At present, there is no single diagnostic test for Alzheimer’s disease. Instead, the diagnosis is reached when the medical practitioner (e.g. psychiatrist, general practitioner, geriatrician, or neurologist) has eliminated all other possible causes of the symptoms being experienced; an overview of these symptoms is provided in a previous Hull & Hull LLP blog of February 17, 2009. As a result, the diagnosis is generally coined ‘probable Alzheimer’s disease’ and this thin wedge of uncertainty often leads to an inability to accept the diagnosis as well as resistance to care and treatment. An autopsy is currently the only means of confirming the diagnosis of Alzheimer’s disease.
The Associated Press reported last week, however, that the first commercial version of a test designed to detect Alzheimer’s disease in its early stages could be available in as few as 12 to 18 months. According to Dr. Daniel Alkon, scientific director of the Blanchette Rockefeller Neurosciences Institute (the Institute has teamed with Inverness Medical Innovations Inc. for this endeavour), the test works by detecting abnormal function of a protein that is known to be involved in memory storage.
Early diagnosis will have a multitude of benefits: incorrect diagnosis of the disease based primarily on a patient’s behaviour can be greatly reduced, lifestyle changes can be made which may slow the progression of the disease, the patient and their family may gain valuable time to plan for the future, and those with a family history of Alzheimer’s disease will have tangible information with which to move forward.
Jennifer Hartman, Guest Blogger
"I regard large inherited wealth as a misfortune, which merely serves to dull men’s faculties. A man who possesses great wealth should, therefore, allow only a small portion to descend to his relatives. Even if he has children, I consider it a mistake to hand over to them considerable sums of money beyond what is necessary for their education. To do so merely encourages laziness and impedes the healthy development of the individual’s capacity to make an independent position for himself." – excerpt from the last will of Alfred Nobel, 1833-1896
Born in Stockholm on October 21, 1833, Alfred Nobel was the third son of Immanuel Nobel, an engineer and inventor, and Andriette Ahlsell. After being sent abroad for study, Alfred became best known for mixing siliceous earth with nitroglycerine, forming it into a rod, and coining it ‘dynamite’. In addition to his obvious attraction to science, innovation and industrialism, Nobel was also drawn to social issues, as touched upon in a previous Hull and Hull LLP blog .
On November 27, 1895, Nobel signed his third and last will in Paris. It was handwritten on a yellow notepad, with notes scribbled in the margin, and Nobel had discussed it with no one. (Click here for the full text of the will).
After he died of a stroke at his villa in Italy in 1896, shock and controversy ensued when it was discovered that Nobel had bequeathed the bulk of his fortune (the equivalent of $214 million in today’s money) for the establishment of what would come to be known as the Nobel Prizes: coveted and prestigious annual prizes in five categories, awarded without distinction of nationality. Ragnar Sohlman and Rudolf Lilljequist, two of Nobel’s young engineers, were named as executors, and one of their first tasks was to collect Nobel’s far-flung assets and move them quickly back to Sweden before French authorities could make claim to the money. Nobel’s shares, bonds and documents were rounded up and hurried to the Swedish consulate in Paris by horse-drawn cab, escorted by Sohlman, who was armed with a revolver ‘at the ready in case of direct attack’.
The will was incredibly controversial, and was indeed flawed, imprecise and legally deficient. Apparently Nobel had had such negative experiences with lawyers (‘niggling parasites’, as he referred to them) when defending his dynamite patents that he had drawn up the will himself. Initially, Nobel’s permanent domicile could not be easily determined since he had lived in so many countries. To complicate matters, the executors were left the task of forming the Foundation, which was done in Sweden where the will was eventually probated. Nobel had not even consulted the various Prize-awarding institutions to seek their consent to participate in the awarding of the Prizes. Most surprisingly for Nobel’s relatives, this third will contradicted an earlier will in that Nobel’s heirs, instead of receiving twenty percent of the estate would now only receive specific legacies. Two bitter nephews quickly challenged the will and tried to have it declared null and void, however, another nephew residing in Russia told Sohlman about the Russian concept that the executor is ‘the spokesman of the soul’ of the testator. King Oscar II of Sweden added fuel to the fire when he dismissed Nobel’s wishes as ‘nonsensical’ and ’not patriotic minded’ because his property would now be dispersed internationally. King Oscar II later recanted his disapproval when he realized that publicity about the prizes might, in fact, benefit Sweden, and in 1902, handed out the first prizes to the laureates on December 10, the anniversary of Nobel’s death.
Jennifer Hartman, guest blogger
Who is the third who walks always beside you?
When I count, there are only you and I together
But when I look ahead up the white road
There is always another one walking beside you
– T.S. Eliot, The Waste Land, 1922
I just finished reading a fascinating book authored by John Geiger called The Third Man Factor: The Secret to Survival in Extreme Environments. When faced with edge-of-death circumstances, numerous people throughout history have encountered what is commonly referred to as ‘the Third Man’. Confronted by life at its extremes, these people have had the sense that they were suddenly joined by a friendly, trusted presence – a guardian, if you will, who “led them out of the impossible”. The Third Man Factor details many of these remarkable experiences, highlights the common threads of extreme physical and mental distress, monotony and isolation, and explores the domains of physiology, sociology, religion, neurology and psychology to flesh out the meaning of the appearance of the Third Man.
In 1895, while attempting to complete the first solo circumnavigation of the world, Joshua Slocum’s sloop-rigged fishing boat Spray was caught in a violent storm. Slocum became convinced of another on board who steered the boat through the gale while Slocum huddled in the boat’s cabin, sick with food poisoning, but unworried. Slocum had experienced the Third Man phenomenon, someone to whom he referred as his ‘invisible helmsman’. An account of Slocum’s surreal encounter was published in the Boston Globe on October 14, 1895, under the headline “Spook on Spray”.
Other Third Man experiences include:
· Reinhold Messner, legendary Italian mountaineer and the first man to summit Everest solo and without supplementary oxygen. In 1970, after having summited Pakistan’s 8,126 metre Nanga Parbat with his younger brother Günther, the two became separated on the precarious descent, and Messner soon came to the horrific realization that Günther had been swept down in an avalanche. It was then that Messner encountered a lone phantom climber calling out to him, comforting him and eventually guiding him down the mountain to safety.
· Ernest Shackleton, British explorer, and head of the Imperial Trans-Antarctic Expedition of 1914-1916. After his ship Endurance became trapped in ice and was destroyed, Shackleton (pictured below) set off on a perilous 36-hour trek across the mountains and glaciers of South Georgia in an attempt to seek rescue. In his book, South: The Endurance Expedition, Shackleton wrote that “…it seemed to me often that we were four, not three.” He referred to this fourth man as a ‘Divine Companion’. It was Shackleton’s experience that actually inspired T.S. Eliot in The Waste Land.
· Charles Lindbergh, early aviator. In 1927, during the first solo, non-stop trans-Atlantic flight from New York to Paris, Lindbergh encountered ‘vague outlined forms, disembodied beings’ aboard the Spirit of St. Louis while desperately trying to stave off profound exhaustion. These forms not only reassured Lindbergh, but discussed navigational problems and advised him on his flight.
Hallucination? Divine intervention? Sensory illusion? Visit www.thirdmanfactor.com to join a forum for a more in-depth discussion of this phenomenon.
Jennifer Hartman, guest blogger
I think that in a year I may retire. I cannot take my money with me when I die and I wish to enjoy it, with my family, while I live. – Harry Houdini, Magician and Escapologist
When I was around 6 or 7 years old, I was unequivocally obsessed with Harry Houdini. My brother and I used to have contests at the local pool to see which of us could hold our breath the longest. He always won, and I’d end the day a few nickels lighter.
Born Ehrich Weisz on this day in 1874, Harry Houdini emigrated with his family from Budapest to the United States in 1878. As a young man, Houdini’s initial attempts to establish a career in magic were relatively unsuccessful; he even had to double as ‘a Wild Man’ carnival act. Harry met his kindred soul in Beatrice (Bess) Raymond, a teenager trying to succeed in show business as a singer and dancer. They married in 1894. After meeting manager Martin Beck, Houdini found his niche in escape acts: handcuffs, ropes, straitjackets, and chains. His most memorable act was to escape “The Chinese Water Torture Cell” (pictured below). To develop his breath-holding capabilities, Houdini even had an oversized bathtub installed in his house so he could practice regularly.
In the fall of 1926, after having broken his ankle while performing the Chinese Water Torture stunt, and after several sleepless nights caring for Bess after she suffered a bout of food poisoning, Houdini was in his Montreal dressing room chatting with a college student who also happened to be an amateur boxer. The student asked Houdini if it was true that Houdini could withstand any blow to his body above the waist. A weakened Houdini replied yes, and began to rise to his feet, but before he had time to tighten his abdominal muscles, the boxer punched him three times. Houdini suffered a burst appendix, and later, peritonitis. He died on the afternoon of October 31, 1926 at age 52, and was later buried in his bronze ‘buried alive casket’, his head resting on a black sack of letters his mother had written him while alive. No autopsy was performed. In his 23-clause-long will, which had been prepared in 1924 with a codicil added in 1925, Houdini left his collection of over 5,000 books (valued at $30,000) to the Library of Congress. His brother Theo received most of his magic equipment and memorabilia; however, Houdini stipulated that the magic apparatus be ‘burnt and destroyed’ upon Theo’s death. Two assistants received $500 each, while The Society of American Magicians received $1,000. His ‘hat rabbits’ reportedly were given to the children of friends. The balance of Houdini’s estate went to Bess, and it was enough to cover his extensive debts and to allow Bess to live comfortably. Bess also received $50,000 in life insurance money, since Houdini had remarkably purchased a double indemnity life insurance policy in the event of his accidental death.
The Chinese Water Torture Cell secret remains a mystery to this day, and my breath-holding record stands at 1:03.
Jennifer Hartman, guest blogger
One form of Advance Directive is the Do Not Resuscitate Order, commonly referred to as a DNR Order, or simply a DNR. It is a written order, signed by a medical professional, indicating one’s desire that lifesaving measures not be initiated if one were to stop breathing or if one’s heart has stopped. A DNR Order is generally only put in place when a person is suffering from a serious, often terminal condition, and when ‘CPR will almost certainly not benefit the patient and is not part of the plan of treatment’.
Up until February 2008, an odd, but not insignificant loophole existed that prevented paramedics and firefighters from honouring any existing DNR while a person was being provided with emergency assistance on the scene, or while in transport to a medical facility. The Ambulance Act’s Basic Life Support Patient Care Standards, Version 2 meant that paramedics were legally obliged to initiate life support measures, including, but not limited to, chest compressions, artificial ventilation, and intubation. Perhaps 911 had been called in order for the person to be transported to a hospital to be rehydrated, or to be treated for an infection. Prior to February 2008, if something catastrophic were to thereafter unfold en route, emergency resuscitation measures would have been initiated, possibly with unimaginable consequences, even if a DNR order was provided to the paramedics or firefighters on-site.
In order to address this disconnect between personal wishes, best intentions and legal constraints, a DNR Task Force was struck in 2003. As a result, there is a new Do Not Resuscitate Confirmation Form that became the new standard in Ontario as of February 1, 2008. Once completed by a physician or nurse, the form authorizes paramedics and firefighters to withhold life support measures, as well as to provide palliative comfort care measures such as suctioning, oxygen, pain control (including morphine) and tranquilizers. This form can be viewed online here.
Jennifer Hartman, guest blogger