“Send the patient to Dr. A. I don’t do dementia.”
As soon as these words were out of my mouth, I felt deeply ashamed of myself. The receptionist gave me a bewildered look, turned around and went off to redirect the patient to another physician. I was left alone in my office, to contemplate the uneasy feeling that was starting to bubble in my chest.
By then I had practiced geriatrics for over ten years. Of course, I “did” dementia, along with a long list of other common and less common chronic diseases. I just joined a new geriatric practice, where each one of us was encouraged to cultivate their focus or special interest. I found myself vigorously affirming my disinterest in any form of cognitive problems and frailty. Hmmm… but weren’t these the very conditions I had wanted to tackle when I first became a geriatrician? What was happening? Where did my resistance come from?
My thoughts took me back to my childhood home in Poland. I saw my grandmother, whom I adored and occasionally feared. I remembered her dark, angry looks of 1930s movie star, sharp mind of a math teacher and always, always a lit cigarette in her mouth (that generation really didn’t know any better). “I don’t care if I die of a heart attack,” she was fond of saying, “so long as I don’t lose my mind.” Have you ever noticed a mysterious way in which such pronouncements tend to become a self-fulfilling prophecy? Yes, she did get dementia and I got to see her struggle first hand, as she continued to live with us almost until the end of her life.
As it often happens with painful memories, this one, too, got buried deep under the many layers of my mind. Has it ever influenced my career choices? Not consciously. I graduated from med school and moved to US to join my husband. However, when the time came to choose the fellowship, there was never any question. I was fortunate to get into a prestigious geriatric program at New York Presbyterian Hospital in New York, where, yes, the science was immaculate, but more importantly, the love of elderly patients was palpable. It prepared me well for serving my patients.
Except for one thing.
The sense of failure and helplessness I felt when faced with patients with memory problems was overwhelming. It wasn’t incompetence – I was on top of all the treatment guidelines. But it took some time to realize that all our medications, indeed, all our interventions were perfectly useless. Even with cancer you could offer your patient some hope. Not quite so with dementia. Every week I saw patients and their families, slowly devastated by progression of the dementia. Medications didn’t work. There was nothing else to offer. I felt like a fraud.
Disillusioned with the shortcomings of mainstream medicine, I entered Dr. Andrew Weil’s fellowship in integrative medicine at University of Arizona. There I have learned a whole-person, or holistic approach to medicine. A patient wasn’t just a collection of organs, systems and diagnoses. I learned that healing does not always mean cure. I also realized that in healing there is nothing more powerful than human mind. Even if the fellowship didn’t provide me with all the answers, at least I left with renewed faith.
Last several years brought a number of studies that allowed me a glimmer of hope. Each study concentrated on particular intervention: a supplement, exercise or dietary intervention. Each showed a small, but measurable result. What if, I thought, we put all those interventions together? Would they have an additive effect? The very same year two studies came out confirming my suspicion. Thanks to MEND study from UCLA and FINGER study out of Finland we now know that dementia can be not only prevented, but possibly reversed with lifestyle modifications. This is as close to a medical miracle as you get. For decades we have been thought that there is but one way for the patients with cognitive problems: decline, decline, decline.
Now, I no longer shy away from people with dementia. With a few trailblazer patients I have been implementing the interventions based on the studies and noticing improvement on memory testing and overall functioning. It is a vast undertaking. MEND study alone lists no less than twenty six different interventions. It is my mission and heartfelt pleasure to help people who are concerned about their memory or just want to optimize their aging to navigate their way through the growing sea of evidence. That is why I have created a step-by-step program that will help to take advantage of all this exciting knowledge.
I know that my grandmother would approve.