Wednesday, October 14, 2009

Irresponsible Advice About the Swine Flu Vaccine

Bill Maher should stick to politics. He's been Twittering that people who get swine flu shots are idiots and also mouthed off on his "Real Time With Bill Maher" show about the vaccine, implying that getting the vaccine was the same thing as being injected with the disease, which it is not.

Now ordinarily this would not be a big deal. I mean, who would look to a talk show host for medical advice? Unfortunately, with this being a new vaccine, and a high level of suspicion about the government's ability to do anything whatsoever running rampant in the country, this just encourages those who are dubious about it to feel justified in skipping it. This would not be a good idea.

The H1N1 (swine) flu is a different strain of flu virus. Unlike the usual seasonal influenza that is more apt to be severe in the elderly, with the H1N1 virus, younger people are more vulnerable and become sicker than their elders.

This may be because the new H1N1 virus is related to the deadly 1918 Spanish flu, and since variants of the 1918 flu type were in circulation for several generations after it first appeared, people 65 and over tend to be less vulnerable to the new flu since they have had exposure to its cousin in the past.

In addition, those who were vaccinated against the swine flu strain that was prevalent in 1976 may also have a certain degree of cross-immunity to the new H1N1 virus.

This leaves younger people at most risk for severe illness in this new pandemic. In addition, pregnant women, whose immunity is lowered by their condition, and those with specific health problems, are also vulnerable.

There are two kinds of vaccine: One injectable, which is a killed virus that is incapable of causing illness, and a nasal spray version that is a weakened virus. It is recommended that those with impaired immunity only receive the injected vaccine.

It is the height of irresponsibility on Maher's part to be blathering about a medical subject about which he obviously knows very little, and contradicting Dr. Bill Frist, his guest on the show, who was trying to get across the importance of vaccination.

There are reasons some people shouldn't receive either vaccination. If they are allergic to eggs, as my mother is, they cannot receive any flu vaccines because the virus used to create them is incubated in eggs. In addition, there may be concerns about the preservative, thimerasol, which is used in the injectable vaccines for both H1N1 and regular seasonal flu.

And of course, it is always a personal decision whether one wants to have a shot or not. But to make that decision, a person needs to be armed with the facts, not a talk show host's personal aversions. If you want the facts, please go to this site and read up on them. Then you can make a truly informed decision about receiving the H1N1 vaccination.

(cross-posted at Mauigirl's Meanderings)

Saturday, February 21, 2009

Alice in Wonderland Syndrome

Well, I'm finally back here. The excitement of the election and the inauguration of Barack Obama has finally died down a bit and I'm able to tear my brain away from politics enough to concentrate on doing some medical research.

It also helps that I recently discovered a brand new condition that is fascinating to me and will be of interest, I'm sure, to all of you hypochondriacs out there.

I discovered it because a friend recently told me that when she was a child she experienced spells where everything around her - the door, the window, the furniture, whatever - seemed abnormally large and she felt abnormally small. This experience was accompanied by a distinctive odor. I immediately thought that if this was something neurological, which it appeared to be, it probably had a name like "Alice in Wonderland Syndrome," since it sounded so much like what happened in the story..."One pill makes you larger, one pill makes you smaller..."

So, being me, I had to go Google it. Imagine my surprise when I found there really is a syndrome called Alice in Wonderland Syndrome!

According to, Alice in Wonderland Syndrome was first described by C.W. Lippman in 1952, but J. Todd actually named the syndrome "Alice in Wonderland" syndrome in his 1955 article, "The Syndrome of Alice in Wonderland," in the Canadian Medical Association Journal. As a result, the syndrome is sometimes also called Todd's Syndrome.

What Are the Symptoms of Alice in Wonderland Syndrome?

According to the Migraine Aura Foundation, the syndrome refers to "a variety of self-experienced body image disturbances affecting the experience of the size, mass, shape of the body or its position in space."

Sometimes the affected person experiences a feeling of everything around them being much larger and they themselves feel smaller (macropsia) or vice versa - where they feel very large and everything around them seems very small (micropsia). These perceptions are also known as macro-somatognosia or micro-somatognosia.

These symptoms can appear along with other distortions, in time, vision, or other senses (including smell, which would explain the odor my friend experienced).

Sufferers may also see changes in the size of body parts such as their hands.

Following is a full list of possible additional symptoms:

"- feeling as if walking doesn't get them anywhere, as if they were walking on a treadmill
- the perception that only parts of their body are larger/smaller than normal
- - the feeling of walking on sponges
lingering touch sensation, i.e. after you've touched something, you continue to feel it after you've stopped touching it. Touch sensation hallucinations can also occur.
- lingering sound sensation, i.e. you continue hearing something after the noise has stopped
- anxiety
- loss of limb control and general discoordination, usually because of distorted perceptions of where one's body is in relation to surroundings
- agnosia / memory loss (though this is thought to be more of a side-effect: If you're having to think really hard about every movement, it's hard to pay attention to anything else and thus hard to remember things.)"

What Causes It?

Alice in Wonderland Syndrome can be caused by/associated with:

- Migraines (the symptoms of AIWS may be part of the "aura" that precedes a migraine; often no headache is actually experienced).
- Certain drugs (including cough syrups containing dextromethorphan)
- Viruses (Epstein-Barr, which causes Mononucleosis, or other viruses)
- Epilepsy
- Brain tumors
- Schizophrenia
- Delirium Tremens (from alcohol abuse)

What Are the Treatments?

Generally there is no specific treatment for AIWS; the root cause is what must be treated. For the most common cause, migraines, there are a number of remedies, as well as dietary restrictions that can help mitigate the symptoms. See this link to the Mayo Clinic for full information about migraine headaches.

For more information on treatment for epilepsy, see this link to

Often the syndrome occurs in young children and eventually they may outgrow it. Others don't experience it until adulthood.

Will You Get It?

Probably not, unless you are a migraine sufferer. According to Pediatrics in Review:

"In the US it is estimated that 8.7 million females and 2.6 million males suffer from disabling migraine. The occurrence of migraine is greatest in adulthood, but this disorder is one of the most common causes of headache in children as well. In a 14-year longitudinal study of more than 9000 school children, Billie reported that 5% had had migraine attacks by 15 years of age.

A recent population-based study in Olmsted County, Minnesota, suggests an even greater incidence in this age range. For example, the highest incidence of newly diagnosed migraine headaches appearing in males, 246 per 100 000 person-years, occurred in those aged 10 to 14 years."

For an interesting article on the subject, see this article from WABC news.

Saturday, April 12, 2008

Help for Hypochondriacs!

A friend found a handy tool for us hypochondriacs on the "Real Simple" website. It's called the:

Hypochondriac's Handbook.

The "handbook," which is a 12-page web article, deals with such diverse subjects as chronic thirst (not necessarily diabetes), breast pain (not necessarily cancer) chronic headaches (not necessarily a brain tumor), and so on.

Time Magazine has also recently published articles about hypochndriacs. How to Heal a Hypochondriac talks about the tendency of medical students to become raging hypochondriacs as they gain more and more medical knowledge, truly illustrating Alexander Pope's contention that "a little knowledge is a dangerous thing."

The article goes on to talk about hypochondriacs in general:

"For doctors in training, nurses and medical journalists, hypochondria is an occupational hazard. The feeling usually passes after a while, leaving only a funny story to tell at a dinner party. But for the tens of thousands who suffer from true hypochondria, it's no joke. Hypochondriacs live in constant terror that they are dying of some awful disease, or even several awful diseases at once. Doctors can assure them that there's nothing wrong, but since the cough or the pain is real, the assurances fall on deaf ears. And because no physician or test can offer a 100% guarantee that one doesn't have cancer or multiple sclerosis or an ulcer, a hypochondriac always has fuel to feed his or her worst fears."

Sound like you? I know it sounds like me. Apparently we hypochondriacs are becoming a big wasteful clog in the medical system's pipes. And if you found this site by searching the Internet, you, like me, are part of the problem, and there is even a name for us - cyberchondriacs!

"According to one estimate, hypochondria racks up some $20 billion in wasted medical resources in the U.S. alone. And the problem may be getting worse, thanks to the proliferation of medical information on the Internet. 'They go on the Web,' says Dr. Arthur Barsky, a psychiatrist at Harvard Medical School and Brigham and Women's Hospital in Boston, 'and learn about new diseases and new presentations of old diseases that they never even knew about before.' Doctors have taken to calling this phenomenon cyberchondria.'"

Luckily for us, there are those who are taking our situation seriously.

"...a few clinicians, like Barsky and Columbia University neuropsychiatrist Dr. Brian Fallon, have begun to take the condition more seriously. 'It's not correct to say there's nothing wrong with a hypochondriac," Fallon asserts. "There is something wrong, but it's a disorder of thought, not of the body.' And, as he points out, disorders of thought are neither imaginary nor untreatable."

Dr. Fallon realized that hypochondriacs had a lot in common with those who suffer from Obsessive-Compulsive Disorder, or OCD.

"'Both disorders,' he says, 'involve intrusive, worrisome thoughts, the need for reassurance and a low tolerance for uncertainty.' Psychiatrists had lately come to think that OCD could be treated with Prozac and similar drugs, and Fallon decided the medications might work for hypochondria as well. With only 57 subjects, the study was too small to be definitive, but it was certainly promising: about 75% of those who got the drug showed significant improvement."

I can vouch for the fact that since I've been on a low dose of Prozac for the past several years, I am much less apt to go into panic mode and have an anxiety attack when I notice a new symptom, nor am I as apt to immediately assume I have some new disease the second I hear about it (it usually takes at least a few days now!).

Because some of the patients who responded were actually being given placebos, Dr. Fallon concluded there may be other causes of hypochondria, such as depression (stemming from guilt or loss) or a tendency to overanalyze and overreact to every bodily sensation, which is called "somatization."

Whatever the cause, hypochondria becomes a vicious cycle, and it is hard to break. To deal with this, Barsky recommends cognitive behavior therapy.

"'Just as focusing on a pain makes it seem more significant, ignoring it can make it seem much less,' says Barsky. Patients are also instructed to counter panicky thoughts with self-reassurance, reminding themselves, for example, that stomach pain almost never means stomach cancer. Both cognitive therapy and medication seem to work, and at this point it's hard to say whether one is better than the other."

Let's hope both doctors and patients become more aware of hypochondria and try to treat it. This way it will be a win-win for both!

Saturday, March 29, 2008

Updates on Alzheimer's Disease

Alzheimer's Disease is of particular interest to me, since my mother-in-law has it, and my father did too in his last years, although we never had a specific diagnosis.

Those of you who follow my other blog may be aware that in February we had a family crisis of sorts. My father-in-law, who is my mother-in-law's caretaker, was suddenly stricken ill (life-threatening bleeding in his intestines from diverticulosis) and hospitalized. Since we were unable to properly care for my mother-in-law, we needed to find respite care for her until my father-in-law recovered.

We were suddenly plunged head-first into the world of caregiving, and the financial and legal issues associated with it.

With the help of the hospital's social worker, we were able to find my mother-in-law a very nice nursing home for the time-being.

Through the magic of the internet, we found a local attorney who was able to draw up a Power of Durable Attorney document for my father-in-law to sign (up until then we did not have that document, which is very important for any children of elderly parents to obtain). Without it we couldn't access his bank account or other assets to pay for anything he or my mother-in-law needed.

Then we consulted with an eldercare attorney to get direction on the best way to handle the situation going forward.

Currently my father-in-law is back home while my mother-in-law is still in the nursing home while we figure out what the next step should be. Should she stay permanently in the nursing home? Or is she still well enough to live at home, albeit with help? My father-in-law now admits that her care is too much for him, especially after his recent health problem. But if she goes permanently into a nursing home, the financial implications become problematic.

As it is, we may have waited too long to address some of these eldercare issues, because it is uncertain whether we will be able to get Power of Attorney for my mother-in-law since she may not be deemed competent to sign the document; in that case it means going to court to obtain guardianship for her - which will involve about two more months of time and a $3000 legal bill.

We also learned that because both of my in-laws' names are on the deed to their house, both of their signatures would be required to sell the house if they need to sell. If my MIL is not competent, then my father-in-law or we need guardianship so we can sign in her stead.

The reason I'm sharing all this with you is for those who may have relatives in a similar situation. I hope you will heed my tale as a warning to go get the advice and legal documents you need before an emergency arises that forces you to do it. It would be a lot less stressful that way!

The Family Caregiver Alliance contains a wealth of information on all aspects of caregiving and eldercare issues if you would like more information about this important subject.

Now, on to the news:

Researchers at Rhode Island Hospital and Brown University learned that people with early Alzheimer's Disease were involved in more crashes and performed more poorly on road tests than those without the disease.

I'm sure this comes as no surprise for those of us who have had a parent with Alzheimer's Disease. My father, never a good driver, first got lost more easily and then started hitting things fairly frequently as he began to develop dementia. When he finally had a more serious accident as a result of running a red light, we asked him to stop driving, and he agreed. Luckily no one was hurt.

My husband's grandmother, who hadn't learned to drive until her husband died when she was 70, drove safely for about 10 years until she started to lose her grip. She drove a standard shift car, and one day suddenly couldn't remember how to change gears. That was when my in-laws realized she couldn't drive any more.

If you have a loved one with early dementia and are concerned about their driving, the Caregivers Alliance link above has more information on how best to address this problem.

According to Reuters, the NYU School of Medicine has discovered that PET scans can help diagnose Alzheimer's and other dementias. PET (Positron Emission Tomography) "correctly classified 94 percent of the normal subjects, 95 percent with Alzheimer's disease, 92 percent with dementia with Lewy bodies and 94 percent with frontotemporal dementia."

One of the problems with Alzheimer's Disease in the past has been the difficulty of accurately identifying it in the patient. Because Alzheimer's Disease and other forms of dementia may need different therapies, this is an important finding that should help doctors diagnose Alzheimer's earlier and with more accuracy.

According to the reasearcher
, "'Because the incidence of these disorders is expected to increase dramatically as the baby-boom generation ages,' she added, 'accurate diagnosis becomes extremely important, particularly at the early and mild stages of dementia when life-style changes and therapeutic interventions are supposed to be most effective.'"

In other news, researchers at the University of California found that melatonin and light therapy can help Alzheimer's patients remain acclimated to the normal day and night sleep-wake cycle.

Many Alzheimer's patients tend to wake up at odd hours of the night and sleep during the day when they could be interacting with others and participating in activities.

The light therapy is similar to what is used for people with Seasonal Affective Disorder - patients are exposed to bright light for an hour or so in the morning.

For the study at the University of California, Alzheimer's patients were divided into three groups: One got only morning light therapy, one got both morning light therapy plus melatonin at bedtime, and the third group didn't have any special treatment.

It was found that only the group receiving both light therapy and melatonin improved in their daytime alertness.

Since light therapy alone did not show an effect, it is unclear whether it provided any benefit to the group that received melatonin, or whether melatonin alone was responsible for the improvement. Further research needs to be done to clarify this.

Many Alzheimer's patients are recalcitrant when it comes to taking pills and other medications. My mother-in-law is relatively good about this but sometimes she hides a pill in her mouth and spits it out when no one's looking, the same way my cat does when I give him a pill. The solution has been to crush pills in applesauce and have her consume them that way, which works as long as she's in the mood for applesauce.

Last summer, however, the FDA approved an Alzheimer's medication that is delivered in a patch. The medication, Exelon, is a drug for treating mild to moderate Alzheimer's Disease that has already been approved in the form of a capsule and an oral solution. It works similarly to Aricept, another commonly prescribed drug used for Alzheimer's Disease.

The patch, which can be applied to the back, chest or upper arm, delivers the drug in a steady dosage throughout 24 hours, after which it must be replaced with a new one.

A study showed patients using the patch had fewer side effects than with the capsule version of the drug.

Further research continues constantly, so if you have a loved one with this disease or are worried about getting it yourself, don't be discouraged. If you are interested in learning more, please check the National Institute of Neurologic Disorders website.

UPDATE: In doing some further research, I discovered that there have been studies that show Perispinal etanercept (Enbrel, Amgen), an anticytokine therapy that targets excess tumor necrosis factor - alpha (TNF-α) - in the brain, has been shown to produce almost immediate cognitive and behavioral improvement in a patient with moderate Alzheimer's Disease.

The therapy, which has already been approved for use in rheumatoid arthritis, reduces neurological inflammation. It is administered via a once-a-week injection into the cerebro-spinal system. Full research article is available at this site.

Further research must be done, but this seems to be a promising therapy.