A:Scoliosis is curvature of the spine that most frequently occurs during the growth spurt prior to puberty. Most cases are mild; however, they can become more severe as a person ages. Those that are severe can reduce the amount of space within the chest cavity, making it very difficult for the lungs to function efficiently. If the curve worsens, the spine will twist as well as curve sideways. Symptoms may include one hip sitting higher than the other, uneven shoulders, and one shoulder blade that will protrude more than the other.

It appears scoliosis may be hereditary but also may be caused by infection or spinal injury, from a birth defect, or because of a neuromuscular condition such as muscular dystrophy or cerebral palsy.
Diagnosis may be made in a physician’s office through visual examination but may be confirmed through X-ray. MRI is used for very specific cases.

Some individuals, particularly young children, may not require treatment or surgery but may be monitored through X-rays on a timely basis to determine any advances in the curvature. Children still in the growing phase may opt to wear a brace that may have to be worn 23 hours each day for several years. While the brace will not cure the condition, it may prevent any advancement. Once a child stops growing, the brace will be discontinued. The most common spinal fusion is for adolescent scoliosis that involves fusion and bone grafting; however, instrumentation for older individuals has progressed to segmental metal sections to support the bone and bone grafting.

Enter alternative approaches such as chiropractic manipulation, biofeedback and electrical stimulation. Some eight years ago Aetna Insurance Company was funding electrical stimulation because of its proven benefits, so this approach isn’t new. Electrical stimulation is a non-invasive method of control, whereby muscles on one side of the spine are stimulated electrically to contract and pull the vertebrae into a more normal position. The stimulation at that time was generally applied for anywhere between 8 and 10 hours during sleep and continued until the patient reached skeletal stability. The advantage is and was that no brace need be worn, the therapy is part-time, and there is an improvement of self-image in the affected adolescents who may have a difficult time coping. One study was performed in 1984 and others have followed since that time. The 1984 study found spinal fusion with instrumentation was effective in halting the progression of the curve in severe cases. In 1985 another study found if treatment begins early enough and the progression is not too severe, the curve can be reversed. As one might expect, over the last 20 years the success of this form of correction has been heavily debated. The treatment is still considered investigational because peer-reviewed literature apparently does not support it as effective as brace treatment. Additional well-designed randomized, controlled trials are needed to compare the use of this treatment over other alternatives such as braces.

As with many cases, we hurry up and wait. Research is truly remarkable in discovering new ways to deal with old problems. It will be very interesting to see what another eight years will bring. Thank you for your input.

Readers who would like related information can log on to nsf@scoliosis.org or write to the National Scoliosis Foundation at 5 Cabot Place, Stoughton, MA 02072.

Your help would be most greatly appreciated.

A: You present with an interesting case that has numerous possible answers. A burning sensation in the body can be caused by nerve damage, circulatory problems that impair the flow of blood to the legs, injury, excessively strenuous exercise, diabetes, meralgia paresthetica, multiple sclerosis, hypothyroidism, kidney disorders, peripheral neuropathy, and sciatica. When a person suffers from nerve damage, the brain receives mixed signals from the site. The result is a burning sensation or numbness that may occur without any visible wound or injury.

There are numerous reasons for blood to flow improperly throughout the system. A small blood clot within a vessel of the leg known as DVT (deep vein thrombosis) can cause burning in the affected leg. An exacerbation of DVT symptoms will occur with walking, stair climbing and exercising. PAD (peripheral artery disease) can also result in such symptoms and is more likely to cause symptoms in both legs. A physician may choose to order an EMG, CT, MRI, MR neurography or venous doppler ultrasound and artery tests to assist with the diagnosis.

There are more than 100 types of nerve damage and a physician’s responsibility is to deduce, through the process of elimination, which type or types a patient has or if the condition is from an entirely different disorder. The nervous system regulates breathing, controls muscles, and is involved with every single thing the body does. As such, symptoms will depend on where the problem is and the nerves that are affected. Damage might occur to the nerves of the brain and spinal cord or in the peripheral nerves located throughout the entire body. Autonomic nerve damage can present with lightheadedness, bladder dysfunction, hyperhydrosis and more. Damage to motor nerves may cause twitching, paralysis and weakness. Sensory nerve damage may present with tingling, burning, a numb feeling, and pain. Approximately 50% of all diabetics suffer from a condition known as diabetic neuropathy with the sensory nerves most commonly affected. The result is burning and numbness. Nutritional deficiencies, particularly of vitamins B6 and B12, produce symptoms of nerve damage but one may not have nerve damage or a documented B6 deficiency to benefit from that vitamin if they have peripheral neuropathy.

Once the underlying cause is determined, nutritional deficiencies can be corrected with supplemental vitamins, medications can be changed, sugar levels can be placed under tighter control, and a physician might choose to order prescription drugs to reduce the symptoms. Meditation, biofeedback, physical therapy, and acupuncture might also reduce or alleviate symptoms. The bottom line is that you need to be seen by a health care professional, neurologist, or other specialist so you can determine the reason for your symptoms. You may be worrying needlessly and have a totally unrelated yet minor condition that doesn’t require testing or treatment. So don’t wait. You deserve answers now.

My medications are Alendronate Sodium 70 mg once a week, Naproxen 500 mg twice a day, oxybutynin 5 mg one or two each day, Iron 65 mg equal to 325 mg ferrous sulphate daily, hydrochlorothiazide 12.5 mg daily, tramadol HCL 50 mg for pain when needed, aspirin when needed for pain, Citracal citrate plus D calcium two each day, Viactin calcium plus D and K daily, and cod liver oil capsules one to two each day. I was wondering if any of these medications and vitamins are causing my flaky scalp.

I’m very active in my senior center. I drive my own car, shop, laugh and try to have a good time. I live in my own home. I try to do my own housework but hire to have my lawn mowed because my husband passed away six years ago. So, what about my flaky scalp?

A: There are numerous reasons for flaky scalp or dandruff to occur that commonly present when the scalp is too dry or oddly enough, when it is too oily. A fungus known as malassezia lives on the scalp and has been linked with the development of dandruff. A natural oil that is secreted from glands fuels the growth of this particular fungus. Overgrowth tends to occur in some individuals who undergo hormonal changes, following being diagnosed with a specific neurological disorder such as Parkinson’s, because of infrequent washing of the hair, suppression of the immune system, and a number of other possibilities. Two of the most common extrinsic causes for the condition include excessive sunlight exposure or the use of harsh hair styling/hair coloring products.

As a general rule, flaky scalp can be treated successfully with dandruff shampoo. Be sure not to scratch your scalp when washing your hair because you will run the risk of causing further irritation. Keep in mind that not all dandruff shampoos work for everyone so don’t be too quick to buy a large bottle of one brand your first time out because it may be on sale. Most shampoos that contain ketoconazole work best; however, they require a prescription. Those that contain selenium sulfide are available without prescription and may prove effective. The mousse you use may be adding to your problem so discontinue it for a time and experiment with the Selsun to see if you obtain the results you are seeking. Be sure to rinse your hair well following the application of any shampoo to remove all residue from your scalp.

On the home front, a 50/50 ratio of almond oil and olive oil rubbed onto the scalp 15 minutes prior to shampooing with a mild product might work for you. Or, you might consider massaging your scalp with virgin coconut oil, followed by aloe vera or aloe vera extract; or lemon juice and honey in equal amounts applied to the scalp; the age-old cider vinegar trick will clean your hair and may also rid you of a buildup of flaky skin. All these tips should be repeated about once a week, follow with a mild shampoo.

While medications can affect each of us in a different manner, I do not feel the drugs you are on are contributing to your dilemma. Therefore, I recommend you make an appointment with your health care provider so he or she can examine your scalp. If any question remains, ask for a referral to a dermatologist because the method of treatment will depend on the diagnosis you receive. For example, if you suffer from plaque psoriasis that can present with silvery patches on the elbows, knees, back and scalp, you may require prescription medication for control.

Dandruff, if that is what you have, is not contagious, is a very common problem that affects millions of individuals, and is generally not serious except for the embarrassment of those who suffer from it. Get an answer so you can remedy your situation and by all means, keep on laughing.

A: Knee replacement is considered when a patient has a painful, stiff knee that makes it extremely difficult to perform even the simplest of other activities and when medication and other treatment fails to work sufficiently. The procedure is commonly reserved for individuals over the age of 50 who have been diagnosed with severe osteoarthritis; however, there are always exceptions to the rule.

During the surgery, an incision up to 12 inches is made in the front of the knee. The damaged portion of the joint is then removed and the surfaces are shaped to hold either a plastic or metal joint. This artificial joint is attached to the shin and thigh bone either with cement or other material. Similar to a jig saw puzzle, the pieces all fit together properly to form a new joint with the muscles and ligaments that surround them providing support and allowing normal function. When a minimally invasive procedure is performed, the incision is only about five inches, allowing for less tissue damage. The rather new, less invasive procedure causes less pain, faster recovery and better motion because of less scar tissue formation. Patients who undergo either procedure are advised not to pivot, squat or kneel for at least six weeks to allow the muscles and ligaments to strengthen sufficiently. Stair climbing should also be kept to a minimum. Knee replacement has been performed since the 1970s and the technique improves constantly; however, there are risks that include infection, bleeding, blood clots, nerve damage from swelling and pressure, and the replacement parts that can loosen or break.

Replacements that were once good for about 10 years are now lasting 20 years or longer. Having said this, some patients may require a repeat surgical procedure only a few years following the original surgery. Known as revision knee replacement, the second procedure is a major undertaking with results that aren’t typically as successful as the initial procedure. Surprisingly, only about two to three percent of all procedures require a second procedure be performed within five years of the original surgery. The advantage of a second go-round is that some of the parts previously inserted may be functioning just as they should and only minor revision may be necessary. I do not know why your husband’s spacer was too small. This is a question best left to his surgeon to answer. Perhaps something else is going on in there that needs attention. I am sure your husband is not running in marathons, although some individuals do following replacement. If he isn’t putting undue stress on his knee, he should not be having to look forward to another procedure but my assumption is that he is having difficulties ambulating and something must be done to improve his quality of life. Accompany your husband to his surgeon’s office for a frank talk to determine why the problem has occurred yet again. If you have confidence in the specialist who initially worked on him, you may feel comfortable sticking with him or her. If not, you may even feel it is time for a second opinion. Often a new set of eyes can see a great deal more. Good luck.

Other readers who would like related information can order Dr. Gott’s Health Report “An Informed Approach To Surgery” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

A: Excessive intestinal gas may be indicative of a digestive order such as irritable bowel syndrome, celiac disease, a lactose intolerance, gastroesophageal reflux disease, and numerous other possibilities. It may be brought on by specific foods that are difficult to digest such as beans, lentils, fructose, and dairy products that contain lactose. Generally speaking, gas causes embarrassment and discomfort, but it isn’t medically harmful. Nonetheless, I can understand your dismay at the severity of your wife’s flatulence.

As a person swallows foods and liquids, he or she also takes in small amounts of air that collect in the digestive system. Gas is released when solid foods are digested, with most of that gas being carbon dioxide, methane and hydrogen. The body responds by burping, belching, or passing gas and fortunately, this generally occurs without any detectable odor or sounds. When gas is caused by trace elements of sulphur gasses that may develop if the food has not been properly digested and begins to break down, an offensive odor results.

Some foods are more easy to digest than others. I urge her to speak with a dietitian who can give her direction on proper foods and steer her away from those that contribute to more flatulence. While waiting to see the specialist, she might consider adding bananas, yogurt, rice, potatoes, lettuce and oranges to her diet. Keep in mind that we all respond differently to specific foods, so she might go so far as to keep a diary of what works and what doesn’t. She may also consider eating five or six smaller meals each day rather than three more common but larger ones. She will not be consuming any more foods or calories but smaller meals are easier to digest and her symptoms may lessen. She should chew her food slowly, refrain from talking and gulping air throughout the meal that will exacerbate things. She should not chew gum, nor should she smoke since both habits cause a person to swallow more air than usual and the smoking habit can actually irritate her already compromised digestive system. I’m sure she has tried Beano, charcoal tablets and the plethora of available products at your local pharmacy, but she might consult with a health care professional for other suggestions.

I’m leaning toward your wife’s diet causing the majority of her problem; however, she could certainly be lactose intolerant. This condition occurs when lactose moves through the large intestine without being properly digested, resulting in gas, bloating and abdominal pain. Again, your health care professional or a dietitian can guide you accordingly. If she suffers from bloating and persistent abdominal pain, unexplained weight loss, episodic diarrhea and/or constipation, incontinence, blood in the stool or other unusual signs, she should speak with her physician or a gastroenterologist in follow-up. In fact, even without symptoms, any persistent change in gastrointestinal function should be evaluated.

Readers who are interested in related information can order Dr. Gott’s Health Report “Digestive Gas” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

A: Gout is a painful form of arthritis that presents with pain and swelling in a single joint, most commonly the great toe. The site may be very warm to the touch and inflamed. The condition occurs when excess uric acid collects in the body and needle-like crystals deposit in a joint. Specific foods, including shellfish and red meats, drinks high in fructose, excessive amounts of alcohol, and organ meats can trigger an attack. Some medications including specific diuretics and low-dose aspirin can also be to blame. Those at a higher risk include men, women following menopause, and individuals diagnosed with kidney disease. It rarely affects children but does tend to run in families.

Diagnosis is commonly made through visual examination of the site. When any question remains, fluid extraction from the affected joint can be analyzed under a microscope to determine if urate crystals are present.

Treatment may include nonsteroidal anti-inflammatory drugs (NSAIDs) that are prescribed to reduce inflammation and pain. High doses of short-acting NSAIDS such as naproxen and indomethacin, provide the fastest relief of symptoms which are commonly ordered to treat an acute attack. NSAIDS may cause stomach upset or diarrhea but are generally well-tolerated. For those who cannot take NSAIDS because of impaired kidney function, an ulcer or because they are on an anticoagulant may respond well to corticosteroids that can either be taken orally or by injection directly into the affected joint. When corticosteroids are contraindicated, colchicine can be used.

When it comes to home remedies, ice packs or cold compresses may reduce the inflammation and lower the pain. There is some controversy regarding this therapy, since crystals form more rapidly in low temperatures, but it may be worth a try. Cherries in any form – fresh, canned, or dried are purported to lessen the pain. Five to ten a day for prevention and as many as 15 for an acute attack are recommended. Drink eight 6 ounce glasses of fluid daily. This may help wash urate from the system and will also help prevent kidney stones from forming. Avoid consuming alcohol. While previously disputed, in 2004 a study by researchers at Mass General Hospital found that beer and liquor do increase the risk of developing gout, while drinking red wine does not. I should add that questionnaires and not direct observation were at the base of the study; therefore, the conclusion is still being questioned. Control your diet by eliminating anchovies, herring, mackerel, sweetbreads, brain and kidney. Lime is a good source of vitamin C but the citric acid found in lime also helps dissolve uric acid. Herbs including ginger root or white willow bark can be made into teas and supplements such as feverfew might be considered. It is strongly recommended an herbalist be consulted before beginning any home therapy.

Readers who would like related information can order Dr. Gott’s Health Report “Compelling Home Remedies” by sending a self-addressed, stamped number 20 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

He takes Toprol XL, Clonidine, coumadin and Crestor. Our neurologist did a thorough health history and asked many questions about chemicals, lead paint, new rugs, bug repellent with DEET, lawn spraying, etc. I’m beginning to wonder about all of this. Our neighbors have their lawn sprayed often. One has it done eight times from April to October. This spraying is now illegal in Ontario, Canada. What do they know that we don’t? Can any of this have had an effect on my husband’s neurological health? I failed to mention, we have five cancers on our street within seven of our neighbors. Sign me Wondering About Chemicals in WNY.

A: Any pesticides legally used in this country must be registered with the EPA; however, registration does not indicate the products are safe, nor does it guarantee the chemicals have been fully tested for their environmental and human health effects. Thirty six of the pesticides most commonly used on lawns were registered almost 30 years ago. Studies have shown that of these 36 pesticides, 14 are probable carcinogens, 15 are linked with birth defects, 21 with reproductive effects, 22 with liver or kidney damage, 24 with neuro-toxicity, and 34 are irritants or sensitizers.

It appears the federal law governing pesticide use relies on what is referred to as a risk-benefit statute, allowing the use of pesticides with known hazards based on the judgment that various levels of risk are acceptable. It appears the required toxicity studies have yet to be either performed or submitted. On the flip side, some individuals believe the benefits of using pesticides on a lawn for aesthetic purposes does not outweigh the health risks associated with their exposure. Pesticide residue remains on grass even when dry and inhalation and dermal exposure are a reality.

The professional lawn maintenance business has developed into a billion dollar industry and to create better lawns, those companies rely on chemical pesticides. As with most pesticides, these chemicals have the potential to create serious problems that affect human health and our environment. Under the Federal Insecticide, Fungicide and Rodenticide Act, the EPA is required to evaluate the risks and benefits of a proposed pesticide BEFORE it is registered for use.

So, how do we keep that nice green lawn surrounding our homes? Consider going organic. Natural lawn care companies are growing in popularity but may require investigation on the part of the consumer before hiring the professional to assure the product or products used are safe. There is at least one and perhaps more fertilizers on the market that stresses a “natural base”. In reality, this product has a small percentage of composed chicken manure that is mixed with a large percentage of synthetic, petroleum-based fertilizer. Let the buyer beware.

DEET is the active ingredient in numerous insect repellent products available on the market today. It is commonly used to repel biting insects such as mosquitoes and ticks. The product is available in liquid, lotion, spray and in materials such as wrist bands. The product repels, but does not kill. Based on extensive toxicity testing, the EPA considers that as long as consumers follow the label directions provided, it does not pose a health concern. As a point of information, the EPA completed its review of the product 15 years ago. The percentage of DEET in products varies greatly so consumers should be aware of what is included in the package they are purchasing.

With regard to the Canadian ban, and I quote, “science hasn’t yet proven what effect, if any, pesticides have on our health, but given the risks, governments must err on the side of caution. The lack of scientific certainty cannot be an excuse to delay action to protect health and the environment.”
One company that manufactures 2,4-D has decided to sue the federal government and seek $2 million in damages, arguing that Quebec’s rules violate Canada’s trade obligations because it prohibits a product without any scientific basis. This one may rattle around in the court system for many years to come, so stay tuned.

So, could your neighbors’ zeal for an award-winning yard be the cause of your husband’s plethora of medical issues and the frightening number of cancer cases in your neighborhood? Because I don’t know the herbicide your neighbors use or what they are spraying for, I cannot analyze the potential for harmful ingredients. Maybe they are environmentally conscious and going organic. Therefore, my answer is perhaps, but yours is a million dollar question that could be disputed for years to come. Good luck.

I also have a low white blood count, have tested positive for the Jo-1 antibody. However, my EMG was negative so myositis was ruled out. All other tests have been negative. The only symptoms I have are fatigue which when present, is fairly severe but it is not always present and mild muscle discomfort in my upper arms; and it feels as if I am getting the flu but the flu never occurs. Any information you can give would be appreciated.

A: Raynaud’s disease is a condition in which specific areas of the body – typically the fingers, toes, ears and nose – feel numb and cold because of limited circulation to those areas. Signs and symptoms include tingling or stinging pain and color changes to the area. The skin commonly turns a gray/white initially, after which it turns blue. As circulation improves, the area may tingle, swell, throb, and turn red. Not everyone will experience the three color change, nor will the order be the same for all individuals diagnosed with Raynaud’s. Attacks may be brief, lasting less than a minute, or they may last for several hours.

It isn’t clearly known why some individuals are more prone to the condition than are others but living in colder areas of the country and stress are definitely known to have a bearing. There may be an inherited component that comes into play, as well. We can all understand that when the body, particularly the hands and feet, are exposed to cold temperatures, those extremities lose heat. The body’s entire system slows and blood is shunted to the core to preserve heat. Small arteries narrow even more and those with Raynaud’s have greater than normal symptoms. Most individuals do not go out of doors without gloves or mittens but even running cold water from a faucet or removing a cube of ice from a freezer tray can trigger a reaction.

There are two types of Raynaud’s, primary and secondary. The primary form has no connection to an underlying medical vasovagal condition. The latter type is less common and does have an underlying problem such as carpal tunnel syndrome, rheumatoid arthritis, scleroderma, lupus and others. Further, there are specific medications, including some for chemotherapy, beta blockers for hypertension and others that have been linked with Raynaud’s.

Treatment begins with wearing warm gloves, mittens and heavy socks when out of doors and dressing in layers. One suggestion is for you to visit a sporting goods store and purchasing hot packs that are worn by some individuals that indulge in outdoor activities in cold weather. The packs are activated and simply slip into a mitten to provide several hours of heat. If it is necessary to progress beyond this, vasodilators or calcium channel blockers might be prescribed by your physician.

A low white blood count (which may be normal for some individuals) can be caused by an autoimmune disorder, viral infection, cancer or other diseases that harm bone marrow, specific drugs that destroy white blood cells, radiation, vitamin deficiencies, and more. You might wish to speak with the physician who ordered your lab work to determine the cause for your low count. I might also suggest he or she delve deeper into an autoimmune (rheumatologic) cause. Your normal EMG implies you don’t have myositis, however one study found that 11% of patients with myositis had a normal reading.

Myositis refers to muscle inflammation that may be caused by infection, injury, or an autoimmune disorder such as polymyositis or dermatomyositis that cause muscle weakness, with the latter also causing a skin rash. Difficulties breathing, frequent falls and fatigue are common. Treatment of such disorders might include high doses of corticosteroids, physical therapy, the application of heat, and ample rest.

Be sure to eat well, include fresh fruits and vegetables in your daily diet, exercise as much as allowed by your physician, and take time out of your daily routine to rest to combat the fatigue. Good luck.

A: There are varying opinions as to why a person does or doesn’t remember dreams. One professor of neurology at Harvard Medical School feels no one knows why dreams occur but speculates that dreaming will allow a person the opportunity to practice things he or she may or may not ever have to do. Sigmund Freud felt dreams are an expression of what a person is repressing during waking hours. Carl Jung felt dreams are messages of lost or neglected parts of oneself that needs to be reintegrated. What is reasonably consistent, however, is that everyone dreams every night. We may vaguely remember them, be able to explain them in vivid detail, or have no knowledge of even dreaming.

There are three stages of non-REM (rapid eye movement) sleep and two stages of REM sleep. The average individual cycles through all the stages up to six times each night, although not always in the same order. N1, the first stage, is considered the lightest and occurs as an individual drifts off to sleep. N2 is a deeper phase when brain activity begins to slow, as does a person’s heart rate and breathing. Body temperature may fall slightly as the body relaxes. N3 stage is the beginning of slow wave or deep sleep. Brain waves are generally slower, although faster waves can occur. This phase can last up to 15 minutes but the overall first deep sleep of the night may last an hour or longer, providing necessary bodily regeneration. N4 is known as REM sleep. Blood flow, breathing and brain activity increases. The first period of REM sleep of the evening commonly begins about 90 minutes after stages N1 and N2 and may last for 10 minutes. The length of REM sessions then increase in length, with the final episode lasting an hour or longer. It’s during R4 that dreams occur, with the brain being almost as active as it is when a person is awake. During the REM phase we lose muscle tone throughout the body except for the diaphragm and muscles of the eyes. Perhaps that is why some individuals feel they cannot move their extremities. This may explain why we try to run away from a bad situation or scream in fear yet are incapable of moving our arms and legs or of screaming out loud. Some medications can make dreams extremely vivid.

So, in answer to your question, N4 represents about one fourth of an individual’s sleep time. Dreams can last from a few seconds to around 20 minutes. If we multiply those 20 minute sessions by six throughout the phases of REM sleep, that may amount to two hours of dream time.

Dreams may signify our brains organizing memories and activities of the day, even though there may not be any logical reasoning behind the way they evolve. Dreaming allows us to “act out” during sleep, and interpret things in ways completely different from how we would ordinarily express ourselves when awake. The brain’s activity is truly remarkable.

Readers who are interested in learning related information can order Dr. Gott’s Health Report “Sleep/Wake Disorders” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

A: Alzheimer’s is a very common form of dementia that affects the elderly. This brain disorder causes the gradual loss of brain cells, beginning slowly and affecting the area that controls language, and memory. As the disease — and it is a disease — progresses, symptoms will worsen. Your grandmother may not recognize you, she may have problems reading, writing, or speaking. She may forget how to do simple household chores she once did with ease, such as putting the milk back into the refrigerator or jars back in the cupboard.

Alzheimer’s doesn’t affect everyone but it will appear in some individuals as they reach their 60s. The risk for development will increase as age progresses. While it is normal to think more slowly as we age, most of us will fortunately have our learning and memory skills intact. With Alzheimer’s, however, communications, thinking, and learning are affected. To simplify things, there are several warning signs of Alzheimer’s that should not be ignored or chalked off to the aging process. They include memory loss, difficulties in performing simple tasks, a lack of or decrease in judgment, a loss of initiative, and changes in personality, mood or behavior.

Early diagnosis is important because it will allow both the patient and his or her caregivers time to make some important decisions. The first step will likely begin with an examination and it will be vital for a relative, friend or someone who knows the patient to be able to answer the doctor’s questions. The patient may be fearful of having the doctor find something wrong and may cover in ways you can’t begin to believe. It may be necessary for your mother to keep a journal of inappropriate functioning, such as dressing in very warm clothing on a hot day, going out of doors and not knowing how to get back into the house, not remembering names, and so forth. This should not be taken as a criticism toward your grandmother but will give a health care provider extensive information for making a correct diagnosis.

Mild cases of Alzheimer’s may initially only require a little extra careful attention to assure your grandmother’s safety. Perhaps she will no longer be able to use the stove for fear of injuring herself, or she will not be allowed to walk to the park without having someone accompany her. Patience is critical for her well being. Remember that she may be terribly frightened. She shouldn’t be talked down to but should have the situation explained to her in simple terms. Advances regarding the disorder are being made every day and it may be a specific medication will work to advantage in slowing the progression of the disorder. If her doctor feels she is adequately cared for at home, there is no need to upset her by placing her in a nursing home. On the other hand, if things have exacerbated rapidly, you and your family might give some thought to nursing home placement where she can have 24 hour coverage.

Speak with your mother and proceed accordingly. A good resource is the Alzheimer’s Association website at alz.org.

Readers who would like related information can order Dr. Gott’s Health Report “Alzheimer’s Disease” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.