Possible spinal stenosis: cervical or lumbar

I have a habit of sitting up in bed in the evening watching TV with a pillow propping up my neck before I fall asleep. At times I feel that my neck is very forwardly flexed. Before I decide to “call it a day ” I place my pillow in its natural position and then lie supine on my back, as I find lying in a lateral position on either side is somewhat discomforting to my hip.

When I get up during the night to go to the washroom, I sometimes get a numbness in both of my forearms, a feeling of “pins and needles”, and wonder whether this is the result of a sudden release of the nerve roots. Or maybe I also have symptoms of cervical spinal stenosis. As a footnote: X-rays of my spine at all levels show considerable wedging of the vertebrae, especially in the thoracic region.

For a while I have experienced pain in my left hip with numbness in the buttocks and anterior aspect of the left thigh; symptoms worsen when standing and are relieved by sitting, suggesting a possible diagnosis of possible lumbar spinal stenosis at the level of L3.

Since the innervation of the left hip comes from the L3 nerve root, it is also possible that the pain is referred pain from the L3 nerve root – not unlike pain in the right shoulder from referred pain coming from C3 nerve root – the same nerve which innervates the diaphragm.

[For this scenario, one needs inflammation of the diaphragm from an infected gall bladder; Damage of cardiac muscle T1-2 causing numbness of medial aspect of forearm; careful history of appendicitis will reveal the numbness began in the paraumbilical region (innervation of appendix). The subsequent tenderness and especially rebound tenderness in the right lower quadrant of the abdomen is due to local inflammation of abdominal muscles in that area of the abdomen.]

I greatly appreciate having taken several week-long courses in Orthopaedic Medicine by Stephanie Suders – the private physiotherapist of the famous Sir James Cyriax.

While working as a Medical advisor for the Workers Compensation Board of Manitoba in the 1980’s I was so appalled at the quality of the medical reports we received from the attending physicians of the claimants that the board on my advice sponsored a 3-day weekend workshop outlining the fundamentals of Orthopaedic Medicine, specifically the examination and non-surgical treatment of musculoskeletal problems. Dr. Don Fraser and his physiotherapist presented this course. I used my photographic equipment to record their course material and made a copy for the WCB. I was surprised when a few months later the Board informed me that my services were no longer required {? Nov 1992)/ When I asked the CEO the reason for the firing -his reply was we don’t have to answer that question. I guess I should have taken legal action. in 1968 I experienced similar when I was the medical director of the Winnipeg Clinic Research Institute Laboratory. Again I did not take legal action.

Any victim would gave sought legal action

Choices for Alzheimer’s management: more nursing home beds or medical research?

Before discussing these 2 choices, here are some interesting facts regarding Alzheimer’s that I have come across in my research.

Alzheimer’s ranks as the 6th leading cause of death in the US, surpassing  breast and  prostate cancer deaths combined; currently, someone develops Alzheimer’s every minute (thats 60 new cases every hour, 1440 for each day (24×60) and  525,600  for each year (1440×365). Predictions are that by 2050, this rate will double to a new case of Alzheimer’s developing every 30 seconds doubling the number to over 1 million new cases annually.

The medicare costs today to treat Alzheimer’s in the USA is $236 billion annually, excluding the $5000 that caregivers also spend annually. Based on the increase in the number of people over age 85, it is predicted that these costs will rise to over one trillion dollars annually by 2050.

Canadian picture -just as gloomy: according to Canadian vital statistics for  2013 , Alzheimer’s ranked as the 5th major cause of death behind, cancer, heart disease, stroke, and chronic respiratory disease; because the elderly are currently the fastest growing segment of our population  there are now more people over age 65 than those under age 17 with the prediction that by 2050 half of the elderly will be over age 85.

Since incidence of Alzheimer’s increases with age, only 8% of the Canadian population have some degree of Alzheimer’s at age 65, but by age 85 this incidence increases to 35%.  By the year 2050, with half of the the Canadian population over the age of 85, 35% of them could have Alzheimer’s, an alarming prognosis. It could also become the number one cause of death. The current annual health care costs for Alzheimer’s is around $30 billion,  which could increase to over $300 billion by 2050. It alone could bankrupt our healthcare system in Canada.

We desparetly need a solution now. In the title of this post I suggested there were 2 routes available: more nursing home beds or basic research to find the cause and cure  of Alzheimer’s. As with other pandemics in the past we also had similar 2 choices. For example, in the 1940’s and 50s with the polio epidemic, governments were facing a similar policy decision – should they   invest their resources to build more and better iron lungs and hospitals for the patients who need them? Or should they invest in basic medical research to find a cure for polio? The National Foundation for Infantile Paralysis as it was called in those days chose the latter – a wise decision.

Regarding Alzheimers we have the same 2 choices-more nursing home beds or medical research.  I especially like the comments by Dr. Roy Walford in his book  Maximum Life Span. (pages 17-18):

“… My point is that old age homes and all the vast social support structures continuously accumulating to care for the helpless aged are the iron lungs of gerontology. Improvements in the social, economic and medical support system for the elderly will merely provide symptomatic relief for an expanding problem. …” .

By giving top priority to constructing 1200 more nursing home beds, the province of Manitoba would seem to have made their decision. Of note in  Saskatchewan, the government claims that everyday there are 10 new cases of Alzheimer’s. That’s over 3600 cases each year. If eventually, 25% of these cases require nursing home beds, then the province would need to build over 900 beds annually. In the 19th century, tuberculosis – known also as the white plague – was the leading cause of death, claiming over 35% of the population. Sanatoria like the one in Ninette, Manitoba were quickly constructed and filled. With the discovery of antibiotics which specifically killed the tuberculosis bacterium, patients no longer needed to go to sanatoria to be cured and these buildings soon became museums.

I have become quite fascinated with the advances made in Alzheimer’s research, and will discuss the topics of the role of Vitamin D and the 7 common ways we have to slow the aging process in my future posts.

transgender vs cis(gender)

Cis(gender)- is defined as the sex you are assigned at birth, while transgender is an umbrella term for people whose gender identity differs from the sex they are assigned at birth.

Recently I have been working on various keynote presentations on the paradigm shift for gerontology, specifically on anti-aging.  To ‘add life to your years and years to your life’,  it seems gerontologists have shifted from pursing life extension strategies to anti-aging.

In that regard I have searched for more information on the biological markers for aging. One of the tests I have found relates to the significant loss of hormone levels, specifically DHEA. According to Roy Walford in his textbook (The 120 year diet ) table 2.2 in males DHEA  declines from 3400 ng./ml of plasma in the 20-30 age group to less than 900 ng/ml by age 60. Corresponding figures for females are 2200 to 800 .

The Fifth edition (2013) of Disease Prevention and Treatment  published by Life Extension Foundation on p. 608 details how DHEA is converted to Androstenediol an intermediate hormone which can then produce either and/or  both– the male and female sex hormones, viz. testosterone and the 3 major estrogens (estrone,, estradiol and estriol).  The hormonal cascade also shows that the enzyme aromatase can convert testosterone to the female sex hormones.

I wonder if an imbalance of this hormonal cascade can produce the increase in transgenders we are witnessing. Maybe by altering these conversions we could preventive the transgender phenomenon.

 

 

Anti-aging therapies and doctor assisted dying

These anti-aging therapies include bio-identical hormonal replacement, management of oxidative stress with anti- oxidants, reduction of chronic inflammation a forerunner of atherosclerosis and heart disease, genetic-restoring telomere length, stem cell therapy to replace senescent cells, etc.

In one of my keynote presentations, I discuss 7 ways to slow the aging process. Hopefully by slowing and/or reversing the aging process, these individuals can also change their biological clock to a period when they did not have these chronic diseases!

Should these breakthroughs materialize, we may even witness the time when people in nursing homes may actually be discharged and return to their homes, much like we now do with patients who are sent home from hospital after recovering from a medical illness or surgical treatment.

Maybe the health status of those individuals requesting “assisted dying” could be enhanced or their delayed if their biological life clock was reversed to an earlier period when they did not have those debilitating symptoms.

The late Dr.Roy Walford. in his book Maximum Life Span relates the history of the government’s approach to the polio epidemic of the 1940’s and 50’s His comment: “… if the government had invested in perfecting better iron lungs we would now have the best designed most comfortable iron lungs imaginable inhabited by thousands of polio victims…” Instead, by investing in basic research and developing a vaccine, epidemics like polio and smallpox have now theoretically been eradicated from our planet.

Regarding nursing homes, Walford comments “…the vast social support structures continuously accumulating to care for the helpless elderly are the iron lungs of Gerontology…”

It should be noted that in the 19th century when Dr. Edward Jenner developed his crude smallpox vaccine, he and the world did not know that smallpox was also caused by a virus. In my view the current knowledge of the causes of the aging process is probably at the same stage when Jenner was experimenting with a smallpox vaccine which he tested on his own son.

We do not really know what causes the aging process that leads to the development of the chronic symptoms and diseases of the elderly, what I like to call the 5 “D’s-disability, depression, discomfort, dementia, chronic diseases, and death. Why do the levels of hormones like DHEA begin to drop after age 30?

Nursing homes as research labs for dementia

The opening statement of the Report entitled “Nutritional Strategies to Combat Alzheimer’s” in the March 2013 issue of Life Extension Magazine, reads as follows:

“Someone in America develops Alzheimer’s every 68 seconds. This rate is projected to more than double by 2053, to one every 33 seconds.”

Since we in Canada have roughly 1/10th of the US population, the corresponding rate for Canada should be roughly one tenth that of USA.

In a recent radio and TV announcement, Canadian health officials outlined the costs of treating Alzheimer’s from the current 30 billion annually to over 300 billion within a couple of decades.

After reading this article, and with my recent attendance at a nursing home meeting where the CEO of that nursing home outlined plans for bed expansion, it occurred to me that nursing homes with their unique resident profile (compared to patients in hospitals or medical offices), might be excellent ‘labs’ to conduct clinical research on Alzheimer’s disease.

When I reviewed my blog, I found a post where I gave some statistics on incidence of dementia, and also my plans for to develop a podcast.

I have experience in the field of genetics and gerontology. I set up 3 private medical research Labs, including the Winnipeg Clinic Research Institute, the Kildonan Institute of Gerontology, and a private Cytogenetic diagnostic Lab. During my research career, I published over 40 scientific papers. Since the mid-1990’s as a medical educator, I have used the information gathered from various sources to develop various tools such as presentations, websites and blogs and videos to share to share my knowledge and interest in research and life extension. Sources I have leveraged include the Life Extension Foundation, Wellness magazine, A4M, etc., as well as my personal library of over 500 volumes, my clinical practice of over 30 years, and more than 20 years of experience treating elderly patients at the Holy Family Nursing Home in Winnipeg, Canada.

Realizing the importance of medical research in 2000, I set up the Semeon Hrushovetz Endowed Fund at the University of Manitoba which purchases books in the area of gerontology and complementary and/or alternative medicine for the Neil John Maclean Health Sciences Library.

Many current investigators, especially those engaged in life extension research, discovered the important role of nutrition in aging (e.g. Vitamin D and Alzheimer’s).

Another area is the field of searching for biological markers for aging and use them to test if anti-aging therapies are valid. Many of these studies, especially those related to biological markers of aging, could very easily be conducted at a nursing home.

I feel the Holy Family Nursing Home with its expansion program provides an excellent opportunity to establish such a unique research centre. I would be interested in an opportunity to discuss this idea with the nursing home’s board or building committee.

Can slowing the aging process reduce the incidence of Alzheimer’s

See my previous blog posts for statistics about the incidence of Alzheimer’s in Canada and Nursing homes as possible research labs for dementia.

Briefly here are the relevant statistics:
– by age 65, 8% of the population have some degree of dementia’ Others say at age 65 5% of population have Alzheimers and it doubles every 5 years so by age 85 it would be 25. – Canadian figures say by age 85 it has reached 35% of the population. Regardless of which figures you taketh data all suggest that aging is a risk factor for Alzheimers.

So my  question is If we can slow the aging process so that those at the chronological age of 85 could have the biological markers of a person age 65, would the incidence of Alzheimer’s also be slowed from 35 % to 8% . Or with the other prediction data ( doubling every 5 years ) dropping from 25% at age 85 t0  8% at age 65

It seems to me that it would not be difficult to design such an experiment, especially since at present we do not have a specific medical treatment for dementia.

Gerontologists could see some positive results within a decade.

Just think if one could slow the aging process significantly, the elderly would die of other chronic diseases  such as heart attacks, strokes, cancer or diabetes. It could certainly reduce the number of Alzheimer’s residents in our nursing homes if positive results are obtained.As I am making  alterations of this post we are witnessing high death rates from the Covid-19 pandemic -80% of which are the elderly in nursing home.It would be interesting to check the data to see what fraction  of these deaths are  residents with dementia,