Healthy Wealthy & Wise Dr. William T. Choctaw, MD, JD
The Healthy Wealthy and Wise Podcast, with Dr. William T. Choctaw, MD, JD is a monthly podcast that focuses on personal growth and development by exploring a range of topics related to mental and physical health, personal wealth, leadership, and interpersonal relationships. Dr. Choctaw draws on his 75yrs experience and 50 plus years of surgical practice since graduating from Yale University School of Medicine.
Each month, we strive to provide our listeners with mental, physical, and spiritual strength by giving actionable advice, tips, guidance, and information to help them achieve their own personal, professional, and spiritual goals. We consider the health of the mind, body, and spirit paramount as a single unit that provides a cumulative strength greater than the individual parts, to strengthen the whole person.
We appreciate the natural differences in need between men, women, adults, and children. We recognize that the power to be happy is within each of us and under our control. We embrace technology and identify how it is applicable to our daily success. We address the entire human experiences from generation z to the baby boomers.
We’re passionate about the total person, and helping our listeners build and lead a full, well-rounded and happy life. So, tune in every month for an inspiring, encouraging, and informative podcast!
Healthy Wealthy & Wise Dr. William T. Choctaw, MD, JD
Rewriting the Script on Dementia and Alzheimer's: An Insightful Discussion with Dr. Choctaw
What if you could shield your brain against the ravages of dementia and Alzheimer's? Picture this: You're increasing your social interactions, getting more exercise, and you're cutting out unhealthy habits. Sound too good to be true? Join us as we transform your understanding of these complex conditions, starting with the basics and moving onto the preventative actions that you can take.
If you've ever felt helpless when faced with the mention of dementia or Alzheimer's, you're not alone. We promise, by the end of this episode, you'll understand the root difference between the two and recognize the symptoms, such as language difficulty, confusion, and poor judgment. We'll guide you through the intricate stages of these diseases, all the way to treatment. Our guest, Dr. Choctaw will bring light to some often-overlooked aspects of depression that frequently accompanies dementia and Alzheimer's, and how a holistic treatment approach can help lead to successful outcomes.
Lastly, we'll reveal how making lifestyle changes may help prevent up to 40% of dementia cases. Imagine reducing the risk of such debilitating diseases by simply increasing your education, staying socially connected, becoming physically active, and decreasing unhealthy habits. Transform your life and those around you, armed with the knowledge and actionable steps we share. Be part of spreading awareness, take the next step, and let's change the narrative around dementia and Alzheimer's together.
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The Host, Dr. William Choctaw; MD, JD, is a healthcare leadership expert, possessing a Medical Doctorate from the Yale University School of Medicine, and a Jurist Doctorate from Western University. Over a span of 50 years practicing medicine, he has served as Chief of Staff, Chief of Surgery, and as a member of the medical executive committee at Citrus Valley Medical Center over a 10 year period. Also, while practicing at Citrus Valley Medical Center, he served as Chief Transformation Officer, (developed a Robust Process Improvement/Lean Six Sigma program). Dr. Choctaw lectures nationally and internationally on medical leadership issues for hospital staffs, executives, and managers. He served as a Physician Surveyor on the Joint Commission. He's the author of 2 books, "Medical Malpractice: A Physician's Guide to the Law" and "Transforming the Patient Experience: A New Paradigm for Hospital and Physician Leadership, published by the Springer Publishing Co. He’s the President of Choctaw Medical Group, Inc., a clinical practice and medical legal consulting firm for medical staff executives, physician leaders, and hospitals.
Welcome to the healthy, wealthy and wise podcast with Dr William Chokta, MDJD. Our mission is to empower you with the knowledge and the tools you need to thrive in all aspects of your life. Join us now as we discuss everything from nutrition and exercise to money management and personal growth. Dr Chokta will provide insightful advice on how to improve your physical and financial health, as well as your emotional and mental well-being. Whether you're looking to boost your energy levels, unlock financial freedom or cultivate a more positive mindset, we've got you covered. Get ready to become the best version of yourself? So let's get started. Here's Dr William Chokta, MDJD.
Speaker 2:Good morning. I'm Dr William T Chokta and I'm delighted to have you with us today. Today, we have a very important topic that we're going to talk about. We're going to talk about dementia versus Alzheimer's, but before we get started, let me just make a general comment. Each month, we strive to provide you, with our listeners, with mental, physical and spiritual strength by giving actionable advice, tips, guidance and information to help you achieve your own personal, professional and spiritual goals. We consider the health of the mind, body and spirit paramount as a single unit that provides a cumulative strength greater than the individual parts to strengthen the whole person. So again, welcome with joining us today for this very important topic.
Speaker 2:As I said, we're going to talk about dementia versus Alzheimer's. Which is it and why is it important? In other words, why is it important for you to know about dementia and Alzheimer's and understand the difference between the two? As always, we like to start off with our beliefs. I believe life is about being of service to others. I believe knowledge is power. I believe leaders can change the world. We also always like to put up an outline. This gives you an idea about what we're going to talk about and, as important, it lets you know, when we're just about done, we're going to talk about dementia, we're going to define it. Then we're going to define Alzheimer's disease. We're going to go through the diagnosis and treatment and also give you some suggestions about prevention. This is part of our masterclass series. The topic today, as all of these presentations, and our goal overall is to help you to have a more healthy, wealthy and wise lifestyle and allow you to be mental, physically and spiritually healthy.
Speaker 2:So what is dementia and how does it differ from Alzheimer's disease? Dementia is a general term for decline in cognitive ability that includes memory loss and thinking difficulties. Let me say that again. Dementia is a general term for decline in cognitive ability that includes memory loss and thinking difficulties. In other words, dementia is an umbrella term that has to do with difficulty with memory. So it's an umbrella term. Dementia is not a disease. It is basically a category, if you will, an umbrella category that includes a number of different disease under it. Alzheimer's, on the other hand, is a specific brain disease. Alzheimer's is a specific brain disease and, what's more important, alzheimer's is the most common cause of dementia. So there are a number of different causes of this umbrella term called dementia and of those different terms. Alzheimer's is one of them and the most common one causing dementia. So again, dementia, general umbrella term for memory difficulties or inability to make proper decisions. It's a disease of the brain that is the most common cause of dementia. So if we were to first just take a look at dementia and this again is an umbrella term for issues that have to deal and that cause dementia we look at things like individuals who begin to develop difficulty with language.
Speaker 2:They can't find the right words to say what they want to say. They have difficulty solving problems. They have confusion of time and place in terms of where they're supposed to be and what they're supposed to be doing. They may have some changes in personality. They end up having examples of poor judgment. They sort of make decisions that are not wise and out of character of what they would usually make. They have problems communicating and they misplace things. Now, we all misplace things, but we're talking about individuals who do it on a broader basis.
Speaker 2:So if we look at Alzheimer's and dementia and compare the two again, dementia is not a disease and Alzheimer's is, and dementia is a very general term that involves difficulty with cognition or thinking. Dementia, on the other hand, is a complex set of diseases that progressively get worse over time. So let's drill down a little more closely now. With dementia, we say it has to do with recent memory loss that affects daily life, but a person with dementia would have troubling remembering conversations or may even ask repeated questions because their short-term memory has been compromised. In terms of difficulty performing regular tasks, someone with dementia might have a difficulty driving a familiar route. Let's say you drive a certain distance to work every day. Let's say it takes you 20 to 30 minutes to get to work. You go the same streets each time, but if you're developing dementia you may have difficulty going through that familiar route and consequently be late for work. Sometimes Individuals with language, individuals with dementia, might have difficulty following or starting conversations. They may use the wrong words and primarily because they're unable to remember the proper words that they should use. In this particular conversation we're talking about dementia now.
Speaker 2:Disorientation of time and place Disorientation with dementia will be confused with the time of day and what's appropriate to do for that time, in other words, for lunchtime. They may be confused whether it's lunchtime or breakfast time, etc. Etc. Decrease for judgment. We talked about bad decisions, about their appearance, and indeed, they may start having difficulty in how they appear physically and how they dress and how they prepared for a particular event, or even going to work Problems with complex tasks.
Speaker 2:A person with dementia will have a difficulty keeping track of finance, let's say paying the bills on time, maybe difficulty managing a certain meal. Maybe this person fixes meals for the family meal or female, but they may not remember the steps, the individual steps, to making a cake or making bread or other types of meals Basic things that they've done for years now become problematic. One of the other more obvious things is misplacing things. Again, we all misplace things, but the distinction I like to use is I may misplace my keys periodically, and that itself may not be that big a deal. However, individuals with dementia, particularly advancing dementia, misplace items in the wrong place. For instance, if I misplace my keys on the desk, that itself may not be a major issue, but if I misplace my keys in the refrigerator, that then is more suggestive of a dementia type of problem than just mild forgetfulness, etc. Etc.
Speaker 2:Changes in mood or behavior, personalities may switch very quickly. Emotions may switch very quickly to the extent that they are out of the ordinary. Again, we all may have different emotions, but these are things that will jump out to you, either within yourself or with those around you. That may be suggestive of a dementia type problem Relating to others. Individuals with dementia may have difficulty remembering individuals and being able to communicate with those individuals who they've known before. And loss of initiative. Persons may just may not feel like they have much energy, just don't want to do very much and not interested in things all of a sudden, whereas maybe before they were very engaged in various different activities. So again, we're talking primarily about dementia now. Dementia is the umbrella term that involves cognitive ability or lack of ability, cognitive meaning thinking. So dementia is a umbrella term that has to do with inability to think the way you normally would think to get things done.
Speaker 2:Another important aspect of dementia that we've touched on slightly, but let's delve a little deeper is the psychological symptoms of dementia Personality changes. You may live with a spouse who begins to develop dementia, who suddenly may shift in personality and behavior to the extent that you notice it. And I mentioned spouse because our spouses notice us more closely than most others, so you, the spouse, would be the first one to know to notice, but you seem more down the last couple of weeks or the last couple of months, or you seem more combative, or something to that effect. A part of the psychological symptoms can include anxiety. Maybe the individual now worries more or frets more about things than they used to, but the little things that didn't bother them now just sort of appear to make them very upset and very uncomfortable. And again, the depression you know not wanting to do anything, not finding any joy or pleasure in anything Many times can be suggestive of a type of depression.
Speaker 2:Obsessive tendencies Again, these are actions of the mind and that translate into behavior that cause us to do certain things that we just would not ordinarily do and where we obsess over something over and over and over again in a way that stands out and does not appear to be normal for us. Pollucinations of paranoia. Pollucinations mean you see or hear things that are not there. You hear sounds that are not really there and you see people or figures, or imagine that you're seeing things that are not there. Inappropriate behavior. Your behavior is a difficult one, but the way this shows up is individuals who may laugh in a situation that appears to be inappropriate. Someone shares a very sad story or very sad experience and this person would laugh or just act inappropriately. These are suggestions, some cognitive, ie thinking abnormality that may be associated with this umbrella term that we call dementia, agitations in mood and just getting upset, a lot or little noises that bother you more than they used to. If the gardener is outside more in the lawn, the sound of the lawnmower may just drive you up the wall, and then just a general lost of interest.
Speaker 2:Let me say a quick word about depression, because depression will basically be impacted by dementia and Alzheimer's, but in general, depression is one of those things, and we're going to talk about it in terms of seniors. Now. My definition of senior is an individual who's six or five years of age and older. Keep in mind, however, that dementia, alzheimer's and depression can occur at any age for an adult, but we're talking about the most common types of situations. Seniors who are depressed. Usually the majority of them do not believe that depression is a health problem, and this is a general problem with mental health illnesses themselves is that we tend to not give them the attention and the concern that we should or that we would say if one were to break a leg or get chest pain or get a laceration on the arm or the foot, whereas we would act very quickly, move to get resolution, whereas with depression, many times we excuse it away, partly because we don't understand it as well as we should. But my point is, all that does is it complicates the problem, it delays treatment, it delays resolution of the problem and it tends to self increase the severity of the problem itself.
Speaker 2:80% of people with depression can be treated successfully with medication, psychotherapy or combination of the two. Let me say that again, 80% of people with depression can be treated successfully with medication, psychotherapy or combination of the two. This is a treatable problem that affects the brain and we need to look at it as such and then be able to have it taken care of. And again, as I mentioned before, most of us adults who get depression know very little about it, and that then, as I said before, complicates treatment and access to appropriate care. One of the things that's also significant is that, as one gets older and heart conditions or heart related conditions become more prominent, a good number of individuals or patients who develop heart attacks also have an associated depression along with it, and it's important to make the point that the body is a unit that is very complex Think of the world's most complex computer available and everything is interrelated. Everything is interrelated, and so one needs to think of the body as a unit with interrelated, interacting parts, because so one area affects the other area, and that's why it's so important to have more of a, in my judgment, more of a holistic approach mind, body and spirit as we deal with a number of these physical and or psychological problems.
Speaker 2:Now, I mentioned earlier, when I was talking about dementia versus Alzheimer's, that Alzheimer's is the most common cause of dementia, and that is true. There are other causes. There are actually four of the causes of dementia, and I'll just mention them briefly. Vascular dementia, which has to do with blood flow to the brain, has something called Lewy body dementia. These are individuals who have had dementia and were found to have certain types of material in the brain that distinguish them from others. There's a frontal temporal lobe type dementia, which is unique, and then there's a mixed type dementia. But again, remember, the most common type of dementia is Alzheimer's disease, and we'll speak about Alzheimer's. So let's take a look at Alzheimer's. Okay, let's leave dementia in general aside.
Speaker 2:As a overall category, alzheimer's has a lot of areas that make it unique in a bad way. The first thing is it's in stages, which is good. The first, the early stage, or the mild stage a patient may have memory loss, mood swings, slow to learn to react, uncomfortable with due situations, prefer the familiar Actually, that's probably all of us I know. I certainly prefer the familiar and still perform basic tasks. We talk about stage one, a mild Alzheimer's disease of the brain, and may have slowing in speech and understanding and periodically lose the train of thought.
Speaker 2:It's important also to understand that Alzheimer's can cause significant psychiatric problems itself, separate and apart from the milds or various types of psychiatric symptoms that you may see in mild forms of dementia. So in stage one Alzheimer's, the patient may become aware of a loss of control, maybe just of their personality or their mood. They may become more irritable than normal, they may become more fearful than normal, more restless, more depressed. These are things that tend to be outside of the normal for that particular person and they tend to be noticed most closely by close members of the family and or those who work and associate with that person on a regular basis. That's stage one of Alzheimer's disease, a physical disease of the brain.
Speaker 2:Okay, that progressively gets worse, and so then we go to stage two, moderate Alzheimer's. Here disability occurs. Distant past may be recalled, but recent events become difficult to remember. They can remember things that happened 20 years ago, but many times they cannot remember things that happened 20 minutes ago or maybe even 20 seconds ago. So it's the recent events that become difficult to remember. They are not able to comprehend location, day and time, and we talked about this a bit in general with dementia, but here we're talking about it progressively getting worse, progressively getting worse.
Speaker 2:And one of the more distressing parts about Alzheimer's is that they may not recognize familiar people. And this is the situation where a mother or a father cannot but does not recognize their son or their daughter or the grandson or the granddaughter, members of the family members that they work with. And this can be obviously not only very distressing for the patient but very distressing for the family and friends and co-workers who associate with this person. Which then takes us to stage three of Alzheimer's, and here the patient is unable to care for themselves appropriately. Many times they are less and less responsive. They are unable to recognize anyone, unable to recognize anyone. So you can imagine this brain now that's damaged and diseased, that's getting progressively, progressively, progressively worse. They may have lost a bowel or bladder function, a bladder control. They may lose the ability to chew and swallow and certainly when they can't do that then they need to be fed. Many times that may require tube peeing. The challenge with that is not just the tube peeing, but if they are not able to chew and swallow because, remember, these are all brain, everything is under the control of the brain. But if that modality goes and you put something in your mouth and you don't remember how to chew and swallow, instead of going into the stomach that material can easily go into the lung and then create a significant problem, particularly being vulnerable to pneumonia and various types of respiratory infections which can quickly proceed to cardiac arrest, mortality and death.
Speaker 2:So what are some things on the more positive side that we can do to sort of slow down or prevent dementia and or dementia related issues? It's amazing how eating healthy and eating properly is always an issue and eating a balanced diet, fruits and vegetables the same thing that we tell I talk about in terms of heart disease, cholesterol, diabetes, etc. Same same approach. Similarly, exercise, regular exercise, stimulates the brain, stimulates the body, has a very positive approach Keeping mentally active, consciously engaging in activity, attending various events, if you retired, attending various social events with friends, family, attending church, attending taking a class, etc. Etc.
Speaker 2:Things you don't want to do is you want to stop smoking. If you are a smoker, any type of tobacco you want to stop. If you drink alcohol, you want to stop. Now I'm one of those physicians that will not give you a pass If you drink beer or wine. There's some who, some reason, have decided that beer and wine is not really, are not really alcohol. Yes, they are. So you need to stop drinking altogether. Why? Because it has a negative effect on the mind and on the body.
Speaker 2:As we know that alcohol, that our Alzheimer's disease, is increasing in this country, and that's not surprising because the population is increasing. The single biggest generation is getting older, called the baby boomers, and so it's no surprise then that now you're going to have more individuals with dementia and more individuals with the Alzheimer's disease. So, again, to summarize a bit, in terms of Alzheimer's, it's a physical damage to the brain which then translates itself into significant damage in terms of cognition and function, particularly function in terms of activity, of daily living, and many times that's one of the ways that you can pick up that there's something significantly wrong in an individual mentally when those activities of daily living getting up in the morning, brushing your teeth, taking a shower, eating breakfast, driving to work, going to participate with the group the individual can no longer do those things. They're certainly not do them safely. So when one thinks of Alzheimer's particularly, I want you to you think of two terms one, cognition, and the other term, function.
Speaker 2:Cognition first, cognition is just a fancy way of saying thinking, thinking. So the person with Alzheimer's is not able to think normally, not able to think in a way that allows them to do those things that they need to do on a regular basis. Second word function. Function is action. So I can think that I want to have a ham sandwich, but that I want to make a ham sandwich, but functionally I need to be able to get up, find the meat, find the bread, put them together and make a sandwich. So Alzheimer's attacks both those areas. One, the thinking becomes quickly impaired or significantly impaired, so that you then see the massive decrease, or deterioration, if you will, of the function on the other side, and these are what we call ADL activities of daily living bathing, dressing, grooming, feeding oneself, et cetera, et cetera. And so when one loses that functionality, then it becomes very, very obvious, and then one can end up being a danger to themselves or to others, and so the cognitive issues, the thinking issues and the functional issues become much more pronounced.
Speaker 2:Now it's also important to keep in mind that Alzheimer's disease is treatable. There are medications that can treat Alzheimer's disease. Obviously, the effectiveness of the medication depends on the stage and depends on the symptomatology. But acetylcholinesis, race inhibitors, is one category of medication for Alzheimer's. Metamantin is another category of medication for Alzheimer's. And so if there's a suspicion of yourself or those around you that Alzheimer's may be a potential issue, certainly speak to your healthcare professional and get an evaluation and decide whether treatment is necessary. In addition to medication. Various types of therapy, cognitive stimulation therapy, cognitive rehabilitation therapy all those things are available to help one's thinking ability. They'll have to preserve that thinking ability over time.
Speaker 2:So in terms of prevention and some may argue whether it's preventable or not, but I would suggest I don't see a downside to trying to prevent Alzheimer's or dementia. And so some of those things that one can do in terms of prevention is certainly socialize and talk with friends, or interact with friends and family more Quite. Honestly, I find this interesting. I used to consider myself well, consider myself an introvert, and my point is this is when everybody wants to be an extrovert, because it's healthier to be an extrovert, certainly as it relates to brain and brain types of cognitive difficulties Stay physically active. What we do know that there is a mind-body connection and that when you exercise you feel better and when you feel better you exercise more. Abort substances and we talked about that in terms of drugs and alcohol, recreational drugs and alcohol and smoking and practice cognitive training. In other words, the mind really is the brain really is a muscle, and so, like with any other muscle or computerized muscle, if you will, repetition in a positive way can help it, and so those, these are some things that we may have under our own control, that we can do. So another way of saying some of that is some have suggested that 40% of dementia cases can be prevented with lifestyle changes.
Speaker 2:There's some basic lifestyle changes and some of those lifestyle changes that we've talked about. One is to increase education, exercise that mind, talk to people either formally, informally, interact intellectually, increase the physical activity. Remember the mind and the body go together and they help each other and also, at the same time, increase social contact, be more of a social butterfly, if you will. That that is beneficial to you in a long-term process. And things you wanna decrease are things like high blood pressure, meaning that you wanna make sure that it's under control. Keep your doctor appointments, take your medication regularly, check your blood pressure at home yourself. Also, you wanna control obesity, smoking, depression, make sure your diabetes is under control, eliminate alcohol intake. You wanna avoid head injury, and head injury is something that becomes more prominent in elderly patients, again 65 years of age and older, and part of that is because balance begins to deteriorate long before anything else and so quick turns coming downstairs, going upstairs, standing on ladders all problematic with elderly patients 65 years of age and older. And so you wanna avoid that because obviously any type of external trauma to the head or to the brain increases the rate of progression of something like dementia and possible Alzheimer's disease. Again, prevention, social engagement, physical exercise, avoid substance abuse, mental exercise, reading classes, get a hobby.
Speaker 2:In summary, dementia is not a disease, but rather an umbrella term that describes a wide range of symptoms that affects people's ability to perform everyday activities on their own. Alzheimer's is a disease of the brain that leads to dementia. Dementia and indeed is the most common type of dementia and arguably one of the most serious types of dementia. Common symptoms of dementia include thinking issues, decreased memory, poor judgment, decreased focus, changes in language, decreased behavior. Alzheimer's increases that or copies that and makes it even worse. Quite honestly, alzheimer's occurs mostly in individuals over six to five years of age. In later stages Alzheimer's has huge damage to the brain in its ability to function. We call that the ability to do activities of daily living dressing, eating, brushing your teeth, grooming, etc. There is a very active Alzheimer's association that is located in Chicago, illinois. Their phone number is 1-800-272-3900. If you believe that either you yourself or someone you know or family member has dementia in or Alzheimer's, certainly recommend that you bring that up with your healthcare professional and get an evaluation and exam and whatever tests that need to be done. But you can also yourself call the Alzheimer's Association and do your own research in independently.
Speaker 2:Knowledge is power, just so that you better understand what's going on. My basic principles. I always like to end with my basic principles. My first principle is God is in charge. I am a physician of faith and indeed is my belief in my faith in God that has sustained me over these years and allowed me to provide care for my patients. Second, I don't have any bad days. I've fixed my own health and I've had bad days. I figured out about 30 years ago that whether I had a good day or a bad day was really up to me, and I made a decision that I did not need any more bad days. I had had enough. So now my days are either good days or great days.
Speaker 2:Principle number three don't sweat the small stuff. Most stuff is small. I have learned not to allow small things to bother me as much as they used to. I have figured out that most times I make the biggest deal, for the most part as I think it is. So I'm working, I'm better not 100%, but I'm better about letting it go.
Speaker 2:Principle number four forgiveness is therapy. Whatever occurs to you that you perceive as negative, I suggest to you to immediately forgive. Forgive the individual, whatever the circumstances are. It does not matter what the facts are, just automatically forgive that. That, indeed, is therapy. And the final principle is everything is a relationship Work relationship, family relationship, et cetera, et cetera. Relationships are based on three things Mutual respect, mutual trust, good communication. If you have those things, you have a very good relationship. If you do not have those things, you have work to do. These discussions, this podcast series, is part of a masterclass series with a number of different topics, and I would encourage you to subscribe. Should you choose to, you can go to wwwbuzzsproutcom forward slash 210103. That's wwwbuzzsproutcom forward slash 210103. And finally, be the change that you want to see in the world. Thank you and have a wonderful day.
Speaker 1:And then take the next step of action and share it with your family, friends and or your coworkers. They'll be glad you did so. Until the next time, live your best possible life the best possible way. You've been listening to the Healthy, Wealthy and Wise Podcast with Dr William Choctaw, MDJD.
