QUOTE FOR MONDAY:

There are many causes of gastroparesis. Diabetes is one of the most common causes for gastroparesis. Other causes include infections, endocrine disorders like hypothyroidism, connective tissue disorders like scleroderma, autoimmune conditions, neuromuscular diseases, idiopathic (unknown) causes, psychological conditions, eating disorders, certain cancers, radiation treatment applied over the chest or abdomen, some chemotherapy agents, and surgery of the upper intestinal tract.

American College of Gastroenterology

Part II Gastroparesis August Awareness Month

How is Gastroparesis Treated?
The treatment for gastroparesis in an individual depends on the severity of symptoms. Treatments are aimed at managing symptoms over a long-term.

Treatment approaches may involve one or a combination of:

  • dietary and lifestyle measures,
  • medications, and/or
  • procedures that may include surgery, such as
  • enteral nutrition,
  • parenteral nutrition,
  • gastric electrical stimulation (Enterra), or
  • other surgical procedures

Some people with gastroparesis have mild symptoms that come and go, which can be managed with dietary and lifestyle measures.

Others have moderate to more severe symptoms that additionally may be treated with medications to stimulate motility and/or reduce nausea and vomiting.

Some people have severe symptoms that are difficult to treat or do not respond to initial treatment approaches. They may require additional procedures to maintain nutrition and/or reduce symptoms.

Goals of Treatment
The goals of treatment are to manage and reduce symptoms, maintain quality of daily living, and minimize related problems such as:

  • Severe dehydration due to persistent vomiting
  • Bezoars (solid collections of food, fiber, or other material), which can cause nausea, vomiting, obstruction, or interfere with absorption of some medications in pill form
  • Difficulty managing blood glucose levels in people with diabetes
  • Malnutrition due to poor absorption of nutrients or a low calorie intake

Manage Risk and Benefit
No single treatment helps all persons with gastroparesis. All drugs and procedures have inherent risks, some more than others. Some of the risks are unavoidable, while others can be avoided and managed. For patients and families it is important to talk to the doctor or health care team about both benefit and risk.

As a patient, in the context of your personal illness status, consider:

  • How severe is your own condition – what effect is it having on your life
  • What is the possible benefit from the treatment suggested or prescribed to you
  • What are the chances that you will receive benefit from the treatment
  • How much benefit should you reasonably expect
  • What possible side effects or complications might there be from the treatment
  • What are the chances that you will experience a side effect or serious adverse event from the treatment
  • What can you do to reduce the chances of side effects or complications
  • How will you know when a side effect occurs
  • Exactly what should you do if a side effect or complication occurs

How to live with Gastroparesis:

Gastroparesis is a long-term condition that can impair quality of life and well-being. Living with gastroparesis affects not only those who suffer but also many others, especially family members and friends. It also touches on relationships in the classroom, in the workplace, or in social interactions.

It takes skills and strengths to deal with a challenging digestive condition like gastroparesis. It means being a kind of active researcher, always looking for what does and does not help, hurt, and work best.

It is important to understand the condition and to advocate for better health. If you or a friend or loved one has gastroparesis, it is also important to understand that you are not alone with this diagnosis.

QUOTE FOR THE WEEKEND:

“Gastroparesis is caused by nerve injury, including damage to the vagus nerve. In its normal state, the vagus nerve contracts (tightens) the stomach muscles to help move food through the digestive tract. In cases of gastroparesis, the vagus nerve commonly damaged by people with diabetes. This prevents the muscles of the stomach and intestine from working properly, which keeps food from moving from the stomach to the intestines.”

Cleveland Clinic

 

Part I Gastroparesis August Awareness Month

 

Should focus attention on important health messages about gastroparesis diagnosis, treatment, and quality of life issues. The goals include improving understanding of gastroparesis to help patients and families manage the condition, and encouraging preventive strategies.

The number of people with gastroparesis appears to be rising. Yet gastroparesis is poorly understood. More community awareness is needed about the condition.

The more awareness for gastroparesis, the greater the ability to impact positive outcomes, such as additional research and improved patient care for the functional GI and motility disorders.

Gastroparesis is also called delayed gastric emptying. The term “gastric” refers to the stomach.

Normally, the stomach empties its contents in a controlled manner into the small intestines. In gastroparesis, the muscle contractions (motility) that move food along the digestive tract do not work properly and the stomach empties too slowly.

Gastroparesis is characterized by the presence of certain long-term symptoms together with delayed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test.

Signs and Symptoms:

The signs and symptoms of gastroparesis may differ among persons with the condition. Symptoms usually occur during and after eating a meal.

Symptoms that are characteristic of gastroparesis include:

  • Nausea and/or vomiting
  • Retching (dry heaves)
  • Stomach fullness after a normal sized meal
  • Early fullness (satiety) – the inability to finish a meal

Diagnosing Gastroparesis:

The symptoms of gastroparesis are similar to those that occur in a number of other illnesses. When symptoms persist over time or keep coming back, it’s time to see a doctor to diagnose the problem. An accurate diagnosis is the starting point for effective treatment.

Diagnosis of gastroparesis begins with a doctor asking about symptoms and past medical and health experiences (history), and then performing a physical exam. Any medications that are being taken need to be disclosed.

Tests will likely be performed as part of the examination. These help to identify or rule out other conditions that might be causing symptoms. Tests also check for anything that may be blocking or obstructing stomach emptying. Examples of these tests include:

  • a blood test,
  • an upper endoscopy, which uses a flexible scope to look into the stomach,
  • an upper GI series that looks at the stomach on an x-ray, or
  • an ultrasound, which uses sound waves that create images to look for disease in the pancreas or gallbladder that may be causing symptoms.

If – after review of the symptoms, history, and examination – the doctor suspects gastroparesis, a test to measure how fast the stomach empties is required to confirm the diagnosis.

Slow gastric emptying alone does not correlate directly with a diagnosis of gastroparesis.

There are several different ways to measure the time it takes for food to empty from the stomach into the small intestine. These include scintigraphy, wireless motility capsule, or breath test. Your doctor will provide details of the one chosen.

Gastric Emptying Study (Scintigraphy)
The diagnostic test of choice for gastroparesis is a gastric emptying study (scintigraphy). The test is done in a hospital or specialty center.

It involves eating a bland meal of solid food that contains a small amount of radioative material so that it can be tracked inside the body. The abdomen is scanned over the next few hours to see how quickly the meal passes out of the stomach. A radiologist will interpret the study at periodic intervals after the meal.

A diagnosis of gastroparesis is confirmed when 10% or more of the meal is still in the stomach after 4 hours.

Other methods for measuring gastric emptying include a wireless motility capsule and a breath test.

Wireless Motility Capsule
The ingestible wireless motility capsule (SmartPill) is swallowed and transmits data to a small receiver that the patient carries. The data collected is interpreted by a radiologist. While taking the test, people can go about their daily routine. After a day or two, the disposable capsule is excreted naturally from the body.

Breath Test
The breath test involves eating a meal that contains a nonradioactive component that can be tracked and measured in the breath over a period of hours. The results can then be calculated to determine how quickly the stomach empties.

Stay tune for Part II tomorrow!

 

QUOTE FOR FRIDAY:

“Alzheimer’s disease tends to develop slowly and gradually worsens over several years. Eventually, Alzheimer’s disease affects most areas of your brain.  The Alzheimer’s stages can help you understand what might happen, but it’s important to know that these stages are only rough generalizations. The disease is a continuous process. Each person has a different experience with Alzheimer’s and its symptoms.”

MAYO CLINIC

Part 4 What is actually Alzheimer’s Disease? (Staging levels of the disease):

 

Here is a summary of the seven stages of Alzheimer’s based on Dr. Resiberg’s system:

Stage 1: No Impairment

During this stage, Alzheimer’s is not detectable and no memory problems or other symptoms of dementia are evident.

Stage 2: Very Mild Decline

The senior may notice minor memory problems or lose things around the house, although not to the point where the memory loss can easily be distinguished from normal age-related memory loss. The person will still do well on memory tests and the disease is unlikely to be detected by loved ones or physicians.

Stage 3: Mild Decline

At this stage, the family members and friends of the senior may begin to notice cognitive problems. Performance on memory tests are affected and physicians will be able to detect impaired cognitive function.

People in stage 3 will have difficulty in many areas including:

  • Finding the right word during conversations
  • Organizing and planning
  • Remembering names of new acquaintances

People with stage three Alzheimer’s may also frequently lose personal possessions, including valuables.

Stage 4: Moderate Decline

In stage four of Alzheimer’s, clear-cut symptoms of the disease are apparent. People with stage four of Alzheimer’s:

  • Have difficulty with simple arithmetic
  • Have poor short-term memory (may not recall what they ate for breakfast, for example)
  • Inability to manage finance and pay bills
  • May forget details about their life histories

Stage 5: Moderately Severe Decline

During the fifth stage of Alzheimer’s, people begin to need help with many day-to-day activities. People in stage five of the disease may experience:

  • Difficulty dressing appropriately
  • Inability to recall simple details about themselves such as their own phone number
  • Significant confusion

On the other hand, people in stage five maintain functionality. They typically can still bathe and toilet independently. They also usually still know their family members and some detail about their personal histories, especially their childhood and youth.

Stage 6: Severe Decline

People with the sixth stage of Alzheimer’s need constant supervision and frequently require professional care. Symptoms include:

  • Confusion or unawareness of environment and surroundings
  • Inability to recognize faces except for the closest friends and relatives
  • Inability to remember most details of personal history
  • Loss of bladder and bowel control
  • Major personality changes and potential behavior problems
  • The need for assistance with activities of daily living such as toileting and bathing
  • Wandering

Stages 7: Very Severe Decline

Stage seven is the final stage of Alzheimer’s. Because the disease is a terminal illness, people in stage seven are nearing death. In stage seven of the disease, people lose the ability to communicate or respond to their environment. While they may still be able to utter words and phrases, they have no insight into their condition and need assistance with all activities of daily living. In the final stages of Alzheimer’s, people may lose their ability to swallow.

QUOTE FOR THURSDAY:

“What you can do other than diagnosing and Rx Alzheimer’s.  If your family member or friend has a serious memory problem, you can help the person live as normal a life as possible. You can help the person stay active, go places, and keep up everyday routines; if they allow you. You can remind the person of the time of day, where he or she lives, and what is happening at home and in the world. You also can help the person remember to take medicine or visit the doctor.”

National Institute of Aging

 

Part 3 What actually is Alzheimer’s Disease? (diagnosing and Rx).

The National Institute of aging states the following procedures also may be used to diagnose dementia:

  • “Cognitive and neuropsychological tests. These tests are used to assess memory, problem solving, language skills, math skills, and other abilities related to mental functioning.
  • Laboratory tests. Testing a person’s blood and other fluids , as well as checking levels of various chemicals, hormones, and vitamins, can help find or rule out possible causes of symptoms.
  • Brain scans. These tests can identify strokes, tumors, and other problems that can cause dementia. Scans also identify changes in the brain’s structure and function. The most common scans are:
    • Computed tomography (CT), which uses x rays to produce images of the brain and other organs
    • Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to produce detailed images of body structures, including tissues, organs, bones, and nerves
    • Positron emission tomography (PET), which uses radiation to provide pictures of brain activity
  • Psychiatric evaluation. This evaluation will help determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
  • Genetic tests. Some dementias are caused by a known gene defect. In these cases, a genetic test can help people know if they are at risk for dementia. It is important to talk with a genetic counselor before and after getting tested, along with family members and the doctor.

QUOTE FOR WEDNESDAY:

“Researchers believe there is not a single cause of Alzheimer’s disease. The disease likely develops from multiple factors, such as genetics, lifestyle and environment. Scientists have identified factors that increase the risk of Alzheimer’s. While some risk factors — age, family history and heredity — can’t be changed, emerging evidence suggests there may be other factors we can influence.”

Alzheimer’s Association

 

Part 2 What is actually Alzheimer’s Disease? (Facts and Causes):

People with this disease:

 

  • In 2014, as many as 5 million Americans were living with Alzheimer’s disease.
  • The symptoms of the disease can first appear after age 60 and the risk increases with age.
  • Younger people may get Alzheimer’s disease, but it is less common.
  • The number of people living with the disease doubles every 5 years beyond age 65.
  • This number is projected to nearly triple to 14 million people by 2060.

Scientists do not yet fully understand what causes Alzheimer’s disease. There probably is not one single cause, but several factors that affect each person differently.

  • Age is the best known risk factor for Alzheimer’s disease.
  • Family history—researchers believe that genetics may play a role in developing Alzheimer’s disease.
  • Changes in the brain can begin years before the first symptoms appear.
  • Researchers are studying whether education, diet, and environment play a role in developing Alzheimer’s disease.
  • Scientists are finding more evidence that some of the risk factors for heart disease and stroke, such as high blood pressure and high cholesterol may also increase the risk of Alzheimer’s disease.
  • There is growing evidence that physical, mental, and social activities may reduce the risk of Alzheimer’s disease.

Alzheimer’s disease is

  • One of the top 10 leading causes of death in the United States.
  • The 6th leading cause of death among US adults.
  • The 5th leading cause of death among adults aged 65 years or older.

In 2014, an estimated 5 million Americans aged 65 years or older had Alzheimer’s disease. This number is projected to nearly triple to 14 million people by 2060.

In 2010, the costs of treating Alzheimer’s disease were projected to fall between $159 and $215 billion.4 By 2040, these costs are projected to jump to between $379 and more than $500 billion annually.4

Death rates for Alzheimer’s disease are increasing, unlike heart disease and cancer death rates that are on the decline.5 Dementia, including Alzheimer’s disease, has been shown to be under-reported in death certificates and therefore the proportion of older people who die from Alzheimer’s may be considerably higher.

Various disorders and factors contribute to the development of dementia. Neuro-degenerative disorders result in a progressive and irreversible loss of neurons and brain functioning. Currently, there are no cures for these types of disorders. They include:

Other types of progressive brain disease include:

In addition, certain medical conditions can cause serious memory problems that resemble dementia. These problems should go away once the conditions are treated. These conditions include:

  • Side effects of certain medicines
  • Emotional problems, such as stress, anxiety, or depression
  • Certain vitamin deficiencies
  • Drinking too much alcohol
  • Blood clots, tumors, or infections in the brain
  • Delirium
  • Head injury, such as a concussion from a fall or accident
  • Thyroid, kidney, or liver problems

Doctors have identified many other conditions that can cause dementia or dementia-like symptoms. These conditions include:

  • Argyrophilic grain disease, a common, late-onset degenerative disease
  • Creutzfeldt-Jakob disease, a rare brain disorder
  • Huntington’s disease, an inherited, progressive brain disease
  • Chronic traumatic encephalopathy (CTE), caused by repeated traumatic brain injury
  • HIV-associated dementia (HAD)

The overlap in symptoms of various dementias can make it hard to get an accurate diagnosis. But a proper diagnosis is important to get the right treatment. Seek help from a neurologist—a doctor who specializes in disorders of the brain and nervous system—or other medical specialist who knows about dementia.