Medical Checkup

Recently I had my annual Medicare “Wellness Checkup”. As I was mentally reviewing how things were going with me recently and what I should share with my primary care physician (PCP), I prepared a mental outline of just four words – Head, Heart, Blood, Foot. This gave me enough of a reminder that I would not forget what I should share with her. But I thought this might be a good outline to summarize my medical situation for this blog as well.

 

Head – Alzheimer’s Studies

I’ve shared recently about my involvement in a number of Alzheimer’s studies, so I won’t repeat that here. If you want to read details and you have not done so, here is a link. But I’d like to spend a little more time on the most recent study that I’m about to embark upon – the AHEAD study. Unlike all the other Alzheimer’s related studies, this one is a phase 3 Clinical Research Study (see below for what this means). But since it may actually have an impact on any progression of the disease, it will also mean that I will be dropped from both the ABC and APT Webstudy as those are looking at changes over time in individuals who are not receiving treatment.

The fact that they consider me eligible for the AHEAD study means that I have met their criteria, including (1) no current diagnosis, and (2) has an elevated or intermediate level of amyloid in my brain. While the latter will be confirmed by an initial PET scan (see participation requirements) , the spinal tap I had in 2019 would have shown the presence of the proteins that are produced by the amyloids.

While all the other tests that I take periodically continue to show unimpaired mental abilities, I have begun to notice that I have had a few instances the past few months where I was trying to come up with either a word of a name and totally drew a blank – very unlike me. Is this an early indication of Alzheimer’s in me? I don’t know, but I will continue to monitor myself for additional instances of these memory failures.

Clinical Research Studies

Just a little education on drug studies. Once a drug has gone through laboratory testing and possible testing in animals, it enters a series of clinical research studies. These studies are divided into several phases as follows:

Phase 1 – Is it safe?

In this phase, a small dosage of the drug is administered to a few people, perhaps a dozen, of healthy subjects to ensure that there are no major side effects. If there are none, then the dosage may be increased and administered to another group. This process continues until the doctors find a dosage that is most likely to work while having an acceptable level of side effects.

Phase 2 – Does it work?

In this phase a group of 25-100 patients who have the disease that the drug is designed for are given a dose to see if the drug works as intended. Sometimes the patients are divided into groups and they receive different dosage amounts, or it is administered in a different way (say orally v. via an IV).

Phase 3 – Is it better than an alternative?

In this phase the drug (or a placebo) is administered to a large number of people, perhaps a thousand or more, for a long period of time, perhaps 2-4 years. Some (picked at random) may receive a placebo instead. These patients, and often the doctors administering the drug, do not know if they have received the actual drug or the placebo. This is to ensure that the impact of the drug is what is creating the difference and not that just the patient’s attitude is having an impact. Patients are selected from many different geographies, economic levels, racial groups, etc. to see if there may be other things at work.

 

Heart – Cardiology Status

I also posted about my recent nuclear stress test, so I’ll not repeat myself on that here. You can follow this link if you are interested. I relayed this to my PCP as well that I have no concerns about my heart health.

 

Blood – Bloodwork and Diabetes Status

Back in mid-July, upon the recommendation of my PCP I had my first appointment with a pharmacologist, an individual who examined all my current medications as well as my most recent bloodwork. She was looking for any potential drug interactions (when you take as many pills as I do each day, that is always a possibility), as well as she made recommendations on future treatment or dosage changes that might be of benefit.

She saw no potential interactions, but noted that I was at the maximum dosage of a couple of the medications I take to manage my blood sugar levels. But of concern was that my sugar level has started going back up. My A1c levels were always somewhat marginal, i.e., pre-diabetic, and with medication were being kept from getting out of hand, but even so had slowly crept up into the diabetic range, i.e., over 7. I’d managed to keep it not much more than that, but then it started back up again and my most recent bloodwork showed me at 8.0 – too high!

Thus, her recommendation was that since I was already at the maximum dosage of the primary medications I take for it, that it was time to begin taking insulin. She passed that onto my PCP who ordered an initial supply for me. Time for a daily needle stick – in addition to the finger stick I take to check my levels each morning!

As I write this, it’s now been about 6 weeks since I started a daily injection. The rules are (1) start at a dosage of 10 units, (2) every three days take an average of my morning (fasting) blood sugars and if the average is not yet in range, increase dosage by 2 units, and (3) when consistently below a reading of 130, then maintain that dosage.

My average before starting was about 195 (per her instructions I brought my meter with me that showed a history of the readings). After the first two weeks, my average was down to 179. After another three weeks my average was down to 163 (very stubborn and keeps plateauing!) But then I finally started seeing some real progress. Only a week later my average for the past week is 145, including my first reading ever below the target 130!

I’m hoping that I will reach my target by about mid-month. Since my next scheduled A1c test is in January and it measures average sugar levels for the prior 90 days, I’m pretty certain to be below 7 – and my personal target is to see it in the low 6’s. I will celebrate (with non-sugary foods of course) if I can reach that!

 

Foot – Slow Healing Process

I’ve noted in the past about the fact that I have a distortion at the ball of my big right toe due to arthritis and the pressure that walking puts on that area of my foot. This builds up a callus which eventually breaks loose and leaves me with a sizable hole on the bottom of my foot. This first happened in the spring of 2017 and in May of that year I developed sepsis which put me in the ICU for several days. In January of 2018, after several months of weekly tissue grafts, I developed an infection under the graft and had a second bout of sepsis. After more healing, staying off my foot for an extended period and treatment at a wound care center, I finally got it healed up.

But then this spring, after nearly 3 years, the callus once again broke off. This time I went to a podiatrist and was fortunate enough to get one that had previously worked in the wound care center. For the past several months I’ve been meeting with him about every three weeks for evaluation. In between I’ve been trying to offload my foot as much as possible (not walking on it, using a cane so I can put less pressure on it, etc.) Once the hole started getting smaller, he referred me to a pedorthist (a person who specializes in custom shoes). It took several weeks for a new pair to be delivered (the COVID pandemic has affected all kinds of supply chains). With these new shoes I can put aside the cane, but I’m still trying to avoid as much walking as possible.

I’ve managed to avoid any more episodes of sepsis (since a bad case can kill you), but the slowness of the healing process is quite frustrating. In the meantime, I do a lot of sitting (which causes sores in other places that I won’t go into here), and I faithfully change the dressing on my foot per the podiatrist’s instructions.

 

Summary

Head – OK, but being aware of any potential changes while I “give back” through participation in studies.

Heart – Great, no issues at all since my original heart attack in 2005

Blood – New regimen, making progress

Foot – Going slowly which is frustrating

 

Appendix – How Long Will I Live?

Back in 2015, when I was starting this blog, I addressed this question (see link). With this medical update, I thought it appropriate to look at this again. Since I have good genealogical records, I have listed below all my ancestors back to my great-great-great-grandparents (58 people as there are two who are more recent immigrants and I don’t know their parents back in Europe).

At age 73, I am now older than 28 of these 58 ancestors. So, I’m pretty much in the middle of all these individuals. But in just two years I will be as old or older than another 6 of them. Thus, while there are certainly days where I feel “old”, and with my sparse white hair, slow walk, etc. I would certainly not be mistaken for being “young”, I am hopeful of having about another decade on this earth. Then at age 83, I would have become older than all but 8 of these 58 direct ancestors.

But I’m really not in charge of my destiny. Sure, I try to do the right things in taking care of my health. But God is the one who has the final say, and whenever “my time is up”, then I will happily join with Him in glory!

 

Ancestors of Alan Russell:

·        Vernon Russell – 85

o   Erskine Russell – 75

§  Louis Russell – 74

·        Walter Russell – 43

o   Silas Russell – 83

o   Hester [Disbrow] Russell – 90

·        Lois [Cook] Russell – 38

o   Levi Cook – 81

o   Sally [Barton] Cook – 87

§  Anna [Merchant] Russell – 32

·        Francis Merchant – 74

o   unknown

·        Nancy [Soan] Merchant – 60

o   unknown

o   Vera [Levy] [Russell] Rogers – 68

§  Maurice Levy – 42

·        Alexander Levy – 78

o   Lewis Levy – 64

o   Caroline [Lee] Levy – 81

·        Phoebe [Isaacs] Levy – 66

o   Phillip Isaacs – 76

o   Anna [Marks] Isaacs – 85

§  Caroline [Northrop] Levy – 63

·        Lawrence Northrop – 83

o   Joel Northrop – 74

o   Catherine [Canfield] Northrop – 76

·        Mary Lois [Rogers] Northrop – 82

o   Benjamin Rogers – 61

o   Lois [Chaffee] Rogers – 38

·        Sylvia [Pierpont] Russell – 88

o   Harold Pierpont – 71

§  Wilson Pierpont – 66

·        Charles Pierpont – 59

o   Austin Pierpont – 57

o   Sally [Beecher] Pierpont – 52

·        Mary Ann [Warner] Pierpont – 82

o   Jared Warner – 67

o   Mary [Bronson] Warner – 90

§  Annie [Merrill] Pierpont – 39

·        Nathan Merrill – 85

o   Elijah Merrill – 64

o   Anna [Perkins] Merrill – 89

·        Eunice Hoadley – 72

o   Artemus Hoadley – 39

o   Alma [Frisbie] Hoadley – 82

o   Sara [Blackman] Pierpont – 81

§  Clarence Blackman – 59

·        Isaac Blackman – 79

o   Joel Blackman – 57

o   Nancy [Crofutt] Blackman – 62

·        Harriett [Johnson] Blackman – 71

o   Cyrus Johnson – 49

o   Frances [Lockwood] Johnson – 79

§  Alice [Talmadge] Blackman – 58

·        Stephen Talmadge – 80

o   William Talmadge – 64

o   Anna [Sperry] Talmadge – 82

·        Sarah [Few] Talmadge – 81

o   John Few – 74

o   Rebecca [Fisher] Few – 75

Age at death:

·        31-40: 5       (32, 38, 38, 39, 39)

·        41-50: 3       (42, 43, 49)

·        51-60: 7       (52, 57, 57, 58, 59, 59, 60)

·        61-70: 10     (60, 61, 62, 63, 64, 64, 64, 66, 67, 68)

·        71-75: 9       (71, 71, 72, 74, 74, 74, 74, 75, 75)

·        76-80: 6       (76, 76, 78, 79, 79, 80)

·        81-85: 13     (81, 81, 81, 81, 82, 82, 82, 82, 83, 83, 85, 85, 85)

·        86+: 5           (87, 88, 89, 90, 90)