Michael the Cat

"Bananas? Really?"

The Red Wine Experiment

In Opa’s family, there is a high risk of cardiovascular disease. Opa himself has cardiovascular disease and had life-saving bypass surgery almost 20 years ago.  At 85, he has outlived all of his 10 siblings many of whom did not survive beyond middle age.

After the bypass surgery, Opa was prescribed the beta-blocker Sotalol to control blood pressure and the statin Lipitor to control cholesterol. Although he took these medications faithfully for more than 15 years, both his blood pressure and LDL cholesterol levels remained high. Opa was also diagnosed with non-alcoholic fatty liver disease (NAFLD) which was attributed to his diet. Four years ago, Opa decided that the side-effects of Lipitor, particularly muscle pain and fatigue, were no longer tolerable. And, against his doctor's advice, he stopped using all prescribed medications.  

Opa hardly eats any meat, but he does love cheese, cream, milk and butter. So when he discontinued the meds, I suggested that we start drinking red wine with rich meals to help lower cholesterol (and also because I happen to like red wine). He agreed even though he didn't particularly like wine and almost never drank alcohol.

Like many others, I have known for a long time that moderate drinking of red wine and other alcoholic beverages is associated with a reduced risk of heart disease. But I didn’t know how much cardio protection wine offers until today.

According to the British Medical Journal, 30 grams of alcohol a day may cause an estimated reduction of 24.7% in risk of coronary heart disease ("standard" drinks of a 5 oz glass of wine, a 12 oz can of beer, and a 1.5 oz shot of hard liquor each contain about 14 grams of alcohol).

Findings published in the American Heart Association journal showed that “drinking 1 to 2 drinks per day, 3 to 4 days per week decreased the risk of having a heart attack by as much as 32%... and was found to be associated with an approximately 20% reduction in the risk for ischemic stroke and may even be beneficial in preventing subsequent strokes.”

In regard to mortality by all causes, the American Heart Association published a 2010 review showing that moderate alcohol consumption reduces the risk of mortality by all causes by 20%. (It should go without saying, but I'll mention anyway that high levels of alcohol consumption show the opposite effect.)

But what about statins?

Statins also reduce mortality. According to a recent Cochrane review, statins reduce risk of mortality by all causes by 0.76%. Across studies, for every group of 100 patients who did not take statins, 5.17 died within a few years, and for every group of 100 patients who took statins, 4.41 died within a few years. This positive effect, although small, is greater than the findings yielded in the previous Cochrane review which showed a 0.07% reduction in mortality. Also noteworthy is that some 15% - 20% of patients using statins experience side effects; muscle aches, fatigue, liver toxicity, and memory loss are among the most recognized to date.

And beta-blockers?

 

The Journal of the American Medical Association (Jama) released a media statement in October of 2012 with this headline: Beta-Blocker Use Not Associated with Lower Risk of Cardiovascular Events. Although beta-blockers have been the standard treatment for coronary artery disease, the 2012 review showed that “beta-blocker use was not associated with a lower event rate of cardiovascular events at 44-month follow-up, even among patients with prior history of MI [myocardial infarction]. Further research is warranted to identify subgroups that benefit from beta-blocker therapy and the optimal duration of beta-blocker therapy.”

So did Opa make the right decision when he switched to wine?

Beta blockers have not been shown to have any long term cardioprotective effects. Statins have been shown to reduce the rate of mortality by nearly 1% but also have unpleasant (and sometimes dangerous) side-effects. And two drinks of red wine (or other alcoholic beverage) a few times a week have been shown to reduce the risk of mortality by 20%, the risk of heart attack by 32%, and the risk of stroke by 20%. Plus side-effects are generally pleasant. So, based on the research, it's safe to say yes, Opa made the right decision. It'a slso safe to say that he made the right decision based on the results of his check-up.

As I think I mentioned in a previous post, Opa recently returned to his doctor for a complete physical (read: he finally said yes after numerous suggestions over the past few years). Results were as follows:

· blood pressure 120/80 (normal)

· LDL cholesterol 2.1 (considered to be in the ideal range for people at risk of heart disease)

· liver function normal (confirmed by blood tests and ultrasound)

Opa’s doctor was amazed (as was I!) and wondered what might account for these results. He smiled when I suggested that it might be the red wine. His advice to Opa? “While I can’t prescribe red wine, I suggest that you just keep doing what you’re doing.”

 

I didn't mention it to the doctor, but I can't help but think that, in Opa's case, the dementia might also be a cardio protective factor. Or maybe not the dementia per se but its meditation-like, "living in the present" effects, coupled perhaps with our calm, low-stress home environment. 

 

Studies consistently show the health benefits of meditation. Most striking is a 2009 study from the Medical College of Wisconsin in Milwaukee presented to the American Heart Association. Findings from the 9-year study showed that participants with coronary heart disease who practiced meditation had 47% lower rates of heart attack, stroke, and mortality by all causes compared to nonmeditating controls.

 

Although Opa would never have been interested in meditation or concepts like "living in the present" in younger days, I don't think this research would surprise him today. In fact, if you ask him what the secret to good health is, he will invariably respond with this:

 

He might also want to add: "And maybe drink a little red wine."

Early Morning Ultrasound

Opa and I are not morning people. So, needless to say, I wasn’t thrilled when Opa’s ultrasound was booked for 7:30 am. I was even less thrilled when I learned that the test required an 8 hour fast. Opa is a round-the-clock grazer and he is also very persistent, especially when it comes to quenching his thirst.

Opa drinks 3 quarts of milk a day, and only turns to water when no other drinkable liquids are available. (I recently found a bottle of Tamari on his nightstand.) So I am thinking that it will be quite a challenge to keep Opa on this 8 hour fast. I decide to discuss it with him.

“You know, Dad, you have a checkup appointment tomorrow morning at the hospital and you’re not allowed to have anything to eat or drink after midnight.”

“No problem!” he says confidently.

“Yes, but I was wondering if it might not be a good idea to put a note on the fridge to remind you just in case?”

“The note is a good idea,” he says. “But I don’t think you should put it on the fridge.”

“Where should I put it then?”

“On my finger,” he says with a grin. “If you tied a note to my finger I would notice it right away.”

I laugh. “But what if you rip it off in your sleep?”

“Hm... Yes, yes, I would probably do that. You could tie a note to the handle of the fridge. I would notice that right away too.”

“Thanks, Dad. Great idea.”
 

At midnight, I have the note ready. And I tie the fridge and cupboard door handles securely together with string.

 

 

I also take some extra precautions: wine and cognac are removed from the cold cellar, and scissors and knives are removed from the kitchen and stored in my room for the night.

When I get up rhis morning at 5:30, the note has been moved to the kitchen table, but everything else is intact. At 6:00 am, I wake up Opa. He springs to life and seems quite happy.

“Where are we going?” he asks with a smile of anticipation as I get his shaving stuff ready. But when he hears my answer, his mood fizzles. “To the hospital for a checkup? At this hour? It’s still dark!”

“I know, Dad. It’s really early. I tried to get a different time for you, but...”

“No, I am not going.” He turns and walks away. “I go back to bed.”

 I know from experience that you don’t try to oppose Opa (or me) first thing in the morning. I also know that today I have an advantage: Opa’s 8 hour fast.  

“Before you go, Dad, I was hoping to treat you for a big breakfast after the appointment. Bacon and eggs, pancakes with syrup, orange juice, coffee... or whatever else you’d like. What do you think?”

He turns and glares at me. Then his eyebrows slowly unfurl and I know I’ve got him. Within seconds he is a happy again and lets me shave him (note to self: research electric razors). The rest of the day goes without a hitch... well, except for the clearly audible commentaries about his fellow patients in the waiting room (“Why is that bald man who just came in not wearing a hat? Is he not freezing?” “Look at that woman in the corner! Vow, is she big!”). But I am used to this now.

Breakfast was delicious. We're off to see his family doctor soon for the results of other tests. Maybe afterwards we'll go out for fish and chips.

Sweet Potato Disposal

So we’re cutting sweet potato fries and Opa walks by and snags one.

“It’s raw, Dad. I don’t think you’ll like it.”

“Oh, no, I like it”, he says as he takes a bite and continues walking through the kitchen.

Later, I water the plants in the sunroom and see this:

 

 

Winter Lock Out

I reheat a delicious Moussaka that my dear friend Penny sent home for me and Opa. I cook up some green beans and a salad to go with it. When everything is almost ready, I decide to dash outside to the green bin to dispose of the vegetable scraps. This takes only seconds, but when I return the door is locked.  

It’s December, minus five degrees and windy. I am in jeans and a t-shirt. Oh well, no biggie. I run around to the front porch and ring the doorbell. No answer. I ring again harder. Still no answer. So I ring and I ring until the old, wind-up doorbell gives up the ghost. Through the windows, I can see clear through the house and into the kitchen but no Opa. Where the heck is he?

I run around to the other side of the house. No light in the bathroom. No light in the bedrooms. I run back to the front door, shivering. I knock hard. Nothing. I run to the side door again and see that the basement light is on. Aha! He must be down there! I bang on the side door a couple more times. Nothing. So I crawl under the stoop and start banging on the basement window. No signs of life.

Now I’m worried for us both. Did something happen to Opa? Am I going to get hypothermia and die out here? Is the stove on high? I’m considering kicking in the basement window when I see Opa peeking around a pillar in the basement. He looks scared.

I yell through the window, “Dad it’s me! Unlock the door!”

“Oh, okay, okay,” he says.

When the door opens, Opa is annoyed with me. “You scared me! What were you doing making all that noise?"

But then he sees my frost-bitten face and notices how I'm dressed, and he looks at me like he's sure I've lost my mind. Then he pats me very kindly on the shoulder, "You know, Helena, you really shouldn’t go out without a coat in this weather! It's freezing!”

"Yes, you’re right, father. That was foolish of me," I say, unable to keep the sarcastic tone out of my voice. Opa shakes his head and walks away.

Fortunately, the stove was on low and dinner was saved! Yay! Once my fingers are thawed out enough to use utensils, I serve us dinner. It's a wonderful meal. The Moussaka is outstanding and the beans are soggy just the way Opa likes them. But lesson learned: NEVER, ever, under any circumstances leave the house without keys! Or without a coat in winter.

Opa Chef for Cats

Opa goes through periods of heightened creativity, particularly at night when the rest of the house is asleep. One of the activities he likes to do is prepare interesting and nutritious breakfasts for our cat Michael. Sometimes he forgets that our cat Mia passed away this summer and will prepare breakie for two.

Recently, there were two bowls of milk garnished with fresh sliced strawberries along side the regular bowl of cat food. Michael ignored the strawberries and milk.

   
The next day, there was more of a variety: bread soaked in milk, orange juice, leftover vegetable pulp from the juicer, and a liverwurst sandwich cut up into bite size pieces.

 

 

As usual, Michael ignored the tasty offerings and went straight for his cat food.

 

 



On the third day, there was a cup of sugar, a bowl of mango juice, a caramel pudding cup, a bowl of sugar, and two wedges of Laughing Cow cheese.

 

Only this time, Opa decided to remove the bowl of cat food, presumably to entice Michael to sample the latest breakfast smorgasbord. Michael was not pleased.

 

Visuoperceptual Impairment

Visuoperceptual distortions are problems that involve both vision and perception. Common mistakes are illusions (seeing a face in a shadow), misperceptions (mistaking a stain on the carpet for a hole), and misidentifications (difficulties distinguishing daughter from grandaughter).

Understandably caregivers might mistake these distortions as delusions. But it is important to know that what the person with dementia is experiencing is not a true delusion. It is not based on incorrect reasoning or delusional thinking. Rather, it is the result of damage to neuro-visual system. Consequences include but are not limited to:

• needing more time to adapt to changes in light levels (eg when going from a dark room into sunlight or viceversa)
• changes in the reaction of the pupil to light
• loss of peripheral vision (being able to see things outside of the direct line of vision),
• reduced ability to differentiate colours
• problems directing or changing gaze
• problems with the recognition of objects, faces and colours
• loss of ability to name what has been seen
• double vision
• problems with depth perception.

As a result a person  may:

• become lost or disorientated, even in familiar places
• have problems locating people or objects
• misinterpret reflections (i.e. seeing an 'intruder' or refusing to go into a bathroom because it appears occupied, mistaking images on the TV for real people).

Regular eye examinations are important since cataracts, glaucoma, macular degeneration and retinal complications from diabetes also cause visuoperceptual distortions.

As a caregiver, the best approach is not to point out or correct distortions unless they are disturbing to the person experiencing them.