Category Archives: Health

Intimations

Much to my surprise, I experienced atrial fibrillation — a rapid and quite disturbing heart beat —  on July 4, while we were visiting our condo in Virginia. It happened during my morning jog, but exercise might not have been the cause. Risk factors include age, heredity, caffeine, too much wine, and even Lyme disease. Anyway, it was off to the emergency room for me, where they restored my heart’s normal rhythm with medication.

Now I’m in for lots of examinations and tests. I’ve already had one excellent consultation in Virginia. Soon, I’ll be wearing something called a Holter monitor and undergoing an echo electro-cardiagram.

The internet is helpful in assuring me that this condition is “common,” and indeed, as I mention it to folks, I find that many have had it.

But an experience like this makes a senior think. This aging thing cannot be ignored. I don’t know what life style changes the docs will mandate when my tests are done, but I’m sure there will be some. I’m expecting a stern lecture on moderation in all things.

The experience has convinced me that the downsizing path we’re following is the right one. We need less stuff and a smaller house. And best if it’s near our protective tribe, not to mention a major medical facility.

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Link: “Polypharmacy” and Its Risks for Seniors

Are seniors taking too many pills? Some are, according to the New
York Times, as a result of what it calls “polypharmacy.”

We seniors visit our various specialists, and each one prescribes something for one of the problems they deal with — high blood pressure, acid reflux, thyroid, rosacea, or whatever. Then we hear about some supplement that’s in fashion and start taking it too — fish oil, perhaps, or Vitamin D, or zinc. After a while, our weekly pill boxes can get chock full, forcing us to buy a larger model to accommodate all our meds.

“Pretty soon, you have an 82-year-old man who’s on 14 medications,” according to one of the physicians interviewed by the Times.

Some interactions among common medications can be dangerous, the Times reports. Taking a statin for cholesterol with amlodipine for high blood pressure can lead to muscle spasms and weakness. I used to take both of these together — guess I was lucky.

I thought about Sally down in Florida as I read this article. The kindly neighbor who rescued Sally after her fall commented, “There were pills everywhere.”

The solution is to be upfront with all the medical practitioners you consult. Let them know about everything you are taking — the non-prescription medications and supplements as well as the prescription drugs. But that’s not enough. After all, my physicians knew I was taking a statin with amlodipine, but none of them said anything about it.

A further worthwhile safety measure is reading the enclosures that come with prescriptions alerting you to side effects and interactions. Keep an eye out for articles like this one in the Times. And, don’t hesitate to ask your physicians about why they are prescribing drugs and what you need to know about side effects. Some may not credit you with the intelligence to handle the information, but more likely they are under the pressure of time.

Be your own advocate.

 

Medicare and Hearing Aids: An Old Prejudice

We’ve been reading in Pat Thane’s book, A History of Old Age, that as hospitals developed in the nineteenth century, the ailing old often found themselves kept out. Doctors and hospitals wanted to cure their patients, and the old were regarded as having an incurable disease — old age — with a known pathology of slow but steady decay. The general view was that the old are inevitably going to loose their teeth, their eyesight, and their hearing, just as they are going to suffer impairments of the mind, digestion, and the heart; and nothing was to be done about it. There was no sense in trying to treat the problems of the old.

Such a primitive view, the reader thinks. Thank heaven we live in a time when so many of the infirmities of old age can be cured or treated and held at bay. We have our medications for gout, glaucoma, indigestion, and high blood pressure. We have our cataract surgeries and our knee and hip replacements. And we’re thankful for it.

But the attitude that the old must endure their suffering prevails in the exclusion of hearing aids, eyeglasses, and dental care under Medicare. Back in the 1960s, when the Medicare law was drafted, hearing loss, declining eyesight, and loss of teeth were regarded as routine accompaniments to aging, not conditions that should be corrected.

Let’s just take the problem of hearing loss. According to a recent New York Times article,

“Congress banned Medicare coverage of hearing aids 50 years ago because ‘people thought hearing loss was just a normal part of aging,’ said Dr. (Christine) Cassel, one of the authors of a recent JAMA editorial on hearing health policies. ‘They didn’t see it as a disability or a medical problem.’”

The hearing aid exclusion is a big problem for America’s seniors. AARP notes that 9 million people over 65 are afflicted by hearing loss, yet according to another source only 30 percent are actually using hearing aids. Cost is a major factor. Estimates of the average cost of a hearing aid range from $1,300 to $3,000, and most people need two of them.

Uncorrected hearing loss is more than annoying to the victim and those close to the victim — it’s dangerous. Drivers and walkers need good hearing in order to avoid accidents. Studies show that those with hearing loss have more falls, more hospitalizations, and more physical and mental problems overall.

Worst of all, hearing loss is associated with dementia and abnormal brain shrinkage. Dr. Frank Lin of Johns Hopkins has found that the brain’s “temporal gyri,” involved in hearing, are particularly affected by shrinkage among the hearing impaired; but these structures also “play roles in memory and sensory integration and have been shown to be involved in the early stages of mild cognitive impairment and Alzheimer’s disease.”

Hearing loss is anything but a routine aspect of aging that can be safely ignored. Representative Debbie Dingell of Michigan recognizes this and has introduced H.R. 1653, the Medicare Hearing Aid Coverage Act, to end the Medicare hearing aid exclusion. Florida Democrat Alan Grayson has gone her two better with H.R. 3308, the Seniors Have Eyes, Ears, and Teeth Act, requiring coverage of eyeglasses and dental care as well.

Meanwhile, the President’s Council of Advisors on Science and Technology is recommending federal actions to decrease the cost of hearing aids and to make a basic model available over the counter.

Congress fell victim to a primitive view of old age in 1965, when it excluded hearing aids from coverage under Medicare. The time for action to correct this mistake is long past.

 

 

 

Lessons From DeVita’s “Death of Cancer”

What practical advice can a common-sense senior glean from Vincent Devita’s book, The Death of Cancer? DeVita doesn’t shy away from the practical side of things — in fact, he devotes his final chapter, Outrageous Fortune, Part II (Part I was about a friend) to describing how he dealt with his own prostate cancer diagnosis.

One lesson from that chapter is that the person receiving the diagnosis is not in a good position to be making decisions alone. Someone newly diagnosed is going to be anxious and worried, and won’t be hearing everything the physicians have to say. DeVita himself, a world renowned cancer treatment expert, found he wasn’t thinking clearly and had to turn to a friend, another world renowned cancer expert, for guidance in his decision-making.

The problem is that most of us don’t happen to count cancer experts among our friends. So let’s hope that when the time comes, we have a doctor we trust as well as friends and family who can support us emotionally and even help us with our research.

Research is going to be necessary. DeVita has a rather disturbing few pages on the best places to go for the treatment of various types of cancer — and it’s information that the lay-person would be challenged to discover. Fortunately, DeVita assures the reader, “the United States has the best cancer care in the world. Not all patients receive their care at cancer centers, nor do they need to. Much of cancer care can be delivered at community hospitals.”

But someone diagnosed with an unusual cancer, an advanced cancer, or a type with a poor survival rate, should be at a center, DeVita writes, that is “cutting edge” and practicing “state of the art” cancer treatment and management.

How do we find such places? DeVita has his recommendations, writing that the National Cancer Center in Bethesda, the Dana-Farber Cancer Center in Boston, and the Stanford Cancer Institute are the best places to go for treatment of lymphomas. DeVita goes on — “Yale may be the best place to go for cutaneous T cell lymphomas but not for any other type.” “The Mayo Clinic is good for state of the art care for common tumors, but I wouldn’t send someone there who needed something creative or inventive.” “The best place for adult leukemia therapy is MD Anderson in Houston, Texas.”  You can read other such recommendations on pages 238-239 of DeVita’s book, but it’s time-sensitive advice. As time passes, some centers will improve and others may decline.

Anyway, how is a lay person to find out which is the best center for his or her particular situation? That’s where the research comes in. It’s going to require asking a lot of questions, doing a lot of internet research, and perhaps, as dear friends recently did, traveling to potential treatment sites to form your own opinion.

DeVita favors centers that devote themselves exclusively to treating cancer patients to university-based centers with a variety of other priorities. He advocates aggressive treatment over treatments that may leave the patient more comfortable, but have, in his view, little chance of success. And he wants patients to have access to the latest and best approaches, such as combination targeted chemotherapy and immunotherapy. There might be a new treatment available now, he argues, that will enable a patient to survive for several years, when something even better may have come along to give still more years of life.

DeVita’s book has certainly convinced me that advanced, aggressive treatment at the best possible facility would be worth a try. Whether I would still feel that way should I live into my eighties is a question, though I would probably still give a first round of treatment a shot. Maybe by then, cancer will have been well and truly conquered, though I doubt it.

 

 

Noted Physician Predicts End of Cancer As Major Health Issue

DeathofCancerWe seniors all have our little ways of whistling past the graveyard. Some avoid making a will. Some avoid completing an advance directive. For years, I’ve avoided reading about cancer. This is not acceptable in a common-sense senior, so when I saw that Dr. Vincent DeVita’s book, The Death of Cancer, was getting good reviews, I decided to mend my ways.

Perhaps it’s just as well that I waited, since the book is an education in the tremendous progress that has been made against cancer over the past few decades — so much progress that DeVita predicts “the end of cancer as a major public health issue.” No one could be better qualified to make such a judgement. DeVita has been a clinician and cancer researcher since the 1960s, director of the National Cancer Institute, physician in chief at Memorial Sloan Kettering Cancer Center, director of Yale University’s Cancer Center, and president of the American Cancer Society.

Thanks to advances in chemotherapy, the use of combined therapies, immunotherapy, and other progress, childhood leukemia, Hodgkins disease, and several other types of advanced lymphoma are now almost completely curable. Mortality from colon cancer and breast cancer has dropped sharply, and major advances have been made against ovarian cancer, advanced melanoma, prostate cancer, and even lung cancer.

Mary Lasker, presenting an award in 1957

Mary Lasker, presenting an award in 1957

This progress has been achieved largely through government programs and government spending — something those who want to slash the federal budget should think about. Government efforts got a big boost in 1971, when President Nixon, with bipartisan support in Congress, launched the War on Cancer. DeVita is fascinating on the role of Mary Lasker, philanthropist, socialite, and skillful manipulator of vain politicians, in making the War on Cancer possible through passage of the National Cancer Act.

Of course, the War on Cancer hasn’t been a happy story of a straight-line advance to victory. The original goal of conquering cancer by 1976, the bicentennial year, was adopted by Lasker as a lobbying tool, but was never realistic. That original goal has sparked numerous damaging stories over the years about the failure of the War on Cancer — a claim that DeVita is at pains to debunk.

His tale, however, is full of descriptions of epic clashes between institutions, departments within institutions, and famous physicians that make the reader grateful we’ve gotten as far as we have. Renowned cancer centers have resisted adopting new and better approaches or modified treatment protocols for unscientific reasons, rendering them ineffective. Surgeons have persisted in performing disfiguring radical mastectomies to treat breast cancer, despite evidence that lumpectomy followed by chemotherapy is more effective in preventing recurrence. DeVita even suggests that some physicians have continued using outdated treatments of various sorts, and denounced those advocating new approaches, simply because their incomes depended on it.  He is particularly biting in criticizing the Food and Drug Administration for delays in approving new drugs for use in cancer patients who have no other option than death.

The Death of Cancer is a gripping, highly informative book that is well worth reading. But what does it mean for a common-sense senior who faces a cancer diagnosis? Or who faces such a diagnosis in a loved one? Where do we turn? How do we find the best treatment? Common Sense for Seniors will look at these issues in an upcoming post.

 

 

 

 

 

 

Link: Eat Fish To Avoid Alzheimer’s

My canned fish collection

My canned fish collection

Here’s an article with a straightforward title: “To Reduce the Risk of Alzheimer’s, Eat Fish.”  Turns out there’s a catch: fish only help if you happen to carry a gene associated with the disease. Still, if we don’t know whether we have that gene, eating fish sounds like a good idea.

I’ve been a believer in fish, particularly fatty fish, for quite a while — but because they are rich in Omega 3s, which help with cholesterol. Take a look at the fish collection in my cupboard. And now, for an anchovy sandwich.

Link: Not Fair To Say “Never Put Me In A Nursing Home”

Thanks to the Washington Post for “Promise You’ll Never Put Me In A Nursing Home.” It’s not fair to ask a spouse or other loved one to make this promise. The fact is, any of us may need skilled nursing care one day.  We shouldn’t make our loved ones agonize over the decision, when the time comes.  A better course is to look around for the kind of place we might like to be, if necessary, and to let our loved ones know.

Link: Geriatricians In Short Supply

Physicians specializing in geriatric care are an endangered species, according this article in the New York Times. They are scarce in the area where I’m living, though we do have a couple of internal medicine practitioners who list geriatric medicine as a second specialty.

A geriatrician discussed in the article treated one patient on the day of the interview for pressure ulcers, a poorly dressed wound, dehydration, and depression. These were all problems that afflicted Sally down in Florida. The poorly dressed wound was a particular problem. I wish she could have seen a geriatrician.

Seniors are increasing in numbers all around the country. We should find ways of increasing the numbers of physicians trained to treat them.