DEAR DR. ROACH: My mother passed away at age 81, just a short time before Christmas. Advanced dementia appeared to be the culprit that led to her demise. Her dementia was caused primarily by vascular insufficiency, as both of her carotid arteries were more than 60 percent blocked; although some doctors said she could have had some ministrokes, even though all tests and cognitive actions showed no evidence of a stroke.
The last week of her life, she could not swallow, so she had stopped eating and drinking. She declined very quickly after that. Could it be possible that the dementia caused her to forget how to swallow?
ANSWER: I am sorry to hear about your mother’s passing.
Vascular insufficiency, as demonstrated by the blockages in your mother’s carotid arteries, means a decrease in the ability to provide the blood to the brain. This can cause symptoms that are temporary (a TIA, transient ischemic attack) or permanent (a stroke). A “ministroke” doesn’t necessarily have any obvious loss of ability such as speech or cause weakness. However, many of these small strokes can cause dementia, called vascular or multi-infarct dementia. (“Infarct” means death of tissue.)
The brain performs many processes that we aren’t consciously aware of. We swallow reflexively — that is, without being consciously aware of it, without difficulty. A small stroke in one of the areas in the brain that coordinate this complex action can prevent normal swallowing, both the reflexive and intentional type. So it’s not that her cognitive, thinking brain was so impaired, it’s that multiple parts of the brain were affected.
DEAR DR. ROACH: I am a 60-year-old man in generally good health. I recently had severe hip pain. After a set of X-rays, mild arthritis was found in the hip. Tylenol was recommended for the inflammation. A few days later at my annual physical, the cardiac C-reactive protein test was 3.9, which the written results stated was high. My doctor’s recommendation was to take 81 mg of aspirin daily. What is the best anti-inflammatory regimen to deal with and treat both issues without taking too much or creating other problems? — M.O’B.
ANSWER: “Mild arthritis” isn’t a diagnosis. There are many kinds of arthritis, and I suspect your doctor is treating you for the most common type in 60-year-olds — osteoarthritis. Tylenol is a perfectly good first-line treatment for mild osteoarthritis; however, it treats pain, not inflammation.
The C-reactive protein is a test of inflammation. Very high levels of CRP suggest an inflammatory condition, such as rheumatoid or psoriatic arthritis. Chronic infection also typically has a high CRP. In people without a chronic condition, CRP predicts the risk of heart disease independently of cholesterol. Because your level is high, your doctor is recommending aspirin, which lowers the risk of heart disease.
In the JUPITER study, treatment with a statin drug in people with high CRP, even if they had normal cholesterol, reduced risk of heart attacks.
The concern I have is that, without knowing more about your symptoms and X-ray findings, I don’t know whether you may have an inflammatory arthritis, which might explain both the hip findings and the blood test result. If you do, then it might be necessary for you to have other treatments besides Tylenol. It’s worth a call to your doctor to discuss the X-ray findings and the high CRP, since your CRP is much higher than I would expect from osteoarthritis.
READERS: The booklet on COPD explains both emphysema and chronic bronchitis, the two elements of COPD, in detail. Readers can obtain a copy by writing: Dr. Roach — No. 601, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow 4-6 weeks for delivery.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.
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