with antidepressants.
--Dr. Stephen Stahl, UC San Diego

Investigators such as Dr. Stahl have an increasing appreciation of the many actions of estrogen on the brain. The same types of cellular receptors for estrogen that abound in reproductive tissues are also found throughout the brain, notably in many areas involved in mood and memory functions. Does your mind mind a lack of estrogen?

Dr. Stahl notes that phases of a woman's life associated with large hormonal fluctuations --think postpartum and perimenopausal-- are times in which a woman is at highest risk for the onset of major depression. Women with a history of a depressive episode following any estrogen shift are even more vulnerable to a recurrence following other 'reproductive events' later in life. In other words, if you think premenstrual was difficult, look out for perimenopause.

Stahl calls this phenomenon 'kindling,' and theorizes that each mood crash associated with estrogen withdrawal may actually damage the brain. He dubs this process excitotoxicity in which the neurons are literally excited to death, and these episodes increase the future risk of treatment-resistant depression under similar hormonal circumstances.

A study supporting the use of estrogen in the treatment of depression was conducted at Massachusetts General Hospital. Fifty perimenopausal women --defined here as the transitional state from cycling hormones to no hormones at all marked by irregular periods and elevated FSH levels-- were diagnosed with varying degrees of depression. Half were randomized by investigators to receive estradiol (known to some as 'bio-identical' estrogen) via a skin patch such as Vivelle Dot or Estraderm. The control subjects got sticky, hormone-free blanks.

Two-thirds of the estradiol treatment group were depression free after three months of patchwork compared to only one-fifth of those without hormones.

Is frustration frying your brain?

When your teenager awakens in the morning with a fully developed case of rage, do you go there with him, or do you smile benignly at the little darling and turn the other cheek? A study out of Maryland* suggests that your response may significantly influence your risk for a stroke.

I'll bet these Baltimore investigators had a field day with this one. They invited 67 "older subjects" down to the lab for an afternoon of testing. The unsuspecting seniors (ages 55 to 81) were subjected to "repeated interruptions of statements and harassment during mental arithmetic tests," while their vital signs were monitored as the aggravation wore on.

The hot reactors in the group raised their blood pressures along with their ire. These simmering subjects were found to have a significantly increased number of unsuspected little infarcts on subsequent MRI brain scanning (see 'The White Matter Matter' below). In other words, their explosive reactions to life's little unpleasantries had taken a permanent toll on the health of their brains.

Lead investigator Dr. Shari Waldstein concluded, "If these findings are replicated, it may be worthwhile to investigate whether treatment of stress-induced blood pressure responses -- in addition to the resting blood pressure -- can reduce cerebrovascular risk."
*Waldstein, SR, et al. Stroke. 2004 Jun;35(6):1294-8.

Sunday, March 2, 2008

Exercise and estrogen

Lady rats discovered that exercise plus estrogen was the magic formula for keeping their memory for maze-running intact. This interaction of estrogen and physical activity on the cells of the hippocampus which is the memory center of the brain may be important for humans as well.

Brain-derived neurotrophic factor (BDNF) is a molecule recognized by neuroscientists for its role in nerve cell growth and repair. In particular, BDNF promotes the growth of dendrites or those little tree-branch-like projections off a nerve cell body that hook that cell up with its neighbors. The more those neurons connect one to another, the easier the flow of important information such as the next word and the next word in the sentence that you are speaking.

Animal studies suggest that in the presence of estrogen, happy neurons bristle with dendrites. And lots of dendrites in the hippocampus and the frontal lobe of your brain promotes, perhaps, the fluent flow of speech. Without estrogen, dendrites drop off neurons like the broken teeth of an old comb. Those left out of estrogen and low on dendrites may be left dazed and confused in the kitchen, wondering for what they came.

Back to our California rats. While physical activity increased their hippocampal BDNF, this exercise effect was reduced by a loss of estrogen in a time-dependent fashion. In other words, the longer the rats went without estrogen, the less brain benefits were derived from working out on the old exercise wheel. By the seventh estrogen-free week, exercise affected BDNF levels not at all. What's even worse, voluntary activity levels dropped off as well; those rats who were out of estrogen were disinclined to bustle about their cages for the sheer joy of mousy bustling.

Estrogen replacement then restored the rodents' BDNF back to normal levels. And hopping back on the workout wheel, in combination with long-term estrogen use, increased BDNF the most of all.

The white matter matter

The brain is divided into two main regions: the superficial gray matter, and the white matter below. Gray matter is the surface control center; the nerve cell bodies in this layer connect to one another via long extensions called axons. These electrical connectors travel through the white matter, so-named because a white, fatty material called myelin surrounds and insulates the axons, one from another.

We have long known that damage to the gray area through stroke or injury results in devastating paralysis and loss of physical functions such as speech. Through the fancy radiological technique of magnetic resonance imaging (MRI), we now know that the white matter is also vulnerable to a patchy sort of damage which, over time, can have a cumulative effect on motor, speech, and thinking skills.

These damaged areas appear on MRI scanning as small bright spots within the large body of white matter. The number of these 'white matter hyperintensities' (WMH) increases with age. WMHs have also been linked to a history of hypertension, migraine, and depression. Microscopic studies done on brains whose owners no longer need them confirm that these areas represent ischemic damage due to a loss of blood supply and fresh oxygen to the tissue. Many bright spots in the brain do not foreshadow a bright future for cognitive functioning. The following two studies have aided researchers in understanding the significance of such MRI findings.

Maryland researchers at Johns Hopkins University scanned the aging brains of 3600 individuals and graded the white matter abnormalities from 0 (no white matter matters to speak of) to 9 (a huge load of stressed-out white matter). Over the next five years, they followed the group for the occurrence of stroke. The higher the grade, the more the brains failed to age in good style. Those whose white matter was heavily spotted and bright (grade 5 or higher) had triple the stroke incidence compared to those whose white matter was scarcely spotted at all.

In 1932, public health authorities in Scotland administered the "Scottish Mental Survey" to all the resident 11 year olds. In 1999, scientists at the University of Edinburgh rounded up a bevy of 78 year olds and compared their current cognitive ability to their pre-teen mental testing as well as their current brain MRI scans.* The scientists found that the amount of white-matter lesions in their subjects' aging Scottish noggins was a better marker for present mental functioning than the early-age IQ scores. Furthermore, the impact of the white matter changes was independent of youthful mental ability.

Don't take it's 'just age' for an answer if bright spots are spotted on your MRI scan. Get cardiovascular risk factors such as elevated blood pressure, cigarette use, elevated blood sugar, and high cholesterol out of your life.
*Leaper, SA et al. Radiology. 2001 Oct;221(1):51-5.Click here to read

Just plane trouble

I was standing in the crowded aisle of the plane, waiting for the attendants to unlock the doors and let us out. I realized, with a sudden weak-in-the-knees, adrenalin sort of rush that I did not have my purse with me. Hoping to find it stowed on the floor of my seat, now several rows back, I turned to face the crush of people pressing forward.

"Scuse sorry... left my purse...pardon me."

I squeezed my way against the crowd, arms held tightly against my chest. Finally, I reached my former seat and leaned forward to check the floor for my purse. Freed at last from my tight grip, it swung forward from my shoulder to hit me in the face. My very red face.