“The best way for a student to learn a skill is to go to work in some good company (or hospital), under masters, and get paid while he learns.” W. Edwards Deming, Out of the Crisis
| By David Willis BBC News in Missouri |
 Dianne struggles to communicate with her mother |
Next to her on the bed sat two of her closest relatives - her daughter and grandson.
They hugged her, teased her, squeezed her hand: nothing.
They talked of hobbies, and pets, and adventures from her past: not a word.
Then - briefly - the haunted expression grew into a smile and both planted kisses on her pallid skin.
For Dianne Kerley and her son Mike it was the best they could hope for.
Fifteen years ago Dianne's 78-year-old mother Flossie (Mike's grandmother) was diagnosed with Alzheimer's disease.
Since then she has lost not only her memory, but the ability to look after herself, as well as the ability to walk and talk.
Traumatic deterioration
They say that Alzheimer's begins with forgetting your keys and ends with you forgetting what your keys are for, but it is a whole lot worse than that.
 Flossie no longer recognises her family |
Before long Flossie's sense of balance and co-ordination will be compromised.
In the final stages of the disease so too will her ability to breathe.
Until then all Dianne and Mike can do is undertake a heartbreaking weekly pilgrimage to a nursing home in eastern Missouri and watch her fade away before their eyes.
"It was two years ago - at Thanksgiving," said Dianne, recalling the last time her mother recognised her.
"Ten or 12 seconds and then it was gone.
"She was like: 'Well hi! How are you?' and I'm like: 'Well, we sure do miss you,' and she was like: 'You do?. Then all of a sudden the fog just went over - and that was it."
It is difficult to imagine a slower, more agonising death.
Alzheimer's leaves the patient a prisoner in their own body whilst systematically eroding everything about them that makes them human.
What should be the golden years are marked by blank stares and tragically unrequited expressions of love.
My own grandmother
Flossie's situation reminded me of my grandmother.
Sprightly and independent, she was like a granny from central casting - white hair, glasses, rocking chair and slippers.
 It is very traumatic for Dianne and Mike |
She came to live with us shortly after my parents married and she was a hoot.
She helped out at children's tea parties, always had the best biscuits in the house, and allowed me to watch shows on her black and white TV that my mother frowned on.
But as the years went by, Granny started to change.
Not only would she say the same things, she would do the same things, time and time again.
She would list the names of everyone in the family before arriving at mine, come in to tell us something and then forget what she had come to say.
All the time she was becoming befuddled by tasks which once seemed second nature.
Slowly but surely her sharp mind and sense of fun began to fade like a tropical sunset.
When she lost control of her bladder my mother decided she could not cope and we put her in a home.
The first time I visited she barely recognised me.
A few more trips and she had lost the ability to speak.
Months later a nurse rang to say granny had faded away in her sleep.
We shed a tear then breathed a huge sigh of relief.
New hope
The fact is that even though Alzheimer's was discovered more than 100 years ago it is only in the last two decades that we have really come to know anything about it.
 Trials of new treatments are in progress |
Lack of funding has a lot to do with it.
The US government spends roughly eight times as much on cancer research as is does researching Alzheimer's disease, and half what it spends on substance abuse.
Finally, though, there is some hope.
This week the Irish-American company Elan and the US firm Wyeth will jointly announce they are pressing ahead with the $300m (£151m) trial of a drug which could block the production of a protein called beta amyloid which many scientists believe causes Alzheimer's.
Present in all of us, too much beta amyloid can cause plaques to form in the brain, and those plaques feast on brain cells.
There is a lot at stake, not least financially. If a drug is discovered which prevents Alzheimer's half the population of the US alone could eventually end up taking it.
Need is great
Never has the need been greater: as the first baby boomers turn 60 the fear is the heath care system could be overwhelmed by what some are predicting could be an epidemic of Alzheimer's disease.
It costs $50,000 a year just to keep Flossie in a nursing home.
Back in Missouri, Mike and Dianne are bidding her farewell: "There's that pretty smile, sleep tight OK?"
Flossie sits perfectly still - beyond hooded eyelids brain cells are dying.
As she reaches the hallway Dianne stifles a tear.
Hers is the heart-rendering tragedy of the long goodbye.
• You can watch David Willis's report on BBC World News America at at 0030 BST on BBC News and at 0000 BST (1900 ET / 1600 PT) on BBC World News and BBC America (for viewers outside the UK only).
Are you or is someone you know suffering from Alzheimer's disease? Are you affected by the issues in this story? Send us your comments using the form below.
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紅麴每日不應攝食超過15毫克--標題"紅麴"為hc加入 衛生署核可的紅麴相關健康產品共有四件。但衛生署呼籲，健康食品是提供一般民眾保健之用，病患應聽從醫師建議，避免混用藥物與健康食品，建議民眾選擇有認 證產品，紅麴中的有效成分Monacolin K每日不應攝食超過15毫克。衛生署總共通過四件紅麴健康食品，包括紅麴清醇膠囊、微庫醇紅麴膠囊、桂格新養生穀粉紅麴配方、天然紅麴，都是國內知名的大 廠牌。 食品衛生處副處長謝定宏說，衛生署核准的健康食品紅麴產品上就標有警語，包括患有嚴重疾病、感染症、肝病或經外科手術等情況，請勿使用這類紅麴產品，或應先諮詢醫師、不應替代藥品使用等。 衛生署從民國88年核准健康食品以來，總共通過13種保健功效的健康食品，包括腸胃道蠕動、降血脂、免疫調節、抗衰老等功效，共做成125個健康食品產品，包括靈芝多醣、乳酸菌、紅麴等產品。 台酒：產品無橘黴素 台灣菸酒公司啤酒事業部副總林讚峰表示，紅麴若培養不當的確會產生橘黴素，因此市售不少大陸產製，甚至日本製商品，都可能有存留橘黴素。不過，台灣菸酒公司採用國產在來米培製的安卡紅麴，從化學儀器檢驗是測不出橘黴素遺留，因此台灣菸酒生產相關紅麴產品可放心食用。 |
Surgeons are increasingly offering an added benefit to their breast-cancer patients: removing the tumor and cosmetically repairing the breast at the same time.
Women with breast cancer traditionally would see a cancer surgeon to have the diseased tissue removed and later see a plastic surgeon for reconstruction. Now, more cancer surgeons are getting trained in cosmetic techniques that preserve or restore a breast's shape or appearance. This emerging field of "oncoplastic surgery" could allow a patient to minimize the number of times she must go under the knife.
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The shift comes as traditional plastic surgeons turn increasingly to purely cosmetic procedures, which pay more. Indeed, the number of breast-reconstruction surgeries declined 29% to 57,100 last year from 2000, a development the American Society of Plastic Surgeons attributes in part to poor insurance reimbursement for these procedures.
Breast cancer strikes one out of eight American women at some time in their lives. Making plans for breast reconstruction at the same time as cancer surgery can speed a woman on the path of psychological, as well as physical, recovery. And by combining procedures to reduce the number of operations, it also reduces the risk of complications from successive surgeries.
The combination of cancer surgery with cosmetic techniques is aimed mainly at women with early-stage cancer getting a lumpectomy, a procedure that removes cancerous tissue but leaves the rest of the breast. Oncoplastic surgery also can sometimes benefit patients who need a mastectomy, or total breast removal, by helping to prepare their bodies for subsequent reconstruction.
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"There is a growing awareness that we haven't done as good a job as we should" in offering aesthetic options to breast-cancer patients, says Pat Whitworth, director of the Nashville Breast Center in Nashville, Tenn.
In a typical lumpectomy, also called a partial mastectomy, the surgeon makes an incision, scoops out the cancerous tissue and then closes the opening. That can often leave the breast with a disfiguring dent. In oncoplastic surgery, by contrast, a wedge is removed and tissue under the skin is then pulled together to close the defect. That can leave the breast looking smaller, but otherwise normal. Sometimes an oncoplastic approach may be taken by two surgeons teaming up to do cancer removal and repair in the same operation.
"What we're talking about for the most part is how to do a nice lumpectomy," rather than relying on breast reconstruction that uses artificial implants or tissue transplants, says Benjamin Anderson, director of the University of Washington's breast clinic in Seattle.
Sandy Masson, a 48-year-old nurse and director of women's services at Hoag Hospital in Newport Beach, Calif., was diagnosed with breast cancer in April. The first surgeon she consulted recommended a mastectomy, because she had two lumps in different parts of her breast, and she was set to go ahead with it. Ms. Masson, a mother of two young children, says her only thought was: "I want to live; I don't care what I look like."
At the urging of colleagues, Ms. Masson then consulted Melvin Silverstein, an oncoplastic surgeon who had recently moved his practice to Hoag. He told her she could avoid a mastectomy without incurring any increased risk to her survival. Dr. Silverstein says he removed a crescent-shaped chunk of tissue that got both cancerous lumps but spared a substantial portion of the breast. In the same operation, he reduced the size of her other breast to give her a symmetrical appearance.
A week later, Ms. Masson was back to work and is now undergoing chemotherapy. "I'm normal now and not deformed," Ms. Masson said recently, lifting her blouse and bra to display Dr. Silverstein's handiwork.
The number of surgeons using oncoplastic techniques is small but growing, says Diana Rowden, a breast-cancer survivor and vice president of health sciences at Susan G. Komen for the Cure, a Dallas-based advocacy group. There is no professional certification for oncoplastic surgeons, so patients should inquire about a practitioner's training and experience.
The American Society of Breast Surgeons since 2005 has sponsored introductory oncoplastic courses at its annual meeting. In December, the American Society of Breast Disease, a group that includes radiologists and oncologists, held its first School for Oncoplastic Surgery in Texas. The three-day course, to be repeated this year, included a session at the cadaver laboratory at Baylor Medical Center at Frisco, where the surgeons got to practice some techniques. Practitioners say they don't make more money from oncoplastic surgery than from regular cancer surgery, and say the attraction is mainly wanting to do a better job for their patients.
Some cancer surgeons say they are seeking oncoplastic training because of a shortage of reconstructive surgeons, a growing problem especially in rural areas and midsize towns. Plastic surgeons are "bailing out" because "they get paid $1,000 for reconstruction when instead they could do four breast augmentations at $5,000 a pop or more," says Michael Cross, a breast surgeon in Fayetteville, Ark. Reconstructive surgeries also often take more time to perform than purely cosmetic procedures.
"The vast majority of plastic surgeons still do both reconstructive and cosmetic surgery," says Michael McGuire, a spokesman for the American Society of Plastic Surgeons. Still, he blames the decline in reconstructive surgery in recent years on poor insurance reimbursement that "is part of the greater health-care crisis in this country." Federal and state laws require insurance companies to cover breast reconstruction, but the laws don't set payment rates.
Dr. McGuire says he welcomes efforts by cancer surgeons to learn what plastic surgeons can do, but he is skeptical of oncoplastic courses. "To think a surgeon can learn how to do this in a weekend course is unwise," he says. Cancer surgeons say that some techniques aren't difficult and can be quickly adopted. They agree that more intensive training is needed for more complicated procedures, such as reconstruction using artificial implants.
Stephania Timothy, a general surgeon in Wenatchee, Wash., says that after attending a daylong course in New York recently, she was able to start using simple incision techniques that give patients better cosmetic results. She says she plans to improve her skills by practicing at the University of Washington's cadaver laboratory and by pursuing more training.
The Mary Kay Ash Charitable Foundation announced Monday that it will fund a small fellowship program "to train breast surgeons in the emerging field of oncoplastic surgery." The program will be led by Gail Lebovic, a cancer surgeon at the Cooper Clinic in Dallas, who has received specialized training in reconstructive and plastic surgery.
Tanya Elmer says that after she was diagnosed with breast cancer two years ago, she interviewed surgeons who told her they would "get rid of the cancer and then 'you can go to another doctor' " for reconstruction. At the urging of a friend, the 54-year-old homemaker in Flower Mound, Texas, went to see Dr. Lebovic.
Ms. Elmer says her mind was eased when Dr. Lebovic explained how she would both perform the surgery and repair the breast. Ms. Elmer says the advance planning for reconstruction enabled her to complete the treatments after two surgeries, rather than three.
Write to Rhonda L. Rundle at rhonda.rundle@wsj.com
A 55-year-old man who smokes is as likely to die in the next 10 years as a 65-year-old who has never smoked. A 35-year-old woman is twice as likely to die in an accident as she is to die of breast cancer in the next 10 years.
And after 75, heart disease is the biggest killer of smokers and nonsmokers alike, though lung cancer and respiratory disease remain huge risks for smokers.
New risk charts in a paper last month in The Journal of the National Cancer Institute provide a broader perspective than most of the risk calculators available on the Internet, because they cover the risks for 10 causes of death and for all causes combined, while differentiating by age and among smokers, nonsmokers and former smokers.
At first glance, it may appear that smokers and nonsmokers die of heart disease at the same rate, but they do not. A 35-year-old smoker is seven times as likely to die of heart disease as a nonsmoker the same age. But as smokers age and as some survive the more common smokers’ diseases, the numbers begin to converge. By 75, their rate of death from heart disease is almost, but still not quite, the same.
“Often, numbers are presented as lifetime statistics, which make the risk look too large, or as one-year statistics, which make the risk look too small,” said Dr. Lisa M. Schwartz, a co-author of the paper and an associate professor of medicine at Dartmouth. “These charts provide the information you need to understand a risk, and whether to consider taking some action to reduce it. How big is my risk? And how does this risk compare to others?”
【甯瑋瑜╱台北報導】衛生署最新調查顯示，半數國人過去一周曾吃高鹽（含鈉離子）食物，更有三分之二的人購買包裝 食品時，從不注意鈉含量，無形中攝取超量的鈉。衛生署官員昨指出，將盡快訂出「高鈉」、「低鈉」標準，要求廠商在包裝上標示。名廚阿基師與詹姆士說，只要 善用食材原味烹調，不必放鹽巴，照樣可煮出美食。
吃出健康
衛 生署國民健康局去年對四千三百多位民眾進行電訪，發現半數國人過去一周曾吃豆腐乳、炸雞等高鹽食物；高血壓患者要限制鹽分攝取，但受訪的高血壓患者近四成 過去一周曾吃高鹽食物，百分之七點二九更是天天吃。女性鹽分攝取不如男性多，買包裝食品有四成會仔細看標示的鈉含量，男性不到三成。
可以水果或蒜調味
衛生署建議國人每日鈉的總攝取量不超過兩千四百毫克，相當於六克的鹽。食品衛生處副處長謝定宏表示，天然蔬果中可能含有鈉成分，民眾可先減四百毫克，購買包裝食品時，一天以不超過兩千毫克為原則。
衛 署昨特地請名廚阿基師與詹姆士示範低鈉美味料理。阿基師說，好吃的菜餚不一定要重口味，可利用檸檬、鳳梨等食物酸味、中藥材、辛香料，或低鹽佐料酒、蒜、 花椒來調味，不但能減鹽，又能讓菜色口感層次多變化。詹姆士則說，烹調方式影響鹽的使用，烤、蒸、燉可保持食物原有鮮味，減少鹽與味精的使用，醃、燻、 滷、漬則易使用較多的鹽。
阿基師說，簡易家常菜也可少鹽，「煮湯時，以豬肋、雞骨燉煮，魚肉的烹調可搭配大量的洋蔥、青椒提味，青菜也未必要放鹽，可將鹽巴加五倍的水，蒸煮後淋上幾滴鹽水及可調味。」
徵選菜單頭獎五萬
為推動少鹽低鈉運動，衛生署即起至八月二十二日舉行「愛的減鹽私房菜」減鹽料理菜單徵選，呼籲餐飲界、料理學校及一般民眾參與，頭獎獎金五萬元，詳請可上網：www.nv.com.tw/2008lowsalt。
