WHAT’S IN A NAME?

Pick’s disease, as it was known back in my day (whenever that was) is now frontotemporal degeneration. Watson Fields is hosting a meeting for effected families in a few weeks to see how they’re doing and if we can do anything to help.

Pick and Alzheimer were contemporaries and armed with microscopes, scalpels, staining fluids and rigorous, disciplined training and approaches, examined the brain tissue of many people with dementia, post mortem, and identified brain pathologies and locations of them which healthy brains should not have. The inductive leap, as John Steinbeck would say in Sweet Thursday, was that these were the disease-causing entities.

And we were off to the crusades, now 100 years and more of the war on dementia, to find out a lot of things that we still don’t know.

Are the foreign bodies viruses-no; bacteria-no; men from mars-no.
Are they the cause of the disease, or a manifestation of it? Think of a cut healing over with the scab the scab is the healing, not the disease, but it looks creepy and I can imagine mistaking the scab for the pathology instead of the curative process.

Our hospital unit crusade, 1984-1999ish involved seeing many people, eventually figuring out that their symptoms were caused by dementia, not schizophrenia, viruses, bacteria, or women in the moon.

OK, here’s all we’ve got for 100+ years: we know what they don’t have, that the symptoms are hard to mediate and the diseases are degenerative and fatal.

So we picked on Pick and decided we’d sound much more scientific by describing where the disease is found in the frontal and temporal lobes and what happens the brain shrinks and deteriorates and the normal tissue gets pushed around by Pick’s bodies, made of unnatural proteins and the human being loses his brain and mind functioning.

Add frontotemporal degeneration to the list of phenomena we know exist but don’t know why and have nothing to offer for reversing and curing the disease.

But this is not to say we aren’t going to treat it. By staking out the allopathic boundaries of medicine, anything that doesn’t cure or reverse is relegated to another category of practice.

That’s where palliative and later hospice come in. FTD is a nasty disease for which a decrease in the suffering of the patient and family with a multidisciplinary approach is a good outcome. Add in some quality of life like a ride to the beach, some fried clams and Blue Moon and the company of your family and dementia community and we’ve redefined successful treatment.