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The Stages of Alzheimer’s Disease

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Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills, and eventually the ability to carry out the simplest tasks. Named for Dr. Alois Alzheimer who in 1906 noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After her death, Dr. Alzheimer examined her brain and found many abnormal clumps (not called amyloid plaques) and tangled bundles of fibers (not called neurofibrillary, or tau tangles).

These plaques and tangles in the brain are considered some of the main features of the disease along with the loss of connections between nerve cells in the brain.

Mild Alzheimer’s Disease

As Alzheimer’s disease progresses, people experience greater memory loss and other cognitive difficulties. Problems can include wandering and getting lost, trouble handling money and paying bills, repeating questions, taking longer to complete normal daily tasks, and personality and behavior changes. People are often diagnosed in this stage.

Moderate Alzheimer’s Disease

In this stage, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. Memory loss and confusion grow worse, and people begin to have problems recognizing family and friends. They may be unable to learn new things, carry out multi-step tasks such as getting dressed, or cope with new situations. In addition, people at this stage may have hallucinations, delusions, and paranoia and may show impulsive behavior.

Severe Alzheimer’s Disease

Ultimately, plaques and tangles spread throughout the brain, and brain tissue significantly shrinks. People with severe Alzheimer’s cannot communicate and are completely dependent on others for their care. Near the end of life, the person may be in bed most or all of the time as the body shuts down.

Research suggests that a host of factors beyond genetics may play a role in the development and course of Alzheimer’s disease. There is a great deal of interest, for example, in the relationship between cognitive decline and vascular conditions such as heart disease, stroke, and high blood pressure, as well as metabolic conditions such as diabetes and obesity. Ongoing research will help us understand whether risk factors for these conditions may also reduce the risk of Alzheimer’s.

A nutritious diet, physical activity, social engagement, and mentally stimulating pursuits have all been associated with helping people stay healthy as they age. These factors might also help reduce the risk of cognitive decline and Alzheimer’s disease. Clinical trials are testing some of these possibilities.

Beginning treatment early in the disease process may help preserve daily functioning for some time, even though the underlying disease process cannot be stopped or reversed. An early diagnosis also helps families plan for the future. They can take care of financial and legal matters, address potential safety issues, learn about living arrangements, and develop support networks.

In addition, an early diagnosis gives people greater opportunities to participate in clinical trials that are testing possible new treatments for Alzheimer’s disease or other research studies.

Alzheimer’s disease is currently ranked as the sixth leading cause of death in the United States, but recent estimates indicate that the disorder may rank third, just behind heart disease and cancer, as a cause of death for older people. Estimates vary, but experts suggest that more than 5.5 million Americans may have Alzheimer’s. By 2050, this number is projected to rise to nearly 14 million.

Want to get involved and raise awareness and money to fight Alzheimer’s?

The 2018 Wilmington Walk to End Alzheimer’s will be held on November 3 at Wrightsville Beach Park. They will also be hosting a kick off party at Waterman’s Brewing on Thursday, October 4 for an evening of fun, food, and inspiration. Visit their website for more information on how you can participate.

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Impetigo

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With the start of school comes more opportunity for young children to spread illnesses among each other. We’ve heard of strep throat and staph infections, but have you heard of impetigo?

Impetigo is a common bacterial skin infection that can produce blisters or sores anywhere on the body, but usually on the face (around the nose and mouth), neck, hands, and diaper area. It’s most common in children between the ages of two and six.

Impetigo is usually caused by staphylococcal (staph) bacteria, but it can also be caused by streptococcal (strep) bacteria, and usually starts when bacteria get into a break in the skin, such as a cut, scratch, or insect bite.

Signs of impetigo:

  • Itchy red sores that fill with fluid and then burst open, forming a yellow crust
  • Itchy rash
  • Blisters that itch and filled with yellow or honey-colored fluid
  • One or many blisters filled with pus that are easy to pop. In infants, the skin is reddish or raw-looking where a blister has broke
  • Rash that may begin as a single spot, but spreads to other areas with scratching
  • Skin sores on the face, lips, arms, or legs, that spread to other areas
  • Swollen lymph nodes near the infection

If you see these symptoms, visit your physician for diagnosis and treatment recommendations. Impetigo is usually treated with topical or oral antibiotics. If you have multiple lesions or if there is an outbreak, your doctor might prescribe an oral antibiotic. There is no over-the-counter (OTC) treatment for impetigo.

Doctors will often prescribe antibiotic creams such as mupirocin, fusidic acid or retapamulin. Studies have shown that these medications relieve the symptoms better than ointments that do not contain antibiotic medications.

Controlling and preventing impetigo:

Untreated, impetigo often clears up on its own after a few days or weeks. The key is to keep the infected area clean with soap and water (do not scrub), and do not scratch. The downside of not treating impetigo is that some people might develop more lesions that spread to other areas of their body.

If left untreated, you can infect others. Avoid spreading impetigo to other people or other parts of your body by:

  • Cleaning the infected areas with soap and water (do not scrub).
  • Loosely covering scabs and sores until they heal.
  • Gently removing crusty scabs.
  • Washing your hands with soap and water after touching infected areas or infected persons.
  • If you have impetigo, always use a clean washcloth and towel each time.
  • Do not share towels, clothing, razors, and other personal care products with other family members.
  • Avoid touching blisters that are oozing.
  • Wash your hands thoroughly after touching infected skin.

Because impetigo spreads by skin-to-skin contact, there often are small outbreaks within a family or a classroom. Avoid touching objects that someone with impetigo has used, such as utensils, towels, sheets, clothing and toys. If you have impetigo, keep your fingernails short so the bacteria can’t live under your nails and spread. Also, don’t scratch the sores.

The sores of impetigo slowly heal over time, but scars are rare. The cure rate is high, but it can re-occur—especially in young children.

Possible complications include kidney failure (which is rare), many patches of impetigo in children, and in very rare cases permanent skin damage and scarring.

Call your health care provider if the symptoms don’t go away or if there are signs the infection has worsened, such as fever, pain, or increased swelling.

 

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Gastroparesis Awareness Month

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Gastroparesis, also called delayed gastric emptying, is a disorder that slows or stops the movement of food from your stomach to your small intestine, even though there is no blockage in the stomach or intestines.

Normally, after you swallow food, the muscles in the wall of your stomach grind the food into smaller pieces and push them into your small intestine to continue digestion. When you have gastroparesis, your stomach muscles work poorly or not at all, and your stomach takes too long to empty its contents. Gastroparesis can delay digestion, which can lead to various symptoms and complications.

Gastroparesis is not common, and In most cases, doctors aren’t able to find the underlying cause of gastroparesis, even with medical tests. Gastroparesis without a known cause is called idiopathic gastroparesis.

You are more likely to get gastroparesis if you:

  • have diabetes
  • had surgery on your esophagus, stomach, or small intestine, which may injure the vagus nerve. The vagus nerve controls the muscles of the stomach and small intestine.
  • had certain cancer treatments, such as radiation therapy on your chest or stomach area.

People with gastroparesis may have other health problems, such as:

  • diabetes
  • Scleroderma (a group of diseases that cause abnormal growth of connective tissue)
  • hypothyroidism
  • nervous system disorders, such as migraine , Parkinson’s disease , and multiple sclerosis
  • viral infections of the stomach
  • gastroesophageal reflux disease (GERD)
  • eating disorders
  • amyloidosis (abnormal proteins called amyloids build up and form deposits that can collect in organs such as the kidney and heart)

Certain medicines may delay gastric emptying or affect movement of food through your gastrointestinal tract, resulting in symptoms that are similar to those of gastroparesis. If you have been diagnosed with gastroparesis, these medicines may make your symptoms worse. Medicines that may delay gastric emptying or make symptoms worse include the following:

  • narcotic pain medicines, such as codeine, hydrocodone, morphine, oxycodone, and tapentadol  
  • some antidepressants, such as amitriptyline, nortriptyline, and venlafaxine  
  • some anticholinergics —medicines that block certain nerve signals
  • some medicines used to treat overactive bladder
  • pramlintide

These medicines do not cause gastroparesis.

The symptoms of gastroparesis may include:

  • feeling full soon after starting a meal
  • feeling full long after eating a meal
  • nausea
  • vomiting
  • too much bloating
  • too much belching
  • pain in your upper abdomen
  • heartburn
  • poor appetite

You should seek a doctor’s help right away if you have any of the following signs or symptoms:

  • severe pain or cramping in your abdomen
  • blood glucose levels that are too high or too low
  • red blood in your vomit, or vomit that looks like coffee grounds
  • sudden, sharp stomach pain that doesn’t go away
  • vomiting for more than an hour
  • feeling extremely weak or fainting
  • difficulty breathing
  • fever

Complications of gastroparesis may include:

  • Dehydration due to repeated vomiting
  • malnutrition due to poor absorption of nutrients
  • blood glucose, also called blood sugar, levels that are harder to control, which can worsen diabetes
  • low calorie intake
  • Bezoars (A solid collection of food, mucus, vegetable fiber, hair, or other material that your stomach can’t digest. Bezoars can cause blockage, ulcers, and bleeding.)
  • losing weight without trying
  • lower quality of life

How doctors treat gastroparesis depends on the cause, how severe your symptoms and complications are, and how well you respond to different treatments. Sometimes, treating the cause may stop gastroparesis. If diabetes is causing your gastroparesis, your health care professional will work with you to help control your blood glucose levels. When the cause of your gastroparesis is not known, your doctor will provide treatments to help relieve your symptoms and treat complications.

Changing your eating habits can help control gastroparesis and make sure you get the right amount of nutrients, calories, and liquids. Getting the right amount of nutrients, calories, and liquids can also treat the disorder’s two main complications: malnutrition and dehydration.

Your doctor may recommend that you:

  • eat foods low in fat and fiber
  • eat five or six small, nutritious meals a day instead of two or three large meals
  • chew your food thoroughly
  • eat soft, well-cooked foods
  • avoid carbonated, or fizzy, beverages
  • avoid alcohol
  • drink plenty of water or liquids that contain glucose and electrolytes, such as
    • low-fat broths or clear soups
    • naturally sweetened, low-fiber fruit and vegetable juices
    • sports drinks
  • take a brief walk after a meal
  • avoid lying down for 2 hours after a meal
  • take a multivitamin each day

If your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or paste in a blender.

If you have gastroparesis and diabetes, you will need to control your blood glucose levels, especially hyperglycemia. Hyperglycemia may further delay the emptying of food from your stomach. Your doctor will work with you to make sure your blood glucose levels are not too high or too low and don’t keep going up or down. Your doctor may recommend:

  • taking insulin more often, or changing the type of insulin you take
  • taking insulin after, instead of before, meals
  • checking your blood glucose levels often after you eat, and taking insulin when you need it

Your doctor will give you specific instructions for taking insulin based on your needs and the severity of your gastroparesis.

Your doctor may prescribe medicines that help the muscles in the wall of your stomach work better. Talk to your doctor or pharmacist about other medications that may help control nausea and vomiting and reduce pain.

 

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Back to school travel safety

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It’s hard to believe, but it’s already time to kick off another school year—and time to remind our children how to get to and from school safely. These suggestions, from the National Highway Traffic Safety Administration, will get your kids off to a great start.

Riding the school bus

School buses are the safest way for children to travel to and from school. However, there are dangers when children are waiting for the bus and when boarding and leaving the bus. Over the past decade, nearly two-thirds of school-age pedestrians who were fatally injured in school transportation-related accidents were hit by school buses or other vehicles while getting on or off the school bus. Teach your child to always play it SAFE:

  • Stay five steps away from the curb.
  • Always wait for the bus driver to tell you when to board.
  • Face forward after finding a seat on the bus.
  • Exit the bus when it stops, look left-right-left and take five steps away from the bus toward the curb.

Walking to school
If you live within walking distance of your school, walking to school is a great way to start the day. It’s great exercise and gets kids ready to focus on their studies. Children under 10 years old should be accompanied by an adult or someone who will make sure they walk safely. Teach your child to always:

  • Use the sidewalk whenever possible. If there isn’t a sidewalk, walk on the edge of the street or in the grass facing traffic.
  • Stay focused and keep your eyes on the road when walking near traffic. It may be fun to play around with your friends, but goofing-off can prove deadly if you’re not careful.
  • Use crosswalks whenever they are available to cross the street.
  • Look left-right-left more than once before crossing any street.

Riding a bike
Riding a bike is a fun and quick way for kids to get to school or a friend’s house. Be sure to do these simple things to keep your bike ride safe:

  • Always wear a properly fitted helmet and securely fasten the chin strap.
  • Ride in the same direction as traffic and follow traffic signs and signals.
  • Learn how to use arm signals to show when turning right or left.
  • Stay in the bike lane whenever possible.
  • Use the sidewalk appropriately and keep an eye out for other pedestrians. Be sure to call attention when passing a pedestrian.
  • Never use electronics while riding due to distraction and so you can hear traffic around you.

Driving to school
If your teen is driving to school, riding with another teen or driving younger siblings to school, make sure you discuss safety rules:

  • Always have a safe driver behind the wheel.
  • Everyone must buckle up or the car doesn’t move.
  • Use appropriate car seats and/or booster seats when driving younger siblings to school. Every child under age 13 must ride in the back seat. No exceptions.
  • NO phone use while driving.

And for those of us driving to work or running errands, remember that when school is back in session, more cars and buses will be on the road. Watch out for stopped school buses and use extra caution around schools and bus stops.

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Travel tips for diabetics

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With a few weeks left in the summer and more people traveling this year than last year, we thought it would be a good time to remind those with diabetes of how to take care and precaution when away from home.

Depending on where you are headed, there may be specific vaccines and immunizations that you need for your destination. Be sure to get the the right ones and get them on time. Stay up to date on all of your immunizations whether traveling or not.

Eating healthy is critical for diabetics and it can be even more difficult to do when traveling. However, choosing healthy menu items like vegetables, fish, and chicken, and avoiding fried and fast foods can keep you on track which is especially important for those with diabetes. So is limiting alcoholic beverages. Ask your health care team how many alcoholic beverages you can  safely drink and always eat something when you do drink to prevent low blood glucose.

If you are traveling by car on a long road trip, check your blood glucose levels before driving. You should also stop and check your blood glucose levels every two hours. Always carry your diabetes medicines and supplies in the car where you can reach them in case your blood glucose levels drop too low.

Since travel plans can often change and be out of your control, you should bring twice the amount of diabetes supplies and medicines you normally need. If you are traveling to another country, don’t count on buying supplies while there. Different countries use different kinds of diabetes medicines. Also ask your health care team if any adjustments need to be made to your medicine schedule if you are traveling across time zones.

Not that you need an excuse to buy a new pair of shoes, but since you may be walking more than usual on your trip, it’s important to take comfortable, well-fitting shoes on vacation.

If you are traveling for an extended period of time, ask your doctor for a written prescription for your diabetes medications and the name of a doctor in the place you’re visiting. If traveling by plane, ask your doctor for a letter that lists all of the medical supplies and medicines that you’ll need on the plane. The doctor should also include a list of any devices that shouldn’t go through an x-ray machine. If you use an insulin pump, ask airport security to check the device by hand. X-ray machines can damage insulin pumps, whether the pump is on your body or in your luggage.

Be sure to carry your diabetes medicines and your blood testing supplies with you and never put these items in your checked baggage. Avoid storing insulin at extreme temperatures. You also don’t want to run the risk of a lost suitcase.

Have all syringes and insulin delivery systems (including vials of insulin) clearly marked with the preprinted pharmacy label that identifies the medicine. The airline industry recommends that patients travel with their original pharmacy labeled packaging. Keep your diabetes medications and emergency snacks with you at your seat – don’t store them in an overhead bin. In case your blood sugar gets too low. If you use insulin, make sure you also pack a glucagon emergency kit.

If the airline offers a meal for your flight, call ahead for a diabetic, low fat, or low cholesterol meal. Ask when the meal will be served so you know when to take your insulin. If no food is offered on your flight, bring a meal on board yourself.

Just like when riding in a car and stopping every couple of hours, when on a plane, get up from your seat and walk around when possible to avoid sitting for long periods of time.

No matter where you go, make sure you keep your health insurance card and emergency phone numbers handy. Additionally, keep a copy of your medical information, including a list of your conditions, medicines, and recent lab test results. A list of your prescription names with dosage information and prescription numbers from your pharmacy can also be helpful in an emergency.

 

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The Art of Compounding

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Before prescriptions became mass produced with advanced manufacturing of the 1950s and ‘60s, nearly all medications were compounded by pharmacists. Afterwards, the pharmacist’s role as a preparer of medications quickly changed to that of a dispenser of manufactured dosage forms, and most pharmacists no longer were trained to compound medications. However, the “one-size-fits-all” nature of many mass-produced medications meant that some patients’ needs were not being met.

When the health needs of a patient cannot be met by an FDA-approved or commercially available medication, licensed pharmacists are able to combine, mix, or alter the ingredients of a drug to create a medication tailored to the needs of an individual patient. Pharmacy compounding is the art and science of preparing personalized medications for patients.

Compounded medications are made based on a doctor’s prescription in which individual ingredients are mixed together in the exact strength and dosage form required by the patient. This method allows the compounding pharmacist to work with the patient and the prescriber to customize a medication to meet the patient’s specific needs. The end result are medicines compounded for the patient where the exact strength and dosage form (e.g., cream, pill or liquid) required by the patient are also customized.

An example of when a compounded drug is needed is when a patient has an allergy and needs a medication without a certain dye. Another would be if a patient (perhaps a child or an elderly person) cannot swallow a pill and needs a medicine in a liquid dosage form that is not otherwise available.

Compounded drugs are not FDA-approved. State boards of pharmacy have primary responsibility for the oversight of state-licensed pharmacies that compound drugs, but the FDA retains some authority over their operations. Registered outsourcing facilities are regulated by the FDA, must comply with the FDA’s Current Good Manufacturing Practice requirements, and are required to be inspected by the FDA.   

The FDA approval process is intended for mass-produced drugs made by manufacturers. Because compounded medications are personalized for individual patients, the federal government has approved the use of compounded medications for those individuals who have received a prescription for that specific compounded medication.                              

Though we are not a full-service compounding pharmacy, we can:

  • Compound syrups and suspensions for children or adults who can’t swallow pills
  • Compound creams and ointments from a dermatologist’s prescription
  • Add flavor to a medication that is otherwise difficult for a patient to ingest.
  • Compound mouthwashes for sore throats and mouth ulcers from a doctor’s or dentist’s prescription

The practice of compounding is becoming a popular solution to veterinary problems, too. Your pharmacist can provide some specialized prescription services to veterinarians in the treatment of almost all animals. Exotic pets, horses, dogs, cats and zoo animals may all require medication at some point and our pharmacists can assist veterinarians in offering dosages that are patient-specific in strength and formulation.

When you have a need for certain types of compounded medication, trust the experts at Village Pharmacy to provide the appropriate medication in the form and dosage that’s right for you, or your pet.

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Arthritis in children

Just like adults, children can get arthritis causing the same pain, swelling, stiffness and loss of motion in the joints. The most common type of juvenile arthritis is idiopathic, meaning the cause is not known.

Juvenile arthritis is usually an autoimmune disorder meaning the immune system attacks some of the body’s healthy cells and tissues. It affects children of all ages and ethnicities. Almost 300,000 American children under the age of 18 have arthritis or other rheumatic conditions.

Signs and symptoms

Does your child wake up in the morning with a limp due to knee pain? Other signs include:

  • Joint swelling, pain, and stiffness that doesn’t go away
  • Excessive clumsiness
  • High fever and skin rash
  • Swelling in lymph nodes in the neck and other areas of the body

Most children with arthritis do have times of remission where symptoms will get better or go away for a period of time, but there are other times when they get worse and flare up. Arthritis in children can also cause eye inflammation and growth problems—causing bones and joints to grow unevenly.

If you think your child has juvenile arthritis, seek medical attention from your pediatrician. Your doctor will ask about symptoms and family history, as well as conduct a physical exam and lab tests, and they will also take some x-rays.

Treatment

If your child is diagnosed with juvenile arthritis a team of doctors may be involved to provide your child with the best treatment and care. In addition to a pediatric rheumatologist, you may seek care from a physical therapist, occupational therapist, psychologist, eye doctor, dentist, bone surgeon, dietician, pharmacist, social worker, rheumatology nurse and the school nurse.

These medical professionals will try to make sure your child can have a good quality of life and stay involved in social activities. Most children with arthritis will need both medications as well as therapies to reduce swelling and maintain joint movement.

Working with these professionals is the best way to help your child (and you) both physically and emotionally. As a parent, it’s important to learn all that you can about your child’s condition and treatment. Encourage your child to exercise and keep up with physical therapy. And, be sure to work with your child’s school so they understand the limitations that your child may have — all the while trying to treat your child as normal as possible.

Though pain sometimes does limit what children with juvenile arthritis can do, exercise is key to reducing their symptoms and maintaining function and range of motion in joints. Working with a physical therapist and occupational therapist to create exercises that you can do outside of their regular appointment time will help control symptoms. Most children can take part in physical activities and certain sports when symptoms are under control. Swimming is a good activity because it works so many joints and muscles without putting weight on the joints. If the disease does have a flare up, your child’s doctor may advise your child to limit certain activities. Once the flare is over, your child can return to his or her normal activities.

Researchers are looking for possible causes by studying genetic and environmental factors. They are also trying to improve current treatments and find new medicines that will work better with fewer side effects.

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