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The neuropeptides calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating polypeptide (PACAP) have emerged as mediators of migraine pathogenesis. Both are vasodilatory peptides that can cause migraine-like attacks when infused into people and migraine-like symptoms when injected into rodents.
A notable clinical difference is that PACAP, but not CGRP, causes premonitory-like symptoms in patients. Both peptides are found in distinct, but overlapping areas relevant to migraine, most notably with the prevalence of CGRP in trigeminal ganglia and PACAP in sphenopalatine ganglia.
Dr Varipapa is now using a new, non-medicine treatment for migraine called Relivion. It is a wearable headset for the acute and prevention of migraine. Contact Dr. Varipapa’s Team if your interested in this treatment.
“Relivion is a non-drug, wearable neuromodulation therapy that stimulates the six branches of the occipital and trigeminal nerves, which are responsible for migraines.Β
The therapy has demonstrated high clinical efficiency, previously only possible with invasive procedures.
The device is comfortably placed around the head, and the electrodes are accurately positioned above the target nerves for efficient stimulation. The treatment intensity level is adjustable for patient comfort.”
Are there foods that could help prevent Alzheimerβs? What about foods that can damage your brain health? Tony
In recent years, there has actually been a lot of interest in this very question.
A healthy diet, of course, is a critical tool in warding off nearly all of the diseases of aging. Your body just functions better when youβre feeding it all those good nutrients it needs.
“The long-awaited era of disease-modifying therapy for Alzheimerβs disease has finally arrived and will substantially impact how the disease is perceived and managed, although these new treatments will pose challenges for equitable access. The drugs closest to widespread clinical implementation are lecanemab and donanemabβintravenous monoclonal antibodies that remove Ξ²-amyloid plaques from the brain and can slow cognitive and functional decline.”
Donanemab appears to be the βeasier’ choice. MMSE 20-28, Monthly Infusion (vs q2Wk), Stop when Amyloid PET is negative. Probably need to get APOE on these patients. https://doi.org/10.1016/S1474-4422(23)00274-0
Contact Dr. Varipapa’s office if you are interested in exploring this option.
This was a sobering story on CPR in the elderly (NPR)
A ‘natural death’ may be preferable for many to enduring CPR
A frightening issue discussed in this article was the concept ofΒ ‘CPR-Induced Consciousness’, where chest compressions circulate enough blood to the brain to awaken the patient during cardiac arrest, who may then literally experience hell, with ribs popping, needles entering their skin or a breathing tube passing through their larynx.
TL:DR
Survival
The overall survival rate from CPR ranges from 7.6% out-of-hospital and only 17% in-hospital.
These numbers are worse in the elderly (6.7% in the 70βs to 2.4% in those over 90.)
Less than 2% of patients with cancer, heart, lung or liver disease survive more that 6 months.
Harm?
Fractured/cracked ribs common (and very painful.)
Pulmonary hemorrhage, liver lacerations and broken sternums also occur
CPR-Induced Consciousness
Chest compressions circulate enough blood to the brain to awaken the patient during cardiac arrest, who may then experience ribs popping, needles entering their skin, a breathing tube passing through their larynx.
Brain Injury
30% of survivors of in-hospital cardiac arrest have significant neurologic disability
Only 2% of survivors over 85 escape significant brain damage
Quality of Life
The traumatic nature of CPR may be why as many as half of patients who survive wish they hadn’t received it, even though they lived. It’s not just a matter of life or death, if you survive, but quality of life.
“New research has found the spike protein of the SARS-CoV-2 virus in the blood of long Covid patients up to a year after infection but not in people who have fully recovered from Covid. Virus has also been found in tissues including the brain, lungs, and lining of the gut, according to scientists and studies
The findings suggest that leftover reservoirs of virus could be provoking the immune system in some people, causing complications such as blood clots and inflammation, which may fuel certain long Covid symptoms, scientists say.”
“The data are stark: the typical American diet is shortening the lives of many Americans.Β Diet-related deaths outrankΒ deaths from smoking, and aboutΒ half of U.S. deaths from heart diseaseΒ β nearly 900 deaths a day β are linked to poor diet. The pandemic highlighted the problem, with much worse outcomes for people with obesity and other diet-related diseases.”
βIn this special episode of The Drive, we have pulled together a variety of clips from previous podcasts with sleep expert Dr. Matthew Walker to help listeners understand this topic more deeply, as well as to identify which previous episodes featuring Matt may be of interest. In this episode, Matt gives an overview of why we sleep, the stages of sleep, and sleep chronotypes, and he provides tips to those looking to improve their total sleep and sleep efficiency. Additionally, Matt discusses the pros and cons of napping, and gives his current thinking on the effects of blue light and caffeine on sleep. Finally, Matt explains the dangers of sleeping pills and reveals what he believes are the most useful alternatives for someone struggling with sleep, such as those with insomnia.β
CNMRI: Neurology, Sleep Medicine, MRI 