Generations Healthcare

Orange County Register Columnist Jane Glen Haas was a patient at Newport Nursing & Rehab during her recovery after shoulder replacement surgery. Following are excerpts from her newspaper column.

I’ve been replacing joints for a long time. My knees are almost a decade old and my hip was new two years ago. By the time I opted for the shoulder replacement operation, I was having extreme pain - bone-on-bone grinding on the joint and unbelievable nerve pain radiating from the back of the neck to the joint. I had stopped driving, fearing the pain could impact my steering.

What was really new for me this time was that after a week in the hospital, I left for three weeks at Newport Nursing & Rehabilitation Center. I went directly home after other operations and had physical therapy at an outpatient center three times a week.

Well, I finally learned my lesson. Medicare pays for a minimum of two hours of physical and occupational therapy every day at a rehab facility like Newport Nursing, as opposed to just three hours a week for outpatient therapy. Medicare provides up to 100 days for qualified members who want to use a rehabilitation home.

So why Newport Nursing for rehab?

First, it was recommended by an orthopedist. Second, it’s locally owned by Generations Healthcare. And with only 59 beds, most of them reserved for orthopedic recoveries, it seemed just the right size.

There’s more. The nurses, aides, even the shower gal have been helpful, pleasant, comforting.

The food is good. The activities are fun. Best of all, when the weather allows, I can sit at a table in the beautiful garden outside my room and enjoy winter in Southern California.
But there’s more.

After all this isn’t a holiday. It’s a work break with therapists, and Newport Nursing has some of the best. Two of them were assigned to me

Lise Ketterer, an occupational therapist, concentrated on getting me comfortable with daily activities like grooming, hygiene, dressing.

Kristin Sykes, who has a doctorate in physical therapy, worked with me to improve walking with a cane, including decreasing fall risk, improving posture, stability and overall muscular control.

If a rehab experience is on your agenda after surgery, take the time for a pre-op visit. Meet the nurses who make sure you’re comfortable, and the therapists, the reason you’re there.

Always remember this is your option: Rehab is your choice. If you’re miserable, you can always go home.

If you chose well, as I did, you’ll go home in good shape.

Approximately 700,000 strokes occur in America each year. Strokes are the leading cause of disability in adults in America, and the number three cause of death. A stroke is a traumatic and life changing event, but with proper timely diagnosis, and treatment, the lasting effects of a stroke can be minimized.

A stroke occurs when blood supply to the brain is limited or cut off.  If the brain’s blood and oxygen flow is disrupted for even a matter of minutes the brain tissue begins to die, resulting in an infarct. An infarct is a localized area of dead brain tissue which causes physical and chemical changes to the brain that can result in memory loss, decreased physical function to one or both sides of the body, speech difficulty or loss, or psychological limitations or impairments.  The severity of the stroke determines the severity of the lasting effects. Depending on the trauma suffered, varying degrees of occupational and/or physical therapy can improve bodily functions, language capabilities, and cognitive functioning.

There are two types strokes; ischemic and hemorrhagic. An Ischemic Stroke is characterized by an obstruction within a blood vessel supplying blood to the brain, cutting off or limiting the supply of blood to the brain. Ischemic strokes account for 87% of all stroke cases. A Hemorrhagic stroke,  which causes only 13% of all strokes, results from of a weakened blood vessel bursting, spilling blood onto the brain. The effects of these types of strokes are equally as different as the causes. The one thing that is the same is: for all stroke patients rehabilitation is imperative.

Within 2-7 days following the onset of a stroke patients should engage in rehabilitation in order to realize the most return of function and adaptation. Through the use of rehabilitation, and other interventions, the natural return of functions can be hastened and the extent of neurologic damage can be limited. For more permanent physical impairments and limitations therapy also provides a solution. Rehabilitative therapies, such as physical, occupational or speech therapy, help patients adapt to their new limitations by teaching them new skills to continue their day-to-day activities. Although patients may not return to an optimal and completely independent way of life many can still master their own care. These strides are greatly dependent on the therapy received and the patients overall drive to resume daily activities.

With early and diligent rehabilitative therapy, under the direction of trusted, experienced therapists, there are great possibilities for positive outcomes for those who have suffered a stroke.

Researchers have recently become very interested in the affects of culture on the diagnosis and treatment of Alzheimer’s and dementia in America. They believe the exploration of cultural influences is critical, as culture affects understanding of dementia, how services are utilized, and the psychosocial experiences of the families of those with dementia. As of 2005 the population of adults 65 years or older in the United States was 8% African-American, 5% Latino, and 2.3% Asian-Pacific Islander, but by 2050 these numbers are projected to increase to 12% African-American, 16% Latino, and 6.5% Asian-Pacific Islander. These cultures are of particular interest because African-Americans are two times more likely and Latinos are one and a half times more likely to develop Alzheimer’s or dementia. While Asians, though less likely to develop the disease, face intense social stigmas.

One of the primary issues in dealing with Alzheimer’s or dementia for minorities is timely diagnosis. On average African-Americans wait 6 years after the first signs of Alzheimer’s/dementia before seeking a diagnosis, while the delay for Caucasians averages only 2 years. The reasons for the delay in diagnosis is generally a cultural misunderstanding of the signs of, and a lack of knowledge about the disease.

Among many minorities the initial signs of Alzheimer’s or dementia are attributed to the normal process of aging. African-Americans see it as “the old timer’s” disease. Latinos use the phrase “el loco” for the craziness, and the Chinese refer to “hu tu” for becoming forgetful in old age. Through these beliefs they normalize the symptoms and miss the signs of a more serious problem.

Once a deeper problem is recognized there are additional obstacles to gaining a diagnosis.  Most minorities do not turn directly to medical care. They rely primarily on the advice of family and then turn to an outside source. African-Americans rely heavily on religious leaders, Latinos turn to friends, while Caucasians rely on doctors. The knowledge base of each of these groups dramatically effects the care they receive, and the timely treatment of the disease. Recognizing these primary sources of information emphasizes the importance of public education on these diseases.

This also affirms the strong need for primary care physicians to become more aware and proactive in the diagnosis of Alzheimer’s and dementia. In 1999 a team of researchers (Boise, Morgan, Kaye & Camicioli) found that many caregivers delayed seeking a diagnosis because they lacked information about dementia and did not know which doctors to ask.

Early detection and preventative care are the most important steps in retarding the onset of dementia. It is essential to increased public and clinician awareness to catch and treat the disease early. Action to increase awareness will have a great impact on the treatment of these ravishing diseases, particularly among those minorities most susceptible.

Almost everyone has heard about Alzheimer’s disease, and some have experienced it up close and personal for the devastating disease that it is.  Vast amounts of literature reveal the signs and symptoms of Alzheimer’s and even the genetic and lifestyle causes that experts believe can bring on the debilitating progression of the disease.  Not everyone is aware, however, that there are actually three forms of Alzheimer’s disease.  These include:

• Late onset
• Early onset
• Familial

This article will describe the variants of Alzheimer’s disease as well as some of the latest genetic discoveries that surround each type.

Late-onset Alzheimer’s

The most common form of Alzheimer’s disease and that for which most are aware is late-onset Alzheimer’s which affects 50 percent of older adults age 85 and over.  The chance of its development increases twofold every five years past the age of 65.  About 90 percent of those afflicted with Alzheimer’s suffer from the late onset form which is typically diagnosed at the age of 65 or older.   It is sometimes referred to as sporadic Alzheimer’s.
Genetic variations and environmental factors are most often attributed to the cause of late-onset Alzheimer’s by researchers.   A gene found on chromosome 19 known as APOE has been proven to affect the likelihood of developing Alzheimer’s.  Until recently, the probability of another gene within chromosome 10 could not be conclusively linked to the dreaded disease.   According to Philippe Marambaud of the Feinstein Institute for Medical Research and Albert Einstein College of Medicine, and along with a group of his colleagues, their research is pointing to the likelihood of a gene that is active in the hippocampus region which functions as a calcium channel.
Since Alzheimer’s results in a calcium or plaque build-up in the brain, this made complete sense to the researchers.  The gene, for which prior it had no known purpose, is called CALHM1.  The brain’s regulation of calcium had been proposed for a causative factor of Alzheimer’s disease before, and the new study finds that it indeed may be the case.  “The present work provides strong support for the calcium hypothesis of Alzheimer’s disease and is also an important step toward understanding the potential pathological cross talk between calcium signaling disturbances,” Marambaud reported.

Early-onset Alzheimer’s

A much less common variation of Alzheimer’s disease is the early onset form.   Approximately 5 to 10 percent of those diagnosed with Alzheimer’s are under the age of 65.  Most of these individuals experience symptoms in the 50s, with those in the age ranges of 30- to 40-years old less common.   Persons with Down syndrome are more susceptible to early-onset Alzheimer’s disease.
Unlike late-onset Alzheimer’s, the genes that cause an early onset of the disease are very specific and not as general as the APOE gene.  According to the Mayo Clinic, these genes have been identified within chromosome 14 as APP, PSEN 1 or the PSEN2 genes.  Individuals who possess a genetic mutation of one of these three genes are very likely to develop early-onset Alzheimer’s.
Those who suffer from it may have difficulty obtaining a diagnosis due to busier lifestyles, initial misdiagnoses, or a general, understandable feeling of denial.  The Mayo Clinic reports that research does not indicate a faster progression of early-onset Alzheimer’s as it relates to the other forms.  Perhaps the misconception of a faster acceleration of early-onset Alzheimer’s is due to later diagnoses.

Familial Alzheimer’s

The rarest form of Alzheimer’s disease is the familial type.   Also an early-onset form, Familial Alzheimer’s Disease (FAD) afflicts less than 1 percent of all persons suffering from Alzheimer’s.   Inheriting a genetic fault on chromosomes 1, 14 or 21 occurs in 50 percent of next-generation offspring.  So it is with very high probability that anyone who is diagnosed with early-onset Alzheimer’s has a parent or grandparent also diagnosed with this form of Alzheimer’s.  Most individuals diagnosed with FAD are in the age-range group of 40 to 50, but it isn’t entirely uncommon to see those diagnosed with it to be in their 30s.
It is a very personal decision as to whether one should get tested for this genetic mutation, but it could be advantageous from the standpoint of coping with FAD.  While it’s extremely challenging for the patient, it can also be difficult for family members or those persons who interact with the patient.  By obtaining an early diagnosis, plans can be made ahead of time and de-stressing of one’s environment as much as possible can take place.  As well, pharmaceuticals or clinical trials can be considered for any form of early-onset Alzheimer’s or for Alzheimer’s disease in general.