Golden Oak Medicine PLLC

08/31/2026

how much of your energy is going toward something you can’t control?

You can’t control the progression of a disease, whether family members step up, or what has already happened. But you can decide where your energy goes next.

Try the Circle of Control exercise. It’s simple, but it can completely change how you approach an overwhelming caregiving day.

Follow for practical caregiver tools, dementia education, and support from a geriatrician who works with caregivers every day.

08/28/2026

Caregiving is hard enough. The story you repeat to yourself shouldn’t make it even heavier.

This isn’t about “thinking positive.” It’s about finding a way to hold what’s happening that is still true, but gives you a little more room to cope.

If you’re caring for a parent, spouse, or someone you love, try this today:

“Is there another way I can hold this that is still true, but hurts me less?”

Save this for the hard days. And tell me in the comments: What thought do you find yourself repeating most often as a caregiver?

I’m a geriatrician, and I’ll be sharing practical tools to help caregivers navigate the emotional and everyday realities of this role. Follow for more.

08/24/2026

If you’re caring for someone you love, no one really prepares you for how much this role can ask of you.

This theme has come up again and again in my conversations with patients and caregivers this past week. I’ve written about caregiving on GeriAcademy and have been developing a 12-module caregiver coaching program, but I realized I want to start sharing these tools here too.

Over the next several posts, we’ll talk about perspective, guilt, difficult emotions, family conflict, communication, healthcare advocacy, decision-making, self-care, and what happens as your caregiving role changes.

Because caregivers deserve more than being told to “take care of yourself.”

First up: perspective. Follow along for the series.

07/28/2026

Why does your APOE4 gene status matter BEFORE starting Alzheimer’s treatments like Leqembi or Kisunla? 🧠🧬
The APOE gene makes a protein that carries lipids—like cholesterol—throughout your brain. While we all inherit two copies, carrying the ε4 variant is the strongest genetic risk factor for late-onset Alzheimer’s.
But in the era of anti-amyloid therapies, APOE4 plays a double role: it also drives up the risk of ARIA (brain swelling or micro-bleeds).
Here’s why:
🔹 APOE4 carriers often have heavier amyloid buildup directly in cerebral blood vessel walls.
🔹 When monoclonal antibodies strip that plaque out, vessel walls temporarily weaken, causing fluid leakage (ARIA-E) or small bleeds (ARIA-H).
🔹 In clinical trials, APOE4 homozygotes (2 copies) had ARIA rates up to 45%, compared to just 13% in non-carriers.
This is why pre-treatment genetic testing and regular MRI monitoring are essential for patient safety

07/27/2026

Demystifying ARIA-E and ARIA-H in Alzheimer’s Disease Therapies 🧠👇
When prescribing or discussing new monoclonal antibody treatments for Alzheimer’s—like Leqembi (lecanemab) and Kisunla (donanemab)—understanding ARIA (Amyloid-Related Imaging Abnormalities) is essential for patient safety. 
Here is what happens at the vascular level:
1️⃣ Why it occurs: Amyloid plaque doesn’t just collect between neurons; it embeds in the muscular layer of cerebral blood vessel walls. When therapies rapidly pull amyloid out, vascular tight junctions temporarily weaken.
2️⃣ ARIA-E (Edema): Fluid leaks across the weakened vessel lining, causing localized brain swelling.
3️⃣ ARIA-H (Hemorrhage): Microscopic leakage of red blood cells leads to micro-bleeds or superficial siderosis (iron deposits). 
💡 Why the MRI schedule matters:
The vast majority of ARIA cases are asymptomatic. Patients don’t feel headaches, dizziness, or visual changes, yet imaging displays active edema or micro-bleeds. 
Mandatory safety scans—starting right from baseline and continuing through critical early dosing milestones for both Leqembi and Kisunla—allow clinicians to catch ARIA early, hold infusions, and let the brain stabilize before resuming treatment safely. 
💬 Clinicians: How are you navigating ARIA monitoring and informed consent discussions in your practice?
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07/26/2026

Core Clearance vs. Protofibril Neutralization: Understanding the Two Scientific Paradigms in Anti-Amyloid Therapy 🧠
In Part 2 of our series, Dr. G evaluates Kisunla (donanemab-azbt) and how its therapeutic mechanism differs from continuous maintenance models.
Key Clinical Breakdown:
1️⃣ Targeting the Plaque Core: Kisunla selectively binds to N3pG-amyloid—a modified protein species located inside established plaque deposits.
2️⃣ Finite Dosing Model: By focusing on rapid plaque removal, treatment can be paused once amyloid clearance is confirmed via PET scanning (over 70% of trial participants completed treatment within 18 months).
3️⃣ Clinical Efficacy Comparison: Phase 3 trial data demonstrates that both plaque-core targeting (donanemab) and soluble protofibril targeting (lecanemab) slow early-stage clinical progression by a similar margin (~35–40%).
As clinicians, moving past the “which drug is superior” debate allows us to focus on what matters: matching continuous maintenance versus finite dosing strategies to individual patient profiles.

07/25/2026

Why don’t doctors just stop treatment with Leqembi once an amyloid scan looks clear? 🧠👇
Everyone’s brain naturally produces amyloid protein every day. The main issue isn’t just the hard plaque sitting in the brain, it’s when it forms into toxic, floating clusters called protofibrils (think loose mulch instead of a heavy rock).
In Part 1 of our series, Dr. G breaks down the mechanism of Leqembi: removing mature plaque while binding to those floating protofibrils before they disrupt neural connections.
Because the brain keeps making amyloid daily, fresh protofibrils keep forming, which is why treatment stays ongoing.
What are your thoughts on continuous maintenance therapy? Drop them below! 💬
👉 Follow for Part 2!
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07/22/2026

An unaddressed bump to the head from years ago might be impacting your long-term memory capacity more than you realize 🧠 This is the next vital pillar on our official list of preventable cognitive risks: midlife head injury prevention. Even mild concussions or minor head trauma can trigger an immediate cellular cascade that disrupts the delicate blood-brain barrier. This structural disruption can ignite low-grade, chronic neuroinflammation that smolders silently in your tissue for decades, quietly eroding your cognitive reserve long before clinical symptoms present themselves. Prioritizing neurological safety and proper recovery in your 40s and 50s is an absolute necessity for healthy aging. Disclaimer: This information is shared purely for educational purposes and does not replace professional medical advice—always discuss any history of head injuries or concussions with your physician. Save this video as a quick neurological reference, drop your thoughts below, and hit follow for the next factor! 🛡️✨ wellness

07/03/2026

Your routine at your desk job might be doing silent damage to your mind’s natural growth factor 🧠 This is the next crucial factor on our list of preventable cognitive risks: midlife physical inactivity. Remaining seated for long stretches significantly slows your system’s production of BDNF—a vital protein responsible for protecting your memory architecture and building resilient neural pathways. Incorporating movement isn’t just about physical fitness; it acts as a direct chemical shield to preserve your long-term cognitive reserve. Disclaimer: This information is shared purely for educational purposes and does not replace professional medical advice—always discuss your physical activity goals and health history with your doctor. Save this video as a daily reminder to stay active, drop your thoughts below, and hit follow for the next factor! 🏃‍♂️✨

06/26/2026

It was an honor to be on the Final
Approach podcast with Jonathan Knaul talking about caregiving❤️https://podcasts.apple.com/us/podcast/final-approach-human-stories-from-high-stress-professions/id1852323392?i=1000771885674

Podcast Episode · Final Approach: Human Stories from High-Stress Professions · June 9 · 1h 6m