Friday, December 07, 2007
Losing my keys or losing my mind?
My car keys were nowhere to be found. I checked the usual places and I retraced my steps from the night before. Nothing. My pup, Buddy, has stolen socks and shoes, but he looked innocent. I asked my housemate, Tom, whether he had seen them. He said he hadn't. I got to work using a spare set, but I spent the day wondering whether losing my keys was the first step to losing my mind.

I consulted memory expert Dr. James Lah, an Emory University neurologist. I related the key incident, and he asked me if I usually put them in the same place (I do). He asked if I tend to park my car in the same spot (I do). He said that those habits are how we remember things, and he bet that Tom was the guilty party.

Dr. Lah says some memory lapses are a normal part of aging. If our attention is affected, memories won't be stored efficiently. Fatigue, hormone imbalances, stress, depression, certain prescriptions and distractions can all prevent us from remembering.

We can also have problems retrieving memories. If the storage areas of the brain are damaged by Alzheimer's disease, or a stroke, the brain won't be able to properly recall the information stored in the damaged area.

Lah says it's not unusual to forget names or misplace items occasionally. But forgetting something that you recently did, or forgetting a responsibility that affects your well being - such as not paying bills, may merit a doctor's scrutiny. As our population ages, screening for memory problems will be a critical.

While there are several drugs available for treating Alzheimer's disease memory and thinking problems, Dr. Lah says, excitement is building for neuroprotective treatments that are in the development pipeline, including a vaccine. The hope is that the drugs will prevent and eliminate the brain-clogging deposits that are part of Alzheimer's disease.

Turns out Dr. Lah was right about my keys. Tom had used them to take out the trash and left them in the box where the trash bags were, under the kitchen counter. It's good to know that my mind wasn't the issue... in this case.

Do you worry about your memory? What do you do to keep your memory sharp?
Wednesday, December 05, 2007
Breaking the silence
There was a time when my best friend, Sarah, was the "sex lady." Out of college, one of her first jobs was as a sex educator. Sarah was passionate about it. Often, she would bring work home and, like many of us, dump it by the front door. On more than one occasion, I walked into Sarah's apartment and was greeted by a poster sized picture of full-blown chlamydia. I guess when you talk about sex all day, you don't think twice about what you leave in the hallway.

I thought about Sarah and her days as the "sex lady" recently when I took my dog, Bella, to our local dog park. I ran into "Apoo's Mom." (At the dog park, humans don't go by their real names. It's kinda like being in the CIA.) Apoo's mom is a pathologist. She works in women's health. She spends most of her days looking at slides. We got to talking about, you guessed it, STDs. Apoo's mom went to medical school in Europe and then came to the United States to do her residency. She says she is shocked by the STD problem we have in the U.S. "Almost every slide I see has trichomoniasis," sighed my dog park friend as we watched our "children" chase squirrels. "It is really alarming."

Just a few weeks ago, the Centers for Disease Control put out its annual STD report. The CDC estimates that 19 million infections occur each year - that's more infections than the total number of people who live in New York. According to the CDC, the big three STDs are chlamydia, gonorrhea and syphilis. Left untreated, these STDs can lead to infertility and in the case of syphilis, kill you. Nearly half of all infections happen among people ages 15 to 24.

Intrigued, I called Dr. Claire Brindis, professor of pediatrics at the University of California at San Francisco. "It is a silent topic," says Dr. Brindis. She says a number of factors contribute to the high numbers. First, young people tend to have "serial relationships" and when the relationship becomes "serious," the rules change and condoms come off. "The condom becomes a symbol of trust," says Brindis. But over the course of time, if someone has a series of monogamous relationships (and has a fling here or there), their risk and their partner's risk increases.

Dr. Brindis also points out that some groups have higher rates than others. According to the CDC report, the rate of chlamydia among African Americans was more than eight times higher than the rate among whites. Dr. Brindis says scientists are still trying to figure out why. She says it could be that African American teens tend to have sex earlier and that they don't have the access to condoms other groups do. Another possibility is that the health care community is just doing a better job screening for STDs. "We have better and less invasive tests," says Brindis.

She says we need to get creative when it comes to educating young people about STDs. She mentioned a program in San Francisco that sends "safe sex" messages to teen's cell phones.

I am curious to hear what you think. Why do you think the STD rates are so high? What do you think needs to be done to lower it?
Monday, December 03, 2007
Awake: Waking up during surgery
"My toes wouldn't move. My whole body was completely paralyzed. I had no way to let them know I was awake...I felt the doctor take my hand and I thought oh dear god, they're getting ready to cut my hand."

That's Jodie Stanley describing being awake during surgery. It's a phenomenon called anesthesia awareness. Jodie, a registered nurse, says she had never heard of it until it happened to her. Victims have called it their worst nightmare. "They may remember sounds or conversations in the operating room or they may have excruciating pain or wake up feeling paralyzed, not being able to respond. It's like being alive, but inside a corpse," according to Dr. Peter Sebel of Emory University School of Medicine.

A new movie called "Awake" just came in at No. 4 in the weekend's box office tally. The thriller stars Hayden Christensen as a patient who is fully conscious but physically paralyzed during surgery. The movie's promoters have said, "It will do for anesthesia what 'Jaws' did for swimming in the ocean."

To be clear, anesthesia is very safe, and awareness incidents are rare. Out of the 30 million cases in which anesthesia is used, anesthetic awareness happens in about 1 or 2 cases out of every 1,000 according to the American Society of Anesthesiologists.

Researchers believe that anesthesia awareness is under-reported by 50 percent to 100 percent of the official numbers, says Carol Weihrer, president and founder of the advocacy group Anesthesia Awareness. She bases her numbers on her own experience as an advocate and information she has pulled together from other organizations.

She emphasizes that whenever it does occur, the impact can be traumatic. According to her organization, approximately 50 percent of awareness victims suffer from post-traumatic stress disorder.

It's definitely a scary risk however remote, but there are certain things that can help reduce your risk of experiencing anesthesia awareness. Brain monitors can help reduce the risk by more than 80 percent, but they are available in only half of operating rooms according to Sebel.
Here are some important points you should address with your doctor before going under:

Operating room brain monitors: Are they available in your facility?
Weight: Your body mass index (BMI) or amount of body fat is a factor. Anecdotally, women and slimmer patients report more awareness.
Age: The older you are, the less anesthesia you need.
Existing disease: Your risk can change, especially with diabetes or cancer.
Medications/herbal supplements: Any medications including herbal supplements can have a big effect on the anesthesia.
Type of surgery: Some surgeries are more susceptible to awareness including cardiac and obstetric operations and acute trauma surgery.

Have you or someone you know experienced anesthesia awareness?
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