Tag Archives: Aging

Dr. C's Journal, Men's Health, Opinion, Women's Health

Doctor’s Journal: ‘Alcohol And Health’

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Alcohol has been used by mankind since before recorded history. It causes a pleasant slowdown of the nervous system, Lessening inhibition  and loosening the tongue, making it the perfect lubricant for social interaction. Unfortunately, it is a metabolic poison.

Excess alcohol use is common enough to have resulted in its prohibition in the United States in the 20s. The side effects of this prohibition proved worse than its benefits, and alcohol currently enjoys the status of one of the few legally permitted Psychoactive drugs.

After diligently searching for beneficial effects of alcohol, society discovered that mild drinking promotes longevity. It is difficult to drink just the right amount of alcohol, and  There is little doubt that excessive drinking is deleterious to the body.

The liver is the organ responsible for getting rid of alcohol. Unfortunately, liver function gradually declines with age, so that the older you get the less alcohol you can tolerate. 14 drinks a week is the suggested upper limits for alcohol’s benefit, and this number shrinks as you get older.

I became interested in alcohol in the elderly because of a friend whose doctor discovered that his red blood cells were enlarged. This can be due to alcohol in at least two different ways. If you drink too much alcohol, you need less calories, and often have a poor diet as a result. B12 (and folic acid) deficiency can result and may cause large red blood cells.

I also learned that alcohol can directly caused large red blood cells because of the toxic effects on the bone marrow, where Red blood cells are made. The very young also have more difficulty with alcohol. Early in my career I discovered 2 young infants who had convulsions after getting into their parents wine closets. These convulsions turned out to be caused by a low blood sugar which developed because glucose, the common blood sugar, is consumed in the process of burning, or metabolizing, alcohol.

My own use of alcohol has been progressively declining with age. I feel good with less alcohol for a shorter time the older I get.

—Dr. C.

Medicine, Men's Health, Resources, Women's Health

INFOGRAPHIC: ENHANCING BRAIN HEALTH ACROSS AN INDIVIDUAL’S LIFESPAN

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Opportunities for enhancing brain health across the lifespan

Published online by Cambridge University Press:  22 March 2021

Summary

As we age, there are characteristic changes in our thinking, reasoning and memory skills (referred to as cognitive ageing). However, variation between people in the timing and degree of change experienced suggests that a range of factors determine individual cognitive ageing trajectories. This narrative review considers some of the lifestyle factors that might promote (or harm) cognitive health. The focus on lifestyle factors is because these are potentially modifiable by individuals or may be the targets of behavioural or societal interventions. To support that, the review briefly considers people’s beliefs and attitudes about cognitive ageing; the nature and timing of cognitive changes across the lifespan; and the genetic contributions to cognitive ability level and change. In introducing potentially modifiable determinants, a framing that draws evidence derived from epidemiological studies of dementia is provided, before an overview of lifestyle and behavioural predictors of cognitive health, including education and occupation, diet and activity.

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Men's Health, TELEMEDICINE, Videos, Women's Health

Telehealth: Older Adults increase Use Of Virtual Visits from 4% To 26% (2020)

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From 2019 to 2020, there was a substantial increase in the proportion of older adults who reported that their health care providers offered telehealth visits. In May 2019, 14% of older adults said that their health care providers offered telehealth visits, compared to 62% in June 2020.

Similarly, the percentage of older adults who had ever participated in a telehealth visit rose sharply from 4% in May 2019 to 30% in June 2020. Of those surveyed in 2020, 6% reported having a telehealth visit prior to March 2020, while 26% reported having a telehealth visit in the period from March to June 2020.

Over the past year, some concerns about telehealth visits decreased among adults age 50–80 whether or not they had a telehealth visit. Older adults’ concerns about privacy in telehealth visits decreased from 49% in May 2019 to 24% in June 2020, and concerns about having difficulty seeing or hearing health care providers in telehealth visits decreased from 39% in May 2019 to 25% in June 2020. Concerns about not feeling personally connected to the health care provider decreased slightly (49% to 45%).

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Dr. C "Comments", Men's Health, Prevention, Women's Health

TOP NEW BOOKS ON AGING: “EXERCISED” BY DANIEL E. LIEBERMAN – “EXTENDING LONGEVITY” (HARVARD)

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HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:

‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’

What Happens When We Exercise?
The graph breaks total energy expenditure (TEE) into two parts: active energy expenditure, and resting metabolism. Resting metabolism remains elevated for hours even after exercise ceases, burning additional calories in a phase known as excess post-exercise oxygen consumption (EPOC).

Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.

In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.

Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.

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COMMENTARY

Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.

INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.

But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.

The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.

Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.

–Dr. C.

Dr. C "Comments", Men's Health, TELEMEDICINE, Women's Health

TELEMEDICINE: THE RISE OF TELEDERMATOLOGY (AMA)

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From AMA.org (June 12, 2020):

Teledermatology

“There’s an aging population, and there’s a lot of skin out there,” said Dr. Isaacs. “One in five people in the country develop skin cancer, but there is a plethora of benign skin conditions that also require the expertise of the dermatologist. So, you have increasing demand and a limited supply of dermatologists.”

A basic example of how the TPMG teledermatology program works involves a patient who is concerned about a suspicious lesion or mole on their body. The patient can take a picture of the location in question and send it to their primary care physician for review. The physician can request the patient come in for a more thorough evaluation, or if the physician determines that a dermatologist should be involved, they can send the photo to an on-call dermatologist to review.

If the patient does an in-person evaluation, the physician can also take a higher-quality image and forward that to a dermatologist. The dermatologist can then decide whether there is a problem, if a prescription is needed, or if there should be an in-person evaluation and potential biopsy.

A study in the Journal of the American Academy of Dermatology in 2019 found that when TPMG dermatologists had the chance to look at well-photographed skin lesions, they were able to identify nearly 10% more cancers with almost 40% fewer referrals to the dermatology department.

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COMMENTARY

A high quality I-phone picture of a skin lesion can provide the dermatologist with 90% of the information needed for a diagnosis.

Melanoma diagnosis depends even more on the visual. In fact, Artificial  Intelligence evaluation of Melanoma may be  overtaking dermatologist expertise.

Size can be indicated by including a dime in the photo.

It is true that the roughness, softness or hardness may be important in diagnosis, but perhaps these characteristics could be described by the Patient.

This week, I started worrying about an itchy, rapidly growing lesion on my back. I sent a picture of this to my dermatologist, hoping he would call it a wart and reassure me. It was very regular, soft, and had a rough surface like warts I have had in the past.

However, he saw some redness and had me come in for removal. We will see what the pathology shows.

Dermatologists are in short supply, and making more efficient use of their expertise attractive.

Calling the Doctor’s office, arranging for e-mail Photo transmission, and a talk with the Doctor on the phone could save a visit. The Primary Doctor could send you directly to the dermatologist, or might be comfortable with watching and waiting.

Dermatology is indeed a field ripe for Telemedicine.

—Dr. C.

Men's Health, Resources, Women's Health

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #3: ITCHING WITH DRY SKIN

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As I have aged, my skin has been more itchy. My allergy practice was loaded with Patients whose ECZEMA and HIVES itched. My favorite uncle developed intolerable itching (pruritis) in his 90’s, and died within a year of metastatic Prostate Cancer.

This gives you an idea of the Range of this annoying sensation. My emphasis here will be on CHRONIC ITCHING with DRY SKIN in otherwise HEALTHY PEOPLE without much rash or other skin condition. If you want extra discussion, look at Reference #1. If you are a Doctor, or a brute for punishment, see Ref.#2, a CME review.

Your skin is the largest organ in your body, and deserves respect right from birth. The skin of your child is wonderfly healthy in looks and self repair. EXCESSIVE SUN EXPOSURE is about the only thing you need to protect her from, and the only penalty is increased cancer risk in later life.

As your body ages, your skin looses some of its essential oils, and and becomes more dry (at least you don’t get acne any more). You become more sensitive to dry air, like in the winter, when the cold outside air (adiabatically) drops in relative humidity when warmed to inside temperature.

Do you notice the increase in static electricity shocks in the winter? If not, I’m sure that you do notice that your skin itches more. one treatment for the “winter itch” is to humidify the inside air. If you have a draughty old house like I do, it may be more convenient to use MOISTURIZING LOTIONS.

These were once mainstays of itch control in my former practice (before development of the effective modern medications). Eucerin and Cetaphil were very helpful. Maybe it is because of the name, but I now find myself using Curel “Itch Defense” all over my body twice daily,.

The itching is much less now, except for my EARS. My ear canals (they are skin too!) have recently been very dry and itchy, maybe because i listen to podcasts when walking or swimming.

Unwilling to give up my podcasts, I put some UNSCENTED Johnson’s baby oil with my little finger into my ear canals, as suggested by my ENT Doctor (I wanted to be sure i didn’t have a diagnosable condition like a fungal infection). If I have a small spot that itches a lot, I use some 1% Hydrocortisone cream, and I feel better.

Antihistamines don’t do much for me, but are effective if the itching is a real allergy (most of what people call allergy is not the IGE-MEDIATED, “real” variety). HISTAMINE is the quintessential provocateur of ITCH. Cetirizine (or atarax) is the strongest of available antihistamines, and diphenhydramine (benadryl) the old standby.

Chronic itching can be caused by a plethora of illnesses, as you will find if you choose to read the following papers.

– Dr. C

Reference #1

Reference #2

Men's Health, TELEMEDICINE, Videos, Women's Health

GERIATRIC TELEMEDICINE: NEW CONNECTIVITY AND CONVENIENCE AT HOME

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From Becker’s Hospital Review (May 1, 2020):

Connectivity in combination with mobile devices is making home-based services like telepharmacy and telemedicine a reality. These are great options if patients feel too sick to leave their home or they want a second opinion. It’s also possible to connect people in rural areas with academic medical centers. During the pandemic, the use of telemedicine has risen dramatically.

“Technology is enabling access to healthcare in many ways,” Holcomb said. “You no longer need to live in certain places to get access to great care, and you no longer have to go to your physician in person, for many aspects of a visit – this is helping people get care, even as they stay at home.”

Against the backdrop of the aging population and ongoing pandemic, technology is likely to continue to influence healthcare consumer expectations. Almost every aspect of life has been transformed by the emergence of digital conveniences. Digital technology is transforming industries, including shopping, communications and entertainment. Healthcare is no exception.

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Howard Fillit, MD: The Positives of Telemedicine Adoption for Geriatric Patients