Got an app't with neuro Thursday. I need to talk to him about getting an anti-anxiety med - I know we've talked about it - but what have you had most success with? I know it's very subjective. Thx.
For myself I like xanax and Celex for DH he takes xanax at bedtime and Wellbutrin XR mornings. Of course, that may change at any time. I am wondering if you folks are giving Vitamins to the spouse and which ones? I am going to get the Fish Oil and currently do a multi vitamin.
Imhor, we both take a Centrum Silver vitamin each day. I just want to make sure that along with our cranberry juice, brocolli, blueberries, etc. that we are eating right and have the full vitamin load. It's habit, I guess. I started our children on Flintstone chewable vitamins as toddlers, with us on One-a-Day at that time. After 47 years, I wouldn't know what my body would do without one! <grin>
My brother the retired pharmacist insists i take the centrum silver over 50 says we really need the selenium/mag/manganese/ all that extra stuff. also the norweg high quality fish oil =i give centrum/vit C which is antioxident per bro for DH/plus vit E -all these were also recommended by neuro for AD. hope this helps, divvi
My DH takes two blood pressure meds, namenda, aricept, Lodine and hydrocodone. In addition to the prescription meds, he takes Centrum Silver, vitamin C, cinnamon and tumeric. I think we're going to add vitamin E and Norweg. fish oil as per divvi.
Check with the doctor before adding anything, including nonprescription vitamins/supplements. Vitamin E, for example, is a blood thinner, and you need to be careful giving that to people on blood thinners such as Plavix, patients with VaD, or those who have had TIAs, etc.
The omega-3 in the fish oil may also increase the risk of bleeding when taken in large doses. One of the reported side effects of fish oil is a reduction of blood pressure, so be careful about giving it to people with low blood pressure or those taking blood-pressure reducing medicines. The impact on blood pressure appears to be dose dependent.
Also, look carefully at the contents of any vitamins/supplements. For example, vitamin E plays a part in metabolizing omega acids, so large doses of fish oil place high demands on the body’s vitamin E supply. To avoid this fish oil side effect, vitamin E is added to many commercial fish oil products. As a result, regular use of vitamin E-enriched products may lead to elevated levels of this fat-soluble vitamin.
I think it's a little late in the game for vitamins/supplements for our spouses with AD. Do we really think that this will improve the quality of our loved one's remaining years? Let's say with good nutrition we could extend their physical life by 3-5 years, but their mental decline would/will continue unabated - what have we accomplished? (I want you all to know that my wife takes lots of meds and that I would never, ever withhold care)
I agree with Sunshyne that you should always run all supplements past your doctor/pharmacist before starting them - the interactions with prescription drugs are very real and could be life-threatening.
Hmmm, Sunshyne, you gave us something to think about. All this self medicating and supplements can probably cause more problems than they solve. I wonder how much his doctor knows about vitamins.
Right now my DH also needs something for depression. The AD plus the constant pain is wearing on him but don't want him to take something that will make him a zombie. Could anybody else tell me what has worked and what hasn't?
Glad to see some concern for self medicating and for dealing with supplements.
Dazed, my instinct says to check with his Dr. and with you pharmacist to find meds to help with the depression and pain. Between them they should be able to come up with choices to help the most with the least negative side effects. I did thyis to find meds for med induced constipation. Dr. said I could chose from several, and pharmacist had the list of what he was on and could tell me the ones from the list which had the least interaction issues.
Even with my hubby's Dr.'s knowledge, I had him taking Ibuprophen and extra strength Tylenol for a pain side effect. Found out the hard way, Ibuprophen can cause retention of Potassium (excessive) creating a second problem with his electrolytes, and the tylenol isn't the best choice with his Plavix. Had to go back to the tramadol, which works, but I'd wanted to use OTC meds whioch I could possibly wean him off of easier. Now realize that won't happen.
Between all his issues, I'm juggling 10 prescriptions and 2 OTC, plus am having to persuade him/remind him/prod him to drink at least 1 or 2 bottles of water most days. He prefers his Decaf coffee with a splash of 1/2% milk.
At least he's always been excellent about taking his meds.
Iggy, I have been thinking the same thing myself about vitamins etc. If it doesn't help their mental decline what is the point. Sometimes I wonder if we aren't grasping at straws.
Years ago I worked at a residential school in NJ that was for neurologically impaired kids-mostly CP. Many parents insisted on giving the kids massive doses of every known vitamin and supplement. Yes-they were grasping at straws-but it gave them hope. I think it is a sense of helplessness that does us in.
I'm on fish oil and magnesium. And I'm an advocate for both of them. In both cases a doctor who also had my problems put me on the OTC item, and my family doctor knows about both of them.
My husband doesn't take either. I don't remember which of his meds do not combine well with the fish oil, but when I checked it out I recognized that he could not take it. He also doesn't have arthritis and isn't in constant pain, so I saw no reason to figure out a way for him to take the fish oil.
He also is not taking the combo of drugs that I am taking that was causing night leg cramps. That is why the neurologist that did the test on the nerves on my legs put me on the magnesium. Doesn't do anything for the numb leg, but at least the leg cramps are gone.
Since I am also on a cocktail of drugs, I pass my drug list onto every doctor and tech I see. Just because it is a vitamin or OTC item doesn't mean everyone can take it.
Carosi, thank you for your input. I have wanted to give my DH ibuprophen, aspirin or Tylenol to help with pain, instead of hydrocodone, but found it doesn't mix with Lodine. Our doctor has educated me about the prescription drugs but the supplements I've been giving DH have not been discussed with him. When I hear that a supplement helps with pain or memory, I'm tempted to go right out and buy it and sometimes I do.
iggy and Jean 21, I guess we're hoping some of these supplements will help delay their mental decline as well as their physical health. Probably a false hope but if the average life span is 8 years after diagnosis, we feel we have to do something.
To continue the debate you've started (which I think is a good thing) ... Two thoughts to consider.
(1) Dementia syndromes don't affect just memory or cognition -- they affect all brain functions. And, therefore, they affect all bodily functions that the brain controls. The brain disorder itself kills. Many of us agree that it is better to, e.g., give flu shots to our AD spouses, because flu is not a particularly fun way to die. Similarly, we do what we can to prevent heart attacks (such as giving blood pressure meds), strokes (giving anticoagulants), and so forth, because heart attacks and strokes can disable without killing, making our AD spouses' lives even more miserable. We also struggle to ensure that our spouses have balanced, nutritional meals, so they won't suffer unnecessarily from the numerous problems that come from malnutrition. So one might believe that giving them supplements that might improve cardiovascular health, minimize pain from arthritis, and so on and so forth, falls under the same general category of trying to minimize any unnecessary suffering.
(2) Many of us also give our AD spouses medicines such as cholinesterase inhibitors and/or namenda, to slow the progression of the disease. Several of the supplements we've been discussing, such as vitamin E and fish oil, are being investigated as drugs for treating AD. For example, vitamin E has been shown to slow the progression of AD, and trials are now under way to determine whether the combination of namenda and vitamin E is better than either drug alone. (Note, folks, that they're looking at MUCH higher levels of vitamin E than healthy people would normally take as a nutritional supplement.) There is quite a bit of evidence that fish oils might be beneficial (animal studies, brain cell culture studies, etc), and large-scale trials are underway. So from my perspective, some of these supplements may actually be "AD meds", not just useful for keeping the rest of the body healthy. ...They just need to be taken under the supervision of a doctor who is knowledgeable about such things (the appropriate doses, possible drug interactions, where things stand as far as the clinical trials go, etc.)
You summed it up pretty well, Sunshyne. I didn't know large-scale trials were underway concerning fish oil and vitamin E. If they're harmless, easily accessible and just may help, I'm for doing it now and not waiting for all the trials to be over. Got to talk to the doctor!
Dazed, you can get quite a bit of information about clinical trials -- often including background information on the rationale for conducting the trial in the first place -- at
http://clinicaltrials.gov/ct2/home
Search for, e.g., vitamin e and alzheimer's
Sometimes they also give info on dosage levels, which can be useful.
Note: vitamin E can be synthesized in two "stereoisomers", or "mirror images" of each other, called "d" and "l". Natural vitamin E is the "d" form only, and that is the only form that is biologically active in the human body. Synthetic vitamin E contains both forms -- and the bottle will say it contains "dl-alpha-tocopherol." So in establishing the dosage, it is important to notice whether the vitamin is "natural" d-alpha-tocopherol or synthetic dl-alpha-tocopherol (aka dl-alpha-tocopheryl acetate).
I knew that one should take twice as much of the synthetic form as the "natural" form to get the same benefit, since only half of the "dl" mixture is biologically active. However, I've also recently read (not sure if it's true) that although the "l" form has antioxidant activity, it may actually inhibit the "d"-form from entering cell membranes. It is therefore usually best to take the natural ("d"-) form of vitamin E. HOWEVER ... the clinical trials on the combination of namenda (memantine) and vitamin E are being done with the dl-form.
Oh Boy, I got into a foreign web site and all the writing looked like tic tac toe marks. I was trying to find out if the trials showed fish oil did any good. Sunshyne, I really admire your ability to research things!
Starling. I am undergoing tests for leg cramps, numbness (of skin) on legs, cold feet and restless leg syndrome They have about decided that it is not pad - I just had repeat of arterial ultrasound and have already had venous ultrasound. Not nuff there to cause the problem. I do have high colesterol - just placed on lipitor. I am on a baby asprin and tomoxafin (estrogen suppressor, I am a cancer survivor) and a vitamin because folic acid was a little low. I have tried potassium, magnesium, bananas, quinine water to no avail. Vascular guy is now thinking about handing me off to neurologist. What has been your experience., patricia
Dazed, it comes with many, many years of practice. :-)
For a review of earlier fish oil studies, see:
http://www.ajcn.org/cgi/content/full/85/4/929 (You can download for free by clicking the "full text (pdf)" link in the upper right-hand corner)
I've been poking around the very recent literature. The subject is still controversial, possibly simply because of the way some studies have been designed. Evidence is strong that fish oil (including fish consumption) helps protect against developing AD. It appears, so far, that conclusions as to whether fish oil is effective at treating AD that has already developed depend on how severe the symptoms are, which symptoms are evaluated, the tests that are used to evaluate efficacy, the type of oil and the dosage regimen, and what controls were used (e.g., separating the results from patients that carry the APOE mutation from those that don't. )
As with pretty much any type of research, the early clinical trials have identified problems in the design of the trials themselves, so additional research is needed to draw solid conclusions. For example, one study I found concluded omega3 supplements given to patients with mild to moderate AD had possible positive effects on depressive symptoms (assessed by MADRS) in non-APOE4 carriers and agitation symptoms (assessed by NPI) in APOE4 carriers. Other studies failed to look at APOE.
Another study found that fish oil has significant benefits for treating MCI but was not effective for treating mild to moderate AD when the ADAS-cog was used to evaluate efficacy, while all patients showed improvement on the CIBIC-plus test. They acknowledged that they needed to run larger trials (more patients) and to use a "less heterogeneous" population (i.e., they should not have lumped patients with mild and moderate AD together.)
Also note: I have not really dug into this, but it appears that fish oil supplements may be beneficial for treating mood disorders -- depression, bipolar, etc. So it is entirely possible that while moderate-severe AD itself will not respond to fish oil, some behavioral symptoms may.
I haven't found any studies that concluded fish oil supplements might be harmful. (Depending, of course, on what meds your ADLO might be on (contraindicated for patients on warfarin, for example) ... and any allergies s/he may have to fish!)
On diet modifications to help prevent AD (and significantly slow down MCI), this article was interesting:
I thought the first question was about anti-anxity meds for the caregiver??? Anyway I took/take Paxil everyday and Xanax when I got panicky. I'm very sensitive to meds so I take half a Paxil and a 1/4 to 1/2 a Xanax.
My husband was on Paxil and Ativan for restlessness and Anxiety and later Tegretol for his aggression.
no I wanted anti-anxiety for my husband. He took his first trazodone last night and has indeed been very calm today, though I can't imagine it would have any effect yet. Although last night he did escape from his room without my hearing his bells (hung on the door to alert me). He's quite careful to be sneaky about it!
Sunshyne, thanks for the information. I'm not good at all at researching things. Your simple explanations really helped. I'm pretty well convinced that we should be taking fish oil or eating a lot of fish.
TheQueen, the magnesium was prescribed by the neurologist because I take Advir and Pravacol. So does he. He uses the magnesium to couteract the side effects of those two meds. Works for him. Works for me too, but I actually am taking the full dose and not the half dose as he is.
The numb leg and the dead nerves (I've got them in both legs) and the numb toes (which turned out to be that they got cold even in the summer) are all something else. Neither the fish oil nor the magnesium work on any of those conditions. At this point we aren't doing anything for them either. Wearing socks does seem to help the toes, which is why I'm pretty sure that their getting cold is part of that problem.
My DH had begun experiencing anxiety attacks. I didn't recognize it as that at first because he would complain of extreme stomach pain. It turns out that he begins to breath too rapidly which caused hyperventilation. This would go on for an hour or more and his stomach would hurt. The stomach hurting would cause him to pant and hyperventilate more and the cycle would continue. Fortunately we have a wonderful neighbor who is also a gastro doc and he came over during one of these episodes and enlightened me. It seems we need to get an anti-anxiety drug for him to give at these times. My concern is that prior to AD diagnosis my DH was addicted to xanex and valium. Would it be ok to give him xanex now that I'm in control of his meds? I have an appointment next week with our Neurologist.
being upfront with your neuro about his past addictions is imperative. your dr will weigh all the circumstances for your DH case and then will be able to make an appropriate choice of drug for him. i know how dreadful anxiety can make you feel. best of luck, (and you may want to stash one of those pills foryourself just in case:)...divvi