In recent past we are seeing longevity increasing. I am seeing older patients in my practice. It is not unusual for me to see many patients over 80 years of age and also I see patients older than 90 years of age every week. Some are weak and have some memory problem and some have many medical issues. Some are fully oriented and almost independent and some cannot do much on their own. Some of the families accept the aging process and have limited expectation, but then there are others who have unrealistic expectations. That brings me to the story for today
I have seen 2 older women at one time Bothe were over 90 years of age . One has been seen by me for many years and she had some cardiac issues and she had some fluid around the lungs and she also had sleep apnea and so i had done follow up. She started having some problem at night , she had some shortness of breath and she called me and then came to me. She was concerned that the her PAP -the pressurized device that is used for sleep apnea was not working well. I saw her and after examining her that the problem was not with PAP but was due to her heart valve having problem ,She had murmur and also was short of breath and was waking up due to water accumulating in her lungs . The chest x- ray that I did confirmed my suspicion . She was followed by a cardiologist and he had told her that she was fine . I echocardiogram and then had her see the cardiologist . She was diagnosed with severe narrowing of the aortic valve and he suggested doing a surgery - relatively new type of valve repair called TARV . She did not want it and so we adjusted some medicines and she did ok. She did OK and then had a fall and has some bleeding in brain but did OK But she was getting weak and so she had to start living with her daughtercard month passed by and she had pain the belly and she came to ER , She had Gall Bladder attack. She now was quite weak and was in no position to undergo gall bladder surgery. So we did a drain and she responded to antibiotics Her numbers - blood tests and oxygen and fever etch was better. But she was weak and tired and could not eat. She could not do any walking and needed help even getting out of bed . She and the family had made decision that she did not want any aggressive treatment. So we decided to try to discharge her home with meds .While I was talking to her and her family , I told them that the house that we have owned looks good and have no obvious problems ,but the it is old and slowly somethings go wrong . the paint is pealing and the roof may start leaking or the plumbing may be also an issue. The aging body is like old house and even though one 'looks' good all the organs are old and they start giving out under stress. One has to understand that .Unfortunately not all patients and families either understand the limitations or accept it.
