Medicana: August 2007

A recent article reported in Medical News Today confirms what I have suspected for some time: stress apparently is a co-factor for memory loss associated with Alzheimer's Disease.

A study being being published in the September 1st issue of Biological Psychiatry was designed to explore the relationship between mutations of the APOE gene (also called allele) and cortisol levels. It is known that the a4 variant of the APOE gene contributes to the risk for memory loss related to Alzheimer's Disease, as do high circulating levels of cortisol, associated with high stress levels.

The article is "The Effects of Prolonged Stress and APOE Genotype on Memory and Cortisol in Older Adults" by Guerry M. Peavy, Kelly L. Lange, David P. Salmon, Thomas L. Patterson, Sherry Goldman, Anthony C. Gamst, Paul J. Mills, Srikrishna Khandrika and Douglas Galasko. It appears in Biological Psychiatry, Volume 62, Issue 5 (September 1, 2007), published by Elsevier.

The study results showed that "low-stress subjects performed better than high-stress subjects on delayed recall of stories, word lists, and visual designs. APOE-epsilon4-negative subjects obtained better scores than epsilon4-positive subjects on immediate and delayed recall of visual designs."

The study also showed worse memory and higher cortisol concentrations in the high stress, epsilon4-positive group. The authors concluded that the findings indicate "prolonged exposure of older, nondemented individuals to stress in the presence of an epsilon4 allele leads to memory decline." They hope to do further studies to learn whether stress and this gene mutation interact to increase the risk of developing Alzheimer's disease in the first place.

I was not surprised to read about this, as I have been aware of several cases of Alzheimer's Disease that seemed to come on rather suddenly after a highly stressful situation. The mother-in-law of a friend of mine, who seemed totally normal not long before her husband died, became almost completely demented by the end of the following year. My husband's grandmother didn't show any overt memory loss or signs of Alzheimer's until not long after her only son accidentally (we think) shot himself in the head and was stricken blind as a result.

My father's mental state was pretty normal (other than his usual problems with depression) until a year or so after major heart surgery, which must have been stressful for both mind and body. I wonder to this day whether he would have been better off dying of heart failure at 86 rather than living to 92, with the last three years lived in an ever-increasing fog of memory loss, loss of skills, loss of comprehension, and loss of personality.

My mother-in-law now seems to be in the middle stages of Alzheimer's Disease; but her forgetfulness started not long after her own mother died in the nursing home of complications from Alzheimer's Disease. My mother-in-law had been under tremendous stress for a number of years before her mother's death, when her mother was still living in a senior citzen's apartment building. She went there every day, made sure her mother ate, bathed her, brought her over to her own home to entertain her, dealt with her mother's temper tantrums as she worsened and showed personality changes, etc. Her mother died not that long after entering the nursing home because she broke her hip, which tipped her over the edge into incoherence after the hip was operated on. This was still more stress for my mother-in-law, who developed shingles at this time, another indication of the body's reaction to stress, which lowers the immune system response.

While further studies are planned, it makes sense to me that if you have any Alzheimer's Disease in your family, that you should avoid stress as much as possible. While we don't know whether the development of AD can be prevented or delayed by reducing stress, it sure couldn't hurt.

Of course, as a hypochondriac, you will probably now get stressed out worrying whether your stress levels are leading to early Alzheimer's Disease. This will be self-defeating, so go meditate or something! And a little yoga might help too.

For all I poke fun of myself for being a hypochondriac, I believe hypochondria, in moderation, can actually be a very good thing, leading to a long and healthy life. Why? Because if you're the right type of hypochondriac, you go to the doctor when you have suspicious symptoms. And serious illnesses, caught early, are curable.

Naturally, this can be carried to extremes, and we all know people who run to the doctor for every sniffle or scratch, and drive people crazy with their constant obsessing over their health. This can be unhealthy, by driving up stress levels and actually causing stress-related illnesses.

So, as a hypochondriac, how do you know when you should worry, and when you should tell yourself to let it go?

Luckily for us, MSN.com has published an article from the Mayo Clinic about 10 Symptoms Not to Ignore. Following are their recommendations; I'll put my own comments in blue.

1. Unexplained weight loss
If you find you're losing excessive weight without intending to do so, see your doctor. Unintentional excessive weight loss is considered to be a loss of more than:

5 percent of your weight within one month
10 percent of your weight within six to 12 months

An unexplained drop in weight could be caused by a number of conditions, such as an overactive thyroid (hyperthyroidism), depression, liver disease, cancer or other noncancerous disorders, or disorders that interfere with how well your body absorbs nutrients (malabsorption disorders).

Heart disease is not mentioned as one of the causes of weight loss, but that is another reason people may lose weight for no reason. As my father progressed into heart failure in his mid-80's, he lost weight. He didn't seem to develop the edema (fluid retention/swelling) that some heart failure patients get, which can disguise the weight loss. His only issue was breathing difficulties at night.

Old age in general can result in weight loss, as people find it harder to chew, lose their appetite and sense of taste and smell, or live alone and don't feel like cooking. As mentioned in the previous post, it is important for the elderly to continue to keep up their nutrition, particularly protein. If they aren't willing or able to eat more, then nutritional substitutes such as Boost or Ensure can help keep up their caloric intake.

2. Persistent fever
If you have a normal immune system and you're not undergoing treatment, such as chemotherapy for cancer, a persistent low-grade fever — over 100.4 F — should be checked if it lasts for a week or more. If you have a fever with shaking chills, or a high fever — greater than 103 F — or if you're otherwise severely ill, see your doctor as soon as possible.

If you have an immune system problem or take immune-suppressing drugs, fever may not be a reliable warning sign and your primary doctor or oncologist can tell you what would signal a need for an evaluation.

Persistent fever can signal hidden infections, which could be anything from a urinary tract infection to tuberculosis. At other times, malignant conditions — such as lymphomas — cause prolonged or persistent fevers, as can some medications and conditions, and reactions to certain drugs.

Fever is common with treatable infections, such as urinary tract infections. But if a low-grade fever persists for more than two weeks, check with your doctor. Some underlying cancers can cause prolonged, persistent fever, as can tuberculosis and other disorders.

3. Shortness of breath
Feeling short of breath — beyond the typical stuffy nose or shortness of breath from exercise — could signal an underlying health problem. If you ever find that you're unable to get your breath or that you're gasping for air or wheezing, seek emergency medical care.

Feeling breathless with or without exertion or when reclining also is a symptom that needs to be medically evaluated without delay. (This was one of the key symptoms my father had with his congestive heart failure.)

Causes for breathlessness may include chronic obstructive pulmonary disease, chronic bronchitis, asthma, heart problems, anxiety, panic attacks, pneumonia, a blood clot in the lung (pulmonary embolism), pulmonary fibrosis and pulmonary hypertension.

4. Unexplained changes in bowel habits
See your doctor if you have any of the following:
-Severe diarrhea lasting more than two days
-Mild diarrhea lasting a week
-Constipation that lasts for more than two weeks
-Unexplained urges to have a bowel movement
-Bloody diarrhea
-Black or tarry-colored stools

Changes in bowel habits may signal a bacterial infection — such as campylobacter or salmonella — or a viral or parasitic infection. Among other possible causes are inflammatory bowel disease and colon cancer.

Of course, as a hypochondriac, you will want to know as many possible causes as you can, so you'll have more to worry about and so you can help your doctor by figuring out what is wrong with you ahead of time and informing him or her of your diagnosis.

Other reasons for diarrhea or changes in bowel habits include celiac disease (or milder forms of gluten intolerance, where the body is sensitive to wheat products) and irritable bowel syndrome (IBS).

Bloody or black diarrhea may not even be a problem related to the bowels; the cause could be a bleeding ulcer in the stomach. This happened to my father-in-law a few years ago. He began having black diarrhea and feeling very weak. After he was taken to the emergency room he was diagnosed with a bleeding ulcer; luckily it stopped of its own accord and medication and diet were able to cure him. He's had no problems since.

Bright red blood in the stool can be a symptom of something as simple as hemmorrhoids. But it is important to find out for sure by consulting your doctor.

5. Mental status changes
Immediate medical evaluation is warranted if any of the following occur:
-Sudden or gradual confused thinking
-Disorientation
-Sudden aggressive behavior
-Hallucinations in someone who has never had them

Changes in behavior or thinking may be due to infection, head injury, stroke, low blood sugar or even medications, especially ones you've recently started taking.

Other causes can include a brain tumor or other lesions on the brain, or dementia from Alzheimer's or other similar diseases. Please see my previous posts on Alzheimer's and Brain Tumors for more information to scare yourself with.

6. New or more severe headaches (especially if you're over age 50)
Seek prompt medical attention if you experience:
-A sudden and severe headache, often called a thunderclap headache, because it comes on suddenly like a clap of thunder.
-A headache accompanied by a fever, stiff neck, rash, mental confusion, seizures, vision changes, weakness, numbness, speaking difficulties, scalp tenderness or pain with chewing.
-A headache that begins or worsens after a head injury.

These headache symptoms may be caused by stroke, blood vessel inflammation (arteritis), meningitis, brain tumor, aneurysm or bleeding on the brain after head trauma.

I have known, or known of, several fairly young people who have been the victims of brain aneurysms, where a weakened blood vessel bulges and eventually bursts. One, a man that worked at my company, was only 40. Another, the sister of a friend of mine, was 47. Sometimes an aneurysm is so catastrophic that there is nothing that can be done, as sadly was the case with them. But it can also cause symptoms before it actually bursts, and if the person realizes something is wrong and seeks medical help, surgery may be able to repair the vessel before it bursts.

7. Short-term loss of vision, speaking or movement control
If you have these signs and symptoms, minutes count. These are signs and symptoms of a possible stroke or transient ischemic attack (TIA). Seek immediate emergency medical care if you have any of the following:
-Sudden weakness or numbness of the face, arm or leg on one side of your body
-Sudden dimness, blurring or loss of vision
-Loss of speech, or trouble talking or understanding speech
-A thunderclap headache
-Sudden dizziness, unsteadiness or a fall

If at all possible, try to get to a hospital that specializes in treating strokes. (For more information, see my post on stroke).

8. Flashes of light
The sudden sensation of flashing lights may signal the beginning of retinal detachment. Immediate medical care may be needed to save vision in the affected eye.

Other less serious causes can be a detachment of the vitreous humor in the eye (the gel-like substance that fills the interior of the eye), or an ocular migraine. Naturally I have experienced both of these phenomena.

The detachment of the vitreous humor caused me to see a ringlike light when I looked into bright lights. In and of itself, the detachment of the vitreous humor is not necessarily dangerous; it often happens in nearsighted people as they age. It can lead to a retinal detachment, however, so it is important to have an ophthalmologist keep an eye on it (so to speak). It can leave the person with a lot of "floaters" in the affected eye for awhile but this effect dies down after about 6 months.

The ocular migraine (which apparently is similar to the "aura" that some migraine headache sufferers get when they're getting a migraine, but with the ocular migraine the person never actually gets the headache), can be a bit scary when it happens for the first time. An affected person suddenly becomes aware of a distinctive curved pattern of jagged white light. It starts strongly and then gradually diminishes. These episodes usually only last 15-20 minutes. When I first had one, I thought of retinal detachment, but then remembered a friend of mine had had ocular migraines when she was pregnant. When my symptoms went away after 10 or 15 minutes, I decided it must have been an ocular migraine. (Like me, she gets concerned about health-related issues, so she described her symptoms in detail to me at the time.)

We were on vacation when I had this little episode, so I waited a few days until we returned home and went to the ophthalmologist just to be sure everything was fine. I told him what happened and that I thought it was an ocular migraine, he agreed, and said "You'll have another."

Sure enough, I had several more episodes over the next year or so, but since then I haven't had any others. It's been several years since the last one.

I'd like to add, unless you are an experienced hypochondriac like myself, I would highly recommend that if you have ANY kind of flashing lights, that you consult an ophthalmologist immediately. Don't try to figure out whether it's a vitreous humor detachment, ocular migraine, or detached retina. It's just nice to know that there are other reasons you may have flashing lights in your eye other than the detached retina, which would require laser surgery and could cause you to lose your vision if not treated promptly.

9. Feeling full after eating very little
Feeling full sooner than normal after eating and having persistent nausea and vomiting that last more than a week are warning signs that should be checked by your doctor. There are many possible causes, including pancreatic cancer, stomach cancer and ovarian cancer.

Um, of course, there is one other possibility - you could be pregnant. If this is possible, buy a pregnancy test and check it out!

10. Hot, red or swollen joint
These warning signs may occur with a joint infection, which requires emergency care to save the joint and keep bacteria from spreading elsewhere. Other causes may include gout or certain types of arthritis such as rheumatoid arthritis.

A friend of ours had these symptoms and found it hard to get a diagnosis. The doctor finally decided it was gout.

Be sure to differentiate between swollen ankles or swollen joints, as swollen ankles could be fluid retention, which of course has its own separate list of possible causes, such as heart failure, liver disease, or just eating too much salt on a hot day. (I had swollen ankles once after having been on a plane the previous day and panicked thinking I had heart failure.)

This list is not complete, since it doesn't mention the "7 Warning Signs of Cancer," which are:

-A change in bowel or bladder habits
-A sore that does not heal (including mouth sores - don't just assume it's a canker sore!)
-Unusual bleeding or discharge from any place
-A lump in the breast or other parts of the body
-Chronic indigestion or difficulty in swallowing
-Obvious changes in a wart or mole (or any mole that is irregular in shape or has various colors in it - see this link for more information: http://cancer.about.com/od/skincancermelanoma/p/abcdeskincancer.htm)
-Persistent coughing or hoarseness

The "7 Warning Signs of Cancer" link also has another good symptoms list - for prostate and bladder symptoms.

Now that you are thoroughly educated about symptoms that should be checked out, go forth and worry! Maybe you'd better make a doctor appointment right now just in case.