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CareGivers providing in home care often are faced with various levels of Alzheimer’s disease. The memory loss found during home care varies in degree and thus requires flexible and sometimes creative caregiving techniques.  The follow is a recap of President Ronald Regan’s battle with Alzheimer’s.  Care-To-Go CareGivers in the Phoenix, Scottsdale, Chandler and Gilbert areas salute his contribution to America.

When Alzheimer’s Waited Outside the Oval Office

By LAWRENCE K. ALTMAN, M.D.

WASHINGTON — Ron Reagan’s new memoir, “My Father at 100,” has touched off sensational headlines with its suggestion that President Ronald Reagan might have begun showing hints of Alzheimer’s disease while still in the White House.

But in two interviews this month, the younger Mr. Reagan said he never meant to suggest that his father had dementia before leaving office in 1989. And he graciously took the blame for not being more explicit in a passage that described a few personal observations along with comments from the former president’s doctors.

A “rather small section of the book has attracted outsize attention,” he said in a telephone interview from Seattle, where he lives.

All he meant, he continued, was that the amyloid plaque characteristic of Alzheimer’s can start forming years before it leads to dementia. The former president’s diagnosis was made in 1993, four years after he left office.

“Given what we know about the disease,” his son told me, “I don’t know how you could say that the disease wasn’t likely present in him during the presidency.”

Had it been stated that way, the assertion about Alzheimer’s would have stirred little if any debate. Still, the issue is important for anyone — including candidates for office — because of the difficulty of distinguishing the initial symptoms of Alzheimer’s from, say, simple forgetfulness.

The disease occurs most frequently after 70, but it can strike younger people. Dr. Alois Alzheimer, a German psychiatrist, diagnosed the first case in a 51-year-old woman. It is now recognized as one of a number of types of dementia. And diagnosing it with certainty requires a brain biopsy, rarely done while a patient is still alive.

Mr. Reagan’s mental state was an issue even before he became the oldest man elected president, at 69, in 1980. Adversaries were fond of attributing his penchant for contradictory statements, forgetting names and general absent-mindedness to Alzheimer’s.

I reported on Mr. Reagan’s health, and he told me that his mother, Nelle, had died of senility — and that if he were to develop it in office he would resign.

As a follow-up to questions about Alzheimer’s, my extensive interviews with his White House doctors, key aides and others, I found no evidence that Mr. Reagan exhibited signs of dementia as president. The interviews did not include family members.

Moreover, until Ron Reagan’s memoir appeared, no other family member — and not Edmund Morris, the official biographer who spent seven years with Mr. Reagan in the White House — publicly hinted that he showed evidence of Alzheimer’s as president.

“My Father at 100” (Viking) is an affectionate, often lighthearted account of a son’s attempt to uncover his father’s character by going back to his early days. It is generally well written, except for portions of the closing chapter about Alzheimer’s — which Ron Reagan acknowledged were flawed because he “relied on memory” without checking facts about when and where the suspicion of his father’s Alzheimer’s was first raised.

He writes, for example, that after the former president fell from a bucking horse in Mexico in 1989, his doctors detected probable signs of Alzheimer’s in removing a blood clot that formed between his skull and brain. But such a procedure does not involve a brain biopsy that doctors would need to diagnose dementia.

Moreover, Mr. Reagan was flown to a military hospital near Tucson — not taken to San Diego, as his son writes — and the blood clot, a subdural hematoma, was removed weeks later at the Mayo Clinic in Rochester, Minn.

In the interviews, Ron Reagan genially acknowledged the errors and said that if he had anticipated the controversy he created, he “would have done more due diligence in terms of pinning down dates.”

When his father was president, Mr. Reagan, then a professional dancer with the Joffrey Ballet, visited him two or three times a year. Now 52, the younger Reagan has been a radio and television talk show host, commentator and magazine writer. In the book, he writes that he did not want his father to run for a second term, partly because of political differences (Ron has long been liberal) and partly because of his concern about Mr. Reagan’s health — not the possibility of Alzheimer’s, but the near-fatal gunshot wound he sustained in a 1981 assassination attempt.

Understandably, the son’s memories about his father’s Alzheimer’s focused on when it first produced symptoms. The anecdotes that he cites are either well known or lack convincing evidence for Alzheimer’s.

For example, he recounts the 1984 re-election campaign, when his father performed dismally as he floundered through his responses and was lost for words in his first debate with his opponent, Walter F. Mondale. But Mr. Reagan performed well in the second debate, 11 days later.

While spending a day in the Oval Office in 1987, the younger Reagan noticed that aides were providing his father with scripted index cards — a technique he often used when giving speeches — for phone calls lasting five minutes at most, implying signs of a failing memory. But in an interview, Mr. Reagan said it was “hard to know what to make of that” — and laughed as he said he was using similar notes in our conversation.

The son noted little things that he could not explain and to which he did not attach a name at the time. Based on knowing his father’s demeanor and cognition over a lifetime, the observations created an impression “that something was amiss.” But, he wrote, he did not want to leave an impression that his “father was catatonic or mumbling incoherently” at any period in the White House.

In his last months, Mr. Reagan held court from a hospital bed in his den, uncomplaining and gently agreeable. By this time he looked younger; his face had lost many of its worry lines and wrinkles. But as he stopped eating and drinking and his kidneys failed, Mr. Reagan lost the decade-long battle with Alzheimer’s and died on June 5, 2004.

Alzheimer’s hereditary patterns are not precisely known. Ron Reagan said he is aware that he is at risk for the disease. But he has not had genetic tests for it, and has not been asked or volunteered to take part in any study of the family history of Alzheimer’s.

Care-To-Go provides home care and caregivers in the Phoenix, Scottsdale, Chandler and Gilbert areas.

The old man sat in his gas station on a cold Christmas Eve. He hadn’t been anywhere in years since his wife had passed away. It was just another day to him. He didn’t hate Christmas, just couldn’t find a reason to celebrate. He was sitting there looking at the snow that had been falling for the last hour and wondering what it was all about when the door opened and a homeless man stepped through.
Instead of throwing the man out, Old George as he was known by his customers, told the man to come and sit by the heater and warm up. "Thank you, but I don’t mean to intrude," said the stranger. "I see you’re busy, I’ll just go."
"Not without something hot in your belly." George said.
He turned and opened a wide mouth Thermos and handed it to the stranger. "It ain’t much, but it’s hot and tasty. Stew … Made it myself. When you’re done, there’s coffee and it’s fresh."
Just at that moment he heard the "ding" of the driveway bell. "Excuse me, be right back," George said. There in the driveway was an old ’53 Chevy. Steam was rolling out of the front. The driver was panicked. "Mister can you help me!" said the driver, with a deep Spanish accent. "My wife is with child and my car is broken." George opened the hood. It was bad. The block looked cracked from the cold, the car was dead.
"You ain’t going in this thing," George said as he turned away.
"But Mister, please help …" The door of the office closed behind George as he went inside. He went to the office wall and got the keys to his old truck, and went back outside. He walked around the building, opened the garage, started the truck and drove it around to where the couple was waiting. "Here, take my truck," he said. "She ain’t the best thing you ever looked at, but she runs real good."
George helped put the woman in the truck and watched as it sped off into the night. He turned and walked back inside the office. "Glad I gave ‘em the truck, their tires were shot too. That ‘ol truck has brand new ." George thought he was talking to the stranger, but the man had gone. The Thermos was on the desk, empty, with a used coffee cup beside it. "Well, at least he got something in his belly," George thought.
George went back outside to see if the old Chevy would start. It cranked slowly, but it started. He pulled it into the garage where the truck had been. He thought he would tinker with it for something to do. Christmas Eve meant no customers. He discovered the the block hadn’t cracked, it was just the bottom hose on the radiator. "Well, shoot, I can fix this," he said to
Himself. So he put a new one on.
"Those tires ain’t gonna get ‘em through the winter either." He took the snow treads off of his wife’s old Lincoln. They were like new and he wasn’t going to drive the car anyway.
As he was working, he heard shots being fired. He ran outside and beside a police car an officer lay on the cold ground. Bleeding from the left shoulder, the officer moaned, "Please help me."
George helped the officer inside as he remembered the training he had received in the Army as a medic. He knew the wound needed attention. "Pressure to stop the bleeding," he thought. The uniform company had been there that morning and had left clean shop towels. He used those and duct tape to bind the wound. "Hey, they say duct tape can fix anythin’," he said, trying to make the policeman feel at ease.
"Something for pain," George thought. All he had was the pills he used for his back. "These ought to work." He put some water in a cup and gave the policeman the pills. "You hang in there, I’m going to get you an ambulance."
The phone was dead. "Maybe I can get one of your buddies on that there talk box out in your car." He went out only to find that a bullet had gone into the dashboard destroying the two way radio.
He went back in to find the policeman sitting up. "Thanks," said the officer. "You could have left me there. The guy that shot me is still in the area."
George sat down beside him, "I would never leave an injured man in the Army and I ain’t gonna leave you." George pulled back the bandage to check for bleeding. "Looks worse than what it is. Bullet passed right through ‘ya. Good thing it missed the important stuff though. I think with time your gonna be right as rain."
George got up and poured a cup of coffee. "How do you take it?" he asked.
"None for me," said the officer.
"Oh, yer gonna drink this.  Best in the city. Too bad I ain’t got no donuts." The officer laughed and winced at the same time.
The front door of the office flew open. In burst a young man with a gun. "Give me all your cash! Do it now!" the young man yelled. His hand was shaking and George could tell that he had never done anything like this before.
"That’s the guy that shot me!" exclaimed the officer.
"Son, why are you doing this?" asked George, "You need to put the cannon away. Somebody else might get hurt."
The young man was confused. "Shut up old man, or I’ll shoot you, too. Now give me the cash!"
The cop was reaching for his gun. "Put that thing away," George said to the cop, "we got one too many in here now."
He turned his attention to the young man. "Son, it’s Christmas Eve. If you need money, well then, here. It ain’t much but it’s all I got. Now put that pea shooter away."
George pulled $150 out of his pocket and handed it to the young man, reaching for the barrel of the gun at the same time. The young man released his grip on the gun, fell to his knees and began to cry. "I’m not very good at this am I? All I wanted was to buy something for my wife and son," he went on. "I’ve lost my job, my rent is due, my car got repossessed last week."
George handed the gun to the cop. "Son, we all get in a bit of squeeze now and then. The road gets hard sometimes, but we make it through the best we can."
He got the young man to his feet, and sat him down on a chair across from the cop. "Sometimes we do stupid things." George handed the young man a cup of coffee. "Bein’ stupid is one of the things that makes us human. Comin’ in here with a gun ain’t the answer. Now sit there and get warm and we’ll sort this thing out."
The young man had stopped crying. He looked over to the cop. "Sorry I shot you. It just went off. I’m sorry officer."
"Shut up and drink your coffee " the cop said.
George could hear the sounds of sirens outside. A police car and an ambulance skidded to a halt. Two cops came through the door, guns drawn. "Chuck! You ok?" one of the cops asked the wounded officer.
"Not bad for a guy who took a bullet. How did you find me?"
"GPS locator in the car. Best thing since sliced bread. Who did this?" the other cop asked as he approached the young man.
Chuck answered him, "I don’t know. The guy ran off into the dark. Just dropped his gun and ran."
George and the young man both looked puzzled at each other.
"That guy work here?" the wounded cop continued.
"Yep,"  George said, "just hired him this morning. Boy lost his job."
The paramedics came in and loaded Chuck onto the stretcher. The young man leaned over the wounded cop and whispered, "Why?"
Chuck just said, "Merry Christmas boy … and you too, George, and thanks for everything."
"Well, looks like you got one doozy of a break there. That ought to solve some of your problems."
George went into the back room and came out with a box. He pulled out a ring box. "Here you go, something for the little woman. I don’t think Martha would mind. She said it would come in handy some day."
The young man looked inside to see the biggest diamond ring he ever saw. "I can’t take this," said the young man. "It means something to you."
"And now it means something to you," replied George. "I got my memories. That’s all I need."
George reached into the box again. An airplane, a car and a truck appeared next. They were toys that the oil company had left for him to sell. "Here’s something for that little man of yours."
The young man began to cry again as he handed back the $150 that the old man had handed him earlier.
"And what are you supposed to buy Christmas dinner with? You keep that too," George said. "Now git home to your family."
The young man turned with tears streaming down his face. "I’ll be here in the morning for work, if that job offer is still good."
"Nope. I’m closed Christmas day," George said. "See ya the day after."
George turned around to find that the stranger had returned. "Where’d you come from? I thought you left?"
"I have been here. I have always been here," said the stranger. "You say you don’t celebrate Christmas. Why?"
"Well, after my wife passed away, I just couldn’t see what all the bother was. Puttin’ up a tree and all seemed a waste of a good pine tree. Bakin’ cookies like I used to with Martha just wasn’t the same by myself and besides I was gettin’ a little chubby."
The stranger put his hand on George’s shoulder. "But you do celebrate the holiday, George. You gave me food and drink and warmed me when I was cold and hungry. The woman with child will bear a son and he will become a great doctor.
The policeman you helped will go on to save 19 people from being killed by terrorists. The young man who tried to rob you will make you a rich man and not take any for himself. "That is the spirit of the season and you keep it as good as any man."
George was taken aback by all this stranger had said. "And how do you know all this?" asked the old man.
"Trust me, George. I have the inside track on this sort of thing. And when your days are done you will be with Martha again."
The stranger moved toward the door. "If you will excuse me, George, I have to go now. I have to go home where there is a big celebration planned."
George watched as the old leather jacket and the torn pants that the stranger was wearing turned into a white robe. A golden light began to fill the room.
"You see, George … it’s My birthday. Merry Christmas."
George fell to his knees and replied, "Happy Birthday, Lord Jesus"
Merry Christmas!!
This story is better than any greeting card.

MERRY CHRISTMAS AND GOD BLESS!

What to cook when cancer hits

By Liz Szabo, USA TODAY

Doctors often instruct cancer patients to eat well to keep up their strength.

But for cancer patients, getting through a simple meal can be a challenge. Radiation treatments can burn the throat, making it painful to swallow. Chemotherapy can cause patients to develop mouth sores or leave people nauseated. Other patients find that chemo takes away their sense of smell or alters their sense of taste.

Two books from the American Cancer Society aim to help both patients and their caregivers overcome these hurdles. The Complete Guide to Nutrition for Cancer Survivors ($24.95), published this year, explains how good nutrition can help boost the immune system and fight fatigue.

What to Eat During Cancer Treatment ($19.95), published last year, offers 100 recipes to help patients cope with six major symptoms of treatment. For instance, there’s a brie and apple grilled cheese for patients coping with nausea. Most recipes take only 30 minutes to make.

That’s important, given that cancer patients may not have much energy to spend in the kitchen and caregivers may be pressed for time, says the cancer society’s Colleen Doyle, who edited both books.

The recipes also include foods packed with vitamins and antioxidants, Doyle says. Patients who eat well are often better able to deal with side effects of treatment and may be better able to fight off infections, she says.

"I truly believe food is medicine, and it helps people provide their body with the nutrition they need to heal," say Barbara Grant, a registered dietitian and co-author of Nutrition for Cancer Survivors.

American Cancer Society’s tips for cooking for someone with cancer:

• Ask if the person has any special requests. "Instead of just showing up with chocolate cake, ask, ‘What can I make you? What sounds good?’ " says Grant.

• Ask if you can help with groceries or offer to do the dishes, says the American Cancer Society’s Colleen Doyle, a registered dietitian.

• Offer to put together a "survival kit" in a cooler, filled with snacks and drinks, for times when the cancer patient doesn’t want to get out of bed to go to the kitchen to eat, Doyle says.

• Prepare an "on-the-go" snack mix with nuts, pretzels, dry cereal or crackers for the cancer patient to eat when away from home.

• Instead of making one big casserole, prepare individual servings to freeze and reheat, Doyle says.

• Wash your hands carefully, make sure all meats and eggs are fully cooked, and take care to avoid any kind of contamination, which can be dangerous for people with weakened immune systems.

Recipe: Tuna melt quesadilla

The recipe from the American Cancer Society addresses the common cancer treatment symptoms of unintentional weight loss and taste alterations.

Servings: 3

Prep time: 15 minutes or less

Total time: 15 minutes or less

This twist on a classic gives new life to the tuna melt. A quesadilla is a good choice when a sandwich seems overwhelming. Choose full-fat options if trying to gain weight, reduced-fat if you are watching calories.

Ingredients:

• 1 (5-ounce) can tuna in water, drained

• 1 tablespoon regular or reduced-fat mayonnaise

• 1/2 tablespoon Dijon mustard

• 1 tablespoon finely chopped red onion

• 1 tablespoon pickle relish

• 3 (8-inch) whole wheat or plain tortillas

• 3/4 cup shredded regular or reduced-fat Cheddar or "Mexican style" cheese

Directions:

1. In a bowl, flake the tuna. Add the mayonnaise and mustard and stir to combine. Add the onion and relish.

2. On a microwave-safe plate, place 1 tortilla and spread half with 1/3 of the tuna mixture. Sprinkle the other half with 1/4 cup cheese. Fold the tuna half over the cheese half. Microwave on high for 40 to 50 seconds, or until cheese melts. Repeat twice with the remaining ingredients. Microwaving the quesadilla instead of pan-frying or baking keeps it softer.

Nutritional information:

Per serving (1 quesadilla)

Calories: 360

Total fat: 17 g

Total carbohydrate: 31 g

Dietary fiber: 3 g

Sugars: 3 g

Protein: 21 g

Sodium: 940 mg

For CareGiver Home Care in the Phoenix or Scottsdale area see http://Care-To-Go.com

Caregiver Explains How To Prevent Falls With Better Balance

By John Hanc New York Times

Unintentional falls among those 65 and older are responsible for more than 18,000 deaths and nearly 450,000 hospitalizations annually in the United States, according to the Centers in Atlanta. Most of these falls are caused by a decline in that complex and multidimensional human skill known as balance.

Balance is a critical issue to older people. And more and more, at one-on-one training facilities like Mr. Morea’s or at larger health clubs, whether in yoga and Pilates studios or adult-education exercise classes for older adults, balance training is becoming a priority.

To remain upright and sure-footed, explained Dr. David Thurman, a neurologist with the center and a spokesman for the American Academy of Neurology, “there are several components of the nervous system, as well as motor or movement functions, that need to be intact.” These include the vestibular system of the inner ear, vision and proprioception, the ability to sense where one’s arms, legs or other parts of the body are without looking at them, as well as the strength and flexibility of bones and soft tissue.

“All of these,” Dr. Thurman said, “tend to degrade with age, particularly as people move into their seventh and eighth decades.”

Yet, unlike many effects of aging, balance can be improved, and the age-related declines can be delayed or minimized with proper training.

“The preponderance of evidence,” Dr. Thurman said, “shows fairly convincingly that strength and balance training can reduce the rate of falls by up to about 50 percent.”

Hence, the Department of Health and Human Services in revising its national physical activity guidelines, issued in 2008, added a recommendation for the elderly to include balance exercises as part of their overall physical activity regimen.

The problem, said Michael Rogers, an exercise scientist at Wichita State University, is that while most major public health agencies recommend 30 minutes a day of cardiovascular exercise for the heart and two or three sessions a week of strength training, “there is no real exercise prescription for balance.” So activities that promote balance tend to become integrated into other activities. Mr. Morea does this with older clients like Ms. Luftig in twice-weekly, 30-minute strength-training sessions.

Of course, while it is good to have supervision by a certified fitness professional, not to mention the benefit of a gym full of balance toys (and there are many these days, including wobble boards, balls and cushions), one does not have to work out with a personal trainer to get the benefits of balance training.

“You can do it anytime, anyplace,” said Mr. Rogers, who is research director at Wichita State’s Center for Physical Activity and Aging and teaches exercise classes to older adults. “You don’t have to be involved in a systematic program.”

He added, “You don’t have to be standing on one foot, which is often too difficult for some older people. You can challenge your balance while brushing your teeth.” Simply put one foot in front of the other while you brush, or stand with your feet closer together.

Balance training is often seen as part of a larger trend called functional fitness exercises, which are geared to helping one handle the physical challenges of day-to-day life. Around holiday time, for example, Mr. Rogers tries to prepare the elderly in his class for crowded shopping malls. He has them walk between narrow gaps, occasionally getting brushed by others. This, he said, “helps give them confidence” to face the holiday throngs.

Trainers like Mr. Morea devise balance training drills for their older clients. For example, a woman was having trouble bending down in her kitchen to reach to the back of a floor-level cupboard and retrieve cooking pots. So he developed “pot squat and reach” — a movement that basically imitated what she was doing, except on an unstable surface, so that she could develop the strength, neural connections and balance to confidently perform that movement at home.

One of the nice things about balance training is that the results can be evident fairly quickly.

“The nervous system has considerably more regenerative capacity well into the senior years than we used to think,” said Dr. Thurman. “The capacity for adjustment, compensation and even developing new skills remains there.”

Which is exactly what Ms. Luftig, who lives in Greenwich Village, has found. “I feel more confident,” she said. “In my neighborhood, you have bicycles whizzing by you all the time. You could lose your balance when they come so close. But when that happens now, I feel more stable. I have this ability that I didn’t used to have.”

For assistance in the Phoenix area contact Care-To-Go at 480-284-8611

Backlash grows against full-body scanners in airports

As the TSA  airports try to get a handle on quick and efficient scanning at security checkpoints, new machines may not be the answer.

Our Elder Travel Companions from Phoenix and Scottsdale report longer security delays and frazzled nerves at full body scan airports.  Our seniors in wheel chairs are not subject to this screening and will continue to be checked as usual.  The Travel Companion CareGiver can be a great asset in transiting airport security.

By Gary Stoller, USA TODAY

Opposition to new full-body imaging machines to screen passengers and the government’s deployment of them at most major airports is growing.

Many frequent fliers complain they’re time-consuming or invade their privacy. The world’s airlines say they shouldn’t be used for primary security screening. And questions are being raised about possible effects on passengers’ health.

"The system takes three to five times as long as walking through a metal detector," says Phil Bush of Atlanta, one of many fliers on USA TODAY’s Road Warriors panel who oppose the machines. "This looks to be yet another disaster waiting to happen."

BODY SCANNERS: Concerns about privacy and health set off debate

The machines — dubbed by some fliers as virtual strip searches — were installed at many airports in March after a Christmas Day airline bombing attempt. The Transportation Security Administration (TSA) has spent more than $80 million for about 500 machines, including 133 now at airports. It plans to install about 1,000 by the end of next year.

The machines are running into complaints and questions here and overseas:

•The International Air Transport Association, which represents 250 of the world’s airlines, including major U.S. carriers, says the TSA lacks "a strategy and a vision" of how the machines fit into a comprehensive checkpoint security plan. "The TSA is putting the cart before the horse," association spokesman Steve Lott says.

•Security officials in Dubai said this month they wouldn’t use the machines because they violate "personal privacy," and information about their "side effects" on health isn’t known.

•Last month, the European Commission said in a report that "a rigorous scientific assessment" of potential health risks is needed before machines are deployed there. It also said screening methods besides the new machines should be used on pregnant women, babies, children and people with disabilities.

The U.S. Government Accountability Office said in October that the TSA was deploying the machines without fully testing them and assessing whether they could detect "threat items" concealed on various parts of the body. And in March, the office said it "remains unclear" whether they would have detected the explosives that police allege Umar Farouk Abdulmutallab tried to detonate on a jet bound for Detroit on Christmas.

TSA spokeswoman Kristin Lee says the agency completed testing at the end of last year and is "highly confident" in the machines’ detection capability. She also says their use hasn’t slowed screening at airports and that the agency has taken steps to ensure privacy and safety.

The TSA is deploying two types of machines that can see underneath clothing. One uses a high-speed X-ray beam, and the other bounces electromagnetic waves off a passenger’s body.

Passengers can refuse screening by the machines and receive a pat-down search by a security officer, screening by a metal detector, or both, the TSA says.

For more information on an Elder Travel Companion go to CareToGoTravel.com and for Phoenix in home care caregiver see Care-To-Go.com