Sunday, January 28, 2018


      I have been in practice for many years and I have noticed the aging population. Now a days it is not uncommon to see patients in their eighties.It is very easy to say that everybody should be treated according to the disease and not according to their age. Some older patients are well preserved and have sharp mind . But the body is like house . So often we see  30-40 years old house and it looks good and has no problems . But when one looks at it , the windows are old and not according to the new standard, or the roof may need to be fixed and the plumbing is old .Many a times when I see older patients who are accompanied by their younger relatives , they are not demented, but when one starts asking questions , we realizes that memory is not as sharp and sometimes the understanding capacity is less than what might have been at younger age. But the family members are not aware if this as they see them everyday. When one does the same routine everyday , early dementia is not obvious. -going to the same place to eat or do shopping or doing same thing like goinfg to same friends or relatives . But when one is given little complex and not the routine task or direction , then the ability to follow the instruction is not as good as younger people.But my main concern is aging body. That brings me to today's patient .

    I have known this patient for last 1 or 15 years , Now she is 91 years old . She lives by herself and her daughter and the grand kids help her. She has heart problems and has been under care of cardiologist . She had fluid around the lungs 7 or 8 years ago and I took it out . It came back and so after doing the procedure 3 times , I had called surgeon and had a catheter called PLEUREX inserted . It can stay for months to year and one can drain the fluid as needed by attaching it to bottle with vacuum bottle  . Her fluid was gone and the drainage was not much and so the catheter was removed . She did fine for may be 3 years . Then she had some fluid and she was OK , Her shortness of the breath was not bad as her activity level is limited . I watched the fluid with periodic chest X- ray and it did not see to be any worse or for that matter any better. As long as she was fine I did not do the drainage with needle..
    She then had fluid around her heart and had elevated pressure in lungs called pulmonary hypertension . The cardiologist 'watched' the fluid around the heart and it did get better. So the she has some shortness of the breath and she was again in the hospital , So the cardiologist felt that I should 'drain' the fluid -same one who did not want to drain the fluid around the heart. She was on blood thinner and I had to hold it and then do the procedure . She did well but had small amount of air around the lung after the procedure . I was worried as if that gets worse then she would need insertion of tube to sick out the air . But my thinking was that her lower part of the lung is chronically collapsed and so it can not expand and so the gap was filled by the air . I did new chest X- ray in 4 hours and the fluid was back and the air was gone. Since then she is in hospital 3 times . We 'adjust' the meds and sent her home and she does OK and is back again . She does not look any different or is not in any distress, but she feels short of breath . The fluid is also same as was 2 months ago.. But again the cardiologist and the family feels we need to treat the fluid . In my estimates she has multiple , chronic problems and they will not be fixed at age 91. But everyone sees the fluid and that they feel can be 'fixed' .So now I have to treat it .
    She is 91 years old and has multiple problems and she will probably have similar issues  and doing more procedures is risky. Thia is what I call AGE OLE OR OLD AGE PROBLEM . .  

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