Written Sunday, October 22, my birthday

I have written before about the scarcity of doctors for older people. 

When we reach our seventies and older, the body begins to break down more and more. Some people can forgo those complaints if they have a great immune system, but as we age our immune systems grow weaker, just as when we were little children. Face it young folks, it happens to us all.

I can tell when my immune system is sick now by how badly my multiple chemical sensitivity is acting up. If I feel good, have no aches or pains, no headache or difficulty breathing when I go to the grocery store, I can shop, go up and down the aisles polluted with scented products on the shelves or by perfume worn by customers, and have no serious repercussions.

But today, my birthday, I had to go to the store. I was out of many things I use every day. Yesterday I was in bed more than I was up. I slept most of the day just as I did when I was a child with the flu, but I did not have the flu. Thankfully, all that sleep was healing and today I feel weak but much better.

My immune system is not acting properly and has not for some time. Diabetes is an autoimmune disease. Fibromyalgia is an autoimmune disorder and so are several other things that plague my life. From conversations I have with older women, I hear they have many of the same aggravating problems I have. Their doctors have no good resources for them. Symptoms are treated as well as the doctor knows how to treat them. 

Where are the geriatric doctors? 

With our population growing older and older, this level of medical doctors is dwindling. Doctors don't want to deal with old people. After all, they are going to die before too long, so no one goes into that field. But with good care, an older person can live in her home possibly until she dies, which is what most of us want. Of course that also depends on the financial situation.

A thirty-five-year old doctor has not a clue what it is like when an older patient says "I am too tired or don't have the energy to take a shower some days."

A young doctor will tell an older patient, "You need to just get out and walk. Start with 20 minutes, then add to it until you walk at least 30 minutes every day. You will feel so much better."

The older patient has trouble with his feet, his hips hurt after only a few minutes on his feet. He gets sharp shooting pains in his feet and his hips feel weak so he is afraid he will fall. His balance is not good anymore so he can't walk on uneven surfaces. But Young Doctor can't imagine being in that shape. He ignores the patient and continues, "Just walk some every day. You'll soon be enjoying it."

Give me a doctor who has watched his parents get old and saw what happened to them. Give me a doctor who has compassion for the older patient and listens, tries to understand what it would be like to have those physical symptoms.

I have seen how doctors treat older people, men and woman. Nurses have much more compassion and understanding. I wonder if we can educate doctors as to what they should look for and how they can help older patients. And would they want to learn and would they do it?

In my experience, doctors seem to think they know it all. But they make mistakes. One doctor told me I had colon cancer and even if a biopsy said differently, he was convinced. My biopsy showed no malignancy.

My husband was told he had osteosarcoma, but he did not. A biopsy showed he had lymphoma. His cancer doctor told him he could live five or more years with this but he lived one year.

A doctor gave my father a drug to calm him down in the hospital and my father went into respiratory arrest and died from that drug.

My brother-in-law was prescribed a medication on the phone by his regular doctor. He died within a day from side effects of that drug. With his medical history, it was obvious he should never have been given that particular medicine.

Recently I talked with people and we discussed how often a doctor even touches a patient today. They often do not, except to feel under the throat. I was told by a Gastroenterologist that they don't need to touch the patient. There are machines that do those tests. 

I still think it is important for a doctor to feel of the abdomen if stomach pain or discomfort is present and use their hands when necessary to look for tumors, swelling, or pain. When you have a physical exam, don't you expect more than some blood tests and a urine sample? I also think an older person should have an annual physical although some group said the annual physical is no longer needed. Really?

We need doctors who treat the whole body, not the part that hurts today, but the entire body because that pain could be coming from somewhere else.

And doctors need more than fifteen minutes with the patient in order to do that.

Elderly patients are often seen by four or more specialists. One treats the thyroid. Another treats the lungs. A cardiologist checks on the heart. A gastro doc prescribes for the stomach and that area.  Another works on the feet and another on the eyes and ears.

Each of them may prescribe a medicine to the patient. How many of those drugs interact with each other and how many more drugs are given for those side affects. 

It is no wonder older people are sick so often. I think the meds make them sicker than they were before going to the doctors. Cutting back on meds is often the patient's call. Doctors hardly remember what they prescribed for you nor why. 

I recently asked that my blood pressure medication be cut back. After some resistance, I was told to halve my once-a-day pill. My blood pressure is still doing well and I was told that new studies show people my age should not have their blood pressure too low. That could lead to falls which would be more life threatening.

No matter what kind of insurance our country finally settles on, I am not sure we will get better care in this country, especially the older population. 

What Your Doctor Won't Tell You About Getting Older by Mark Lachs, M.D.

Originally published as: Treat Me, Not My Age

 This is an eye-opening book. This is called a survival manual for outsmarting the health-care system.

Two things he says that I like:

1. Geriatricians stop more medications than they prescribe.

2.  If you are taking supplements or vitamins, don't be afraid to say. It is important for the doctor to know what you are taking. 

I like his idea, "If you have seen one eighty year old patient, you have seen only one eighty year old patient."

So many tell patients, "Well, you are getting older and that is probably your problem."  I hate that kind of remark. Dr. Lachs does also.

This book gives names of places to go to for more information on alternative treatments and he doesn't frown on using them, although he is a conventional doctor. 

I wish we had more geriatric doctors and that more people would see them instead of feeling ashamed to do so. We are all going to get old, so why not look for the medical care that fits our needs. Find a doctor who understands ageing. And read Dr. Lachs' book.

Young Doctors - Mature Patients - Health issues

Young Doctors and Older Patients

By Glenda Beall in 2007



We live in an area with a large number of retirees, but it seems most of the doctors I see are all still wet behind the ears. I’ve lived with this body of mine for over a half century, but the young girl with the stethoscope sized me up immediately, and put on her smuggest smile as I recited to her all the ailments I sought medical help for in the past 10 years. No point in going back any further. I’ve tried that and I’ve seen the eyes glaze like a talk show host who has Bill Cosby for a guest. I could see the wheels turning inside that pretty little head, and I knew she was thinking about how fast she could get rid of me. The doctor wanted to hear about one symptom she could prescribe for right now, get me on my way, so she could get on to the next fifteen minute appointment.

I usually prefer women doctors as I think they might understand a woman’s particular problems better than a man, but a young man or a young woman has no idea what it feels like to be old enough to be a member of AARP. I’ve had medical assistants and nurses talk to me like I was five years old.

“Come on, Sweetie, come right in here.” She held my chart in her hand, but couldn’t call me by name. I’ve been seated between two technicians who acted like I didn’t exist as they talked over my head about shopping or people they both knew. That kind of behavior dehumanizes a person.

Now -- if I were frail and deaf and blind, maybe she would need to talk to me in a way that was different from the way she talked to the 40 year old who came in ahead of me. But I am an active, busy person with a schedule that keeps me going from morning until night. I have no hearing problem. I walk in under my own steam and I can see just fine.

In all the books, magazines, and online websites having to do with being a smart patient, it says take an active part in your health management. Talk freely to your doctor about what you want and need. When I do this, I get an “attitude” from some of the young doctors. It is almost like they are afraid I might know something about my own health that they don’t know, and they feel I’m challenging them. That is the last thing I want to do. Those of my generation have been taught to listen and do everything a doctor tells them to do. Sometimes that can be a big mistake.

An older friend of mine fell last week for no apparent reason. She didn’t trip. She didn’t break any bones. Just got up to go to the bathroom and fell in the doorway. After I talked with her, I found she was taking so many prescription drugs I’m surprised she could get out of bed. Besides two Atavan every day, she took Ambian and 50 mg of Elavil every night. And she couldn’t figure out why she felt so “tired” all day and had no energy.

It breaks my heart to see people, like my eighty-four year old friend, go to the doctor with no advocate by her side. Once she went in to have the batteries replaced in her pacemaker, but she was sent to the hospital for a replacement and an overnight stay. She had no time to prepare mentally or physically and the whole experience was traumatic for her.

“I have to do what my doctor tells me to do,” she said.

My husband Barry fired his doctor and I was proud of him. After a number of years with a man who truly seemed to understand older patients, he had to go to a new doctor in the same practice. Barry is a gentle and charming man, but this young fellow who was cold and unfriendly, told my husband, “At your age, you can’t expect to feel good.” Now Barry has a new doctor who is nearly as old as he is and they get along fine.

I refuse to become a victim of the medical world, but what can you do? If I had a heart attack, I’d need a doctor. If I develop serious symptoms, I need a doctor to diagnose my problem. But I’ve had three members of my family die, not from a disease, but from medical mistakes. One died from being prescribed the wrong drug. My father died from being over-sedated while sick with pneumonia, and one died, not from cancer, but from MSRA, the infection he caught while in the hospital.

My young, arrogant endocrinologist fires off questions so fast I can’t understand them. She doesn’t want to take time to listen, but just wants to pinpoint one symptom and go after it with ten thousand dollars worth of tests. Someday these sassy self-confident doctors will reach my age, if they are lucky. They will look back and realize they could have been a little more considerate and patient with the Medicare group who often don’t have just one problem, but have a number of things going on as time wears on us and eats away at our main frame.

I don’t know what is taught in medical schools these days, but I’m beginning to believe the TV shows are imitating life. The competition and ego evident in medicine is no different than in any business. I believe we have made great strides in caring for seriously ill patients with cancer, heart disease and specialty surgeries, and in other fields, but where are the doctors who want to treat the not so rare common aches or pains or help prevent them in the first place. Where are the doctors who understand why most of us have sleep problems and need a little help getting our rest so we can feel like volunteering at the Food Pantry the next day? What doctor listens when told I have piercing pain in my head for a few days once or twice a year and it has been going on for twenty years. I’ve been told it is some kind of neuralgia, but no one has identified it.

Do I have it now? No. But can I have something for the pain so I can endure it next time? No, just come to see me when it happens next time.

I don’t bother to tell her that it often happens in the night or on weekends or many times when she is not available. What good would it do? I’ll just go to the ER if I can’t stand the pain like I’ve had to do many times before.

I made the mistake of going to a doctor for congestion and a cough which had affected my voice so badly I could no longer sing in the church choir. Now, after three years, about twenty thousand dollars worth of tests, many chemicals ingested from the prescription medicine I’ve taken like a guinea pig, and after seeing three different specialists, I’m told I probably will just have to live with it. I didn’t need to be told, I had already figured that out.

But what can you do when the ENT doctor says the inhalers prescribed by the pulmonologist are causing the throat problem, but the endocrinologist says it is the thyroid gland causing the hoarseness? I want to do what one lovely gray-haired lady told me as we both sat in the waiting room of yet another young lady doctor.

“I just don’t go to doctors,” she said. “I’m only here to bring my sister who had a stroke.”

She smiled and appeared very pleased with herself. I was envious. Later, after seeing the doctor, when I made my appointment for an MRA and an MRI, I wondered what would happen if I fired all my doctors. After all the tests, I know I’m pretty healthy except for a few things I’ve managed for many years already. I know someone who goes to the public health department every so often and gets blood work done, but never sees a doctor.

My favorite medical person is a nurse practitioner who listens and really cares about her patients. I never feel like she is trying to get rid of me so she can get to the next appointment. She allows me to take a part in my own care. She understands when I tell her I know what I need to do about my diabetes, but I need her to order the blood tests. She understands when I get emotional about a loss, and she is sympathetic, not uncomfortable. She understands when I am frustrated with all the tests a specialist ordered which found absolutely nothing, and she assures me that I own my body and can make decisions whether to continue a treatment or not.

If she held seminars and taught some of these young doctors and nurses about bedside manner and how to interact with older people, our medical profession would be enhanced in this area. But who can tell a doctor anything? These fresh-faced kids come out of school already knowing everything ─ everything except how to recognize and respect the needs of older people.

Cancer floor at Emory Hospital

Tonight I'm just pouring out a stream of conscious writing as I can't get focused on anything but the swirling of decisions, choices, fears of mistakes, that have overwhelmed my world since last Tuesday when my dear love and I were admitted to the hospital. I say I was admitted because even though he has the malignant leg, he and I have taken every single step of this journey together and we will until the end. We had a scan, we are on a pain pump, we have great nurses, we don't like arrogant doctors, and we will deal with all of this as one.
When you have been with someone for 45 years, you cannot imagine being separated from each other. I have spent each day and each night beside his bed, waking when the inevitable medical person slams through the door to his room at midnight just as his breathing has settled into a sweet rhythm that tells me he is in a good deep sleep.
My anger at that kind person who only wants to check his BP and make sure he is doing well, seeths awhile after she leaves, stealing my badly needed sleep.
The TV high on the wall runs constantly around the clock. No sound emits from the mouths of the faces there. Today an old Bonanza brought smiles as Little Joe and Hoss turned jokesters on Pa. The young nurse from Tennessee had never heard of nor had any interest in the Cartwrights. She tends to seriously sick people who come and go and come again to the rooms on E floor.
Each night I see the woman in the red striped pajamas pushing her chemo contraption as she gets in her twenty laps before bedtime. Last night she told me her story. In a couple of weeks she would begin the chemo treatment that would destroy her immune system, killing her cancer cells but also her good cells and prepare her for the stem cell bone marrow transplant that would save her life. She fully expects this procedure to give her time to see the babies of her lovely daughter who walks with her on her nightly rounds.
Although we'd never met before, the five minutes we talked sealed a bond between us. She, pale and bald, her blue eyes naked of brows and lashes, hugged me, encouraged me, and promised we were at the best place in the world to cure us from this cancer. She was convinced she would survive and wear pink at the Relay for Life races every year with her granchildren. I wished I felt as sure - not just for us, but for her - for that lovely daughter who supported her mother all the way.
If there is one thing I've learned over the years of caring for loved ones, there is no sure bet when it comes to medicine. The elderly woman who was at death's door waves from her wheelchair as she leaves with her son. The nine year old who was laughing yesterday, lies in a pool of sweat tonight with robotic electronics blinking and beeping around her bed.
The woman's family had been called in. Doctors shook their heads and said there was no more they could do.
"It's a miracle," exclaimed a young resident as the wheelchair disappeared in the elevator. "No," said Dr. Smith. "It's God's way of showing us we don't know S--t."