May 2009

Q. My Mother had a TIA (transient ischemic attack) stroke in 2004, and on March 25, 2009 she had a stroke, and now it looks like she is getting Alzheimer's -- she cries and sometimes does not recognize me (her daughter), and after sundown she gets depressed. My question is: Should I get her started on some kind of Alzheimer's medicine? My mother is 87 years young.

A. It sounds like you are responsible for making the health care decisions for your mother. I am sure it must feel overwhelming at times. First and foremost I would suggest that you make sure your mother has a primary care doctor whom you feel comfortable with, who knows your mother and who is experienced in caring for elderly patients. Because of your mother's behavioral problems, including her agitation and confusion at night (your refer to sundowning), your doctor will recommend that she have an evaluation to be sure she has no additional medical problems such as side effects from medications, thyroid problem or other underlying kidney or liver disease. She should also have an evaluation to understand better what is the cause of her changes in behavior and whether or not she has dementia. I would not recommend she start any new medication(s) until she has had an expert physician review all the possible problems and talk with you about possible solutions. Although I am not in a position to make a diagnosis, it sounds like your mother may have a type of dementia referred to as vascular dementia. I say this because of her history of both a TIA and later a stroke. We now understand that factors that effect the circulation to the heart also are important to the brain as well. Ideally, your mother's blood pressure, her blood lipids or blood fats, and blood sugar should all be monitored and treated to make sure they are as close to the optimum as possible. Controlling these factors can help slow down the process of dementia. If there are no contraindications, a daily baby aspirin is often recommended. Finally, your mother should be encouraged to walk and get as much regular physical activity as she can, which is often hard because of arthritis and other aging conditions. Hopefully my thoughts will be of some help to you.

Q. I am approaching 74 years old and had an oophorectomy when I was 38 years old. I had an ovarian cyst the size of a honeydew melon. My doctor removed my ovaries, fallopian tubes, cervix, uterus, everything female. Looking back, I think this was probably too drastic a surgery. I took estrogen for a short while. I am very concerned about a stroke since I have a history of heart attacks and strokes in my family. I pretty much follow a Mediterranean diet. Do you think I should see an endocrinologist? Should I being taking hormones? What would you suggest? Thanks for your help. I have watched you on TV several times and enjoy receiving your newsletter.

A. You are right to believe that doctors performed much more surgery on women years ago then they do today. We now know that removing both the ovaries at a young age is not a good idea because it increases the risk of early osteoporosis and heart disease. You probably received a lot of benefit to your heart and bones when you took estrogen briefly. However at age 74 it would be considered too late to begin hormones - and there could be some down sides too. I would suggest that you talk to your doctor about doing a bone density study (a DXA scan) to check your bone density and see if you have osteoporosis. I would also be sure you are getting at least 1000 IU of vitamin D and 1200 mg of calcium with your doctor's approval. ...and of course plenty of exercise including using weights to keep muscles and bones strong. For you heart - I don't know your history or risk factors but all women should know their risk. Make sure your LDL cholesterol is low (ideal under 100 or at least under 130 if you have no heart disease), your Blood Pressure should be under 130/80 (115-120 is ideal for top number), also don't smoke, maybe add fish oils or take a lot of omega 3's in your diet, eat lots of fiber foods, and keep as active as possible. If you have any heart concerns, talk to your doctor about testing such as a heart ultrasound/stress test or even a quick CAT scan to check calcium in your arteries. There are important prescription medicines that could help prevent heart disease and osteoporosis too.

Q. I was doing a little research on the internet regarding undeactive thyroid and learned that I can ask question to Dr. Marie. I am a 32 years old lady living in Vienna, who is desperate to know my situation. I have been diagnosed with underactive thyroid on the 9th of May and I am not feeling any better since I am taking the medicine(hormone replacement). Since I am concerned and seeking help form people like Dr. Marie, I would appreciate if you could tell me how I can contact or to whom I can adress my quesiton.

A. I would be happy to help if I can. Do you have a copy of your blood tests? What was your TSH result? How low was your T4 and T3 level? What medication are you on? What is the dose? What happened to your blood TSH level?

Q. Dr. Dr. Savard, I am a 51 yr. young woman and have been menopausal for al the very least 5 years. No period for that long until just two weeks ago and spotted one day nothing since then. I was put on thyroid medication after I had a biopsy on my scalp because I felt as though my hair was thinning. I was told that my thyroid was a little low and put on meds. I also have continued to put weight on particularly around my middle. It has been a yo yo effect ever since. I have had many blood tests but little results. I haven’t slept in years and have a constant headache. My nose consistently feels dry inside and my sinuses feel plugged with little or no smell sense. I have now developed a constant buzzing or ringing in my ears and feel helpless. My last two blood tests are this: Dec.3 0.83 TSH, 17.16 Free T4, 1.3 Triiodothyronine, 0.5 CReactive Prot Mar. 4 Antithyroid Peroxidase AB 384.7H 0.45 TSH, 21.00 Free T4, 1.4 Triiodothyronine, 2.3 Dhea – S I am on a dose of .05 synthroid / day. Was first told to take two/ day. Felt like I was on fire so I went to a dosage of .075. still no relief, down to .05. My weight even though I frequent the gym at least 4 times per week is a constant battle. I will be taking eltroxin .05 as it will be covered under insurance. I have terrible cravings for sweet and supposedly have had a blood test that says no problem there. My mother is diabetic as well and I am very aware of that. I would give anything to be able to sleep throught the night just once without the aid of sleep meds. I take only half when I finally just can’t tolerate another sleepless night. I have also had a terrible taste in my mouth this last while and am on no other medication.

A. Your medical history is worrisome to me. You mention that you have been menopausal for 5 years and suddenly out of the blue "spotted" for one day. This is unusual and could be worrisome. Have you had a GYN exam? Did you have a uterine ultrasound and/or a biopsy? I also reviewed your blood work and since your TSH is on the low side, I suspect you are taking too much Synthroid which could be interfering with your sleep. It does sound like you tried adjusting the dose. Another concern is you feeling of no sense of smell. This too worries me. Have you had a brain scan to be sure you are okay? I wish I could be of more help. I do think you need to be sure you find a doctor who takes all of your concerns seriously and helps you out.

Q. For many years now, both my husband and I have a suspicion that I may have Celiac disease and would like to know what test or tests we should make inquiry of when presenting this idea to my physician.

A. Research has shown that it can take from 12 months to 9 years on average for a patient who has chronic bowel complaints to be diagnosed with celiac disease. This means that physicians should consider the diagnosis in patients with undiagnosed bowel or other complaints. Although there are a number of blood tests called 'serologic screening" tests for celiac disease, none of the blood tests are definitive. Experts agree that an intestinal biopsy and a good response to a gluten-free diet is essential to make the diagnosis. That means every person who may have the diagnosis should have an intestinal biopsy of the small intestine which will show typical abnormalities found only in celiac patients. The person should also try a gluten free diet which will help the symptoms considerably if the diagnosis is correct.

Q. Hi Dr. Savard ~ Today I watched two different video clips from Good Morning America with you speaking about brain exercise. In one of them (which I think was from this week) I thought I heard you say that we cannot create new brain cells. But in the clip (talking about 5 exercises) you said we can increase the number of cells and develop new pathways. I teach Mental Gym (a brain fitness class) for seniors and I like to keep my students up to date on current research, etc. I want to be sure I didn't misunderstand you and would like some clarification on this. Can we create new brain cells? And what exactly does it mean to develop new pathways - in terms I can relate back to my students? Thank you for your expert help on this topic,

A. I am so sorry that I may have been inconsistent in my describing brain function...it really is confusing even to the researchers and perhaps I misspoke on the first video. Scientists have long believed that we can't regenerate new brain cells however what is exciting and new is the notion that we can strengthen the connection between nerve cells by exercising our brains in many new and creative ways. What this means is that some nerve cells that have been inactive could suddenly be recruited to work and at the same time, nerve cell pathways that are infrequently used could be used more as well. It is almost like muscle tissue - the more you exercise the muscle the greater the blood flow, circulation, and repair of the muscle so that it works stronger, longer and better.