Thursday 5/9/16 APNA CPI preconference discussion on benzo pitfalls: notes from the lecture

Benzo discussion Dr. Limandri:

My impression: great info, so much material to cover though so she mostly skimmed the surface. Lots of the info seemed to come from her own experience. Some material came from the UK — Ashton Manual which I refer to often and it’s full of good info.

Below are my mostly unedited notes from this session along with some lyrics from a famous Rolling Stones song relevant to subject.

1. Women use this class of med more than men. 25-50 yr age range is highest; multitasking requirements for women in that age bracket; middle aged, white, wealthier higher utilizers of benzos. The Rolling Stones wrote a famous song about women using Valium, “Mother’s Little Helper” in the 1960s — here are the lyrics:

What a drag it is getting old
“Kids are different today, ”
I hear ev’ry mother say
Mother needs something today to calm her down
And though she’s not really ill
There’s a little yellow pill
She goes running for the shelter of a mother’s little helper
And it helps her on her way, gets her through her busy day

“Things are different today, ”
I hear ev’ry mother say
Cooking fresh food for a husband’s just a drag
So she buys an instant cake and she burns her frozen steak
And goes running for the shelter of a mother’s little helper
And two help her on her way, get her through her busy day

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

“Men just aren’t the same today”
I hear ev’ry mother say
They just don’t appreciate that you get tired
They’re so hard to satisfy, You can tranquilize your mind
So go running for the shelter of a mother’s little helper
And four help you through the night, help to minimize your plight

Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old

“Life’s just much too hard today, ”
I hear ev’ry mother say
The pusuit of happiness just seems a bore
And if you take more of those, you will get an overdose
No more running for the shelter of a mother’s little helper
They just helped you on your way, through your busy dying day

Notes con’t:

2. More deaths for those who were regular daily users v the infrequent.

3. 3 weeks is the longest time they should be prescribed, per the speaker. Most long term users stay at same dosages, but they have rebound anxiety and end up raising the dose over time. When your patient c/o anxiety while on a benzo — and you choose to up the dose — you’ve done opposite of what you were supposed to do.

4. Primary care providers are the bigger offenders, that is, prescribe benzos the most, possibly because they feel pressured to solve all the problems of their patients.

5. Studies are reporting on stats by psychiatrists and not NPs. Add the NPs and the stats would be different.  For many providers it’s much quicker to write the script than it is to  do MI or other counseling in an effort to back off the dose or taper off. There are providers out there that will write for benzos with no intent to stop because it’s lucrative work, sad to say.

6. GAD has so many somatic c/o so they end up in primary care and while there they end of getting a rx for benzo.

7. Best anxiolytics are SSRIs. Take a bz to bridge until they kick in, for 2-3 weeks, and then stop without taper.

8. DSM5: MDD with anxious distress… emphasize the last part and that it’s linked to the first, as say of encouraging someone to try and SSRI.

9. Why do many people with trauma dislike taking bzd? They feel a loss of control when on them, less reactive, less fight/flight.

10. Dementia and increased falls.

11. It’s expensive to treat all the collateral damage, eg, falls, car accidents, etc.

12. 2.5 x higher rate of suicide attempts: from a big study in Taiwan she mentioned (I don’t have the reference).

13. Anterograde amnesia (use midazolam in your teaching and why it’s used in medical procedures), dissociation, cognitive impairment, paradoxical anxiety that is proven in PET scans. It makes you not care about the anxiety, not care about possible risks. hinders fight/flight — exactly what trauma survivors don’t want.

14. Cognitive impairment makes it hard to learn the skills needed to curb anxiety.

15. COGNITIVE IMPAIRMENT IS WHY YOU DON’T GET WHAT I’M TELLING YOU.

16. CBT to get people off benzos: question why you think it’s helping your anxiety.

Questions from the audience:

State hospitals and volatile patients and common use of bzd’s: increases impulsivity but they’re slower and we can catch them. Use a different gaba med that’s not the benzo receptor: lamictal and gabapentin. both slow the firing and allow staff time to think. State hospitals may want to use benzo cause it’s cheaper.

Alternative anxiolytics: Effexor — more adrenergic at higher doses. 75mg is antidepressant. Fetzima more adrenergic at lower doses so better tolerated. Buspar helpful; others: lamitical and gabapentin. alpha and betas blockers: trauma clients do better on these and feel it right away.

Schizophrenia and benzos: no indication but had been used for akathisia.

Turmeric, the Golden Spice – Herbal Medicine – NCBI Bookshelf

Turmeric, the Golden Spice – Herbal Medicine – NCBI Bookshelf.

Asian Spices

“…antioxidant, anti-inflammatory, antimutagenic, antimicrobial, and anticancer agent…” — what more can we ask for in a supplement? Asian countries also have some of the lowest incidences of Alzheimer’s in the world, and yes, they consume a lot of curcumin.

Adding a daily supplement of turmeric to your diet can only be beneficial. It’s widely available at health food stores and not expensive.

This NIH article’s references are mostly from the past 10 years so I feel it’s worthy of bookmarking. Excellent article with a lot of valuable information.

Seth Rogen and Alzheimer’s: Mystery of the Empty Seats

In February 2014 Sen. Tom Harkin held a hearing about Alzheimer’s in America. There’s been an enormous storm of dialogue on social media that resulted from the 6 minute YouTube clip showing Seth Rogen’s testimony. But it wasn’t just his personal story about Alzheimer’s that’s caused such a ruckus. The backlash is about all the empty seats at the hearing. Here’s Seth’s testimony.

Because I was interested in seeing what happened before and after Seth’s testimony, I watched the entire 2.5 hour hearing. The best minds in science fighting Alzheimer’s were there answering questions. Congressman Dennis Moore, who recently resigned because of his own diagnosis of AD, also gave testimony. One would think that his own colleagues would be there in a show of support. But they weren’t. What a diss!

Here is a clip from an investigative story by CNN, soon after the hearing, where Seth Rogen is interviewed and they discuss the empty seats — at the end of this video please note that AD is now the 3rd leading cause of death, not the 6th:

If you’re interested in learning more and want to watch the full hearing, go to this site:

http://www.harkin.senate.gov/blogitem.cfm?i=ce814fb0-ea30-4186-93e7-1f9094aac7f7

Dementia Village: No more lock-down “memory units”

My mother was placed on the antipsychotic medication Zypexa during a rough stage of her ordeal with Alzheimer’s.  Her need for this medication was never reviewed in the months and years after she started it. There is no doubt in my mind that it could have been discontinued had she been able to receive humane and dignified care.

“Don’t use antipsychotics as first choice to treat behavioral and psychological symptoms of dementia”: this is one recommendation of Choosing Wisely. An initiative of the ABIM Foundation, Choosing Wisely is focused on encouraging physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and in some instances can cause harm.

I’m not sure it’s possible for capitalist societies to put good care above profits.

 

India, Alcohol, Turmeric, and Alzheimer’s Disease

Alcohol use on the rise in India : The Lancet.

India has the lowest incidence of Alzheimer’s Disease (AD) in the world and it’s believed that one of the reasons might be their high consumption of turmeric.

Interestingly, India is also one of the countries with the lowest alcohol consumption rates. Alcohol is a known contributor to dementia. With alcohol use now on the rise in India, researchers should pay close attention to trends in AD prevalence in India over the next few decades.

So would it then be accurate to recommend increasing turmeric in our diets and minimizing or abstaining from alcohol use based on this information? Maybe.

Too Many Nurses in the Kitchen: CNA, LPN, RN, APRN, PHD, DNP

Back in 1990 when I was fresh out of my initial nurse training program, for a LPN, the word in the hospital corridors was that LPN jobs would soon be obsolete. Go back to school and “get your RN” was the buzz. Since rising through the nurse ranks I’ve paid attention to the demise of the LPN and it’s not just alive and well, it’s thriving, in 2014.

I’ve got some analogies: movie ratings — G, PG, R, and X. And places to receive healthcare.

Brain Pacemaker for Alzheimer’s Disease

First brain pacemaker implanted to treat Alzheimer’s.

Racing for a cure: From turmeric to aspirin to brain pacemakers — efforts are definitely being made to find the silver bullet for Alzheimer’s treatment. Eventually someone will nail it but time is ticking.

Life Care Books in Continuing Care Settings

Life Care Books in Continuing Care Settings

 

The use of Life Care Books (LCB) in Continuing Care settings helps to preserve memories, and is especially valuable to persons with dementia, including their families and caregivers. This link is to a NIH study in 2008 conducted in Ireland on the value of creating Life Care Books (yes, they are of value). They can be a source of comfort, and help an individual to recognize that their life was indeed full and rich and had great meaning. There’s a lot of hopelessness, sadness, and grief among residents in long term care, and taking the time to create a LCB is something that can make a real difference.

For Some Caregivers, the Trauma Lingers – NYTimes.com

For Some Caregivers, the Trauma Lingers – NYTimes.com.

Dr. Judy Stone’s story in this NYT article is just like mine. I became overwhelmed during the 5 years I cared for my mother (diagnosed with Alzheimer’s in 2007). I underestimated my ability to provide professional nursing care for her while simultaneously caring for my own family and myself. My standards of care for the entire medical community have always been high — plus I’m a huge patient advocate. So when our (broken) medical system kept failing her at crucial moments I began to feel powerless, and eventually succumbed to a terrible case of caregiver burnout.

Healthcare providers need to be extra mindful when we take on the role of being caregivers for our own loved ones to ensure we have adequate supports in place for ourselves. That old adage “ignorance is bliss” would have come in handy many times during those 0300 nights she and I sat alone together in the ER.

Obama Provides Cash Infusion for our 6th Leading Cause of Death: Alzheimer’s

Characteristics of Alzheimer’s disease (Photo credit: Wikipedia)

 http://www.cbsnews.com/8301-504763_162-57372828-10391704/alzheimers-research-in-u.s-gets-extra-$50-million-in-funding/
CBS News reported on February 7 2012 that the US is severely lacking on its goal of finding a fix for Alzheimer’s. What will be the consequence for this re: the nursing “job shortage” or perceived current “nursing shortage”?  Considered also the impact of Alzheimer’s caregiver burnout with ensuing physical health collapse as another burden on the system — what are the projected stats in this realm? In SC the Alzheimer’s Association offers family members caring for their loved ones at home a whopping $500.00 annually from a (tenuous) grant.

Below is an excerpt from the CBS story — the stats are staggering.

Patient advocates have long said U.S. spending on Alzheimer’s research is far too little considering the disease’s toll. The disease is the sixth leading cause of death in the U.S., according to the CDC’s latest report, taking more than 83,000 lives this past year. More than 5 million people already have Alzheimer’s or related dementias, a number that, barring a medical breakthrough, is expected to more than double by 2050 because of the aging population, according to the Alzheimer’s Association. By then, the medical and nursing home bills are projected to cost $1 trillion annually.

Related articles

• Drug trials for Alzheimer’s may need to start earlier (usatoday.com)