Friday, October 24, 2008


Lou Gehrig’s Disease: Amytrophic Lateral Sclerosis

Amyotrophic Lateral Sclerosis (ALS) is best known for its most famous victim, Lou Gehrig. It is a devastating neurologic disease that eventually ends in the death of its victims.

ALS is one of a group of motor neuron diseases that results from degeneration of motor nerve cells at their origin in the spinal cord and peripheral extensions. Motor nerves stimulate and nourish voluntary muscles. When they cease to function, muscles become wasted and eventually paralyzed. Patients suffering from ALS lose their ability to move including eating, breathing and speaking.

ALS affects approximately 30,000 Americans and 60 percent are male. Life expectancy is between three and 10 years. Respiratory complications are most often the cause of death. Some patients choose to live longer through the use of artificial nutrition and a respirator. ALS does not affect a person’s ability to think. The loss of speech is the greatest obstacle and significantly diminishes a patient’s quality of life.

Although there is an inherited form of ALS, the overwhelming majority of patients, more than 90 percent, suffer from the sporadic, non-inherited form.

The diagnosis of ALS is made by the combination of a thorough neurological examination and diagnostic studies that include nerve conduction studies and electromyography. There is no specific marker in blood or tissue samples.

Many treatments have been attempted over the years. The only FDA- approved drug at this time, Riluzole, marginally slows disease progression, extending survival an average of three months. Rehabilitation, including the use of mobility aids and devices for communication, are most effective.

Little progress has been made in finding a cure for this devastating disease. Like most medical challenges, improved funding may have a remarkable impact.

On Nov. 2, a benefit walk for ALS will be held at Norwich Free Academy. The proceeds will benefit the ALS Association. If you are interested in supporting this event, contact or visit

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC in Norwich. To contact Dr. Alessi, email him To purchase his recently published “Healthy Sports: A Doctor’s Lessons for a Winning Lifestyle” book, visit

Monday, October 13, 2008


Uncomfortable feeling of dizziness has many causes

Dizziness is a general term often used to describe a sensation of unsteadiness. Almost everyone has experienced this sensation and just mentioning the word immediately evokes an uncomfortable feeling.

Normal balance requires three principal structures directing accurate information to the brain:
Eyes. Visual input is key to being oriented in space. Many patients struggle to maintain balance in poorly lit areas and when vision begins to fail.
Sensory nerves. Nerves conducting sensory impulses, particularly pressure and sensation from the feet, are crucial. Patients suffering from peripheral nerve damage find balance a real challenge.
Inner Ear. The inner ear serves as a balance mechanism. Similar to the air bubble in a carpenter’s level, any movement of the head will cause the bubble to move. In the inner ear, this bubble moves along fine, hair-like nerve endings that send signals to the brain. An infection or trauma may cause these signals to be distorted.

Vertigo is a particular form of dizziness that involves a false sensation of motion, particularly a feeling that either the person or their surroundings are spinning.

Some common causes of vertigo include:
Benign Paroxysmal Positional Vertigo. Typically seen in elderly patients who experience dizziness with a change in position. It results when normal-appearing calcium crystals in the inner ear become dislodged.
Vestibular Neuronitis or Labyrinthitis. Results from inflammation or infection of the inner ear.
Meniere’s Disease. Excess build-up of fluid in the inner ear. Hearing loss accompanies the vertigo.
Migraine. Vertigo can be seen just before or during a migraine headache episode.

Dizziness and vertigo require a multi-disciplinary approach that begins with a thorough evaluation by a primary care physician. Sometimes a neurologist or an ear, nose and throat specialist may become involved. Imaging studies of the brain like a CT scan or MRI are often performed as part of the work-up.

Treatment is also varied depending on the cause. Physical therapy, including vestibular rehabilitation exercises, has been very effective for benign paroxysmal positional vertigo. Medications such as antibiotics, antihistamines, steroids and migraine medications may also be indicated.

Vertigo is a complex and disabling cause of dizziness. If you wish to learn more about this, go to our Healthy Living blog at and join the conversation. Patients, family members and medical experts on this subject will be sharing information on an ongoing basis. It is only by working together that we can produce positive change.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital and in private practice at NeuroDiagnostics, LLC in Norwich. To contact Dr. Alessi, email him To purchase his recently published “Healthy Sports: A Doctor’s Lessons for a Winning Lifestyle” book, log on to

Friday, October 10, 2008


Splitting pills can be safe and save you money

Looking for a way to save money on the cost of your medications? Pill splitting may be one option for you that is often overlooked.

Pill splitting is the practice of breaking a double-strength tablet in half and taking just a half piece. For example, if you are prescribed to take 20mg of simvastatin every day, you could split a 40mg strength tablet in half and take just a half-tablet each day (each half would be 20mg).

If you ask around, you may find some who frown upon this practice, but they are usually the ones selling the medications. Here are some frequently asked questions about pill splitting:

Why would someone split pills?
Many medications are available in a variety of tablet strengths. Often the cost difference between the different strengths is very small. By splitting tablets in half, people save money on the cost of their medications.

In the example above, if the 20mg tablets cost $1 each, and the 40mg tablets cost $1.25 each, then a 30-day supply of 20 mg tablets will cost $30. However, for a 30-day supply using a 40mg tablet, only 15 tablets are needed at a cost of $18.75.

Is pill splitting safe?
When done properly, splitting pills and taking the prescribed amount is clinically the same as taking a whole pill at the same dosage. The slight difference that occurs from pills not being perfectly split down the middle is inconsequential.

What medications can and can not be split?
There are many pills that should never be split. In general, any sustained or controlled release medication, or medications with specially coated tablets can cause significant harm if split. Some people believe that any pill that has a line down the middle can be safely split, but that is not true.

There is no easy way to determine which medications can be safely split and which can’t other than asking an expert. Before splitting any medications, speak to your pharmacist about whether or not it is safe to do so.

Who should not split pills?
If you have vision problems or difficulty handling your pills due to arthritis or another medical issue, you should not attempt to split pills. If you have questions concerning your ability to split pills, you should discuss this issue with your doctor. Another option would be to ask a capable family member to do it for you.

How can I split pills safely?
Pills should only be split by using a “pill-splitter”. They are small and inexpensive devices available at any pharmacy and are designed specifically to safely and evenly split pills. Using a knife or razor is an inaccurate and unsafe practice; pill pieces will shoot across the room and you might split your fingers as well.

What should I do if I want to start pill splitting?
If you are considering pill splitting, you should first discuss it with your pharmacist. They can inform you if your medications can be safely split and if it could save you money. The second step is to discuss this issue with your physician. If both you and your doctor are in agreement to begin tablet splitting, then your doctor needs to give you a new prescription to obtain the double-dose tablets with the instructions to “take one-half tablet.”

Michael Smith is a pharmacist and Clinical Coordinator in the Department of Pharmacy Services at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. If you want to comment on this column or other health topics, go to the Healthy Living blog at or e-mail Smith and all of the Healthy Living columnists at

Wednesday, October 01, 2008


Cinnamon: A Fall favorite with health benefits

With weather beginning to get colder and the leaves changing color, it’s time to think about all the favorite foods we love to eat in the fall. With most desserts, such as apple and pumpkin dishes, the spice of choice is cinnamon.

Cinnamon comes from an evergreen tree that grows approximately 30-50 feet, originating in Sri Lanka and India. Wikipedia would tell you that cinnamon has “antimicrobial properties” (used to help preserve food) and kills mosquito larvae (good insect repellent).

However, more recent clinical research has been associated with the effects of cinnamon on blood sugar levels.

A study published in the American Journal of Clinical Nutrition in June 2007 found that when a teaspoon of cinnamon was added to rice pudding, “gastric emptying” was delayed by almost 3% and it improved post-meal blood sugar levels.

One gram of cinnamon was used in this study, approximately equal to a half a teaspoon. Another study (discussed in the Journal of the American Dietetic Association) saw improvements in blood sugar and lipid levels (cholesterol).

Cinnamon has approximately 6 calories per teaspoon, 28 mg of calcium, and contains 5%of your daily value of iron and 20% manganese, and has no sodium or fat. It also contains a little more than one gram of fiber, which could be part of the reason for the delay it may cause in emptying your bowels.

With few calories and added fiber, cinnamon is an excellent choice for spicing up your fall recipes. Next time you reach for dessert this season, add extra cinnamon to your recipe, or try adding it in oatmeal, beverages (cider), breads, or mixed with fresh apple slices. Who would have thought a spice would be so nice?

Whitney Bundy is a registered dietitian and Director of the Food & Nutrition Department at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Bundy and all of the Healthy Living columnists at or comment on their blog at

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