June is Alzheimer’s & Brain Awareness Month providing the perfect opportunity for a discussion about what Alzheimer’s disease is, how it is treated, and what to expect if you or a loved one is diagnosed with the disease. Many of us know someone or have cared for someone with this devastating illness. Understanding the disease can help us navigate caring for loved ones with the diagnosis.
What is Alzheimer’s Disease and how is it diagnosed?
Alzheimer’s disease occurs when certain proteins deposit into the brain causing the brain to shrink and cells to die which leads to dementia. Symptoms of dementia include memory loss, behavioral changes, difficulty swallowing, changes in sleep patterns and difficulty with other activities of daily living including eating/feeding oneself, walking, and talking.
Diagnosing Alzheimer’s disease uses a multifaceted approach including a thorough history and physical/neurological exam, lab testing to rule out other causes of symptoms, neuropsychological testing, and an MRI or PET scan of the brain. There are other tests including a spinal tap to test the level of proteins and a blood test to measure beta-amyloid level in the body. These are more commonly used if someone is displaying symptoms at a young age or is having a very rapid progression of symptoms.
How is Alzheimer’s Disease Treated?
There is no cure for Alzheimer’s disease, but there are some medications that can help with memory loss. Cholinesterase inhibitors (donepezil/Aricept, galantamine/Razadyne, rivastigmine/Exelon) can help with behavior of those with Alzheimer’s disease. These are normally first line treatments and are most useful in those with mild to moderate disease but can be used at any stage. Side effects are common and can include nausea, diarrhea, vivid dreams, loss of appetite/weight loss.
Memantine/Namenda is another medication in a different class but can be used with the above medications and is used for moderate to severe dementia. The goal of this medication is to slow memory loss. Side effects include headaches, dizziness, hallucinations, agitation, and constipation.
A newer medication called Lecanemab is an IV infusion that decreases the amyloid in the brain. This was approved in 2023, so long term data is limited.
Multiple medications can be used to target symptoms of agitation in Alzheimer’s disease, including brexpiprazole. Many of these medications do, however, come with a black box warning as they can increase the risk of death in these patients.
What are the stages of Alzheimer’s disease/what can I expect?
Early/mild disease stage: This stage is exhibited by word finding difficulty, forgetting appointments/where valuables were put, trouble with planning/organizing, and remembering names. Individuals in this stage can usually still perform most ADLs independently.
Middle/moderate disease stage: Middle/moderate stage disease presents with mood changes, difficulty remembering personal history, trouble with social events, confusion about where they are or what day it is, changes in sleep patterns, wandering/getting lost, trouble with bowel/bladder control. These individuals tend to need some help with ADLs.
Late/severe disease stage: This stage is manifested by the loss of communication, difficulty swallowing leading to potential aspiration pneumonia, difficulty with walking, weight loss, decreased responsiveness. These individuals will require 24-hour care and are eligible for hospice services as this is end-stage disease.
Is there any genetic testing available?
Genetic testing is available and may predict one’s susceptibility to developing Alzheimer’s disease. In most cases of disease there is not one single cause. Rather, it can be multiple genetic factors along with environmental and lifestyle factors. A variance in the APOE gene has been linked to early onset Alzheimer’s disease. There is genetic testing available; however, testing positive for the genetic variant does not mean the individual will develop the disease in the future. It simply means the person is at higher risk for disease development than someone that does not carry this variance. It is important to weigh the pros and cons of testing and meet with a genetic counselor to discuss results if testing is completed.
Is there anything I can do to prevent Alzheimer’s Disease?
Increasing physical activity, eating a nutritious diet, not smoking, limiting/avoiding alcohol, managing other chronic illnesses such as diabetes or high blood pressure can all help prevent Alzheimer’s disease. Challenging the brain with puzzles and staying socially active can be helpful as well.
Alzheimer’s disease is incredibly challenging, but there are still ways to help those suffering the disease remain functioning at the peak of their ability throughout the disease course. The medications listed above may help with disease progression, while keeping these individuals socially active and mentally stimulated will feed their mental and emotional well-being. It is important to contact your primary care provider if you notice any cognitive changes as early detection will help you come up with an individualized plan of care.
Erin Dahn, NP-C, is a Lakeview Clinic nurse practitioner specializing in the geriatric population. She works at various long-term care facilities with a home base of Lakeview Clinic – Waconia. Her special interests include palliative care and management of chronic diseases including hypertension, heart failure, diabetes, and dementia.
Almost everyone has heard of cataracts. “My mother had them.” “My grandfather had surgery recently.” These are common things I hear many patients say when I start talking about cataracts. They are one of the most common causes of blindness worldwide. Fortunately, cataract surgery is very safe, predicable, and common in the United States. We all develop cataracts in our later years and a variety of surgical corrections are now available.
Cataracts occur as a natural aging process of the natural lens we are all born with inside the eye. The lens gets hazy like a dirty or frosted windshield which makes it hard to see through. Sometimes symptoms of blurred vision or glare can occur in your 50’s or 60’s and surgery is common in people over 65. In contrast, I also have patients in their 90’s who haven’t had their cataracts removed and still see quite well. Sometimes it is hard to know when to recommend cataract surgery. I usually tell patients, if you cannot read or drive comfortably and your vision is affecting your lifestyle, it is time to consider having your cataracts removed.
Changes in vision could be the result of cataracts but can also be the result of other issues or just natural aging of the eye. This is why routine eye exams are important, even for those who don’t use corrective lenses. If eye exams are not a part of your current health care routine, consider scheduling an eye exam.
The Lakeview Clinic Eye Care team does not have a cataract surgeon, but we work closely with most surgeons in the area. We commonly refer to surgeons we know well who provide options including correction for astigmatism, nearsightedness, and farsightedness. You will need a careful evaluation by a surgeon who will take special measurements of the eye to determine what kind and what power of implant is best for your eye. This lens will last your entire life. Usually after cataract surgery people are less dependent on glasses and are very happy with the result. The Optometrists at Lakeview are happy to provide referrals to area Ophthalmologists for surgery. Once the surgery and most of the post operative care is completed, we are happy to see you for a final glasses prescription check and then continue your routine vision exams.
Dr. Ludwig provides eye care for a wide range of ages from toddlers to seniors. He has many years of experience following chronic conditions like glaucoma and macular degeneration and also provides acute care such as foreign body removal and caring for various eye problems. CLICK HERE to learn more about Dr. Ludwig, O.D.
Pelvic Organ Prolapse (POP) is a condition in which the muscles of your pelvic floor become too weak to hold your organs in place. POP can affect your uterus, bladder, and/or rectum.
What are the types of POP?
Uterine Prolapse
When the ligaments and muscles supporting the uterus weaken, the uterus and cervix drop down into the vagina, and it is called uterine prolapse.
Cystocele
When the tissue and muscle of the anterior vaginal wall (between your vagina and bladder) weaken, the bladder will bulge into the vagina, and this is called a cystocele. This is the most common type of POP.
Rectocele
When the tissue and muscle of the posterior vaginal wall (between your vagina and rectum) weakens, the rectum will bulge into the vagina, and this is called a rectocele.
Vaginal Vault Prolapse
In women who have had a previous hysterectomy, the top innermost part of the vagina can prolapse, and this is called vaginal vault prolapse.
What are the risk factors for POP?
POP is very common. Having a previous vaginal birth is probably the most common risk factor. Most women who have had vaginal births have some degree of POP. Age is also a risk factor since your muscles get weaker as you get older. Other risk factors include chronic cough, chronic straining due to constipation, and frequent heavy lifting. There also seems to be a genetic component, so you may be at increased risk for POP if your sister or mom has it.
What are the symptoms of POP?
With mild cases of POP, you probably won’t have any symptoms at all. In more severe cases, your organs may extend to the opening of the vagina and cause a bulge. POP is not dangerous or painful, but the bulging can be uncomfortable. In some cases, women experience stress incontinence (urine leaking with cough, sneeze and exercise). Sometimes it can cause incomplete emptying of the bladder. Difficulty with bowel movements can occur with rectoceles.
How is POP treated?
Mild POP does not need treatment. If the bulging symptoms are bothersome, you can elect to have treatment. Your doctor may recommend pelvic floor therapy, especially if the prolapse is causing urinary symptoms. They may refer you to a physical therapist who specializes in pelvic floor therapy. The physical therapist will work with you to strengthen your pelvic floor. Another non-surgical option for POP is a pessary, which is a plastic device that fits in the vagina and supports the pelvic organs. Surgery is also an option for treating POP. Surgery for POP depends on what organ is involved. Uterine prolapse can be treated with a hysterectomy. Cystoceles and rectoceles are repaired vaginally with a procedure called anterior colporrhaphy (for cystoceles) and posterior colporrhaphy (for rectoceles). Frequently, all three procedures are performed at the same time.
What if I think I have POP?
You should make an appointment with an ob/gyn. Your doctor will do an exam and determine if you have POP. Then you can discuss what treatments, if any, are appropriate.
Dr. Meath is an Obstetrician and Gynecologist at Lakeview Clinic. In addition to general OB/GYN, Dr. Meath has a special interest in contraception, high-risk obstetrics, gynecologic surgery and menopause.
We all know that exercise is “good” for us to do, yet many people don’t fully realize how much “good” it does, how much or what to do, or how to prioritize it. In honor of April being Physical Wellness month, let’s take a dive, skip, and run into the world of what getting moving does for us and perhaps how we can do more of it!
The WHY
One of the most important points you should know about exercise is that for people who have 150 minutes of physical activity a week, they have a 33% lower risk of ALL causes of mortality. There are several direct and indirect reasons for this, but perhaps a bigger takeaway is it is hard to find a medicine, or medicines for that matter, that have that great of an impact. Furthermore, exercise doesn’t require a prescription or equipment and can be done anywhere!
Below is a table with more specific diseases that exercise helps reduce including not just heart disease, but cancers, musculoskeletal diseases, mental health disease, and help improving cognition. These findings have been shown over hundreds of meta-analyses.
Cardiovascular
Cardiovascular disease reduction by 33% for those with have it at baseline, and 32-42% for those without it at baseline pending intensity.
Stroke reduction by 33%.
Lowers the risk of high blood pressure, diabetes, high cholesterol, metabolic syndrome by 25-33%.
If time spent sitting is <3 hours a day, it is correlated with a 2-year increase in life expectancy.
When it comes to exercise, it’s true that you can get benefits from many different types of exercise and so you should pick exercise that interests and works for you, but there are some important parameters to know so that you can optimize the above benefits.
According to the American College of Cardiology, the recommendations for how much to exercise is:
150 minutes a week at “moderate” exercise OR 75 minutes at “vigorous” exercise, ideally split into 3 or more days a week.
Moderate intensity exercise is when your average heart rate is approximately 70-80% of your max heart rate (your max heart rate being approximately 220-your age) or the “talk test” (you can’t sing, but you can “breathy talk”).
Vigorous intensity exercise is when your average heart rate is above 80% of your max heart rate (in comparison to above if you were to try to talk, your sentences would be broken from breathing).
It should be noted that breaking up your workout is considered just as effective as going straight through (i.e. three 10-minute walks are just as effective as one 30-minute walk) and that if you are not yet at the above exercise recommendations that it is wise to gradually work your way into that amount to reduce injury potential. The benefits of exercise are “dose dependent” so even some exercise is better than none. On the flip side, it is also worth mentioning that not much more of the above benefits are gained over 100 minutes of exercise a day, as it can lead to injury and harm.
Ideally with exercise we advise people to mix and match endurance and speed/power as most people tend to use too much slow twitch muscle versus fast twitch muscle. Interval or high intensity interval training (HIIIT) can help accomplish this and be especially good at helping with fast body changes, although it should also be noted that given the higher intensity of these workouts they should be limited to 2-3 times a week for most people.
Lastly, we recommend incorporating at least 2 strength training days into the week. A basic example of this can look like 8-10 different body weight or weight exercises at 8-12 repetitions, but there are many variations, and some cardio workouts include strength training in them as well.
It is never too late to become physically active and physical activity is one of the most important things you can do for your health as you age. It helps you stay independent longer so that you can do the things you want to do! In addition to the general population exercise recommendations above, flexibility and balance exercises become essential in this age group. Exercises to increase or maintain flexibility should be performed twice a week, ideally after aerobic or strength activities when the body is warmed up. Balance activities, which should also be done at least twice a week, help prevent falling and the risk of injuries.
For more information on what you can do to stay active, particularly if you have any physical barriers (i.e. arthritis), first ask your health care provider for individualized exercise recommendations, as well as about resources available in your community. You can also check with your insurance to see if any free or discounted programs are offered. Lastly, consider exploring more online resources here:
Pregnancy is an ideal time for lifestyle modifications for the sake of both mom and baby!
Here are some of the benefits of exercise during pregnancy:
Reduces the ever-common musculoskeletal discomforts (i.e. low back, pelvic girdle).
It helps avoid excessive gestational weight gain.
Improves mood and mood-related comorbidities.
Prevents urinary incontinence issues.
Better fetal tolerance of labor.
Reduces risk of developing gestational diabetes and pre-eclampsia.
Reduction of macrosomia (large fetal head) and large for gestational age newborns.
Possible reduction in risk of cesarean delivery.
Possible reduction in duration of first stage of labor.
Helps combat childhood obesity after baby is born.
Although there are many benefits to exercise during pregnancy, there are some changes that a pregnant mother needs to be aware of when exercising. Pregnant mothers should avoid activities with high risk of fall/belly injury, hot yoga/hot Pilates/other “hot” workouts, very strenuous activities, heavy lifting, high agility activities given more relaxed ligaments, and certain positions pending how far along they are in their pregnancy (i.e. avoiding prolonged supine positions the last half of pregnancy).
If you are pregnant and unsure what exercises you should or shouldn’t do, it is best to talk to your OB provider as some pregnant mothers need specific exercise restrictions or modifications based on underlying or acquired conditions during pregnancy.
The BARRIERS
The main reason people don’t exercise as much as they would like, is that they often have perceived barriers that make it more difficult for them to do so. Below is a chart of the most common ones that people report, as well as ideas to consider overcoming the specific barrier. That all being said, the best way for you to overcome your own barriers is to write down what your biggest barriers are, and then write down specific things you can do to overcome them to make exercise a priority. Using tools like journals, pedometers, apps to help stick to your goals, and having check-in points in the future to hold yourself accountable and stay on track have all been shown to help keep your success as well!
Barriers
Tips to Counter Barriers
Time
Set a schedule, prioritize, utilize mornings.
Inconvenient
Try short 10-20 minute bursts.
Motivation
Consider the benefits.
Not enjoyable
Try different exercise options, classes, active hobbies.
Find exercise boring.
Try active games.
Lack confidence in ability to be active.
Utilize educational resources or a professional trainer.
Injury fears
Addresses physical restrictions and progress gradually.
Unable to set goals and monitor progress.
Seek assistance in setting small, short term and long-term goals.
Lack encouragement and support.
Involve friends and family.
Lack access to facilities within a convenient distance.
Consider options for walking at work or at home.
If you have any questions about exercise or what you can do to improve your physical fitness in relation to your overall health, your Lakeview medical provider would love to hear from you!
Dr. Leah Clark is a Family Medicine physician at Lakeview Clinic, was a multi-sport athlete in high school and 6-time All-American Track and Field athlete in college. She serves as the head of Lakeview’s Wellness committee and is an exercise and outdoor enthusiast.
A Podiatric Surgeon specializes in treating conditions of the foot and ankle. Foot and ankle pain can hinder your walking and overall mobility, significantly affecting your quality of life. A podiatrist is the most effective resource to help regain that mobility so you can enjoy the more active things in your life. So, if you answer yes to any of the following questions, it is time to see a podiatrist.
Do your feet hurt at the end of the day?
Pain in your arch, top of your foot, big toe, or ankle after a long day of standing or walking can be from arthritis. Treatments range from arch support, injections, or surgical management when conservative measures fail.
Does it feel like someone is stabbing you in the heel when you take the first steps of the morning?
This is a telltale sign of the very common condition plantar fasciitis. Plantar fasciitis is inflammation of a thick band of tissue, the plantar fascia, that runs from your heel all the way to your toes. If left untreated this can escalate into significantly debilitating pain. It is best to be evaluated early if you are experiencing heel pain.
Are your toes crooked and rubbing inside your shoes? Do you have flat feet and painful arches?
Bunions and hammertoes are common conditions that podiatrists treat, along with other foot deformities like flat foot and congenital foot/toe abnormalities. Although surgery is usually required to improve the deformity, it may not be necessary unless it keeps you from your everyday activities. Seeing a podiatrist can help determine the best treatment for you.
Do you have pain around your ankles? Do you sprain your ankles frequently?
Chronic pain on the outside or inside of your ankle with certain activities can be caused by a ligament or tendon injury. Evaluation by a podiatrist can help determine the severity of the injury and the best level of treatment.
Do you have ingrown toenails that hurt in your shoes? Do they get red and infected?
Ingrown toenails hurt! Something so small can cause so much pain. But a simple in-office procedure can help relieve your agony. After foot soaks and bandages, you will be back wearing all your shoes again.
Numbness or tingling in your feet? Are you diabetic?
Nerve pain, or neuropathy, in your feet is not always caused by diabetes. There are multiple causes and some different treatment options. If you are diabetic and suffer from neuropathy a visit to a podiatrist can help limit your risk of complications including infections and amputations. A podiatrist is also your best partner if you do have lower extremity wounds as they can organize wound care and are trained to do procedures to help heal wounds faster.
Did you suffer an injury? Twisted foot/ankle? Can’t bear weight on your foot?
A podiatrist can treat broken bones in the foot and ankle. They are skilled in reading x-rays and correlating the image to your clinical exam to find the correct diagnosis. They can also help manage your sprain or strain treatment with offloading and therapy options.
Seeing a podiatrist is as simple as scheduling an appointment just as you would with any family medicine provider. Podiatry appointments typically take place in a clinical office and many procedures such as an ingrown toenail can be performed the day of your visit right in the office. For more serious conditions such as bunions, patients may need a surgical procedure in a hospital setting. A podiatrist is the best option for any problem with your foot or ankle. They can help determine the proper diagnosis to get the proper treatment. This will help get you back to your life with pain-free mobility.
Dr. Arens attended Scholl College of Podiatric Medicine in Chicago, Illinois. His resident training in foot and ankle surgery was completed in 2016 at Hennepin County Medical Center in Minneapolis.
His practice involves all aspects of podiatric medicine and surgery. He performs surgery of all foot and ankle conditions ranging from bunions and hammertoes to fractures and chronic ankle pain.
