Nov 122016
 

HEALTH November 2016

A Healthy Age

By Amy Abbott

The magnitude of opioid use among seniors is astounding …nearly a third of Medicare beneficiaries receive prescriptions for commonly abused opioids, including OxyContin, Percocet, Vicodin, and Fentanyl or generic equivalents.

While the mainstream media reports on the opiates epidemic, another concern about opioid use hide in plain sight. Nearly 12 million Medicare recipients received at least one prescription for an opioid painkiller last year, according to a federal report.

“The magnitude of opioid use among seniors is astounding,” according to Frederic Blow, director of addiction research at the University of Michigan medical school, in “StatNews.” The article also noted that nearly a third of Medicare beneficiaries receive prescriptions for commonly abused opioids, including OxyContin, Percocet, Vicodin, and Fentanyl or generic equivalents.

 

Why should seniors and caregivers be mindful of opioid usage?

Suzanne Robotti, founder of MedShadow, a New York-based consumer advocacy group, spoke to Senior Wire News Service about why seniors are often prescribed opioids.

“Here’s a common scenario. Seniors may experience back pain, migraines, hip pain, arthritis knees, pulled muscles, or whatever.” She said. “Some people will not take NSAIDs — ibuprofen or naproxen — because stomachs and aging kidneys will not tolerate them.”

Robotti said many seniors do not like to take acetaminophen (Tylenol) because the difference between an effective dose and a toxic dose is just too close. She added that a physician might suggest a patient “take an Aleve and give yourself a couple of days.”

Many seniors will come home with an opioid instead of the other options, and sometimes it may be prescribed by a dentist for a procedure like a root canal.

“In aging bodies, metabolism slows down. Our kidneys and liver are organs through which drugs pass, and the organs now move more slowly. Drugs are in the body much longer, so the half-life is longer,” she said. “A drug that might last six hours in a 50-year-old body could last 50 percent longer in a senior.”

She explained that older people often don’t want to challenge their physicians. “It is typical that if a medication indicates ‘take at breakfast and dinner for ten days or as needed, that patient will take at breakfast and dinner for ten days’ whether necessary or not.”
Why Do These Drugs Act Differently in Aging Bodies?

According to Robotti, “They up your dopamine level and slow down your pain receptors so that you feel less pain.” These benefits explain why opioids are beloved.

But, as she continued, “The medications slow everything down. For some seniors, slowing of systems is a bad idea.” Robotti spoke of new drug for opioid-induced constipation due to slowing of bowel function for older adults. Constipation may lead to yet another medication.

Anyone with breathing problems should be mindful. “Opioids typically depress respiration in all age groups. Of course, older adults are more likely to suffer from COPD and other respiratory diseases from long-term smoking to simply living a long life. Many things like pollution and asthma may cause respiratory problems.”

Many opioids, alone or in conjunction with other prescribed drugs or over the counter medications, may impair cognition. This may lead to a higher risk of falling, and the consequence of a broken bone.

Robotti also worries about herbal remedies and supplements because they are unregulated by the FDA, which only gets involved if there is a problem. If someone needs an herbal remedy or supplement, Robotti recommends consulting a pharmacist about which brand is the best. Not all supplements and herbal remedies are created equal, and Robotti believes pharmacists can help make an informed decision.

 

What’s the Wise Health Consumer to Do?

Robotti offered suggestions: talk to your medical provider and pharmacist, use the Beers Criteria, and try non-drug options. “And don’t just say ‘should I take this drug’ but ask ‘how does this work in my body. Is there a non-drug alternative for me?’”

  • Medical providers: The Beers Criteria is a great go-to for information on medications. The list is available online at www.americangeriatrics.org. According to Robotti, “The Beers criteria goes through all the scientific documentation and notes which drugs should not be given to seniors. This list is clear, simple, and trustworthy and is the first place I turn to when I need information.”Robotti believes that the fewer drugs taken, the more options open. She says “Delay, delay, delay.” To clarify, Robotti is not recommending seniors abandon all prescription medication, but rather be involved in an active, ongoing dialogue with all medical providers about the drugs’ benefits and concerns.
  • Pharmacists: Robotti cites a resource right under our nose, our local pharmacy. “Pharmacists know which drugs will interact and can suggest alternatives. Go to your neighborhood drug store and just as you do at your doctor’s appointment, hand your pharmacist a list of your prescriptions. You will want to include every supplement and herbal remedy as well, as they can also have multiple side effects.Robotti admits to a fondness for pharmacists because “doctors are healers and diagnosticians, but pharmacists are drug experts.”
  • Non-drug options: Robotti is a champion of non-pharmacologic options. Many seniors turn to opioids for pain, when meditation and physical therapy may do the trick.

“There have been several studies that have shown pain can be effectively managed by non-drug options. Our society has an attitude that nobody should be in pain for any moment of the day. I am not suggesting that people live with chronic pain. If the pain is temporary and you know there is a cause for it, try meditation, ice packs, cognitive behavioral therapy, and putting your feet up. Give yourself the chance to heal before reaching for an opioid.”

Robotti started MedShadow borne of her own experience – she was exposed to the synthetic hormone Diethylstilbestrol (DES) while in her mother’s womb. She formed the group to help consumers understand that many drugs have unintended consequences. DES was prescribed from 1938 to 1971 to women at risk of miscarriage and other problems of pregnancy. It was taken off the market 45 years ago when discovered a relationship with cancer in the children born from women who took the synthetic estrogen.

Final word? Please consult your personal health care provider about what is best for you.

Nov 122016
 

HEALTH November 2016

A Healthy Age

By Amy Abbott

The NWS reports there are 25 million clouds-to-ground lightning strikes per year. While your chances are probably as good as winning the lottery, why take the chance? Golfers and football players know the secret. If there is lightning in the area, get indoors. If you are in a car, make sure it has a hard top.

Mildly Obese Diabetes Easier Access to Bariatric Surgery

More than 415 million people globally have diabetes. Of that number, most have Type 2 diabetes mellitus. Fewer than half of adults with Type 2 diabetes can control blood sugar with medication and lifestyle changes, according to Diabetes Care.

Cleveland Clinic, in conjunction with the American Diabetes Association, recently published the results of a new clinical trial. When Body Mass Index (BMI) is reduced, diabetics are better able to manage their disease. The new guidelines help physicians understand the role of bariatric surgery in patients with diabetes and a high BMI.

The study analyzed 11 randomized, controlled trials to compare the success of surgery versus medication intervention and lifestyle improvement. The new guidelines drop the eligibility threshold from a BMI of 35 to 30, which according to Cleveland Clinic, opens up the possibility of bariatric surgery to more than three million Americans.

The official Medicare site (Medicare.gov) noted that Medicare pays for some weight loss surgery for morbidly obese patients. Some commercial insurance plans pay as well. Consult your doctor and insurance plan for more information.

 

However, Doctor, I Was Struck by Lightning!

The National Weather Service reports that more people in the United States have been killed by lighting this year than tornadoes. By September 12, 2016, according to the NWS, 35 people died from lightning strikes. In contrast, 12 individuals died from storms during the same period.

“This year seems to be unusually high,” said John Jensenius, a lightning safety specialist with the National Weather Service in Gray, Maine. “That is because of the totals have been in the 20s for quite some years now, since 2009.”

Has lightning increased or are we more cavalier to nature’s ultimate light show?

The NWS reports there are 25 million clouds-to-ground lightning strikes per year. While your chances are probably as good as winning the lottery, why take the chance?

Golfers and football players know the secret. If there is lightning in the area, get indoors. If you are in a car, make sure it has a hard top.

“When you are struck, you have electricity moving through your body,” Jensenius told the magazine Live Science. “The electricity typically goes through either the cardiovascular or the nervous system.” Cardiac arrest is the usual cause of death.

 

Disagreement on Osteoporosis Coverage

Osteoporosis is pervasive among seniors and causes weakened bones that lead to fractures. Many women have stopped taking medication that may help them avoid the condition, reported a recent New York Times article.

Use of the most popular prescribed osteoporosis drugs fell by 50 percent from 2008 to 2012, according to the article.

Earlier this summer, the American Society for Bone and Mineral Research, the National Osteoporosis Foundation, and the National Bone Health Alliance, asked physicians for more aggressive treatment for patients at highest risk.

“Ninety percent of patients, when you talk to them about starting one of these drugs, won’t go on,” said Dr. Paul D. Miller, medical director of the Colorado Center for Bone Research, Lakewood, Colorado.

Fueled by media stories, the fear for patients is cracked thighbones or rotting jawbones. While the FDA provides a warning in the package insert, these side effects have been rare. Many physicians feel the benefit of the drugs in preventing fractures outweigh the slight risk of the unusual side effects.

The medical community knows that often a fracture may be the start of a slippery slope of bad health for an older individual.

 

Potential Glaucoma Treatment May Eliminate Daily Drops

Science Daily noted that 3 million people with glaucoma in the U.S. could benefit from a new device that slowly releases eye medication. The promising research by Dr. James D. Brandt, director of the University of California Davis Medical Center Glaucoma Service focuses on a silicone ring resting on the eye. A time release, the ring released medication slowly over six months.

As a person with glaucoma for more than a decade, I fight the daily battle to remember my eye drops. We only have two eyes, so one would suspect the motivation is high. Seniors all have tricks to remember our medication; pills may be easier than drops. This new technology could provide vision-saving technology to individuals like me.

Glaucoma remains a leading cause of blindness. People with glaucoma have increased intraocular pressure, and the drops are taken daily lower the pressure and, in turn, permanent damage to the optic nerve.

This new technology requires a visit to the ophthalmologist every six months for a replacement and does not involve surgery.

The UC Davis study showed a well-tolerated device and a high retention rate of 89%.

“In making effective treatments easier for patients, the hope is that we can reduce vision loss from glaucoma, and possibly other diseases,” said Dr. Brandt.

Oct 012016
 

HEALTH October 2016

A Healthy Age

By Amy Abbott

Internal factors affecting hair color over time may include genetic defects, hormones, body distribution, and age.  External factors may include climate, pollutants, toxins, and chemical exposure.

* * * * *

When the wheel of fortune landed on me, I started graying at age 28. I covered my hair with a series of subtle and sometimes outrageous colors, tints, and highlights. When I finally stopped that expensive madness, my hair was nearly all gray and is now turning white.

October 1, 2016  In spring 2016, researchers identified the primary gene responsible for graying hair, noted a study inNature Communications. This research study may someday lead to a pill that prevents what now seems inevitable – the graying of our hair.

Newsweek reported, “Researchers analyzed the DNA of 6,000 people from Latin America to locate the genes that determine hair color, texture, density and other attributes such as whether a person’s hair is straight or has corkscrew curls.” The magazine noted that the study included people of mixed European, Native American and African origin, which represented a mixed gene pool.

What’s your story? Do you blame the broad swath of human history, or pin it down onwhite-haired Grandma Nellie?

My mother’s only sister will be 88 this fall. Except for a few strands of gray near her face, my aunt’s hair remains the lovely auburn shade she had as a girl. My mother, who is her half-sister, had jet black hair that started turning gray then white in her 30s.

When the wheel of fortune landed on me, I started graying at age 28. I covered my hair with a series of subtle and sometimes outrageous colors, tints, and highlights. When I finally stopped that expensive madness, my hair was nearly all gray and is now turning white.

My mother and her sister shared the same father, but different mothers. My aunt’s mother died in childbirth, so we’ll never know if her auburn hair would have lightened. My aunt’s grandmother lived well into her 90s with that striking auburn hair.

My mother’s mother, my grandmother, had dark hair that turned early, as did my mom, as did mine.

“Hair graying is a natural age-associated feature,” reported the National Institute of Health, “The hair graying trait correlates closely with chronological aging, but it occurs to varying degrees in all individuals. Hair is said to gray prematurely if it occurs before the age of 20 in Caucasians and before 30 in African-Americans.”

Twenty or 30? Are you kidding me? Many of my friends in their 60s and 70s are still hitting the bottle (the hair dye bottle) regularly, and not acknowledging this process is happening.

I accepted the inevitable in my mid-50s. You honestly can’t fool Mother Nature, but I tried. In the last years before my decision to let it go, my stylist highlighted my hair, either by pulling strands through a cap or using strips of aluminum foil. One of Buck Rogers’ space creatures might have felt at home next to me in the salon when I underwent this uncomfortable transformation.

Only one downfall and uncomfortable situation. Security demands new passport photos be shot against a white background. I won’t be using my new passport photo for holiday cards anytime soon, as I faded into the background. It wasn’t my finest hour. That fading out wasn’t a problem ten years ago with my last passport photo when my hair was an unknown, chemical color.

What causes this change? Why do some people gray and others keep their natural color? We can thank or blame it on the pigment called melanin, the formation of which begins before birth.

“How Stuff Works” explained, “Except for a few growing cells at the base of the root, the hair is dead tissue and is composed of keratin and related proteins. The hair follicle is a tube-like pocket of the epidermis that encloses a small section of the dermis at its base. Human hair is formed by rapid divisions of cells at the base of the follicle. As the cells are pushed upward from the follicle’s base, they harden and undergo pigmentation.”

At that point, our genetics come into play. Genes produce and regulate the melanin that gives hair its color. Melanin is also responsible for eye color and skin color. Gray hair occurs when the body slows down its production of melanin, which is also determined by genetics.

Unless we turn to chemicals, there’s not much we can do about our genetic make-up.

Several other factors may contribute to change in hair color. Internal factors affecting hair color over time may include genetic defects, hormones, body distribution, and age.  External factors may include climate, pollutants, toxins, and chemical exposure.

Our genes affect other factors about our hair, including the texture, straightness or curliness, and yes, even the loss of hair.

Graying may not be all bad. Advertising has discovered gray and white-haired people, of all ages. Younger people sometimes enhance darker hair with a streak of gray, and those who come by it through family ties are showing up in more ads. Regardless of whether mine came from my maternal grandmother or a wider gene pool, I tell people “I’ve earned it!”

On Go60.US.

Find my books and columns at www.amyabbottwrites.com.

Meet Amy

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