Palliative care as a true art form
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How do you ease the pain from an ailment amidst lost words? How can you serve the afflicted when lines start to blur? When the foundation of communication begins to crumble, what will be the pillar health-care professionals can lean on to support patients afflicted with dementia during their final days?
The practice of medicine is both highly analytical and evidence based in nature. However, it is considered a “practice” because at the highest level, it resembles a musician navigating an instrument. It resembles art. Between lab values, imaging techniques and treatment options, the nuances for individualized patient care so often become threatened.
Dementia, a non-malignant terminal illness, involves the progressive cognitive and social decline in those afflicted. Though there is no cure, dementia is commonly met in the setting of end-of-life care. During this final stage of life, the importance of comfort via symptomatic management and communication usually is a priority in patient care. But what about the care of a patient suffering from dementia? While communication serves as the vehicle to deliver care at a high level, medical professionals are suddenly met with a roadblock. And there … behind the pieces of shattered communication and a dampened map of ethical guidelines, health-care providers are at a standstill.
It’s 4:37 a.m. You receive a text message from the overnight nurse at a care facility regarding a current seizure. After lorazepam is ordered and administered, Mr. H, a quick-witted 76-year-old, stabilizes. Phenobarbital 15mg SC qhs was also added to prevent future similar events. You exhale a sigh of relief.
Mr. H. has been admitted to the floor 36 hours earlier after having a seizure while playing poker with colleagues. Since he became your patient, he’s shared many stories from professional and family life with you, along with as many jokes as he could fit in between. However, over the course of the next seven days, Mr. H. would develop aspiration pneumonia, progressing to ventilator dependency and, ultimately, multi-organ failure with rapid cognitive decline.
What strategies and tools would you use to maximize the well-being of your patient during his decline? How would you bridge the gap of understanding between the patient’s family and health-care team to provide the standard of care that all patients are owed?
To give Mr. H. the type of care he would have wanted, upon his hospital admission, he should have been questioned about his understanding of illness along with the goals of care of the medical team. The patient should have been informed that it is imperative to adhere to the medical regimen implemented by his team along with the risks of not doing so. In the event disease-related complications arose, advanced directives should have been documented to avoid any unnecessary measures.
It is important to note, that with each change in status of the patient’s health status, the goal of treatment must be reassessed. The patient or surrogate decision-maker’s understanding of these goals is paramount in maintaining the patient’s autonomy. It is often said that effective communication is the bedrock of a healthy relationship. This is true regardless of type of relationship.
This is why I and Megan Vierhout wrote Integrated End of Life Care in Dementia: A Comprehensive Guide, a book targeted at providing a much-needed road map to navigate the many challenges involved in end-of-life care for individuals with dementia. Ultimately, our aim is to provide a compass for both health-care professionals and the families of those affected by the progressive effects of dementia. We provide practical advice on optimizing communication with individuals with dementia while taking their cognitive limitations, preferences and needs into account.
I invite you to explore the unpredictable terrain of end-of-life care for patients with dementia. Together, we can pave a smoother, sturdier path toward the practice of medicine as a true art form.
This article is republished from healthydebate under a Creative Commons license. Read the original article.
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What Curiosity Really Kills
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Curiosity Kills The Neurodegeneration
Of the seven things that Leonardo da Vinci considered most important for developing and maintaining the mind, number one on his list was curiosity, and we’re going to be focussing on that today.
In case you are curious about what seven things made Leonardo’s* list, they were:
- Curiosità: an insatiably curious approach to life and an unrelenting quest for continuous learning
- Dimostrazione: a commitment to test knowledge through experience, persistence, and a willingness to learn from mistakes
- Sensazione: the continual refinement of the senses, especially sight, as a means to enliven experience
- Sfumato: (lit: “gone up in smoke”) a willingness to embrace ambiguity, paradox, and uncertainty
- Arte/Scienza: the curated balance of art and science, imagination and logic
- Corporalità: the cultivation of physical grace, ambidexterity, and fitness
- Connessione: a recognition of and appreciation for the interconnectedness of phenomena (systems-based thinking)
*In case you are curious why we wrote “Leonardo” and not “da Vinci” as per our usual convention of shortening names to last names, da Vinci is not technically a name, in much the same way as “of Nazareth” was not a name.
You can read more about all 7 of these in a book that we’ve reviewed previously:
How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb
But for now, let’s take on “curiosity”!
If you need an extra reason to focus on growing and nurturing your curiosity, it was also #1 of Dr. Daniel Levitin’s list of…
The Five Keys Of Aging Healthily
…and that’s from a modern-day neuroscientist whose research focuses on aging, the brain, health, productivity, and creativity.
But how do we foster curiosity in the age of Google?
Curiosity is like a muscle: use it or lose it
While it’s true that many things can be Googled to satisfy one’s curiosity in an instant…
- do you? It’s only useful if you do use it
- is the top result on Google reliable?
- there are many things that aren’t available there
In short: douse “fast
foodinformation” sources, but don’t rely on them! Not just for the sake of having correct information, but also: for the actual brain benefits which is what we are aiming for here with today’s article.If you want the best brain benefits, dive in, and go deep
Here at 10almonds we often present superficial information, with links to deeper information (often: scholarly articles). We do this because a) there’s only so much we can fit in our articles and b) we know you only have so much time available, and/but may choose to dive deeper.
Think of it in layers, e.g:
- Collagen is good for joints and bones
- Collagen is a protein made of these amino acids that also requires these vitamins and minerals to be present in order to formulate it
- Those amino acids are needed in these quantities, of which this particular one is usually the weakest link that might need supplementing, and those vitamins and minerals need to be within this period of time, but not these ones at the exact same time, or else it will disrupt the process of collagen synthesis
(in case you’re curious, we covered this here and here and offered a very good, very in-depth book about it here)
Now, this doesn’t mean that to have a healthy brain you need to have the equivalent knowledge of an anatomy & physiology degree, but it is good to have that level of curiosity in at least some areas of your life—and the more, the better.
Top tips for developing a habit of curiosity
As you probably know, most of our endeavors as humans go best when they are habits:
How To Really Pick Up (And Keep!) Those Habits
And as for specifically building a habit of curiosity:
- Make a deal with yourself that when someone is excited to tell you what they know about something (no matter whether it is your grandkid, or the socially awkward nerd at a party, or whoever), listen and learn, no matter the topic.
- Learn at least one language other than your native language (presumably English for most of our readers). Not only does learning a language convey a lot of brain benefits of its own, but also, it is almost impossible to separate language learning from cultural learning, and so you will learn a lot about another culture too, and have whole new worlds opened up to you. Again, more is better, but one second language is already a lot better than none.
- Make a regular habit of going to your local library, and picking out a non-fiction book to take home and read. This has an advantage over a bookshop, by the way (and not just that the library is free): since library books must be returned, you will keep going back, and build a habit of taking out books.
- Pick a skill that you’d like to make into a fully-fledged hobby, and commit to continually learning as much about it as you can. We already covered language-learning above, but others might include: gardening (perhaps a specific kind), cooking (perhaps a specific kind), needlecraft (perhaps a specific kind), dance (perhaps a specific kind). You could learn a musical instrument. Or it could be something very directly useful, like learning to be a first responder in case of emergencies, and committing to continually learning more about it (because there is always more to learn).
And when it comes to the above choices… Pick things that excite you, regardless of how practical or not they are. Because that stimulation that keeps on driving you? That’s what keeps your brain active, healthy, and sharp.
Enjoy!
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Astrology, Mental health and the Economics of Well Being
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Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?
Around 75 per cent of the Indian population lives in rural areas, but their access to quality mental health care is limited and traditional approaches continue to be in use. The shortage is to such a large extent that there are only 0.7 physicians per 1000 population and only one psychiatrist for every 343,000 Indians. While over the years the mental health sector has seen major developments, like the 2017 mental health care act. This act establishes equal access for all citizens, to avail government-run or funded mental health services in the country. However, it does not bridge the gap in society as the majority of the population remains deeply unaware or unable to access these services.
While the uncertainties of the pandemic brought mental wellbeing to the forefront, the national budget for the sector dropped, making this an issue of human rights. This accessibility to services is further corroborated by the recurring financial expenses of medications and frequent visits to government clinics. The cost of sessions is steep and a single session is not ideal. Spending exorbitant amounts on healthcare is a burden most families can’t afford leading to debt. In the absence of insurance and healthcare schemes and provisions, therapy remains a luxury to many Indians.
Economic struggles are only one of the causes of this discerning gap in the mental health sector. Barriers caused by sexuality, gender, caste and religion also play a major role in mediating people’s perception and access to therapeutic services. The persistent stigma surrounding mental health, especially in India continues to be a hindrance to seeking help. The supernatural inhibitions and disparity in knowledge across communities only create more confusion. The notion that mental well being is an optional expense is popular, even though the country’s population is in a dire state. Data collected in a WHO report found that nearly 15 per cent of Indian adults need active intervention for one or more mental health issues.
The population disregards the very prevalence of such mental disorders and more than often finds it fruitless to receive treatment. Some who are open-minded fail to afford the hiked fees that therapists in urban settings charge, leaving them with no option. While for years Indians attributed the systemic weakness of the mental health system to the people’s attitudes, a 2016 survey showed more than 42% of people have positive attitudes toward mental wellbeing and treatment. While the skeptics remain, these underprivileged sections of society too struggle to gain the accessibility they deserve.
This is where astrology, tarot card reading and other spiritual practices, have created a market for themselves in the well-being industry. The sceptics, and those from poor socio-economic backgrounds resort to these local and easily accessible ways of coping, to instil the faith they so desperately need. Astrology is a layman’s substitute for therapy, or for some even a supplement when they cannot afford extended periods of treatment. Visiting a local astrologer in many ways breeds the self-awareness one would expect from a session in therapy. These practices even hold certain similarities to actual psychotherapy settings, in the way they define, and alleviate aspects of one’s personality and behaviour.
Very often one simply needs an explanation, or an answer to the ‘why’ no matter how scientifically rooted that response truly is. Astrologers impart a level of faith, that things will get better. For those in rural areas, struggling to provide the bare necessities to their family affording therapy is impossible, so their local psychic, astrologer or pandit becomes their anchor during emotional duress. Tarot cards and other practices primarily focus on the future and act as a guide point for how to deal with the things ahead. For a farmer coping with anxiety, access to anti-anxiety medication is strained, and so is therapy. His best bet remains to consult his next-door jyotish about his burdens.
A famous clinician Caroline Hexdall in an interview said that “ Part of the popularity of astrology and tarot today has to do with their universal nature”. With growing technology and the pervasiveness of social media, people can gain easy access to self-care and astrology resources. Apps and web pages provide daily tarot cards, zodiac signs readings and astrological predictions for people, and almost serve the purpose of a therapist. Is reading the lines on our palm, and checking the alignment of the stars enough to cure the mental illness they undergo? Is it a solution or a quick fix as a consequence of an ignorant healthcare system?
Several studies have also shown the deteriorating effects of depending on astrology. Cases of worsening and onset of depression, anxiety and personality disorders are common for those who use astrology as more than just a temporary coping mechanism. It also becomes a source of losing control, as every feeling is attributed to fate and destiny, instilling a sense of helplessness. Ultimately can the mental health system single-handedly address the concerns of inequality and economic access in society?
Maahira Jain is a third-year student at Ashoka University studying Psychology and Media studies. She is a movie buff and is extremely passionate about writing and traveling.
This article is republished from OpenAxis under a Creative Commons license. Read the original article.
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Fiber Fueled – by Dr. Will Bulsiewicz
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We generally know that for gut health we should eat fiber, but what of the balances of different sorts of fiber?
That’s one of the main things that make this book stand out—fostering diversity in our microbiome by fostering diversity in our diet. Specifically, diversity of fiber-containing foods.
The book is part “science made easy for the lay reader”, and part recipe book. The recipes come with shopping lists and a meal planner, though we would recommend to use those as a guide rather than to try to adhere perfectly to them.
In particular, this reviewer would encourage much more generous use of healthful seasonings… and less reliance on there being leftovers several days later (tasty food gets gone quickly in this house!)
As for the science, the feel of this is more like reading a science-based observational documentary with explanations, than of reading a science textbook. Studies are mentioned in passing, but not dissected in any detail, and the focus is more on getting the key learnings across.
Bottom line: if you’d like to boost not just the amount, but also the diversity, of fiber in your diet, and reap the gut-health rewards, this book is a great guide for that!
Click here to get your copy of “Fiber Fueled” from Amazon today!
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Top 8 Fruits That Prevent & Kill Cancer
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Dr. Amy Dee, pharmacist and cancer survivor herself, lays out the best options for anticancer fruits:
The fruits
Without further ado, they are:
- Kiwi: promotes cancer cell death while sparing healthy cells
- Plums & peaches: an interesting choice to list these similar fruits together as one item, but they both also induce cell death in cancer cells while sparing healthy ones
- Dragon fruit: this does the same, while also inhibiting cancer cell growth
- Figs: these have antitumor effects specifically, while removing carcinogens too, and additionally sensitizing cancer cells to light therapy
- cranberries: disrupt cancer cell adhesion, breaking down tumors, while protecting non-cancerous cells against DNA damage
- citrus fruits: inhibit tumor growth and kill cancer cells; regular consumption is also associated with a lower cancer risk (be warned though, grapefruit interacts with some medications)
- cherries: induce cancer cell death; protect healthy cells against DNA damage
- tomatoes: don’t often make it into lists of fruits, but lycopene reduces cancer risk, and slows the growth of cancer cells (10almonds note: watermelon has more lycopene than tomatoes, and is more traditionally considered a fruit in all respects, so could have taken the spot here).
We would also argue that apricots could have had a spot on the list, both for their lycopene content (comparable to tomatoes) and their botanical (and this phytochemical) similarities to peaches and plums.
For more information on each of these (she also talks about the different polyphenols and other nutrients that constitute the active compounds delivering these anticancer effects), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Food Choice & Cancer Risk: Eat To Beat Cancer
- Beat Cancer Kitchen: Deliciously Simple Plant-Based Anticancer Recipes (book)
Take care!
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An Accessible New Development Against Alzheimer’s
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Dopamine vs Alzheimer’s
One of the key hallmarks of Alzheimer’s disease is the formation of hardened beta-amyloid plaques around neurons. The beta-amyloid peptides themselves are supposed to be in the brain, but the hardened pieces of them that form the plaques are not.
While the full nature of the relationship between those plaques and Alzheimer’s disease is not known for sure (there are likely other factors involved, and “the amyloid hypothesis” is at this stage nominally just that, a hypothesis), one thing that has been observed is that increasing or reducing the plaques increases or reduces (respectively) Alzheimer’s symptoms such as memory loss.
Neprilysin
There is an enzyme, neprilysin, that can break down those plaques.
Neprilysin is made naturally in the brain, and/but we cannot take it as a supplement or medication, because it’s too big to pass through the blood-brain barrier.
A team of researchers led by Dr. Takaomi Saido genetically manipulated mice to produce more neprilysin, and those mice resultantly experienced fewer beta-amyloid plaques and better memory in their old age.
However wonderful for the mice (and a great proof of principle) the above approach is not useful as a treatment for humans whose genomes weren’t modified at our conception in a lab.
Since (as mentioned before) we also can’t take it as a medication/supplement, that leaves one remaining option: find a way to make our already-existing brains produce more of it.
The team’s previous research allowed them to narrow this down to “there is probably a hormone made in the hypothalamus that modulates this”, so they began experimenting with making the mice produce more hormones there.
The DREADD switch
DREADDs, or Designer Receptors Exclusively Activated by Designer Drugs, were the next tool in the toolbox. The scientists attached these designer receptors to dopamine-producing neurons in the mice, so that they could be activated by the appropriate designer drugs—basically, allowing for a “make more dopamine” button, without having to literally wire up the brains with electrodes. The “button” gets triggered instead by a chemical trigger, the designer drug. You can read more about them here:
DREADDs for Neuroscientists: A Primer
The result was positive; when the mice made more dopamine, the result was that they also made more neprilysin. So far, the hypothesis is that the presence of dopamine upregulates the production of neprilysin. In other words, the increased neprilysin levels were caused by the increased dopamine levels (the alternatives would have been: they were both caused by the same thing—in this case that’d be the DREADD activation—or the increase was caused by something else entirely that hadn’t been controlled for).
As to how the causal relationship was determined…
“But I don’t have (or want) a DREADD switch in my head”
Happily for us (and probably happily for the mice too, because dopamine causes feelings of happiness), the experiments continued.
This time, instead of using the DREADD system, they tried simply supplementing the mouse food with l-dopa, a dopamine precursor. L-dopa is often used in the treatment of Parkinson’s disease, because the molecules are small enough to pass through the blood-brain barrier, and can be converted to full dopamine inside the brain itself. So, taking l-dopa normally raises dopamine levels.
The results? The mice who were given l-dopa enjoyed:
- higher dopamine levels
- higher neprilysin levels
- lower beta-amyloid plaque levels
- better memory in tests
The next step for the researchers is to investigate how exactly dopamine regulates neprilysin in the brain, but for now, the relationship between l-dopa consumption and the reduction of Alzheimer’s symptoms seems clear.
You can read about the study here:
The dopaminergic system promotes neprilysin-mediated degradation of amyloid-β in the brain
Is there a catch?
L-dopa has common side effects that are not pleasant; the list begins with nausea and vomiting, and continues with things that one might expect from having “too much of a good thing” when it comes to dopamine, such as dyskinesia (extra movements) and hallucinations.
You can read about it more here at the Parkinson’s Foundation:
Parkinson’s Foundation | Levodopa
However! All is not lost. Rather than reaching for the heavy guns by taking l-dopa unnecessarily, there are other dopamine precursors that don’t have those side effects (and are consequently less restricted, to the point they can be purchased as supplements, or indeed, enjoyed where they occur naturally in some foods).
Top of the list of such safe* and readily-available dopamine precursors is…
N-Acetyl L-Tyrosine (NALT): The Dopamine Precursor & More
If you’d like to try that, here’s an example product on Amazon… Or you could eat fish, white beans, tofu, natto, or pumpkin seeds 😉
*Quick note on safety: “safe” is a relative term and may vary from person to person. Please speak with your own doctor to be sure, check with your pharmacist in case of any meds interactions, and be especially careful taking anything that increases dopamine levels if you have bipolar disorder or are otherwise prone to psychosis of any kind. For most people, this shouldn’t be an issue as our brains have a built-in mechanism for scrubbing excess dopamine and ensuring we don’t end up with too much, but for some people whose dopamine regulation is not so good in that regard, it can cause problems. So again, speak with your doctor to be sure, because we are not doctors, let alone your doctor.
Lastly…
If you’d like an entirely drug-free approach, that’s skipping even the “nutraceuticals”, you might enjoy:
Short On Dopamine? Science Has The Answer
Take care!
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The Longevity Diet – by Dr. Valter Longo
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Another book with “The New Science” in its subtitle, so, is this one a new science?
Yes and no; some findings are new, many are not, what really sets this book apart from many of its genre though is that rather than focusing on fighting aging, it focuses on retaining youth. While this may seem like one and the same thing, there is a substantive difference beyond the ideological, which is: while anti-aging research focuses on what causes people to suffer age-related decline and fights each of those things, Dr. Longo’s research focuses on what is predominant in youthful bodies, cells, DNA, and looks to have more of that. Looking in a slightly different place means finding slightly different things, and knowledge is power indeed.
Dr. Longo bases his research and focus on his “5 pillars of longevity”. We’ll not keep them a mystery; they are:
- Juventology research
- Epidemiology
- Clinical studies
- Centenarian studies
- Study of complex systems
The first there (juventology research) may sound like needless jargon, but it is the counterpoint of the field of gerontology, and is otherwise something that didn’t have an established name.
You may wonder why “clinical studies” gets a separate item when the others already include studies; this is because many studies when it comes to aging and related topics are population-based studies, cohort studies, observational studies, or (as is often the case) multiple of the above at once.
Of course, all this discussion of academia is not itself practical information for the reader (unless we happen to work in the field), but it is interesting and does give confidence in the conclusions upon which the practical parts of the book are based.
And what are they? As the title suggests, it’s about diet, and specifically, it’s about Dr. Longo’s “fast-mimicking diet”, which boasts the benefits of intermittent fasting without intermittent fasting. This hinges, of course, on avoiding metabolic overload, which can be achieved with a fairly simple diet governed by the principles outlined in this book, based on the research referenced.
In the category of subjective criticism, there is quite a bit of fluff, much of it self-indulgently autobiographical and very complimentary, but its presence does not take anything away from the excellent content contained in the book.
Bottom line: if you’d like a fresh perspective on regaining/retaining youthfulness, then this is a great book to read.
Click here to check out The Longevity Diet, and stay younger!
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