All posts in Dr. Smith’s Articles

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


Feeling the Heat


I’m generally not a big sweater.  But last evening as my wife saw me returning from chipping and putting a few balls around she noticed the large wet patches on my shirt.  “Did you end up going on a bike ride or is that just from hitting a few golf balls?”   I responded that is was, “All from just strolling around and hitting a few balls.”

This is the time of year in Tennessee when any kind of outdoor physical activity during the daylight hours is majorly sweat-producing.  Indeed, sometimes the heat can really cause a problem for people.  Specifically, there are three heat-related illnesses.  The mildest one is heat cramps with symptoms including muscle cramps, fatigue, thirst, and heavy sweating.  It can usually be treated by getting to a cool place, resting, and hydrating with water, sports drinks, or other rehydration drinks containing electrolytes.

The next, more serious, heat-induced condition is heat exhaustion.  If this hits you, you may notice the symptoms of heat cramps as well as rapid pulse, feeling lightheaded, nausea, headache, and sometimes, cool moist skin with goose bumps.  If you start noticing some of these symptoms, stop all activity and rest in a cool place, and hydrate (not with alcoholic or caffeinated beverages).

If untreated, heat exhaustion can go on to heat stroke, a potentially deadly condition.  In heat stroke the body temperature reaches 104 F or higher.  The skin may be moist or, worse, hot and dry, as the heat challenge overwhelms the body’s ability to cool itself by sweating.  In addition to all the symptoms of heat exhaustion, there may be confusion, agitation, irritability, and sometimes, fainting.  Heat stroke is a medical emergency requiring immediate treatment to avoid damage to the brain and other vital organs or even death.  If you are with someone exhibiting symptoms of heat stroke, call 911 immediately as this isn’t one to just treat on your own. While waiting, move the person to a cool place and cover with a wet sheet or spray with cool water and encourage hydration if they are able to drink.  Fan them to encourage evaporation of the water on them which will further cool them.

Heat-induced illnesses are not terribly rare.  One source lists heat stroke as the third leading cause of death in American athletes.  These cases would be what is called exertional heat stroke, where physical activity is a major player in the overheating.  There is also non-exertional heat stroke which occurs in a person not physically active but overwhelmed by a very hot environment.

There are a few other factors besides the temperature, humidity, and exertion that put someone at greater risk for heat illness.  These include poor hydration, alcohol intake, overdressing (especially if the clothing doesn’t allow evaporation of sweat), very young or old age, and certain medications such as beta blockers, antihistamines, and diuretics.

Mid-summer in Tennessee is still a good time to be outside, but limit your time in the heat of the day and keep hydrating to stay a long ways from these serious heat illnesses.

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


Allergy in East Tennessee

Oh, the sneezing and sniffling and runny noses and itchy eyes that are all around us this time of year.  And it’s not just your imagination – Knoxville ranks as the fifth worst city in the country for allergy sufferers.  That comes as no surprise to the legions of residents who this spring are dealing with all that sneezing and sniffling.  Add on the headaches, fatigue, cough, and popping in the ears, and you have a real damper on your enjoyment of spring and summer.  Further complications to allergy can include asthma flare-ups, sinus infections, ear infections, and sleep disturbance to name just a few.

Estimates vary, but up to about 20% of the population suffer from allergy, and about 20% of allergy sufferers also have asthma.  That doesn’t even include a category called non-allergic rhinitis (rhinitis is the medical term for an inflamed runny nose).  These folks have all the symptoms of allergy, but upon testing, come up negative.  There are seven different types of non-allergic rhinitis and each is treated a bit differently from true allergy. We won’t delve further into all that, but it is one reason why treatment of allergy symptoms isn’t a one size fits all proposition.

Diagnosis of allergy often involves simply recognizing the symptoms and doing a trial of an over-the-counter antihistamine such as Claritin, Allegra, Zyrtec or one of their generic equivalents.  If that does the job, it’s sometimes not a bad way to go.  If not, it’s probably time to check in with your physician.  Treatment options will include:

  • Environmental control measures and allergen avoidance: These include keeping exposure to allergens such as pollen, dust mites, and mold to a minimum
  • Medication management: Patients are often successfully treated with oral antihistamines, decongestants (if high blood pressure is not a problem), Singulair, or nasal steroids, antihistamines, or anticholinergics to name only some of the available options.
  • Immunotherapy (allergy shots): This treatment may be considered more strongly with moderate or severe disease or poor response to other treatment options.

Specific allergens can be identified by skin testing or blood testing, with skin testing generally being deemed the most precise.  So, who should have allergy testing?  Allergy testing can have several benefits.  First of all, it can identify those who have non-allergic rhinitis.  These folks will generally not respond to traditional antihistamines and need other approaches.  Secondly, allergy testing may identify certain allergens to which the person can reduce their exposure.  For example dust mites, mold, animal dander or cockroach are indoor allergens which can be reduced by a variety of methods.

Finally, for those who are not getting good relief despite meds, immunotherapy may be a good option.  Its success rate is generally over 80%, although it usually takes a few months to see improvement.  The entire process may take a couple years to establish and maintain the benefits.  But for those who habitually sneeze and sniffle their way through the day in misery, often grabbing meds on a daily basis, it can be well worth while.

So if the sights and smells of this beautiful East Tennessee spring and summer are being blurred by watery eyes and masked by a runny nose, check in with your doctor and see what can be done!

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

Same day in office allergy testing is available at Trinity’s main office in Fort Sanders West.  Consider our unique model of allergy injections which offers at home shots saving you the hassle of coming to the doctor’s office three times a week or taking time off from work.  Call 539-0270 to schedule an appointment to discuss these options.


Hepatitis C

Jan, a fifty-something mom, registered some surprise when I listed hepatitis C as one of the things I would test in her bloodwork.  “But I’ve never had jaundice or anything that would say I have liver disease. Maybe I’m tired a lot, but who isn’t?”

I explained that the recommendation is that all “baby boomers” born between 1945 and 1965 get one blood test for hepatitis C even if they have no symptoms.  In fact, the majority of folks with hepatitis C virus (HCV) are without symptoms.  If they do get them they tend to be vague with many other possible causes – things like fatigue, muscle and joint aches, tingling in the extremities and itching.  Due to its minimal symptoms, HCV is known as the “silent epidemic” and many infections go unrecognized and untreated for many years.  But the baby boomer generation comprises about three fourths of the chronic HCV infections so screening them could help diagnose and treat a majority of the as-yet-undetected HCV infections.

HCV is caused by a virus that was finally identified in 1989.  The virus particularly attacks the liver, and 75% of those who get it go on to a chronic infection that continues to damage the liver indefinitely unless treated.  In some 20% this chronic HCV leads to cirrhosis, liver failure and/or liver cancer.  The identification of the HCV led to the development of a blood test for it in 1990 and thus the ability to test the blood supply.  This nearly knocked out the previously common problem of contracting HCV from transfusions.

HCV is so common that about 3% of the world’s population has been infected and there are more than 170 million chronic carriers.  Here in the U.S. less than 2% of the population has HCV, but it nevertheless has surpassed HIV as a cause of death.   Likewise, HCV just edges out alcohol as the #1 cause of chronic liver disease in the U.S.  One of the reasons our bodies has such a hard time killing HCV when we are infected is that HCV can produce a staggering 10 trillion new viral particles each day.

So, how does one catch HCV?  As noted, prior to 1990, blood transfusions were a common way for people to contract HCV.  Nowadays the majority of new hepatitis C infections are from the use of illegal drugs with nonsterile needles or in those who snort cocaine with shared straws. HCV can also be transmitted by tattooing with improperly re-used needles, sharing razors, and acupuncture. The use of disposable needles for acupuncture eliminates this transmission route. Although sexual transmission is less likely it still ranks as the second most common mode of transmission.  Infected pregnant women can also occasionally pass HCV on to their unborn child

If you do have any suspicion that you may be infected, if you were born between 1945 and 1965, or if you have engaged in any of the above-mentioned more high risk behaviors, a simple blood test can rule HCV in or out.  Hopefully, if you get a HCV test it will be negative.   But if the test shows that you have been infected with HCV and that it is still active in your system, there are now some highly effective treatments.  A number of treatments, typically taking about 12 weeks, now result in cure rates greater than 90%.  They are admittedly expensive, but there are a number of programs through which many patients receive help in getting their medications at least partially paid for.  Of course avoiding alcohol and other liver toxins becomes even more crucial for those with HCV.

So the best bet for exposing and eradicating the silent epidemic of HCV infection is a rather simple and inexpensive blood test.  If you’ve never had it tested and have any of the risk factors mentioned, ask your doctor to test you.  It’s far better to break the silence than to let this little virus continue to advance its stealth attack on you and your liver.

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