Category Archives: Interviews with experts

Guest interviews help readers figure out how to solve care dilemmas.

Memory and Anesthesia

Memory loss can be aggravated by many lifestyle factors. But  physicians are now finding that medical treatments requiring anesthesia may also have a sudden, negative impact on Alzheimer’s patients — even in early stages of the disease.


In her recent article for InSight, a Memory Center publication,  writer Lisa Bain describes the case of Doris Reimann, who woke up after hip surgery unable to speak  clearly. Doris never walked again and failed to regain her mental faculties. Similar accounts of post-op cognitive decline prompted Dr. Steve Arnold  to look at the connection between surgery, anesthesia, and Alzheimer’s. Other Penn researchers have done the same.

Dr. Roderic Echkenhoff  has observed the results of studies done with lab animals. Anesthesia has been shown to produce “lesions in the brains of mice that mimic those found in brains of people with Alzheimer’s disease.” But surgery itself is a catalyst for the brain’s inflammatory response. It is difficult to determine which of the two factors carry the greatest risk.

While there is abundant anecdotal information from families and clinicians, Dr. Arnold explains that there is not enough data to suggest that surgery or anesthesia should always be avoided. After all, surgery is usually recommended when people are suffering pain that can’t be managed in other ways. Nevertheless, he urges families to talk to their “primary care physician, surgeon, and anesthesiologist about their concerns before surgery with anesthesia” is carried out. This kind of conversation can’t wait until after the operation!

Dementia and Dental Care

Since my mother started grinding her teeth, I’ve been on the hunt for dental services that are affordable and safe for someone with dementia. I wish I could tell you I found some, but I now think it’s impossible to find care that is prompt, safe, and covered by Medicare insurance.

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Mom is from a generation deeply scarred by childhood encounters with cruel, old-school dentistry. Although she bought a long-term care plan before she got dementia, she didn’t think much about her oral health. She has a Medicare Part B insurance plan which covers dental check-ups, but almost none of the providers listed in the directory are accepting new patients. Those that  are adding to their patient roster have long wait times for an appointment. Others on the list may give you an appointment but they require that you pay out of pocket. One provider — where she got a basic check-up last year — told me that most dentists don’t accept Medicare coverage because the reimbursement rates are so low. According to the billing office at that clinic, they get less than ten percent of what it actually costs to treat a patient.

While affordable dental care eludes the elderly, it’s also a problem across our entire society. According to Bonnie Kavoussi’s June 26 article in the Huffington Post, “one in three Americans can’t afford to see the dentist” and more than 100 million Americans do not go to the dentist for checkups and cleanings because of the cost. The issue is explained in greater detail in a PBS special produced by FRONTLINE and the Center for Public Integrity. According to the FRONTLINE program — Dollars and Dentists — “one in four Medicare beneficiaries are missing all of their natural teeth — a problem that threatens not only among the elderly, but also the very poor.”

The PBS special also reveals ways that for-profit providers have taken advantage of elderly people who need dental care. According to FRONTLINE, companies like “Aspen Dental offer credit cards and payment plans to help people finance their procedures if they can’t afford it. But the cards, which are provided in the dentists’ offices, come with hefty financing rates. Aspen says it only offers financing when the care is absolutely necessary, but former employees tell FRONTLINE they were rewarded for getting patients to buy — and finance — as much dental care as possible.” Heather Haynes, a former Aspen employee, stated that, “Even if they had insurance, we were still required to push the finance options on them, and still proceed with the paperwork.”

At this point, we’ve decided to take my mother to a hospital-based clinic and make the up-front investment in solving her problem. The first appointment will cost $125 — nearly as much as her monthly Part B health premium. We know we’re in for more big bills afterward. But ignoring her dental problems is not an option. Eating is one of her few remaining pleasures. If she breaks her teeth, even that sweet joy could disappear.