James Amos

Rounding at Iowa: New Treatments for Alzheimer’s Disease

This is one of the latest Rounding@Iowa podcasts and it’s about new treatments for Azheimer’s Disease, with one specific agent called Lecanemab.

I’m an old psychiatrist, and I remember my clinical impresson of the previous medications for Alzheimer’s Disease, one of which was Donepezil. The scientific literature seemed to suggest that patients and families were more impressed with Donepezil than clinicians were.

According to Dr. Shim, one of the participants in the podcast, it’s been 20 years since there has been a new treatment for Alzheimer’s Disease-and the long term effectiveness of Lecanemab is uncertain.

In addition, there are significant risks associated with the agent as well. As you can guess, it’s very expensive, and while Medicare pays for some of the cost, the podcast participants mentioned that it was difficult to get some treatment monitoring imaging studies covered.

Patients and their physicians need to have a full discussion of the risks and benefits of treatments for Alzheimer’s Disease. It’s just as important to avoid the use of certain drugs that are known to worsen cognitive function, such as benzodiazepines and anticholinergics.

89: Tick-borne Illnesses – Rounding@IOWA

Join Dr. Clancy, Dr. Appenheimer & Dr. Barker as they discuss prevention, diagnosis and treatment of various tick-borne illnesses. CME Credit Available: https://uiowa.cloud-cme.com/course/courseoverview?eid=82296 Host: Gerard Clancy, MD Senior Associate Dean for External Affairs Professor of Psychiatry and Emergency Medicine University of Iowa Carver College of Medicine Guests: Ben Appenheimer, MD Clinical Associate Professor of Internal Medicine-Infectious Diseases Assistant Director, Infectious Diseases Fellowship Program Associate Clinical Director, Infectious Diseases Co-Medical Director, TelePrEP, University of Iowa Health Care University of Iowa Carver College of Medicine Jason Barker, MD Associate Professor of Internal Medicine-Infectious Diseases University of Iowa Carver College of Medicine Financial Disclosures: Dr. Gerard Clancy, his guests, and Rounding@IOWA planning committee members have disclosed no relevant financial relationships. Nurse: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this activity for a maximum of 1.0 ANCC contact hour. Pharmacist and Pharmacy Tech: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this knowledge-based activity for a maximum of 1.0 ACPE contact hours. Credit will be uploaded to the NABP CPE Monitor within 60 days after the activity completion. Pharmacists must provide their NABP ID and DOB (MMDD) to receive credit. JA0000310-0000-26-038-H01 Physician: The University of Iowa Roy J. and Lucille A. Carver College of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Other Health Care Providers: A certificate of completion will be available after successful completion of the course. (It is the responsibility of licensees to determine if this continuing education activity meets the requirements of their professional licensure board.)

The Haunted Bellman’s Luggage Carts

When we moved into the hotel we’re camping in to wait for our house to be built, I rediscovered the joy of driving the bellman’s luggage cart. Does anyone besides me find this a major challenge?

I always get the cart with the crazy, wobbly wheel. Worse yet, they are impossible to steer and the rack itself is prone to popping out of the cart! I then get preoccupied with replacing the rack back in the dysfunctional hole while our luggage starts to tip over and the wobbly wheel prevents me from steering the thing into and out of the elevator.

I think all bellman’s luggage carts are haunted. They are possessed by the spirits of bellmen who didn’t get tipped.

That is why you should smudge the carts. I don’t mean you should actually rub dirt on them (they’ve got enough of that already). I mean you should get somebody who knows how to do that ritual to get rid of the bad energy in the cart. I think they usually burn sage (or maybe thyme?).

Mall Walker

Our hotel is about a 20 minute walk from the shopping mall. Both ways it’s about a 2.5 mile walk. I’ve been over there a few times and I think I’m becoming a mall walker.

The other day at the mall, an older lady approached me and asked me if I’d help open her water bottle, which I was glad to do. It was too tight for her to twist open. She told me a couple of times how she’d traveled to Iceland recently.

On one of my visits to the mall, I sat down in front of a clothing store. Most mannikins have full heads, but at this one, they had only half a head. The top half was gone. I don’t know what it means for a clothing store to have half-head mannikins.

Maybe they’re trying to say, “Hey, if you have half a brain, you’ll shop at our store.”

What’s the Skinny on Indoor Saline Pools and Vitamin D?

We saw a sign in the hotel elevator that made us curious. Part of it said:

“There are also lots of ways to get out and soak up some good ‘ol vitamin D from our saline pool to our grill and patio area.”

Not to quibble or get too sciency (“sciency” turns out to be a real adjective by the way, at least in the Oxford English Dictionary), but the bit about soaking up vitamin D from a saline pool is a little confusing. I suspect that sentence was about an outdoor pool. But at our hotel, the pool is indoors.

Here’s the thing. You can’t soak up Vitamin D through a window. And salt water doesn’t have anything to do with vitamin D absorption. In fact, the way we learned in medical school which vitamins are soluble in water was to memorize the acronym “ADEK.” Vitamins A, D, E, and K are fat soluble, not water soluble. You can’t get Vitamin D from swimming in a saline pool. Saline is still water.

According to the National Institute of Health (NIH) web page for the public about Vitamin D, your skin can’t make it from sunlight through a window.

That doesn’t mean there aren’t health benefits from swimming in a salt water pool. For example, an article on the Healthline web site says it may be better for people with allergies or asthma, or if you can’t stand the smell of chlorine.

On the other hand, you certainly can soak up the sun and Vitamin D from the grill and patio area. Be sure to use sunscreen!

When Do We Get Out of the Woods?

We were out walking the Terry Trueblood Trail the other day. It’s always good to get out of the hotel where we’re staying until our house is built. I get this cooped up feeling and it feels great to escape.

While we were on the trail, we saw this huge field of giant, golden prairie plants that looked familiar. It lined both sides of the walking trail. It was giant mullein. We saw it for the first time a couple of years ago while walking the trail.

Anyway, when you got perspective on it, it gave a sense of coming out of the dark, coming out of the woods.

It reminded me of that scene in Wizard of Oz when Dorothy and the guys emerge from the dark woods into the light. There’s this great little song in the scene that I finally discovered is called “Optimistic Voices.” I found this blog post about it posted back in 2015 by a writer named Marti Wukelic. The blog is called Is There Life After Retirement?

It captured how I felt that day, surrounded by giant mullein. I know that sounds ironic because we were in a sense in the woods of a field of giant prairie plants.

But giant mullein is a sunny color. On both sides of the trail, it rose high above our heads. It was like a giant, golden hallway to heaven and we were stepping into the sun.

Hotel Kitchen Notes

I need to make a note about the kitchenette in our hotel room. It’s big enough for Sena to cook a meal in, but small enough for me to knock the meal on the floor.

The kitchen has a fridge with freezer, yet lettuce freezes in the fridge. We have really crunchy salads. It has a microwave. It doesn’t have a stove but you can get a portable induction cooktop, believe it or not.

Sena cooked fantastic chili on that cooktop, which reminded us of the induction cooktop in the house we moved out of.

There’s no oven. But Sena cooked a frozen pizza in our Presto deep dish fry pan. That was a neat trick.

The only thing I did in the kitchen at our house was heat up frozen pizza. Now I don’t even do that. Every time I stick my head in the fridge, I bump my head on the bottom of the freezer door. In fact, I have not done anything in the kitchenette so far but make trouble.

I lost a cooking challenge once for not completing a dish. I ran out of thyme.

Workout at the Hotel!

We’re camping out in a hotel while our new house is being built. We tried out the exercise equipment. It has been tough to exercise what with all the chores of showing and selling the house, moving all our stuff into storage, and now adjusting to living in a hotel (which will be for a couple of months).

The hotel has a Peloton bicycle. We tried it. One of the foot straps was missing, and we didn’t try the free workout offer.

As some of you know, I wrote a blog post about the Peloton machine a while back, comparing it to my anti-Peloton bike. The title is “The Anti-Peloton Exercise Bicycle.” As part of the moving process, we donated the old bike to charity.

We’re not planning to invest in a Peloton any time soon.

Getting Back Into Juggling Shape!

We’ve been so busy moving that I’ve laid off juggling for a while. I’m sore in every muscle!

We’ve moved into a hotel for a couple of months while our new house is being built. I’ll get back into juggling shape soon!

Hotel Iowa

Well, we’re in the next stage of relocation, which is the Hotel California-excuse me, I mean the Hotel Iowa, so to speak. We’re camping out a hotel while our house is under construction.

We were up well after midnight moving before we got to the hotel. We had a Casey’s pizza for dinner.

The movers got all our stuff into storage-right up to the door. They’re magicians.

The hotel has a really nice complimentary breakfast.

Boxes Are Everything!

As if you haven’t already guessed long before now, we’re moving. I don’t need to tell any of you what a happy, thrilling, fulfilling experience this is. Right.

The added wrinkle this time is that we’re camping out in a hotel while our house is being built. The only reason you’ve seen any blog posts from me lately is that I’ve been posting ahead of my usual schedule until I figure out if the hotel wifi works.

This could go on for a couple of months.