Menopause Moments

Aw shoe-t! Tucking moments on moments

2011-03-08T10:44:00.005-07:00

I tried not to stare at my patient's feet as we discussed her medical condition. I couldn't help wondering, however, me being a doctor and all, whether or not there was something wrong with her left foot. Was that an orthopedic old lady shoe styled for grandmas with bunions?

When she settled onto the exam table, she smiled and stretched out her feet. "I couldn't find black socks this morning, so I settled for brown. But I didn't notice that I had two different shoes on 'til I got to the office--I'm hoping everyone assumed I wore this other shoe because my foot hurts."

Later that afternoon, I recounted this story to another like-minded (or no-minded?) old soul. She laughed, then cleared her throat and said with an apologetic smile "Did you know that your sweater is tucked into your pants in the back."

Good lord, couldn't remember just when I'd gone to the restroom, but I hoped that everyone assumed this partial tuck was part of a deliberate look.

Brownie points

2011-03-06T19:51:00.007-07:00

...an honorary menopause moment

Text from teen: So when will the brownies take effect?
Text from mom: Well they must already be working because you just texted your mom. I'll be right there to pick you up.

Tablet rasa

2010-11-20T12:56:00.004-07:00

Me: What supplements do you take?
Middle-aged woman: Glucosamine...B...er...E...oh yeah D...fish oil...ginkgo...and...um...ohh that other C one.
Me: Do you mean vitamin C?
MAW: (laughing) Yes, that's it!
Me: The gingko's not working.

Hare to hair!

2010-11-13T16:26:00.005-07:00

I was shuffling down a leaf-covered sidewalk, enjoying the late afternoon sunshine. The lady of the house was out front raking, her mid-sized mutt clamoring at her heels for a game of fetch. Spying me, he grabbed his small toy, a saliva-soaked bunny, and dropped it at my feet. He was used to the well-aimed flick of an expert wrist, so he raced down the block anticipating the toss. I, in turn, heaved the soggy animal and hit his mistress upside her head.

A neighborly piece of advice?

2010-06-27T13:41:00.001-06:00

Five words you do not want to hear from your son while you're out of town whether you're menopausal or not:

Did the neighbors call you?

Baked and befuddled on the Boulevard

2010-06-02T21:04:00.005-06:00

I went to a lot of trouble to cross midday traffic on Colorado Blvd. to get to The Great Harvest Bread Company. Cute little bread girl pierced like a pin cushion gives me huge slab of 9-grain bread with butter to eat while I'm waiting for my loaf to go through the slicer. I pay up, leave with bread in hand, savoring my good luck and the fact that I will have something to munch on as I crawl home through northbound traffic.

After slogging through two blocks of brake lights, I start thinking about bread in hand vs. bread in bag...sliced...sitting undisturbed on the Bread Company counter. Beskewered bread girl does not offer me a second slice of bread, nor does she find my "Oops, menopause moment!" comment the least bit funny.

Whose moment was this?

2010-05-24T20:55:00.004-06:00

My patient and I chatted as I did her Pap test. I always try to carry on a bit of light conversation during this uncomfortable task.

I withdrew the brush, trying, as always, to do so without knocking the tip into the speculum. Who knows what happened next, but the flexible plastic handle bent like a bow, sprung from my fingers. flew through the air like an arrow then bounced off of the wall and onto the floor.

My patient did not miss a beat but continued her story about her college-age son. Could she really not have noticed the brush as it circled above her and landed on the floor next to the exam table? Barely suppressing my urge to burst out laughing, I fumbled for a new brush and repeated the sampling. If my patient was aware of my antics, she was too polite to say.

Making medical decisions in menopause: A workshop

2010-05-23T15:37:00.006-06:00

I have a patient who worked as a day trader. You've got to have the metaphorical equivalent of certain male parts to do this kind of work--remaining focused, aggressive, and ruthless in a high stakes, high stress undertaking. She came to me because her world as day trader had fallen apart with the onset of menopause. When the market crashed in early October, 2008, she reported that she'd sat frozen in front of her computer, knowing that she needed to react and regroup yet unable to do anything but watch the debacle.

"You have to understand." she said with uncharacteristic (for her) tears in her eyes, "This was not me."

She proceeded to tell me about other pre-menopausal activities that had been her, namely extreme sports and risky jobs the likes of which I never once considered as options for my cautious self. Yet despite these major changes brought on by diminishing levels of estrogen, her gynecologist declined her request to consider estrogen therapy; she was not, after all, experiencing hot flashes.

One of the best kept secrets about the myriad of changes brought on by menopause is the profound effects that the loss of estrogen has on the brain. There is no doubt that some women do just fine in cognitive and emotional ways through menopause and beyond, but many do not. When my patients report that they are "doing just fine" post-periods, I always ask "How's your mood" and "How's your memory?". Not unusual, then, for me to uncover evidence that, in fact, they are not doing just fine at all.

If you are interested in hearing more about making the complex decisions involved on the road to our 600 month birthdays and beyond, please consider joining me for a menopause workshop on June 5th from 10:30 to noon at my Denver office. Please call 303-393-0300 to register; the non-refundable $20 fee is due at the time you sign-up. You do not need to be my patient to attend. If this topic is of interest to you but June 5th is a no-go, leave your name and number with my staff, and we will contact you with dates later in the summer when I will present the same material.

Hippocampal volume, aging, and estrogen

2010-05-08T18:32:00.007-06:00

If you're reading this blog, chances are good that you have some concerns about your aging brain. You are certainly not alone; I often field questions and complaints about decreasing memory function associated with advancing years.

The most common memory-related issue is the most difficult to assess, namely when is it time to worry, when does forgetful cross the boundary from normal to pathological. If we set cognitive normal at the level at which one's doctor functions, regular readers and my patients know that I would be inclined to overlook verbal slips and frequent loss of keys and reading glasses as a normal response to aging, stress, and general busyness.

In fact, neurologists have defined mild cognitive impairment or MCI as "a transitional state between the cognitive changes of normal aging and very early dementia"(1) that progresses to full-scale dementia such as Alzheimer's Disease at the rate of 10-16% per year. Well, that's not very helpful because, once again, we're stuck with the question of 'what's normal?' Researchers have stepped forward with clarification that's more or less helpful, citing the following characteristics of MCI:

Memory complaint preferably confirmed by another person
Objective memory impairment with a standardized assessment tool
Normal general cognitive functioning
Intact activities of daily living
Not demented

In other words, the person is bothered by memory troubles and, while other people have noticed the deficit, the subject's daily life is unaffected by mental deficits. I start to worry when I hear about troubles in job performance, difficulties with multi-step tasks that were not formerly a problem, frequent missed obligations, and an inability to learn new information. I am especially concerned when the kids call or come in with mom to discuss this issue, and--worst of all--when others are concerned but the patient is not.

Distinguishing so-called normal aging from MCI is, therefore, a bit slippery. One not-ready-for-prime-time technique that identifies slightly confused MCI types at high risk for dementia is the use of MRI brain imaging to measure the size of the hippocampus. This little brain structure sits to the inside of our temporal lobes located just above our ears and is so-named because it's shaped like a seahorse (but NOT like a hippo!). The hippocampus functions as VP in charge of memory formation. Along with everything else in the human body, these centers tend to shrink with age especially in those on the road to dementia. Rochester researchers launched a multi-disciplinary effort between neurologists, psychiatrists, and radiologists to see if measurements of the hippocampi of elderly test subjects with MCI reliably predicted who ended up dazed and confused at the end of nearly three years of observation(2).

In short, it did. The researchers adjusted for head size by computing the volume of the hippocampi as a function of total brain volume, and they compared the size of the subjects' memory centers to a previously studied group of elderly controls with normal mental functioning. A subject with an average hunk of hippocampus received a W score of zero whereas those with itty bitty hippocampi were assigned negative W scores.

The lower a subject's W score, the more likely they were to slip from MCI unto dementia. Those with W scores greater than zero, i.e. endowed with robust hippocampi, progressed to Alzheimer's Disease (AD) at the rate of 15% by study's end which is an average rate of progression as determined by numerous previous studies. On the other hand, among those with itty bitty hippocampi--W scores less than -2.5 which represents a memory center in the 1st percentile of normal size--50% were diagnosed with AD by study's end.

So where does estrogen therapy fit in? This hormone is known to promote neuronal repair and growth, causing rat hippocampal neurons to fairly bristle with spiky connections from one cell to the next. And the more hippocampal neurons connect with one another, the better the rat performs at various rat tricks!

For humans, however, in whom brain biopsies are considered bad form in every venue but TV episodes of House, M.D., MRI imaging was used to measure the size of hippocampi in the brains of post-menopausal women, some on hormones and some without. Researchers found a positive effect on hippocampal size associated with the use of estrogen. But this benefit was not seen in subjects enrolled in the Women's Health Initiative Memory Study who initiated hormone replacement for the first time years past menopause. This disparate effect of estrogen on memory as correlated with the timing of therapy relative to the onset of menopause suggests once again that there is a window of opportunity after which estrogen no longer preserves brain function.
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(1)Grundman M, et al. Mild Cognitive Impairment Can Be Distinguished From AlzheimerDisease and Normal Aging for Clinical Trials. Arch Neurol. 2004;61:59-66.
(2) Clifford, R, et al. Prediction of AD with MRI-Based Hippocampal Volume in Mild Cognitive Impairment. Neurology. 1999 April 22; 52(7): 1397-1403.

Old ladies and verbal fluency

2010-05-02T20:48:00.009-06:00

My last post covered data on the brain health of women abruptly plunged into menopause via bilateral oophorectomies (removal of ovaries), some of whom received post-op estrogen and some of whom did not. On average, those who did fared better in cognition as they motored on in life than those who did not.

So what about ladies who just fade into senescence in a non-surgical sort of way? Well, no paucity of info on that subject either. Consider the Research into Memory, Brain function and Estrogen Replacement study--more familiarly known as the REMEMBER study--where 428 Australian old ladies were enticed down to an Adelaide research center and put through their paces.(1)

How do you know which old Australian is still on her game? Among other things, you see who is fastest on the FAS test. This is a measure of verbal fluency which requires the subject to say as many words as they can think of that start with the letter F, then A, then S in 60 second testing intervals. The doctors down under tried this very task--among other tests-- on the subjects, comparing FAS scores amongst the ladies as associated with their early, late, or never use of estrogen through the golden years of menopause.

The old gals who gravitated to estrogen with that first hot flash bested the rest in FAS facility. Compared to these so-called "early initiators," the never users were not so FASt. But oy, the "late initiators," i.e. those Jills-come-lately to hormone therapy who decided to estrogen up after age 56 or five or more years post-oophorectomy; this group was slowest of all on the word retrieval thing.

These findings mirror those of the WHIMS study wherein women who were older than 67 at the onset of the Women's Health Initiative study were put on full dose Premarin and Provera many, many years post-menopause, thus qualifying as "late-late initiators". This sub-study of the WHI followed the group for the onset of cognitive troubles over the ensuing five years. When compared with a control group given look-alike placebo Premarin, this study group demonstrated significantly more problems retaining their marbles during follow-up.

All this research suggests again a 'window of opportunity' with respect to bolstering aging brains through the use of estrogen, the so-called timing hypothesis proposed by neuroscientists. If the brain, particularly the structures of the forebrain in charge of complex cognition, is full of estrogen receptors, why would it matter when hormone therapy is initiated?

More info to follow!
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(1) MacLennan, AH, et al. Hormone therapy, timing of initiation, and cognition in women aged older than 60 years: the REMEMBER pilot study. Menopause. 2006 Jan-Feb;13(1):28-36.

Window of Opportunity of Estrogen Therapy for Neuroprotection

2010-05-01T20:24:00.010-06:00

Catchy title for a workshop, no? It certainly caught my eye, but alas it was over and done with months ago, and I only heard about it this month.

Not too late, however, for me to share the gist of the message with you, namely that there is ample evidence that estrogen is brain protective--i.e. can decrease your risk of progressing from the occasional menopause moment into a permanent demented state of mind as the years go by--but only if estrogen supplementation is initiated at a time when your brain is still functioning normally.

Actually, this is not new news at all. Researchers have known for years that estrogen plays a critical role in brain function, particularly in those parts of the anterior brain known as the forebrain where memories are formed and complex functions such as learning and multi-tasking are initiated. Diminishing estrogen levels during that lovely adventure known as perimenopause are, therefore, often associated with problems in verbal memory (finding the right word at the right time and using it correctly) as well as difficulty in mastering new skills. Ever tried to teach an old lady how to use e-mail? And if you've spent any time in nursing homes, you are well aware that the majority of the residents are female and a large number of them are struggling with dementia.*

Doctors at the Mayo Clinic studied women who underwent oophorectomies (removal of one or both ovaries) before the age of menopause and compared their brain health through the years following surgery as compared with a group of subjects who hung onto their ovaries through a natural menopause.(1) Removing the ovaries at the time of a hysterectomy done for any reason (such as fibroids or abnormal menstrual bleeding) used to be a common practice in order to protect against the possibility of future ovarian cancer. Since the findings of the Women's Health Initiative made headline news in 2002, the use of estrogen therapy following such surgery has become increasingly uncommon.

Those women who underwent bilateral oophorectomy (both ovaries removed) before menopause were 1.5 times more likely to develop dementia as they aged than the control subjects who did not undergo surgery. And the younger the age at which they experienced loss of ovarian function (and thus loss of estrogen), the more likely they were to develop profound problems with cognitive functioning. Subsequent analysis of the data from the Mayo Clinic group as well as from other studies showed that oophorectomized women who received estrogen therapy until age 50--more or less the time of natural menopause--had a normal risk of dementia.(2) In other words, they were no more likely to develop Alzheimer's disease than women going through menopause in the normal fashion. Furthermore, menopausal women who took hormone therapy initiated at the time of menopause and continued for 10 years, i.e. from ages 50-60, had a reduced risk of dementia.

The scary news, however, regarding hormone therapy and dementia, came from the Women's Health Initiative which looked at the health effects of hormone supplementation in a group of post-menopausal women with an average age of 63 many of whom were a decade or more past menopause. The sub-study that looked at HRT and brain health called the Women's Health Initiative Memory Study (WHIMS) found that those women in the group who initiated HRT (and remember, this was a group specifically chosen for the characteristic that none of them had ever been on HRT prior to the study) years past menopause were significantly more likely to develop dementia.

Scientists have dubbed this the Timing Hypothesis of cognitive aging with respect to the protective qualities of estrogen. Take it early while your brain is still functioning normally, and it is protective. Take it later after you've begun to develop vascular changes from atherosclerosis or the protein plaques of Alzheimer's, and it not only won't protect, it might in fact accelerate the process.

More on the possible mechanisms for this dual effect of estrogen on brain tissue--protective early on and detrimental as aging progresses--in future posts.
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*Whereas the male residents, if there are any, are more than likely suffering from Parkinson's disease, a brain dysfunction much more common in men than women.
(1) Rocca, WA, et al. Increased risk of cognitive impairment or dementia in women who underwent oophorectomy before menopause. Neurology 2007 Sep 11;69(11):1074-83.
(2) Rocca, WA, et al. Oopherectomy, Menopause, Estrogen, and Brain Aging: The Timing Hypothesis. Neurodegenerative Disease.

The changing face of primary care

2010-04-09T15:06:00.002-06:00

My medical partner and I are facing big changes in the way we deliver medical care. I urge all of you--particularly my patients--to head over to Denver Doc Online and read about our dilemma, then leave your thoughts behind.

What's your read on this?

2010-01-10T13:40:00.002-07:00

I noticed this a.m. that all three pairs of readers were on the kitchen table. Oh-oh, I thought, that may spell trouble later on. But I didn't do anything about it, and now I can't find a single pair.

Cutting edge...

2009-12-27T16:38:00.004-07:00

Or lunatic fringe? Here's where the Christmas season took me:

1. I send a grocery certificate to our tireless paper man each year in thanks for his pre-dawn delivery of the news. I keep hoping that this little tip will cause him to throw it slightly closer to the door, but alas, that hasn't happened yet. I didn't send him one last year as I misplaced his "Christmas card" containing his self-addressed envelope (not stamped, however). Pulled a book off the shelf the other day, one that I read...oh say about a year ago...and found said card in play as a bookmark.

2. I received a rebate check about a month ago, not for much but 'free money' and a shame to lose it. But lost it was amidst the circulars and Christmas catalogues and back issues of "Science." While rooting around in my files the other day, I found it paper-clipped to the November bank statement.

3. My husband always totes a large trash bag out Christmas morning to throw away wrapping paper lest I grab it up for reuse next year. The bag swung with a metallic clunk against our radiator. On investigation, he found the scissors that I misplaced while gift-wrapping the night before. I have no idea how it got there, and I wondered if the lost roll of tape was in there too.

What a crumby surprise!

2009-12-09T20:44:00.003-07:00

At the end of this long day, I was writing in charts, snacking on chocolates with sprinkles. I noted a besprinkled candy crumb on the desk, plucked it up and popped it in my mouth. Well no, it wasn't something really, really awful, but I quickly fished that piece of fuzz from my winter gloves off my tongue.

Muffed my muffin mission

2009-12-08T11:23:00.004-07:00

I zipped down the basement stairs to get a package of English muffins out of the freezer. In a bit of a hurry as I had an afternoon engagement, I stopped by the guest bedroom to check out my hair in the mirror there. Would it need washing? Could it be saved with a bit of fluffing and a barrette?

Looking good, I decided, smiling at myself in the dim light. Looking really good. I ran back upstairs, puffed with a false pride of appearance uncommon to middle-aged women in sweats and slippers.

Back in the kitchen, my husband looked up expectantly for the muffins...the muffins still safe in the freezer.

Mary Karr's menopause moment

2009-11-21T15:34:00.003-07:00

Mary Karr, author of "The Liar's Club", has a new book out called "Lit". She was here in Denver on a book tour. A warm and witty speaker, Ms. Karr especially engaged my interest when she had the perfect menopause moment during her talk.

An audience member had asked her if she checked the details of the life events in "Lit" with others who were there at the time. She began explaining that memoirs were most importantly about the way the author remembers events, that there is no need for objective input on details. Midway through her discourse on the role of memory in memoirs, she forgot what the question was.

I just finished this book (lucky enough to get an advance uncorrected proof from Amazon!) and I highly recommend it to you. If Mary Karr comes to your city on her promotional rounds, go see her; she's a pleasure to hear.

The icing on the cake!

2009-11-09T20:33:00.008-07:00

My family's favorite dessert, reserved for special occasions such as birthdays, was the delicious Hungarian delight Dobosh torte. A bakery here in Denver called Vollmer's--long defunct-- was the one and only source of this cake so rich the hairs would stand on the back of one's neck. The end pieces were completely encrusted with chocolate sprinkles and were reserved solely for the birthday celebrant.

My niece Miranda texted me recently "OMG i just found vollmer's dobosh tort at king soopers!" A perfect treat for all of us during a most difficult week as her mom/my sister-in-law was coming to the end of her life with ovarian cancer.

Elaine had been refusing much more than a few mouthfuls of broth or a few swallows of diluted juice for weeks. When the dobosh torte arrived, she had a sliver, and then another. As the end drew near, Elaine said "It may be gilding the lily, but I think I'll have a piece of dobosh torte."

We gave her the end piece and she ate the whole thing--her last request, her final meal!

Put a lid on it!

2009-10-20T19:34:00.003-06:00

In the scheme of menopause moments, this was just a little menopause oversight, annoying but no serious consequences.

I spotted the stupid laundry, let it sit awhile, added the detergent and set the cycle. Then I headed out for the day, expecting to initiate dry and fold upon my return. Well, the soak's on me! Stupid laundry sat all day in soapy water because I forgot to close the washer lid before I left.

How's that for airing my dirty laundry?

The irony of the egg

2009-10-13T14:02:00.004-06:00

In an ironic but menopausal moment, I no sooner finished my last post but I headed downstairs. Cooking smells filled the air, and my first conclusion was that my husband, uncharacteristically, had decided to start in making brunch.

Imagine my surprise and dismay to discover the eggs I'd put on to hard boil prior to heading up to write bumping wildly about in what little water remained in the pot. The chronicling of one menopause moment leads to another.

Is this a new app for IPhones?

2009-10-13T11:10:00.005-06:00

I grabbed my blue fleece jacket after exercise class, thrusting my hand in the pocket to make sure my IPhone was still there. Reassured by its familiar shape, I pulled it out to check for messages. My first shock--it no longer had a cover. The second? My photograph of autumn leaves was gone, replaced by the original "earth from space" wallpaper.

My brain whirled, trying to figure out how a phone could transform completely in an hour. Only then did I come up with the alternative--and correct--conclusion that this was not my blue fleece jacket; mine, in fact, still hung from its hook.

The times when my first explanatory pass at a menopause moment is completely absurd are those when I feel most in danger of impending dementia!

Aging attorney flops at the courthouse

2009-08-15T14:06:00.003-06:00

This is a good moment from Miss Trial here in town:

I think I’ve seen the wearing of slippers to the office covered in your blog, but today I wore my flip flops to court! Didn’t notice until I was putting quarters in the meter, dropped a quarter near my feet and saw them. There was no time for turning back.

So, I flip flopped my way along the sidewalk to the courthouse, went through security and as the flip-flop sound echoed through the hallways I truly did notice people looking at my feet. I shrugged my shoulders and smiled weakly (very). In the courtroom I was able to position my briefcase so my feet didn’t show, and when I walked up to the podium I waddled in a way that the flip-flopping was minimized.

I think it’s time to carry a spare pair of dress shoes in my trunk!

Did Freud see this coming?

2009-07-25T13:38:00.004-06:00

Being very hip and New Age, I was having a texted conversation with a friend who is going through treatment for a serious illness. We were extolling the virtues of daughters at the bedside, and her daughter, appropriately named Georgia, has been a perfect peach. Here was my final word on the subject:

Who will take care of the aging parents who only have sins?

No offense to my own Freudian slip of a son, but I can kinda' see where that came from!

I must've been loaded...

2009-07-23T18:15:00.003-06:00

I've always pretended, as I performed that loathsome chore of unloading the dishwasher, that the exercise of sorting silverware would enhance my IQ. Apparently not.

I unloaded the plates and silverware, then put the dirty dishes from the countertop in the rack before tackling the cups above. I needed a break, so I closed up the dishwasher (I tend to walk into it, leaving my shins all abruised) and wandered around the kitchen sipping coffee and musing.

Back to the task at hand. Opened the dishwasher and thought, with satisfaction, ah hardly any plates left to unload. It was only after I placed the last slightly greasy dish in the cupboard that I realized that I had just put away the dirty plates I'd loaded up not 10 minutes before.

No increased IQ points for me!

Chewing out hubby

2009-06-10T18:31:00.004-06:00

My 50-something year old patient complained of irritability and impatience.

"I'm not myself," she said.

"That easy irritation, easy frustration, is common at this time of life," I assured her. "Snapping at your husband for the way he chews and stuff like that."

Her eyes widened with surprise and recognition. "Did I tell you tell you that?"

"No," I laughed, "I know about that because I hear about it from a lot of women our age."

"I feel so bad," she said, laughing harder than I was, "asking him how does he make an olive sound like a piece of celery."

Twofer honorary menopause moment

2009-05-27T23:46:00.003-06:00

These from Dada:

I'm typing this while the charcoal is heating on the patio. (I'm having my Memorial Day cookout. It's two days late. Reason? When I went to the store on the holiday for my bratwurst cookout items -- buns, brats, potato salad, mustard, etc. -- I returned with everything. Everything except the bratwurst! (And I had a grocery list.) I joined my wife for a veggie meal instead.)

But that's not my point. After reading your very funny MM glasses moment, I just had to share mine from this morning. (BTW, men can have menopause moments too, right? Maybe if not from that, maybe from all the cooked egg whites?)

Today was a landmark day. I would head out early to the Central Appraisal District's office to finally apply for my "over 65" property tax exemption. Mrs. Dada volunteered to go along.

"No, you sleep in, this shouldn't take me long," was my response. To make sure everything went smoothly, I even thought to take a copy of my birth certificate. I drove the 12 miles to their office very early as Mrs. Dada slept. Everything went exactly as I'd planned.

There were no crowds, I immediately signed in and moments later, before a clerk, was all set to go. That is, until she asked, "May I see a photo ID, like your a driver's license, please?"

Hopelessly groping for my wallet was futile. "Oh, I think I left it at home," I said sheepishly, sliding my birth certificate toward her. We both laughed as she slid my rejected birth certificate back to me as I related how the last things my wife always asks me as I depart the house to go shopping are, "Got the cell phone?" and "Do you have your wallet?" (It's almost embarrassing.)

This morning I wish she hadn't slept in, that she'd been around to ask me that last question; to save me 24 miles, a lot of time, and maybe an embarrassing menopause moment.

Fat city!

2009-05-10T12:52:00.008-06:00

A perfect Saturday morning for pancakes, cool and breezy, and I'm blowing off exercise class for a leisurely brunch.

Is it the coolness? The ambient humidity? Why is this batter so thick? Like bread dough thick. I add more buttermilk which briefly thins it out, then it gels back into a pasty goo. I add still a bit more liquid--cautiously, one teaspoon at a time as I'd once thinned a previous batch unto ruin--then I scrape three cakes-worth into the pan scarcely able to get the stuff off of the spoon.

My kids are way past pancake smiley faces, in fact neither one was even home for pancake anything. But listen, this plaster-of-pancake could've been sculpted into 3-D clowns at this point. Midway through cake one, I realize no one could eat two of these things and rise off the kitchen chair to tell about it. My husband graciously allows that "the consistency is atrocious."

Then he leaves his panbrick half-eaten and starts to put the ingredients away.

"Did you use heavy cream to make these pancakes?" he asks, holding up a half-empty quart of heavy whipping cream that looks suspiciously like the buttermilk container.

And I realize, with a literal lump in my stomach, that I've just put away nearly a half cup of real deal cream. Back to bed for a nap, too full for anything else.

"Dying for a hamburger"

2009-04-24T11:18:00.002-06:00

What a fascinating and highly readable book--when was the last time you raced through a non-fiction treatise?

Dr. Waldman and Ms. Lamb have written a winner, and I'm sorry to see it buried in the Amazon stacks without notice or acclaim. I don't even remember how I stumbled on this title but I'm glad I did. In the process of explaining how a hamburger may permanently alter your brain--for the worse--the authors take the reader through the history of cognition and aging as found in scientific textbooks, philosophy, and literature to prove that losing your marbles through the years is a relatively new phenomenon.

Then they move on to cannibalism, horrific neurodegenerative diseases, the germ theory of disease, the biology of prions, the evolving nature of the human diet, the complex relationship of humans to cattle, the meat-packing industry, and international food standards.

Consider the elegance of their explanation of misfolded proteins (the biological basis of neurodegenerative diseases) as seen in the common egg white:

"Imagine a large bowl of raw egg whites. These whites are made of a protein called albumin, which is folded in a unique way.. Because of its shape, this protein is a translucent liquid and can be dissolved in water, Now place a tiny amount of the egg whites in boiling water, where it cooks immediately. The protein is still albumin, but now it is a solid instead of a liquid...there is no way that the cooked egg whites can be made to revert to their uncooked state. All these changes happen because the protein is now folded in a different manner."

Want to better understand how you might possibly cook your brains with a misguided modern diet and the inattention of those to whom we entrust our food supply? Order one of Amazon's bargain-priced, used copies--this book is great food for thought.

Well maybe a backhoe...

2009-04-21T20:41:00.005-06:00

Power Point slide at a continuing medical education conference I attended today:

"A Tough Road to Hoe"

Ho, ho, ho. Maybe the lecturer was too young to know her way down a row.

Were both our oars in the water?

2009-04-19T20:18:00.005-06:00

I went out to lunch today with the mother of my daughter's boyfriend (if there's not a word for such a person in relationship to oneself, there should be!). She was in town for a convention, and it was high time that we bonded. We had a lovely talk over salmon salads and several cups of coffee.

After lunch, next agenda item was a trip to the art museum, but first stop was an urgent visit to the restroom there. While I was finishing up my business in the stall, I heard a woman singing. As we were the only ones in the room, I thought "Good lord she's singing in a public restroom." Simultaneous thoughts included "Are we old enough for that sort of thing?" and "That's something my mother would've done."

As I came out, H had a funny smile on her face and asked "Did you hear that?"

"You mean the singing?" I answered. "I thought it was you."

As I said this, I stuck my hands beneath the motion-activated faucet and it began to sing 'Row, row, row your boat' in a deep baritone. H stuck her hands back under the stream in her sink and a woman's voice chimed in, singing in a round along with the man in mine.

I kid you not. The sinks in the Denver Art Museum sing. And H and I bonded in a menopause moment of laughter.

At a lost for words at the dry cleaners?

2009-03-29T14:50:00.004-06:00

Oh this was too rich to relegate to the comments section. I recently wrote a post about a hare-brained encounter with the kindly Korean lady at my local dry cleaners, and wondered therein how I could explain my 'menopause moment' to her lest she suspect I was losing my mind.

MidlifeMidwife came to my rescue with this language lesson:

"geng nyeon gi ga wa so, mi chyeot na bwa yo. shirl soo hes so yo "

Literally, "because of menopause I went crazy and made a mistake" More like I wasn't in my right mind because of menopause.
(sorry, couldn't resist, my son speaks Korean)

How's this for openers?

2009-03-24T17:32:00.005-06:00

This menopause moment brought to you by Wendy, a blogger friend whose exploits rival mine; either neither one of us is losing it, or we both are!

I was walking round the neighbourhood this morning. The sun was out and the air was nice and warm. We still have snowbanks all around, but they are fast receding. Coming to a muddy ditch, I stopped to watch the fast-moving, icy-looking water, as it ran downhill towards the village.

Smiling and happy, I reach the end of my street, where our post-boxes stand like soldiers by the side of the road. Reaching into my coat pocket, I grasp my set of keys and nonchalantly push the button.
Nothing happens.
I push again.
Oh no!

Quickly, I look around. Nobody has seen me.
Whew!
Fitting my key into the lock on my mailbox, I take out the day's mail.
I can't believe I just tried to open my mailbox with my car door opener!
And my car, of course is at home, sitting innocently in the garage.

Non-neurotic extraverts don't dement!

2009-03-22T20:50:00.006-06:00

Just untangling the conclusions of this Swedish study was a brain workout in its own right, a downright 'how much wood would a woodchuck chuck..." sort of puzzle:

Neither high neuroticism nor low extraversion alone was related to significantly higher incidence of dementia. However, among people with an inactive or socially isolated lifestyle, low neuroticism was associated with a decreased dementia risk (hazard ratio [HR] = 0.51, 95% confidence interval [CI] = 0.27-0.96). When compared to persons with high neuroticism and high extraversion, a decreased risk of dementia was detected in individuals with low neuroticism and high extraversion (HR = 0.51, 95% CI = 0.28-0.94), but not among persons with low neuroticism and low extraversion (HR = 0.95, 95% CI = 0.57-1.60), nor high neuroticism and low extraversion (HR = 0.97 95% CI = 0.57-1.65).(1)

Got it? So do we fret and socialize, stay home and calmly knit, or placidly go out drinking with our buddies? Don't freak out while you discuss this conundrum with your friends because, as you will see once you sort out the various possibilities here, being a Buddha of a buddy is your best bet for the brightest brain.
_____
Wang, HX, et al. Personality and lifestyle in relation to dementia incidence. Neurology. 2009 Jan 20;72(3):253-9.

Use it or lose it...

2009-03-14T13:28:00.007-06:00

is now use it and grow some more.

We used to think is that what you got (in the way of neurons or nerve cells) was all you'd ever have. In fact, during the process of brain development in early of life, not only do millions of neurons migrate but also many die in the process of forming mature circuitry. Recent research, however, confirms that the process of neurogenesis or production of new nerve cells is alive and well in fully formed adult brains. The more we stimulate neural pathways, the more we spur on new growth in areas critical to cognition and memory.

One of our best features as successful actors in a challenging world is our ability to adapt to and learn from new experiences. Known as neural plasticity, this process involves both the generation of new neurons as well as novel hook-ups between the new and old cells in order to generate pathways capable of change and new behavior.

Scientists at the Institute for Cell Engineering at Johns Hopkins University have identified one step on the road to new brain cell development (albeit in mice)(1). Through an epigenetic process(2), they observed that nerve cells stimulated by brain activity--say the little mice were put in new environments which set their little mousy brains awhirl (Hmm, new stuff to climb, new things to sniff and eat, a brand new exercise wheel...)-- produced growth factors, thus stimulating the production of new neurons in the activated region.

One study that illustrates how this principle works in people as well as rodents was done by German scientists working with students learning to juggle. They performed magnetic resonance imaging (MRI) scans on new jugglers three months into their studies and noted a 3% increase in brain matter in certain juggling-related areas of the brain. When the students quit their juggling lessons (perhaps out of frustration, or too much to do, or just persuaded by the researchers to watch TV instead of throwing balls around), those juggling-amplified gray matter regions shrank back to pre-juggling levels.

So carry on with those Thursday, Friday, and Saturday New York Times crossword puzzles, or acrostics, or your Saturday a.m. Spanish language lessons. All those sparks flying about your aging brain are generating new cells and new circuitry even in your later years.
_____
1)Dengke, KM et al. Neuronal Activity-Induced Gadd45b Promotes Epigenetic DNA Demethylation and Adult Neurogenesis. Science Feb. 20, 2009, Vol 323 pp 1074-1077.

2)Epigenetics refers to changes in gene expression without change in underlying DNA. In this study, electrical activation of mature neurons induced a gene called Gadd45b to produce growth factors which trickled out into the immediately surrounding brain tissue causing local generation of new neurons.

Another example of epigenetics is the misguided series of events that occurs due to overeating of the wrong sort of food coupled with undermoving in a couch potato sort of way resulting in the metabolic syndrome and ultimately diabetes.

A clothes encounter of the bird(brained) kind

2009-03-01T21:12:00.006-07:00

Halfway through the Jazzercise class, I remember with a start that I've forgotten to pick up the dry-cleaning. Dry-cleaning that is getting dangerously near that unclaimed, overdue point at which the facility donates it to charity. After class, I sort through my purse for the ticket, but alas, that is missing along with my brain. No problem, these nice cleaners know me by sight.

No, says the little Korean lady at the counter, there's no record of cleaning here for you. Are you sure, I ask, two men's jackets, one khaki one navy blue? No, she says, sorting through computer records and racks in the back. I'm wondering what to tell the owner of those jackets (who will not be pleased) when she announces, with triumph, you pick clothes up February 19th.

Oh heavens, how do you say menopause moment in Korean?

Bye bye travel knit

2009-02-15T19:30:00.006-07:00

Well it's a new me, more or less. I just gave most all of my Chico's travel knit collection to a patient who promises to sell them on E-Bay and split the proceeds with me. I know that many of you will want to check out this wonderful opportunity to get yesterday's middle-aged look while they're still available.

That said, I held back my favorite outfit--a pair of flowered red and green on black pants (that a 9th grade boy in our carpool six years ago told me were cool) with a red top and black jacket. All travel knit. All hot as hell on that warm February day last week, and all of which were heavy and static-filled. I thought I looked pretty righteous until I got out in the sunlight and noted 1) The black of the seldom worn jacket and the black of the oft-worn slacks were entirely different, 2) the pants were too short which, 3) showed off the horror of my mother's leftover black (different black yet again) socks.

Yes, even my mother had she been around to see this outfit, would have opined "Jude, those pants...those socks...look awful."

Stay tuned to E-Bay; the silly clown pants should debut soon.

Water, water, everywhere

2009-01-31T10:56:00.004-07:00

I was chatting by phone with a friend yesterday afternoon. She was telling me about an albino squirrel that had gotten in her apartment, its quarrels with her aging cat, her reluctance to deal with it, her feelings of hapless victimhood. All in all, it was a saga worthy of Stephen King channeling Erma Bombeck but as long and rambling as The Stand.

So I decided to water my plants while interjecting the occasional "You're kidding?!?" to let her know I was still there. All was well with my multitasking until I became aware of sounds like rush hour in a men's urinal--water cascading from three or four over-saturated pots onto the tile floor below.

I guess I can no longer tend and attend--to plants and to conversations--at the same time.

Forget to eat and improve your memory?

2009-01-27T20:53:00.004-07:00

Fruit flies, threadworms, mice, and monkeys live longer when they are calorie deprived. The skinny silhouettes of old nonagenarians suggest that the same holds true for humans. Here's a small study that suggests brain benefits for those who underindulge.

German neurologists invited 50 overweight, aging Deutschelanders down to the lab for a diet trial with a twist. The subjects were, on average, sixty years old and a little overweight. Twenty of them reduced their calorie intake by 30% for three months, twenty ate the same number of calories but switched out their fats to the unsaturated variety, and ten motored on with no change at all.

At the start and the finish of the three month study, the subjects took a memory test that checked their ability to recall a 15 item word list after thirty minutes. The calorie-deprived group upped their scores post-dieting by 20% but the other groups had no better recall than when they began.

Could this mean that fewer calories enhances cognition? Maybe...as always, the researchers called for more research (and perhaps for more research grants).

Four Cups of Tea

2009-01-17T18:09:00.002-07:00

Not so much a memory lapse as a lapse of consciousness. And who but a menopausal woman would nod off over a book in the middle of a sunny Saturday afternoon?

In my defense, I was already 7,234 steps into the day. That included one Jazzercise 'Express' Class, a trip to Target, two loads of laundry, and vacuuming the entire upstairs plus the living room. So I felt entitled to a cup of tea at the kitchen table, feet up on another kitchen chair, and a moment with my current read "Three Cups of Tea."

My tea was still warm when my afternoon delight abruptly screeched to a halt as a half-dreaming jerk of the arm knocked that very cup of tea, nearly full, into my lap.

My cup runneth over, as doth my coffee pot...

2009-01-14T21:29:00.003-07:00

Again. Dang, did it again, twice in as many months. Turned the coffee maker on, but alas, no carafe beneath. Went upstairs, checked e-mail, plucked my eyebrows a bit, found my watch, made the bed, and moseyed downstairs to the smell of burned coffee which had overflowed the basket, on to the hot plate, down the counter, into the canned soup department in the cupboard below, then on to the (fortunately) coffee-colored kitchen carpet. Good thing Mr. Denver Doc snoozed through it all, arriving finally in a freshly mopped kitchen none the wiser as to my morning moment.

Junked mail

2009-01-06T15:34:00.002-07:00

don't read this post if you object to trash talk...

My husband shouted upt the stairs "Any mail today?"

"Oh yeah," I bellowed back, "It's on the counter."

"Which counter?"

Oh heavens, must I point out everything? "The kitchen counter, of course."

By now, I'm downstairs wondering how blind a soul can be. Alas, there on the kitchen counter is a small pile of catalogues and empty envelopes.

"You didn't throw it away, did you?"

What does he think I am anyway? "No, of course not," I said as I grabbed the kitchen trash bin and began to look through it.

Well...yeah...maybe I did...

Does this scene ring a bell?

2009-01-02T21:19:00.002-07:00

Reality Man smirks as he finds the phone, then writes in to rat on Reality Woman:

Tobi will not be outdone. One of our portable phones went missing. The usual suspects--the dogs--could not be convicted. The "handset find" feature seemed to produce no sound--until this morning, when I, the non-menopausal SO, turned on the feature and wandered near the trash can, which was plaintively beeping. The menopausally-challenged one ascribed it to "overzealous" cleaning of her space.

Trash talk

2008-12-18T20:17:00.004-07:00

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?

Stain or abstain: The coffee question

2008-12-14T16:02:00.003-07:00

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?

Grounds for concern

2008-12-02T10:09:00.005-07:00

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!

No waisting these pants!

2008-11-22T12:45:00.005-07:00

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?

Buy this woman a cold Flat Tire beer!

2008-11-02T11:46:00.002-07:00

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.

Acetyl L-Carnitine

2008-10-26T11:42:00.003-06:00

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.

Not so Level-headed

2008-10-22T19:56:00.007-06:00

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.

Sure.

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.

Menopause and working memory

2008-10-16T18:07:00.006-06:00

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.

Huperzine and the lack of menopause moments

2008-10-12T13:12:00.003-06:00

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.

Tossed my cookies!

2008-10-08T20:26:00.003-06:00

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!"

Is there a brain in the House?

2008-10-04T19:52:00.003-06:00

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?

Huperzine A--the first week's report

2008-09-21T17:59:00.003-06:00

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.

Wired for fashion

2008-09-19T12:39:00.001-06:00

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.

Honorary menopause moment

2008-09-16T20:55:00.004-06:00

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.

Muffed muffins

2008-09-14T20:59:00.001-06:00

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.

Polish off your breakfast!

2008-09-10T07:07:00.003-06:00

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.

In top condition!

2008-09-09T20:48:00.002-06:00

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.

Huperzine A

2008-09-05T20:42:00.009-06:00

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.

Not-so-Goldilocks and the three nights sleep

2008-08-23T10:11:00.006-06:00

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!

Color her clueless

2008-08-19T14:45:00.007-06:00

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

2008-08-19T14:15:00.007-06:00

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.

Don't mind your hot flashes...

2008-08-11T21:27:00.004-06:00

...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.

Meal curries no favor with patient

2008-08-05T15:31:00.006-06:00

(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.

Giving the husband the brush-off

2008-07-30T18:02:00.002-06:00

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.

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

2008-07-24T20:36:00.006-06:00

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.

Imagine me and you...lost

2008-07-23T19:58:00.008-06:00

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.

Tuesday, Tuesday, can't trust that day

2008-07-21T20:28:00.009-06:00

E-mail exchange:

From: Menopausebrain@noneurons.com
To: Unsuspectingsponsor@notmenopausal.com
CC: judy.paley@femailhealthnews.com
Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

...so 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.

From: judy.paley@femailhealthnews.com
To: Unsuspectingsponsor@notmenopausal.com
CC: Menopausebrains@noneurons.com
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...

From: Unsuspectingsponsor@notmenopausal.com
To: judy.paley@femailhealthnews.com, Menopausebrains@noneurons.com
Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

Tuesday Sept 2nd is the date.

From: Menopausebrain@noneurons.com
To: judy.paley@femailhealthnews.com,
Unsuspectingsponsor@notmenopausal.com
Re: RE: Lunch and learn - Dr. Paley - rescheduled for September 2, 11:30-12:30pm

Oh yes, tuesday the 4th - so sorry!

Listen, dear, who's playing our song?

2008-07-19T18:25:00.004-06:00

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!

I goofed, so Sioux me!

2008-07-15T11:19:00.007-06:00

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.

Don't send me packing!

2008-07-13T14:35:00.006-06:00

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!

Don't forget your blood pressure meds...

2008-07-12T20:53:00.003-06:00

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.

Hot flashes and verbal memory

2008-07-05T18:59:00.004-06:00

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.

Misplaced modifiers

2008-06-29T21:26:00.001-06:00

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.

Smeared memories

2008-06-26T12:17:00.003-06:00

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?

Minding the Gap

2008-06-24T07:35:00.006-06:00

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!

PET scans prove that neurons like estrogen

2008-06-20T09:22:00.008-06:00

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.

Someone cell me a brain!

2008-06-16T07:53:00.005-06:00

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:
judy.paley@femailhealthnews.com

Mad as a wet hen!

2008-06-15T12:43:00.006-06:00

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.

A pasty white woman

2008-06-05T23:43:00.004-06:00

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!

Verbal fluency and hormone therapy

2008-06-04T20:19:00.004-06:00

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.

Sleep apnea and memory

2008-05-28T17:55:00.001-06:00

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."

Is that your final diagnosis?

2008-05-20T20:48:00.006-06:00

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.

You think what you eat

2008-05-15T20:21:00.001-06:00

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.

Who's cee-ell-yoo less now?

2008-05-14T17:25:00.004-06:00

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?"

How do I get 'dis connected?

2008-05-11T20:11:00.002-06:00

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.

If you can't say anything nice...

2008-05-08T06:54:00.003-06:00

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?

Cat's got your phone?

2008-05-06T19:55:00.007-06:00

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.

Nutmeg

2008-05-03T15:00:00.005-06:00

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?
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(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!

2008-05-03T12:12:00.002-06:00

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:
judy.paley@femailhealthnews.com

Hold that thought AND the box

2008-04-28T20:47:00.004-06:00

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.

The benefits of progesterone

2008-04-27T14:42:00.009-06:00

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.
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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,

Shady business

2008-04-24T19:36:00.004-06:00

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?

If you can't say anything right...

2008-04-22T07:28:00.003-06:00

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.

Losing my buttons!

2008-04-17T21:02:00.004-06:00

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.

And you are...????

2008-04-14T21:36:00.001-06:00

Ah, it's....you. 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!

DNA loves company

2008-04-12T12:33:00.001-06:00

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.

Verbal fluency

2008-04-05T17:43:00.001-06:00

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.