bredesen practitioner in or near west palm beach, FL

[komatta]

Looking for a practitioner of the Bredesen protocol near West Palm Beach, FL, preferably one that accepts medicare/insurance. I have found the Rezlir institute about an hour from my place, but it is cash only. Any help appreciated.

[Chameleon]

Hi Komatta,

Welcome to the APOE4 community! Yes, Relizir is certainly in your neighborhood.

On this site, there is a Searching for a Healthcare Practitioner wiki section which has some techniques that can help you search for a provider. There is also a listing of APOE4-Aware Healthcare Practitioners that may have a practitioner in your area.

Just in general there is a Primer that has lots of information that can help you get started and many people like to share their stories in the Our Stories Forum.

I hope you find a practitioner that is just right for you!

[NF52]

Looking for a practitioner of the Bredesen protocol near West Palm Beach, FL, preferably one that accepts medicare/insurance. I have found the Rezlir institute about an hour from my place, but it is cash only. Any help appreciated.

Welcome, komatta,
As someone who is also on Medicare and a Medicare Advantage Plan, I am aware of the limitations of those plans. I have friends of my age who have worked with people trained in the Bredesen protocol or in the Reversing Cognitive Decline protocol or with their local doctors to get some of the testing done by insurance (lipid profiles, insulin and glucose testing, etc.) and have paid for some testing themselves. I have done that through online sites that periodically have sales on blood tests, and then took the results to my regular dr. to discuss. You can find a list of the typical supplements used in Dr. Bredesen's protocol, although members would advise to start slow and make sure none of the supplements are going to affect conditions you have (such as using blood thinners).
As Chameleon noted, it's also helpful to read the Primer and get an idea of what you can work on in every day life. Lots of research suggests that daily exercise, good sleep habits and looking for purpose in life with an optimistic view can extend a healthy life by years.
As a 4/4 myself, I try to focus on meaning and working on what I can, not striving for perfection. Best wishes.

[komatta]

thanks for the reply. I am actually posting for my 87 y.o. mother, who is diagnosed with MCI and on a medicare supplement plan. I have read Bredesen's book, and while informative, it is somewhat overwhelming, and I thought it would be easier working with a doctor or coach, if I could find one that accepts her medicare. I have just gotten copies of my mother's recent brain scans (diffused atrophy) and blood tests, but of course they don't include most of the tests Bredesen recommends. Would you tell me which sites you use for onlne blood tests? My mother is on blood thinners and on aricept. I will not take her off the aricept yet. The only supplement she is on now is vitamin d. I would like to get more extensive blood tests done before supplementing. I will order a 23andme kit on black Friday to check for APOE4. THey are due to go on sale then. I appreciate you responding to my post, and would equally appreciate any other advice you might have for me.

[SusanJ]

...would equally appreciate any other advice you might have for me.

Before you do a lot of extensive testing, I'd shoot for the low-hanging fruit first. Is her A1c (for insulin resistance) and hsCRP (checking for inflammation) low? Is she sleeping well? Getting exercise? Weight normal? Gut health okay (normal BMs, no food intolerances)?

You can read more in Primer, listed above, for other ideas.

[komatta]

thank you for your reply. The A1c and hsCRP results were not in the test results the doc sent me. I am trying to make a list of tests that she needs and then will order. Her fasting glucose was somewhat high though at 105. Would this be an indication of insulin resistance? She is somewhat overweight, but not obese. She has always suffered from constipation, but recently, she has had bouts of upset stomach and diarrhea, maybe from the aricept, I am not sure. She does not sleep well, unfortunately. I bought her melatonin, but she has not taken it yet. She easily handles all the activities of daily living, and is very active socially, plays bridge, draws, and attends lectures and concerts, but her memory has gotten very bad, she has trouble forming new memories. I agree that low-hanging fruit is the first that should be picked, and if you have any other advice, please let me know. I am new to this.

[komatta]

SusanJ--I may have erred. My mother's HGB is 14 g/dl. This is not the same as A!c, is it?

[NF52]

SusanJ--I may have erred. My mother's HGB is 14 g/dl. This is not the same as A!c, is it?... [She] is diagnosed with MCI and on a medicare supplement plan... I have just gotten copies of my mother's recent brain scans (diffused atrophy) and blood tests, but of course they don't include most of the tests Bredesen recommends. Would you tell me which sites you use for online blood tests? My mother is on blood thinners and on aricept. I will not take her off the aricept yet. The only supplement she is on now is vitamin d.

Hi again, Komatta,I hope you don't mind that I combined parts of two of your posts.
First, your question on HGB:
The good news is that HGB is hemoglobin and using the information below, your mother is one of the lucky folks who is NOT anemic, since the cut-off in women is <12g/dL.
Anemia in the Elderly

Using World Health Organization criteria for anemia (hemoglobin of less than 12 g per dL [120 g per L] in women and less than 13 g per dL [130 g per L] in men), the prevalence of anemia in the elderly has been found to range from 8 to 44 percent, with the highest prevalence in men 85 years and older.

https://www.aafp.org/afp/2000/1001/p1565.html

In contrast, HbA1C is "a measure of average glucose control over the previous 2–3 months" and the question of what the right target is for someone age 87 is now one with consensus on one right answer. Some researchers feel that metabolic syndrome and higher glucose are risk factors in mid-life, but that low HbA1C in the elderly may actually signal frailty. It may also be different for those who are apoE 4/4 and those who have diagnosed Type 2 diabetes.
https://www.diabetesselfmanagement.com/ ... ose-goals/
Here's a deep dive from our wiki on the topic of insulin resistance: Insulin Resistance

Second, your question on online lab companies: I've used Life Extension, which uses Lab Corp as the provider of the actual lab test. Life Extension then sends me (pretty quickly) a report with my results, the normal range and any additional info. Lab Corp happens to have a facility near me; I think you could check other online companies, or start with which labs are near you, but might want to first see what your mother's doctor would be able to order through her insurance.
It's great that she's on Vitamin D, a recent study suggested that having "normal" levels might not provide as much benefit as higher levels. Dr. Bredesen suggests between 50-80 ng/ml. The clinical trial I am in for healthy people ages 60-75 with ApoE 4/4 wants our B-12 levels to be above 500; Dr. Bredesen recommends a level between 500-1500. I would think her doctor might be willing to test for both of those through insurance.

Third, her history and current results raise a question for me to ask: Has anyone who gave your mother those blood tests and imaging test (an MRI, I'd guess) offered to explain the results to you? If not, I'd suggest calling to see if you can meet with someone. The fact that she is on a blood thinner suggests to me that she might have high blood pressure, and a risk of stroke. Multiple supplements could interfere with those blood thinners (ashwaghanda, for example, which is recommended for younger people on the Bredesen protocol at times).

The "diffuse atrophy" that you mention suggests to me that multiple areas of your mother's brain have begun to show loss of neurons (atrophy) that can have many causes, but is often seen in mild cognitive impairment, Alzheimer's disease and vascular dementia. The fact that she plays bridge (something my mother tried in vain to teach any of her 4 children), attends lectures and concerts and seems to enjoy life suggests she has many of the factors that keep dementia at bay. These are often called "cognitive reserve" and "resilience": the ability to for a high-powered brain to find work-arounds when one area starts to lose some skills, and the benefit of an optimistic view of old age.

Her difficulty with forming new memories suggests that her hippocampus, which helps to move working memories into long-term memories, is one of those areas of some atrophy. It is not clear to what extent people above the age of 85, who may have had decades of slow changes on brain function, can reverse decline. However, it is also true that the pace of decline after age 85 appears to be more gradual than those diagnosed with MCI at age 65.

I can't tell you what your mother would want, but I think it's worth having those conversations with her now. Dr. Atul Gawande's book Being Mortal is a great guide to how to ask questions about what matters at any age, no matter what our health. I can tell you that as someone with ApoE 4/4, who has seen a mother, mother-in-law, several aunts and a paternal grandmother slowly experience declines in their mid-80s, I will not be surprised if that happens. At the age of 66 I treasure my life, the work I've done, and my family. I hope at 87, if I'm still here, I still will treasure those things. But my family knows that if I start to dwell more in the present moment than the past days or weeks, and in the past more than the future, I don't want them to grieve that change, nor do I want heroic efforts to prolong my life. As much as possible, I want to still have a say in what music I listen to, what food i eat, when I wake and sleep, and how many babies I get to hold.

Your mother must feel the love that comes through in your posts. Trust that your love is your best gift, regardless of what her future holds.

[komatta]

Thank you so much for your reply. I am sorry to respond so late. I never got an email informing me that a reply had been posted, and just saw this now.
By coincidence, I just recently read Gawande's Being Mortal, as well as Better, another of his works. I always read his stuff in the New Yorker as well. Anyway, Being Mortal encapsulated much of my own situation. My mother was on the verge of going into independent living, even gave a downpayment, but at the last moment said she would prefer to stay at home if I could help her, so here I am.
I have asked for and gotten some other scan results. Nothing was mentioned about the hippocampus. Here are some of the findings in short---
scan of march 2018 says that there is mid cortical and cerebral atrophy in keeping with a patient of 86 years.
scan of 6-27018 says “diffuse peripheral cortical atrophy. central atrophy is also present.

Given the central atrophy, I wonder if she has type 3. Her problems, however, are more making new memories than computational, though she does have problems with the latter as well. Actually she has not been diagnosed with AD, just MCi, and she has no problem with daily activities of life, it is her memory that is failing. She doesn't feel confident paying bills or dealing with day to day business, and her driving is now limited to the market right outside the compound where she lives.
The neurologist who ordered the scans discussed them to the point of saying that there was no sign of stroke (we thought that she may have had one), and that they were "normal" for a woman of my mother's age. My mother's GP told me that the scans had revealed plaque and tangles. There was no discussion of the bloodwork, and most of what Bredesen talks about was not tested for. I just received a 23 and me kit for my mother today, and we will send it out tomorrow and see if she is positive for APOE4. I do intend to speak to my mother's primary dr. and see if she is interested in working with this protocol. A few months ago the dr. saw me reading Bredesen's book in the office and mentioned she had read something by him, but said that there is no clinical evidence for Bredesen's claims.
My mother's mother experienced dementia, though she never got to the point where she didn't recognize family. My mother looks so much now like her mother did at that age, that it makes me think that she is going the same way.
I am mulling over whether it pays to hire a coach, or if I should just put some of the easy parts of the protocol to work first. My mother had relatively minor surgery last week, and it really knocked her energy for a loop, so I didn't want to press any dietary restrictions. She has to go in for another minor surgery this week. All that being said, she still plays cards, goes to the theater, attends lectures and has a good social life.
I had to come back from overseas to help her out, and I am staying with her for the time being.
Please feel free to contact me anytime with any ideas, I am basically flying blind.
Take care

[SusanJ]

...if I should just put some of the easy parts of the protocol to work first.

Yes, that would be my advice. Sleep (search for that topic for ideas) and diet would be two places to focus right now.

Do you live close that you can help directly? Given she is going to have another surgery, maybe focus on some healthy, easy-to-eat meals (like soups with veggies - think easy to digest) to help her heal, which might be a stepping stone to some straightforward diet changes. I know from personal experience, it's hard to get our parents to change their lifetime of diet habits. Small steps.

And also know that if she is having anesthesia, she might be brain foggy with memory problems for a while after. Regardless of E4 status, it can cause those problems in the elderly. You might also consider a detox powder that you could make a smoothie from if she doesn't want to eat much. I personally use https://www.seekinghealth.com/optimal-d ... 4-servings. It's expensive, but pretty non-allergenic and easy to digest, and honestly I just use one scoop when I do use it. Start with adding one of her favorite fruits so she likes the taste of it. You won't need it forever - just while getting into her back in a regular eating schedule again.

And sorry I missed one of your questions, but yes, Aricept can cause upset stomach and diarrhea.