Alzheimer's Prevention

My late wife and I had often shared an inside joke. Often the springboard of the joke was that she asked, why are you doing it THAT WAY? We lived in suburban Chicago, where often a first - tier conversation at a gathering would begin with: "How'd you come?". The culture will recognize this clip from 'Saturday Night Live' as another version of this query I often heard at family parties.

See now my wife and I driving to that same family party, and she notices that I'm taking a route that is not the typical path we had taken to that family member's house. Again, she asks me WHY ARE YOU GOING THAT WAY? I smiled at her and replied almost instantly, not even flinching in advance for the controlling head slap some husbands might get - "Alzheimer's Prevention".

With time, my wife would beat me to the punch. She'd see me or hear me talking about a job that I had planned to do about the house, at my job, or in the garden. She would comment, with an Irish upward lilt in her voice after hearing my innovative ideas for the job in question, "Alzheimer's Prevention???". She was so smart! Having shared the use of compensatory cognitive strategies with gobs of people who'd been diagnosed with a cognitive impairment, I've adopted their use for myself, much of the time. After all, one day I might be across the table from my own speech - language pathologist.

Just as the medical expert attests in the AMA video cited above, lifestyle strategies that may help prevent cardiovascular disease and cancer will also be great preventive tools in one's toolbox against dementias. Diet, exercise, weight control, medical management of 'the three bloods' (pressure, cholesterol, sugar), sleep, and tobacco exposure are largely within our control with proper guidance. When it comes to cognitive strategies, the often cited but barely attributed 'WRAP' strategy is a sufficient anchor for most of us. W = Write down what you want to remember. R = Recall or practice a Routine. A = form an Association of what you need to remember, with another memory that will easily cue your recall. P = Picture your item to remember.

I will often write short notes on a Post - It sheet - often a sheet printed in a bright color - then I leave the sticky page on my desk the night prior, so that I might get the cue to accomplish something that next morning. My cognitive routine that I boasted of frequently to home health patients, entailed my placing all my personal items carried in pockets during the day, in the exact same area in my home each night. Associations are the easiest strategy for me to use; it's just seemingly how my brain is tuned. For example, when I see a photo of Marina Towers in Chicago, I think of 'The Bob Newhart Show' TV series, since the series opening always showed the buildings. When the Denzel Washington character in the new film 'Highest and Lowest' approached an apartment door with the sign 'A24' on it, I immediately recognized it as the name of the movie production company behind the film. Picturing? That I often rely upon, when I am driving distances and relying on landmarks to locate a turn or gauge a distance to reach home.

The strategies extend from simple recalling of everyday names, facts, object positions, and daily events. "Alzheimer's Prevention" means as well, performing a physical task differently at different times. That way, I force myself to focus carefully, move slowly, and be mindful of steps in a sequence of actions. This might include taking a walk about a familiar route, but reversing the direction of travel on random days. Another: bathing in a tub on one day, then showering on another. Young readers of this blog who feel puzzled at the advantages of doing such a simple task in different ways - age about 50 years. You'll see. How'd you come?

We're Just Not Sexy Enough

I have this rant fairly regularly. What public presence does my profession, speech - language pathology (SLP), have? What do people know about what we do, when I tell them what I do? Is our story told well in literature, or in pop culture, news, film, stage, music, or through ANY VENUE? I'll spare you a review of my previous posts on the subject, but my assessment of our plight is dire. It seems that we're just not sexy enough to have our story told. Is being un-sexy a detriment to doing our job? Will we remain the best - kept secret in town, until a doctor's referral drops? The hard reality of clinical practice in SLP includes: a wide variation in the rate of referrals, especially from doctors; referrals rescinded when patients refuse services,even though communication or swallowing may be severely impaired; uneven education by physicians about what SLP does; a dearth of marketing of SLP services to referral sources, by the persons who pay us and supervise us; limitations in non - productive time by SLP practitioners to market themselves; and little or no budgeting within rehabilitation departments for SLP consumable supplies and materials. SEXY? What about survival? Let's see where the sexy train goes off the track.

The medical comedy "Scrubs" featured a recurring character, a soldier being treated for effects of a brain injury in Iraq. SOME of the effects! You see a physical therapist working with the patient on his handwriting, commenting that she had acquired an "occupational therapy pencil" to conduct the treatment. The soldier also presented with memory breakdowns, which led to some opportunities for jokes, not for cognitive treatment.

The Netflix streaming platform currently features the Japanese series "The 19th Medical Chart", a popular series featuring a character who would be called a family practice physician. When the featured physician was consulted on a case of hypopharyngeal cancer, I immediately expected that rehabilitative efforts would be a serious component of this story. Not in the least - the surgery on this lesion was the outcome. Vocal rehabilitation? We'll see what happens.

And wouldn't you know - even physical therapists can lose their sexy edge! The FOX/Netflix series "The Resident", has featured more than one patient character who when offered rehabilitation after orthopedic surgery, complained that therapy would take so long! The surgeon and his internist colleagues shimmer with sexiness, once again.

So my rants about SLP's visibility, its sexiness, always end up with this realization. We may be consultants who may rarely be used, but we're used because, as Dr. James Coyle reminds us, the doctors can't do what we can do. We help our consumers find themselves, and that journey is only as long as it takes.