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Wise as Salamon

ssalamon_non_cg_2566Suzanne Salamon, MD is chief associate of clinical geriatrics at Beth Israel Deaconess Medical Center.   Email general questions to mdeery@brooklinema.gov or call Maureen: 617. 730. 2790.   These are excerpts. Read the full post in this month’s newsletter https://www.brooklinema.gov/Archive.aspx?AMID=37

Coming soon:  Ask a Geriatrician, the book, articles by Dr. Salamon

APRIL: I suspect many of us are getting pretty tired hearing about how Covid-19 has changed our lives in a matter of weeks. We haven’t seen anything like this since the Great Influenza of 1918. Here are a few things we know now and then a silver lining.

How do we catch the virus?  Little drops of fluid from a sneeze or cough or from the handshake of an infected person. That’s why masks are so important along with hand washing and cleaning surfaces.

How sick will it make us?  Some people don’t know they have it, while others die. Risk factors: obesity, smoking, chronic lung problems, poor immunity, and being older, generally over 80. This is in contrast to the 1918 epidemic when people in their 30s and 40s were at higher risk.

How is it diagnosed?  By nose swab, and by a new blood test which is not yet widely used.

How is it treated?  So far, there is no cure. Very sick people are admitted to the hospital where they will get IV fluids and oxygen. We hope there will be a vaccine to help prevent it.

Telemedicine by phone and computer?  Medicare and most insurance now pays for these visits. It’s not ideal; no one can listen to your heart. It does work for discussions and where a physical exam is not required. I hope you all stay healthy.

MARCH:  What should we expect?  Fever, cough, aches and shortness of breath. Runny nose is not typical. Symptoms can be mild or severe. Some recover uneventfully, some become very ill, and some need ventilators. Less than 2% have died. Older people with underlying conditions are more likely to be sicker. Flu and shingles vaccines are not effective however having the flu or shingles weakens the immune system.  (See the whole article in the link above.)

FEBRUARY: What should we expect about the coronavirus?  It spreads when someone with the virus coughs or sneezes. People are most contagious when they are the sickest. Symptoms can appear within 2-14 days of exposure.  Symptoms: fever, cough, achiness and shortness of breath. For now, there is no vaccine but work is ongoing.  Best prevention: avoid close contact with people who are sick, don’t touch your eyes, nose and mouth, cough into your elbow, use wipes to disinfect.  The CDC estimates there have been at least 26 million cases of the flu in the US this season. About 14,000 have died including 90 children. At this time, the most important thing you can do is get a flu shot if you haven’t already.  

JANUARY:  I have been diagnosed with macular degeneration. It is the chief cause of loss of vision in the US, more than cataracts and glaucoma combined. We don’t know what causes it but risks include being older than 55, smoking, being overweight, high blood pressure, heart disease, being Caucasian and extensive sun exposure. Symptoms can include blurred vision, straight lines appearing wavy, seeing objects smaller than they really are, and a dark area in the center of the visual field; sometimes colors are noticeably paler than usual.

DECEMBER:  What is spinal stenosis and how can I deal with the pain?  Stenosis occurs when the spinal chord is squeezed by narrowing of the spine. The most common cause is osteoarthritis. Symptoms occur when walking or standing and are relieved when sitting.  If the nerve is pinched, it can cause sciatica. 25% improve with time, 50% remain stable and 25% get worse. Generally the pain will improve over three months.  Try exercise like swimming, biking and walking, physical therapy and pain medication like Advil, Motrin, Aleve, Tylenol, massage, chiropractic and acupuncture.

NOVEMBER: I am tired when I go to bed but then I cannot fall asleep. I fall asleep at sunrise and can’t get up until noon.  As we get older, our usual sleep habits may change. These may suggest a sleep disorder:  trouble falling asleep even when tired, not refreshed after a night’s sleep, irritable or sleepy during the day, difficulty staying awake when sitting still, or driving, difficulty concentrating, relying on sleeping pills to fall asleep.  It is common to have short periods when we have trouble sleeping but it usually passes.  If it persists, see your doctor about getting a sleep therapist.

OCTOBER:  What vaccines do I need?  Flu (see September), pneumonia 23 and prevnar 13, TDaP and Shingrix. Each pneumonia vaccine helps prevent different types. Get both but not at the same time. TDaP protects against tetanus, diphtheria and whooping cough.  Shingrix is the new and far more effective vaccine for shingles. It is two injections 2 to 6 months apart.

SEPTEMBER: What kind of flu vaccine do I need and when should I get it? As we get older, our immune systems gets weaker making it easier to catch some diseases. Vaccines help prevent disease by helping the body develop immunity.  You need the flu vaccine every fall because the viruses change. This year there is a new one for people over 65 called FLUAD. It is made with eggs.  No studies show that FLUAD is more effective than the current high Fluzone. Some studies have shown that both of these are more effective than the standard. the CDC recommends any flu vaccine as the most important step in protection.  Flu vaccines are safe, you cannot catch flu from the shot. It takes two weeks to build immunity so end of October into November.  It is never too late to get the vaccine.

AUGUST:  My mother is diagnosed with benign neurological syndrome due to tremors on her hands and vocal chords. Does it progress to Parkinson’s?  Tremors are caused by areas in the brain that control movement. Many cases of essential/action tremors are genetic, so if a family member has a tremor, there is a 50% chance this will be passed to the child. Other causes: overactive thyroid, stroke, brain injury, some medications, alcohol abuse, stress, caffeine, steroids, fatigue and amphetamines.  Resting tremors are often seen in Parkinson’s. There are medicines to treat the tremor and gait problems. Voice therapy can help with vocal problems. Overactive thyroid can be treated and familiar tremor can be calmed with certain blood pressure medications.

JULY: Lyme disease is a bacterial infection you get from deer ticks (not dog ticks). These tiny ticks are hard to see. They bite and stay on the skin. Symptoms may include fever, chills, sweats, fatigue, arthritis, headache and aches like the flu. Some develop a bullseye rash. If Lyme is treated early with antibiotics, it is curable. Prevent bites by spraying your clothes and skin with repellent, wearing long pants and socks. Check for ticks and rash after hiking and gardening.

JUNE:  Sciatica. Ow. The sciatic nerve runs from the lower back down each leg. It can be compressed by a bulging disc, arthritic and lumbar spinal stenosis. In addition to anti-inflammatory drugs like ibuprofen and naproxen, alternating heat and cold can help, along with deep muscle massage. Unrelenting pain can be treated with a steroid injection.

Shingles vaccine:  The first shingles vaccine was Zostavax. It is less effective for people over 80. The new one, Shingrix, is more effective regardless of age. It requires two shots 2-6 months apart. It is recommended for people over 50 even if you had shingles, got the older vaccine, or are not sure you’ve had chicken pox.

MAY:  Flowering trees and bushes are beautiful but my nose and eyes are watering. Is there anything I can do?  Pollen from grass, trees and flowers can cause allergies:  runny nose, sneezing, itchy eyes and sometimes, cough.  Allergies are not associated with fever, aches and pains. There is evidence we are seeing more allergies because we are becoming “too clean.” Antibiotic soap may wash away bacteria we need to develop antibodies. Try air purifiers and filters. After gardening, wash clothes and hands and remove shoes at the door. Newer antihistamines like Allegra and Claritin, over the counter, help symptoms with fewer side effects.

APRIL: What is diabetes and how can I prevent it?  It is a disease caused when sugar and fat that we eat cannot be absorbed and used for energy.  Instead they stay in the blood which causes blood sugar to rise, which leads to possible serious side effects.  Type 1 usually occurs in young people whose pancreas doesn’t produce insulin.  Type @ is more common and usually occurs in people who are overweight.  Risks: family history, overweight, some medications and older age.  Eating sugar does not cause diabetes.

MARCH:  What is TIA?  TIA stands for transient ischemic attack. Transient implies the symptoms last for a short time, less than one hour up to 24. Ischemic means not enough blood and oxygen are getting to the brain. Sometimes a TIA is called a mini stroke. While a TIA does not always cause lasting damage, it needs to be taken seriously because nearly 1/3 of people with a TIA will have a stroke in the near future.  Symptoms of a TIA and stroke may include: Face drooping, Arm weakness, Speech problems, Time to call 911 (FAST).  Timing is critical so if you experience any symptoms, get to the hospital.

FEBRUARY:  I have trouble sleeping. I hear that insomnia can lead to dementia. Is this true? Many people have trouble falling or staying asleep. Some studies have shown a connection between chronic insomnia and memory loss but this has not been proven for sure.  It is believed 7-8 hours of sleep can help us think more clearly and improve memory.  You can take a short nap before 5 pm. It is hard to sleep on a full stomach and if you are hungry. Spicy food may cause heartburn and milk products can affect the lactose intolerant. Alcohol can make you fall asleep faster but it can cause restlessness and wakening early.  Tea, turkey and tuna fish may help induce sleep. Exercise and relaxation techniques may help. It is common to have short periods when we have trouble sleeping but they usually pass.

JANUARY: What can you tell me about Parkinson’s disease? It is a disorder where the part of the brain called the substantia nigra stops producing dopamine. Dopamine is important in controlling movement. When dopamine levels are low, symptoms such as shaking or resting tremors, rigidity, slowing of movement and difficulty can occur. The most common initial symptom is a pill-rolling tremor of the thumb and index finger of one hand at rest in the lap. We don’t know what causes Parkinson’s but it often runs in families. It seems to occur in people with high exposure to pesticides and people who have had head injuries. There seems to be a lower risk in smokers and people who drink coffee and tea.

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 New York Times, Huffington Post, New Yorker

  • For Diabetics, Health Risks Fall Sharply, by Sabrina Tavernise and Denise Grady, Times, April 16
    Progress Report
  • Younger Skin Through Exercise, by Gretchen Reynolds, Times, April 16
    Time Passes
  • A Number That May Not Add Up, by Jane E. Brody, Times, April 14
    Weight Matters
  • The Sixth Stage of Grief, by Joel Yanofsky, Times, April 11
    Buying a Puppy
  • Why a Brisk Walk Is Better, by Gretchen Reynolds, Times, December 4
    Pick up the pace
  • In the End, It’s Not About the Food, by Corey Mintz, Times, November 26
    Just a little
  • Think Like a Doctor, by Lisa Sanders, MD, Times, October 3
    A Green Heart
  • A Youthful Glow, Radiating From Within, by Jane E. Brody, Times, September 30
    You look mahvelous
  • Manson Whitlock, Typewriter Repairman, Dies at 96, by Margalit Fox, Times, September 8
    Work works
  • Online Lessons in Dementia Management, by Judith Graham, Times, Sept 5
    Caring and Coping
  • On Becoming an ‘Orphan,’ by Paula Spahn, Times, July 1
    Profound Shift
  • When Aggression Follows Dementia, by Paula Spahn, Times, July 12
    Heart Breaker
  • Eat Your Heart Out, by Gretchen Reynolds, Times, March 7
    Your Heart
  • The 20 Million, by Mark Bittman, Times, June 12
    Hardly eat
  • Gross Ingredients In Processed Foods , by Sarah Klein, Huff Post, May 14
    Eat no meat
  • We Could Be Heroes, by Mark Bittman, Times, May 15
    Eat less meat
  • The Disconnect: Why are so many Americans living by themselves?, by Nathan Heller, New Yorker, April 16
    Love story
  • Nutrition: Options Play a Role in Healthier Choices, by Nicholas Bakalar, The Times, February 13
    Food story
  • The Fat Trap, by Tara Parker-Pope, The Times, December 28
    Sad story
  • In the Body’s Shield Against Cancer, a Culprit in Aging May Lurk, by Nicholas Wade, The Times, Nov 21
    Old story
  • For Beginning Runners, Advice Can Be a Hurdle, by Gina Kolata, The Times, November 14
    Running story
  • What Boomers Do Best (and how you can prosper after 50), by Julia Moulden, Huffington Post, June 12
    Loud story
  • When the Roommate Has Four Legs, by Antoinette Martin, The Times, October 20
    Dog’s life
  • Redefining the Hot Dog, a Cart at a Time, by Jeff Gordinier, Times, August 9 “There are children in New York who have never eaten a hot dog.” Very sad story