health

Be Practical When Tackling Major Lifestyle Changes

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | March 1st, 2019

Dear Doctor: After the new year, I started making some serious lifestyle changes, including losing weight and quitting smoking. It's not my first time around, so I hope you have advice to stay motivated. I really don't want to be making these same resolutions next year.

Dear Reader: As we've all learned by now, there's a world of difference between knowing what's best for us and actually doing it in real life. One of the reasons making changes can be so challenging is that even a seemingly simple goal involves altering our behavior -- and our thinking -- on multiple fronts.

Before you begin, we think it's important to fully understand your goals. Let's begin with your resolution to quit smoking. Start with understanding why you're going to make this change. If the answer is for better health, go a bit deeper and make a list of all the ways that smoking makes you feel bad. Are you short of breath? Is it hard to run (or even quickly walk) a short distance? Do you get winded going up a flight of stairs? Maybe you start the day coughing? On the social side of things, perhaps you're sensitive to how your clothes or hair or car smell, how your family and friends respond to your being a smoker, or to the financial cost of your habit.

Once you've written your list -- and we urge you to be as complete, detailed and honest as possible -- you've taken a significant step toward understanding what's at stake as you go about making this change. Where before all you had was the command "quit smoking," you now have a multifaceted understanding of the different ways this habit affects your life. You have imbued your goal to quit with depth and personal meaning. That's important because when you're struggling through the inevitable rough patches that we all go through when making a lifestyle change, you now have multiple toeholds to help stop the fall.

Another element of successful change is setting reasonable interim goals. Sure, the endpoint is zero cigarettes. But two or three fewer cigarettes per day or week, depending on your habit, is definitely a success. The same goes for weight loss. Lose just 5 ounces per week and by the time the next New Year's Eve rolls around, you're down 16-plus pounds. Taking the long view in reaching your goals will make it easier (and far less painful) to integrate ongoing changes into your daily life.

A final note: In your letter you refer to "some" serious lifestyle changes, indicating you've set more than just the goals of quitting smoking and weight loss. If so, you've added a significant level of difficulty. We think it would be wise to prioritize those changes and work toward them sequentially rather than all at once. Pick the goal that's most important. When you feel solidly on the road to success with it, then tackle the next one. That way you've got a better chance of crossing at least one or two of the goals off your list of resolutions, rather than feeling overwhelmed and giving up on all of them.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Mother-in-Law's Memory Lapses Worry Family

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 27th, 2019

Dear Doctor: My mother-in-law just turned 70. Physically, she's great, but when it comes to memory stuff, like remembering new names or shopping without a grocery list, she's not doing so hot. Do you have any mental tricks or exercises to help her? Her doctor says it's all normal and there's no sign of dementia, but my wife is still worried.

Dear Reader: Whether it's forgetting the name of a new acquaintance, where we left our sunglasses or whether we unplugged the coffee pot before leaving the house, we've all had our memory fail us. We agree with your mother-in-law's doctor that some degree of memory loss is indeed a normal part of aging. The volume of the brain, after peaking in our early 20s, then begins a gradual decline. Nerve cells in the brain begin to shrink or even atrophy, and interconnections between neurons become less numerous. Add in the changes to blood flow that occur as the cardiovascular system goes through its own aging process, and occasional struggles with memory come as no surprise.

Memory changes often begin with subtle episodes when you're in your 40s and progress from there. Although these changes have been a recognized part of aging for thousands of years -- the Greeks wrote about it in 700 B.C. -- the fear of dementia can turn each new lapse into an occasion for worry. It's understandable that, despite a doctor's reassurances, your wife and her mother are concerned.

The good news is that her doctor is monitoring your mother-in-law's symptoms and sees no cause for alarm. However, cognitive changes are often gradual. We think it's wise to remain aware of your mother-in-law's mental state.

In the meantime, there has been some interesting new research into improving memory for people of all ages.

According to a study published a few years ago in The Quarterly Journal of Experimental Psychology, a powerful tool in the memory arsenal turns out to be drawing. Researchers asked participants in the study to remember a certain word. One group was asked to write the word down, the other to draw it. When it came time to remember the word, the group that made drawings was markedly better at recall than those who simply wrote the word down. What's really interesting is the drawing technique boosted memory not only of specific words and objects, but also of complex ideas and abstract concepts.

When it comes to remembering names, memory experts advise saying the name aloud as you meet the new person. More recent research found that you boost the memory effect if you use the name of a new acquaintance in conversation moments after you meet. That is, saying the name aloud to a third party helps you to remember it.

Finally, we've known for some time that exercise can help memory. Now a recent study in Nature Medicine suggests irisin, a hormone produced during exercise, is part of the reason. Irisin appears to not only improve brain health, but researchers say it may also lessen the damage that occurs during Alzheimer's disease.

Try sharing these facts and techniques with your mother-in-law. You may also find them to be useful in your own life.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

health

Study Reveals Appendix May Play Role in Developing Parkinson's

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | February 25th, 2019

Dear Doctor: Is it true that there's a link between the appendix and Parkinson's disease? I thought all an appendix ever does is burst sometimes. Does this mean we should get our appendixes removed, the way our parents used to get their tonsils taken out?

Dear Reader: The appendix has always been a bit of a mystery. It's narrow pouch, between 2 and 4 inches long, that sits in the lower-right quadrant of the abdomen near where the small and large intestines meet. The fact that the appendix serves no obvious purpose in adults had led it to be considered a vestigial organ. That is, an organ that has lost its function over time. As you point out, the appendix is mainly known for its ability to become inflamed. Since perforation then becomes a risk, which would cause infectious materials to spill into the abdominal cavity, an inflamed appendix is often surgically removed.

Ongoing research has shed new light on the appendix. It's known that during gestation, the appendix makes certain types of cells that play a role in normal fetal development. After birth, the appendix takes on some immune functions. And though it was believed the appendix becomes inert in later adulthood, newer studies suggest that one role of the appendix is to harbor beneficial bacteria that are important to intestinal health. Now, with a study recently published in the journal Science Translational Medicine, a potential link between the appendix and Parkinson's disease has emerged.

Parkinson's is a progressive disorder of the nervous system. It arises due to the loss of cells in the brain that produce dopamine and which control movement. Why this happens is not yet known. The symptoms of Parkinson's disease emerge and progress gradually. They include tremors, muscle stiffness, movement that becomes progressively slower, problems with balance, changes to speech and handwriting, and a loss of facial expression.

The brain cells of many people with Parkinson's have been found to contain a protein called alpha-synuclein. This protein clumps together into structures known as Lewy bodies, and is believed to be so toxic to brain cells that it causes their death. This same protein has also been found in the intestines of Parkinson's patients. That's significant because some researchers believe that the vagus nerve, which runs from the gut to the brain, may serve as a pathway along which the toxic proteins can travel.

Because certain gastrointestinal symptoms often precede the motor effects of Parkinson's disease, researchers specifically designed this latest study to explore the potential of a gut-brain connection. In one section of the study, which analyzed the long-term hospital data of 1.7 million Swedish individuals, they found that people who underwent an appendectomy as young adults had a 20 percent lower risk of developing Parkinson's decades later. The study also found accumulations of alpha-synuclein, the protein mentioned earlier, in 46 out of 48 appendixes of healthy individuals.

As to whether all of this points the way to preventative appendectomies, the answer is no. While this research does open up new avenues of study into the causes of Parkinson's disease, it doesn't reach any conclusions. For now, unless it's inflamed, the appendix stays.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

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