Archive for August 2017

Maintain Your Brain

            Seventy year old Mrs. Lansing drew a complete blank as I asked her if she could recall any of the five words I’d given her to remember some 4-5 minutes ago as part of her mental status exam.  Inwardly I always wince at those moments.  It feels like I’m unintentionally bullying a harassed person into looking the fearful specter of their approaching dementia directly in the eye.  Her husband quickly came to her rescue with a small white lie, “That’s alright darlin’, I don’t remember any of them either,” and we all smiled with relief.

Dementia is the common term for a set of symptoms including memory loss, mood changes, and difficulty with communication and reasoning.  Modern medicine is trying to replace the term with “major and minor neurocognitive disorder”.  Yah, for now let’s stick with the term everyone knows, dementia.  There are several types of dementia, with the most common two being Alzheimer’s disease (AD) and vascular dementia (due to atherosclerosis [plaque] on the blood vessels supplying the brain) coming in a close second.

AD currently affects about 5 million Americans.  There are a handful of approved prescription medications to treat AD.  They delay (but do not stop) the progression of the disease by about 6 to 12 months.  This is useful, but far from a cure.  Likewise various supplements and vitamin treatments have come and gone over the years.  When subjected to careful scrutiny the results have generally been disappointing.  The likelihood of AD dramatically increases with age, roughly doubling in likelihood every 5 years after age 65.  If one lives to 85 years old the likelihood of having AD is almost 50%.

So can anything be done to prevent it?  Of course certain risk factors cannot be altered, such as age, family history and genetics.  But at the same time, there is a growing body of research showing that certain lifestyle choices have a substantial impact on whether AD or vascular dementia will indeed show up in your life.  Certain treatable maladies contribute to a significant increase in dementia.  For example, dementia is:

  • 41% higher in smokers
  • 39 % higher in people with high blood pressure
  • 22% higher among whites who are obese
  • 77% higher in diabetics

So obviously there is room for better lifestyle and aggressive treatment of these

conditions to help delay or prevent the onset of dementia.  A recent article predicted that substantial improvement in lifestyle factors could reduce the risk for AD (and perhaps even more so vascular dementia) by 50%.

What lifestyle factors can substantially impact the likelihood and/or timing of you or me getting dementia?

  • Being a regular exerciser could reduce AD by 21%. A recent study showed 5% greater brain mass retention in active folks vs. inactive.  Five percent may not sound like a lot, but when it comes to the brain, it is substantial.  A reasonable goal in terms of time and activity would be a 30 minute brisk (3-4 miles per hour) walk or the equivalent 5 days per week.
  • Quit smoking
  • Avoid excess alcohol. Anything beyond one drink a day in females or two daily in males is associated with increased risk of dementia.
  • Stay socially connected and mentally active.
  • A heart-healthy diet rich in nuts, seeds, whole fruits and vegetables, olive oil, fish and other low fat meats, and low in sugars and simple carbohydrates is beneficial in reducing vascular dementia.
  • Finally, if you have diabetes, cholesterol issues, obesity, or high blood pressure, treating these well can impact the incidence of dementia.

In the end, there is no way to guarantee that you will avoid the scourge of dementia.  At the same time, we want to avoid the fatalism that assumes that nothing we do will impact its likelihood or timing.  Dementia is a grim enemy.  While more weapons against it are sought, it’s worth using every one that is available to delay or prevent it.

Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville.  Contact him at 982-0835


Facetime with a doctor?

Telemedicine is expanding the availability of healthcare options to more people.  When you’re stuck at work or on the ball field with your son, it would be great to have a quick appointment with a trusted medical professional from Trinity.  Someone who knows you best and has your chart available is the best person to provide you care.

Take a look at this survey and help us determine how we bring this new resource to you and your family.  Thanks!!

Telemedicine Survey


Don’t be Sleepy the Dwarf. Get a sleep study!

sleeping on a benchSleep apnea is an under recognized contributor to heart disease, high blood pressure, insulin resistance, metabolic syndrome, and depression.  Most individuals cannot tell if they have sleep apnea themselves other than maybe constantly feeling tired or falling asleep accidentally while sitting still.  Sometimes spouses are ‘kind’ enough to disclose their partner’s sleep habits (or even video it for their own nefarious purposes).

Sleep studies are a simple and effective means to diagnose sleep apnea and disordered breathing.  In years past this meant a one to three night stay in the hospital with an associated $3000 per night bill.  Now we have reliable home testing equipment.  The latest guidelines validate that home testing is an appropriate method for many patients.

Cleveland Clinic Sleep Study Guidelines

Trinity Medical Associates has had a partnership with a sleep study company that offers our patients a clear upfront price of $250 for three nights of home study.  They are happy to process the claim with a patient’s insurance company who may pay for some or all of the test depending on the policy.  However, the maximum out of pocket cost for any patient regardless of insurance coverage is only $250.  That is a great bargain when compared to in hospital testing for a single night.

If you are interested in discussing poor sleep and excessive sleepiness or would like to set up a home sleep study, please give us a call to schedule an appointment.  Sleep is a critical pillar for our best health.  You won’t believe the difference good sleep can make.


Community physician day: Steedman Sarbah, MD, MBA

Steedman Sarbah, MDOnce a month we set aside time to meet with physicians and specialists in our area to better facilitate communication and referral for our patients.  As an independent primary care practice, we have the ability to utilize any specialist in the area, regardless of hospital or group affiliation, in order to more fully meet the needs of our patients.

This month the physicians and clinical staff of Trinity had the opportunity to meet with Dr. Steedman Sarbah.  Dr. Sarbah specializes in Gastroenterology and has clinical interests in diseases of the liver, inflammatory bowel disease, acid peptic disorders as well as the more common diseases of the intestines and colon cancer screening.

We share a mutual interest in using nutrition as therapy for non-alcoholic fatty liver disease (NAFLD, sometimes referred to as simply fatty liver disease) which, if left untreated, could lead to cirrhosis and liver failure.  It is quickly becoming one of the more common reasons for needing a liver transplant.

If you have had abnormal or high liver enzymes with recent blood work, talk with your physician about how a Medical Nutrition Management office visit or our VitalSigns Launch class might help you reverse your risk of developing fatty liver disease.