San Antonio Express-News (Sunday)
At a loss for words; washing away gluten
Q: About a year ago, my 77-year-old wife started to have some trouble speaking, and in some cases remembering or forming words. It’s not so bad that you don’t understand her, and it’s not constant. But it’s there just the same.
The family thought she may have had a TIA, as at the time she had been drinking quite a lot — she has since totally stopped — but saw no other symptoms. She saw her doctor a couple months ago, and he felt she hadn’t had a TIA and wanted to send her to a speech therapist.
The speech therapist felt that she may be under stress and to see a counselor. In the meantime, she’s seen a neurologist who has tested her extensively. The diagnosis is she is suffering from PPA (primary progressive aphasia).
There is a lot of information on this condition on the internet. But how does one get through all of this to see what is most successful and/or current? Will her fight involve medication, therapy, something else or all of them? Can you tell us what the latest and most successful direction may be?
A: Primary progressive aphasia is a type of dementia, in the group of frontotemporal dementias, named for the part of the brain most affected. These diseases include what used to be called Pick’s disease. The underlying cause seems to be deposits of abnormal proteins in the brain. This is similar to Alzheimer’s disease, though the proteins are different. Wordfinding difficulties are the hallmark early symptom of PPA.
Unfortunately, there are no currently approved medication treatments for PPA that can slow or stop the progression of the disease. Treatment is aimed at relieving symptoms and ensuring the safety of the person affected by PPA. Driving, for example, can become dangerous early on in the course of PPA.
Speech therapy is an important part of treatment in the early stages of the disease, and swallowing evaluation becomes important as the disease progresses, since people with more advanced disease are prone to aspiration — breathing food particles into the lung can cause lung damage and infection.
Although there are currently no approved treatments, extensive work is being done, especially with medications that may block the tau proteins, which accumulate in the brain. In the meantime, compassionate care will help both you and your wife. Medications can help with some of the behavioral changes that often accompany the wordfinding difficulties. I recommend getting more information from the National Aphasia Association at aphasia.org.
Q: My son is in his mid-20s and has been a vegan for four years. After getting dangerously thin and weak, he was recently diagnosed with celiac disease. He is now so fearful of eating gluten that he will eat only from paper plates and uses disposable utensils for every meal. He also will not eat anything that has been cooked in a pot or pan that may have been used to cook anything with gluten, even though it has been carefully washed.
I have two questions. The first, could becoming a vegan have anything to do with causing his celiac disease? The second, is it likely that gluten will contaminate cooking/ eating instruments after being washed in a dishwasher or by hand?
A: I am unaware of any reason that a vegan diet would increase risk of developing celiac disease, a sensitivity to a protein found in gluten, which is mostly found in wheat, rye and barley.
Machine-washing plates will remove gluten. Hand-washing should be done with a separate sponge from those used to clean gluten-containing plates.
Q: My hairdresser is being evasive about whether she has been vaccinated for COVID. She does not wear a mask. I am vaccinated, and I want everyone else to be as well to avoid more harmful strains of the disease. I’m 67 and have underlying conditions. Should I find a new hairdresser?
A: Being fully vaccinated means you have a high degree of protection from COVID-19, but there is no vaccine (or really any treatment in medicine) that is 100 percent effective. There are many cases of people getting COVID-19 after vaccination, and although it is usually a milder case, a very few people require hospitalization despite vaccination. The Centers for Disease Control and Prevention recently noted that more than 99 percent of hospitalizations and deaths from COVID-19 now are among people who are unvaccinated.
The CDC has also recommended that people who have been vaccinated may resume the activities they did before the pandemic, but that advice may not apply to people with underlying health conditions. The World Health Organization, on the other hand, still recommends mask-wearing for fully vaccinated people.
The decision to wear a mask depends on your personal risk, on whether you are a caretaker for people who might be at increased risk and on the degree of disease prevalence in your community. If you were to contract COVID-19, you might have no symptoms or such mild symptoms that you could potentially infect other people without knowing it.
A hairdresser is quite close to you for an extended period, and new variants of the virus (such as delta) are much more contagious. The decision is yours, but my advice would be to use a hairdresser who is vaccinated. Her unwillingness to tell you her vaccination status or use a mask is a red flag, and given your increased risk, I think it prudent to find a vaccinated hairdresser.
Q: I read your recent column on how to find veins for getting blood. I have infusions every three weeks and have very thin veins that roll. I’m also 74 years old. There are a couple of tricks the nurses use for me:
1. As you mentioned, heat. They wrap both lower arms in those heated blankets the infusion center has on hand and let them warm for 10 to 15 minutes.
2. They will set a tourniquet both above and below the area they’ll try to enter. One just above the wrist, and one below the elbow.
3. They also have a little vein reader machine. Like looking at bones on an X-ray, this shows the blood vessels, where the valves are, etc., in real time.
I hope this helps the letter writer.
A: I appreciate the advice. I have seen the “vein reader machine,” which uses nearinfrared light and lasers to identify blood vessels. I wish we had had those when I was a medical house officer.