Thursday October 9, 2008

My hand, neck and head tremors are pronounced today so I have to type slowly. Thanks for spell checkers.


Anger, rage, resentment, a temper, hot under the collar, fly off the handle, livid, mad?????? ;



Bad, right? It scares you, right? Try to avoid it, right?  You’re not alone!


Some how we grew up thinking that anger is a bad thing and that we should never get angry or not allow ourselves to feel it. But it is a very normal and healthy emotion. We never question when we’re happy and joyful.


So why does anger exist and what do we do with it? You probably never thought about it but it’s simple. The purpose of anger is to bring about a positive and healthy change.


One key to controlling our temper is to have realistic expectations of others. No one is ever wrong or right all the time. It is wrong to expect others to always be happy and helpful. None of us are “up” all the time. We all have times that we are sick, stressed or just plain tired. And, right or wrong, these things do affect our moods.


We need to remember that other people are affected by these same things. They may have reasons for their seemingly rude behavior and are not just being selfish or thoughtless. We need to avoid getting offended every time people don’t respond or act the way we think they should. They might just be having a bad day.


We also need to remember that everyone and everything do not exist for our convenience or purpose. We will control anger better if we do not say things like “I can’t stand this …” or “They better never …” These statements lock us into emotionalizing rather than thinking.


Consider this…Learn to align yourself with reality. Don’t let everything bother you to the point that you always “lose it” over other people’s failures. Show them the same kind of understanding you would like to have on your challenging days.

Say a prayer — “Help me not to expect others to be perfect or to always do things my way. Make me willing to overlook offenses, to see people’s hearts and be sensitive to their needs.”




What is Lewy Body Dementia (LBD)?


v LBD is a progressive degenerative (deterioration) dementia.


v The following clinical features help distinguish LBD from Alzheimer’s  Disease (AD):


Ø Fluctuations (changes) in cognitive function (mental processes of perception, memory, judgment, and reasoning) with varying levels of alertness and attention: Clues to the presence of fluctuations include excessive daytime drowsiness (if nighttime sleep is adequate) or daytime sleep longer than 2 hours, staring into space for long periods, and episodes of disorganized speech.


Ø Visual hallucinations (sensory experiences of something that does not exist outside the mind)


Ø Parkinsonian motor features (resembling a group of nervous disorders similar to Parkinson’s disease, marked by muscular rigidity, tremor, and impaired motor control)


v Although extrapyramidal (involuntary movements) features may occur late in the course of AD, they appear relatively early in LBD.


Ø  Patients with AD virtually always have anterograde memory loss (affecting time immediately following trauma) as a prominent symptom and sign early in the course of the illness, anterograde memory loss may be less prominent in LBD. Experts have suggested that (one way of testing one’s word finding ability) patients with LBD do relatively better on tests of confrontation naming,  short and medium recall, and recognition than AD patients, whereas AD patients do better on tests of verbal fluency, visual perception, and performance tasks.


v     Executive function deficits (a term used to describe a set of mental processes that helps us connect past experience with present action. We use executive function when we perform such activities as planning, organizing, strategizing and paying attention to and remembering details) and visuospatial impairment (This is one component of cognitive functioning and it refers to our ability to process and interpret visual information about where objects are in space. This is an important aspect of cognitive functioning because it is responsible for a wide range of activities of daily living. For instance, it underlies our ability to move around in an environment and orient ourselves appropriately. Visuospatial perception is also involved in our ability to accurately reach for objects in our visual field and our ability to shift our gaze to different points in space) may be more prominent in persons with LBD than in those with AD.


v   Other symptoms that may alert clinicians to the diagnosis of LBD (versus AD)  include the following:


Ø  Nonvisual hallucinations


Ø  Delusions


Ø  Unexplained syncope (fainting)


Ø  Rapid eye movement sleep disorder (In a person with REM sleep behavior disorder (RBD), the paralysis that normally occurs during REM sleep is incomplete or absent, allowing the person to “act out” his or her dreams. RBD is characterized by the acting out of dreams that are vivid, intense, and violent. Dream-enacting behaviors are usually nondirected include talking, yelling, punching, kicking, leaping, sitting, jumping from bed, arm flailing, and grabbing while still asleep. These behaviors are sometimes violent causing self-injury or injury to the bed partner. RBD is usually seen in middle-aged to elderly people (more often in men). The person may be awakened or may wake spontaneously during the attack and vividly recall the dream that corresponds to the physical activity).


Ø  Neuroleptic sensitivity (typical antipsychotic agents such as Haldol, Navane, Thorazine, Stelazine, Trilafon, Mellaril)



Enough already. My concentration and attention span are waning quickly. It has taken me over 3 hours just to prepare this small blog today.


Dr. David


4 Responses

  1. Oh, Dr. Dave, I am so blessed by what you write. I wish my mother had been able to read your thoughts on anger last year when she was deep into it. Now, praise God, she is peaceful and serene. God is good.


  2. Dr. David,

    You have no idea how many people will be helped by this. In the long run, perhaps more than by your original practice. Romans 8:28

    Linda Gurganus

  3. Dr David,

    Thank you for your willingness to share your life with us.
    It is very helpful to me.
    My husband was Dx with Lewy Body last Oct also. Your thoughts and feelings are important to me as I am sure they will help me to be a better caregiver to my husband. He doesn’t share his feelings, so many times I must guess and honestly it’s not something I’m getting better at.
    As long as I can keep him feeling safe, comfortable and more than anything else, loved, I think it’s a good day.
    Thank you again and I look forward to reading your blog.
    You and your family are in my thoughts and prayers.

  4. I think you started this blog about 1 week ago and already you have given us a wealth of information. You can feel very appreciated by all of us out there.

    As far as putting your license in suspension, well I have 2 thoughts :
    1. If would give you hope that a miracle could happen then yes keep it or
    2. My strongest feeling is that is a false hope and that some of the dealing with this disease is to accept it. Life is easier if you are not filled with anger or frustration.Having the glass half full and appreciating all that you have is better than the half empty glass.

    Hope Stewart

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