Sometimes, lack of knowledge can lead to years of anxiety. Frank remembers some difficult times: “I had an operation on my testicles when I was about 6 years old,” says this insurance company vice president. He lowers his voice and continues:
“My testicles were filling up with fluid. The thing I didn’t know for years was that they didn’t operate on my penis. I thought my penis was shaped funny because of the surgery. I thought they cut my penis. When I saw other guys in high school gym class I knew my penis was okay, that the ‘seam’ on the backside of the penis was normal, not the line where they cut me. But thinking I had a scar, that I had been cut, that I was sort of lopsided, that caused me a lot of anxiety for a long time.”
Frank didn’t have a brother in whom he could confide or compare his penis to see if his was normal. So he never told anyone of his fears. Sex education was not a big part of his home life. “Once my dad brought home a book—he got it from the doctor, I think. Anyway it was very technical and anatomical. I was supposed to read it and then meet with him later in the day if I had any questions.” He stops, and almost snorts the next sentence. “I didn’t have any questions. My dad seemed very embarrassed—more so even than me.”
Frank, married for 15 years to a woman who is a social worker, believes that he’s learned to be more open about sex, and it’s an easier topic for him than it used to be. “But,” he says, “I still wouldn’t initiate such a conversation.”
*7\184\8*
The toenails are considered in this chapter on skin care because nails and skin are intimately connected. The toenails of some older people tend to become thickened and difficult to cut. Sometimes they become misshapen and irritate the toes or makes it difficult to fit shoes properly.
You may be able to care for your own nails. If you suffer from diseases of the circulation or diabetes mellitus, proper toenail care is crucial. Avoid injuries to your feet from the nails. Cut the nails with a special toenail clipper straight across, even though this may be difficult if they are thick and misshapen. It is usually easier to cut the nails after you have bathed because then the nails have softened a bit. If you have any toenail problems, consult a podiatrist or chiropodist for advice.
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Many blood malignancies progress very slowly in older people. The common malignancies are chronic leukemia and multiple myeloma, both of which may first reveal themselves as anemia. These two diseases are discussed in detail in chapter 14. Treatment can usually be accomplished successfully with drugs and occasionally with radiation therapy. Proper treatment can bring you a satisfactory level of well-being and activity and keep you going for a long time.
An 88-year-old man I knew had had chronic leukemia for about twenty-five years. He was active and productive all this time and visited his physician periodically for examinations. In his later years he occasionally required a small degree of chemotherapy to keep his leukemia under control. At 88, he developed pain in his spleen, which had become enlarged because of the leukemia. Radiation therapy to his spleen improved his symptoms, but some months later, his leukemia began to progress rapidly, and his family came from out of town to prepare for his last days.
His condition was evaluated by a hematologist (blood specialist), who recommended a new course of chemotherapy. Beyond anyone’s expectations, the man’s white blood cell count returned to normal, his anemia improved, and he felt well again. Although only a few months have passed since his treatment began, he continues to feel well and en joy life. His family returned to their homes, and even though everyone is aware of the likelihood of a relapse, he has managed thus far to improve with treatment.
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The adrenal glands produce the hormone cortisone, which controls the amount of fluid and salt in the body and helps the body respond to stress. The correct amount of cortisone is important for your well-being. Some illnesses affecting older people can lead to a decrease in the spontaneous production of cortisone. However, most cases of insufficient natural cortisone occur because a cortisone medication has been prescribed for an illness such as asthma, arthritis, or certain skin conditions, which suppresses the body’s production of cortisone.
Some people spontaneously produce excess amounts of cortisone, which leads to Cushing’s disease. The cortisone accumulates and adversely affects many parts of the body. This is due to tumors of the adrenal gland or excessive stimulation of the adrenal glands by pituitary gland hormones. You may become overweight and develop high blood pressure or diabetes mellitus. Your bones may weaken and be prone to fractures, and your skin may develop small hemorrhages under the surface at the slightest touch. You may begin to feel generally weak and ill.
The diagnosis of Cushing’s disease is made by special blood tests. Treatment may consist of surgical removal of one or both adrenal glands. In many cases radiation to the pituitary gland can be effective in halting the disease. The pituitary gland is located in the brain and manufactures the hormone ACTH, which stimulates the adrenal gland to produce cortisone. Radiation can sometimes stop the formation of excess amounts of ACTH, thus decreasing the amount of cortisone.
Too much cortisone medication can cause the same symptoms as Cushing’s disease or excessive adrenal hormone production. When cortisone treatment is required, as in rheumatoid arthritis or asthma, the pills sometimes can be taken every two days instead of every day to decrease some of the side effects. Your physician can monitor your treatment and check the effects.
Some illnesses cause the adrenal glands to stop working partially or completely. The adrenal glands can be affected by a tuberculosis infection or by a tumor. Or the glands may stop producing cortisone for no apparent reason.
If you lack cortisone, you will probably feel weak and have little energy. You may lose weight or be found to have low blood pressure. The color of your skin may darken even when you have not been in the sun. Nausea, loss of appetite, and frequent vomiting also can occur. This illness, known as Addison’s disease, progresses slowly, but it may become serious under stressful situations. If, for instance, you require surgery and an anesthetic, a lack of cortisone can lead to severe complications. Any physician or surgeon should be made aware that you suffer from Addison’s disease so that cortisone can be given before surgery.
If you are receiving cortisone pills or injections, or know that you have Addison’s disease, it is important for you to wear a Medic-Alert® bracelet that says you are receiving cortisone therapy. The main danger is that during a serious illness, infection, or surgery, your body may not be able to produce enough cortisone to meet the body’s requirements. Because your adrenal glands have shut off, you may go into shock because of the stress. In an emergency situation the physician will temporarily increase the amount of cortisone.
The diagnosis of Addison’s disease is made through blood tests, which will show whether the electrolytes are abnormal and whether the amount of cortisone is sufficient. Cortisone, usually given as pills, is the treatment for Addison’s disease, and it must be continued for life.
If you are receiving cortisone by injection or pills for illnesses such as asthma or rheumatoid arthritis, the adrenal glands may become underactive. In effect, they “think” that they have sufficient cortisone and therefore shut off their own production. If you stop taking the cortisone medication suddenly, the adrenal glands do not have enough time to produce their own supply to replace the lost cortisone. This leads to a drop in blood pressure, general weakness, and often nausea and vomiting. If left untreated, it can lead to shock just as in Addison’s disease.
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One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the BACK PAIN
One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the BACK PAIN
One of the most common problems affecting people of all ages is back pain. The fact that back disorders often affect relatively healthy and energetic young people suggests that with increasing age this condition will continue.
The lower back contains the segments of the vertebral column (backbone). Within it are nerves that come from the spinal cord. The nerves leave the spinal canal (the space in the vertebral column) through small outlets between the vertebrae and make their way to the lower part of the abdomen, pelvis, and legs. When the segments of the vertebral column become abnormal, the connecting joints may develop a type of arthritis. Because of this, there may be pressure, causing the nerves to become “pinched.”
In youth the vertebral segments are cushioned by discs, a flexible, resilient material called the nucleus pulpo-sus. With age the discs become relatively dry and less resilient. Subsequently, the distance between the vertebral segments decreases, and the mobility and flexibility of the spine diminishes.
The ligaments supporting the vertebral segments may also become weakened and stretched, leading to a combination of arthritic changes within the vertebral column and a narrowing of the spaces through which the nerves pass. A slipped disc, which protrudes and presses on nerves, and other mechanical derangements affecting the spaces between the vertebral bodies and its ligaments can all lead to low back pain.
Other, unusual causes of low back pain must be excluded before your physician assumes that your discomfort is the result of a mechanical imbalance of the vertebral column. Different kinds of tumors can affect bones, including those in the vertebrae, and, although rare, infections affecting the bones (osteomyelitis) can also occur. Paget’s disease, a metabolic process in which the bones recycle calcium at an excessive speed, can affect the backbone and lead to chronic back pain. Other bones, including the pelvis and skull, are frequently afflicted with Paget’s disease.
One common cause of abrupt, severe back pain is the sudden collapse (compression fracture) of one or more vertebrae. Possibly because of more dramatic changes in hormone balance that occur after the menopause, this is more common in women than in men. The pain of compression fracture can be severe but usually subsides within a few days or weeks. Treatment includes locally applied heat, bed rest for a few days, and mild pain relievers.
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Some common problems that can seriously affect your ability to be independent are the result of diseases of the ear. The ear performs two major functions: hearing and balance. The outer ear gathers sound and concentrates it through the ear canal until it reaches the ear drum, the beginning of the middle ear. The middle ear is responsible for transmitting the sound through a number of small bones to the inner ear. Within the inner ear is a mechanism that translates the sound waves into nerve impulses, which are sent to the brain for interpretation. The important balance apparatus is contained within the inner ear.
How Is Hearing Tested? Although you may notice that your hearing has deteriorated, often it is your family and friends who first become aware of it. If the problem has occurred suddenly, urgent medical attention is recommended. Usually the deterioration is gradual and often takes a long time before you recognize the degree of your disability.
To examine the cause of your hearing loss properly, an audiogram (hearing test) should be done. This will usually help determine the type of deafness and the most helpful treatment. A full ear examination is usually done in conjunction with the audiogram.
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During the past few years it has been shown that the loss of intellectual abilities and memory experienced by some older individuals is due to Alzheimer’s disease. This disease was previously thought to be a rare and unusual disorder, but now, due to medical research and public awareness, Alzheimer’s disease is recognized as being more common and is better understood.
Unfortunately no known treatment can prevent the progress of the mental confusion and lapses of memory that are the symptoms of this neurological disturbance. Family members are often the first to recognize the problem and an individual afflicted with Alzheimer’s disease may not be aware of it. At times individuals may realize that their memory is seriously impaired and that help is necessary for certain normal activities.
How Is Alzheimer’s Disease Treated? Because a number of illnesses, some of which can be treated, seem to mimic Alzheimer’s disease, it is worth having a thorough evaluation by a physician who is knowledgeable in the field, before a diagnosis of Alzheimer’s disease is made. No special test proves that a person has this disorder, but investigations can be done to show that no other recognizable illness can account for the symptoms. Sometimes medications that may have been given for other problems can aggravate the symptoms of mental confusion and when these are stopped, the person may feel and function better. On occasion, a person with Alzheimer’s disease also develops depression, which may improve slightly when treated with antidepressant medications. Drugs such as Hydergine®, which are commonly prescribed, have never been shown conclusively to help maintain memory or intellectual function.
Although at present there is no cure for Alzheimer’s disease, many things can be done to help the families cope with their loved ones who are so afflicted. This includes counseling on how to deal with personality changes, abnormal behavior, and forgetfulness. Respite programs are becoming available to give the caregivers some relief from the constant needs of Alzheimer victims. Special day programs are being developed that may allow Alzheimer patients to be involved in suitable and satisfying activities which are designed for people with intellectual impairment. There is hope that treatments may be developed to halt the progress of this ailment and perhaps prevent the symptoms from interfering with the normal, enjoyable activities that most of us look forward to during our later years.
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Cancer of the pancreas can be painless during the early stages, but the effects can be serious even when the tumor is small. Often, the early symptoms are nonspecific and do not point to the pancreas at all, so a diagnosis may not be made. For unexplained reasons, psychological effects such as depression occur frequently in this disorder. But, since depression is often attributed to the process of aging, tests to discover this tumor may not be done immediately and even when done may not be conclusive. Weight loss without explanation or a blockage of the bile ducts (connection between the liver and small bowel), causing jaundice, may be the first signs of pancreatic cancer.
Even though X-rays, nuclear scans, echograms, and CAT scans may be done, the diagnosis can still be difficult to establish. I have seen a few older people who were losing weight and feeling depressed undergo repeated X-rays and echograms. When a tumor was not found, treatment was directed to the psychological symptoms, with little improvement. Many months later, more specific symptoms finally appeared or the tumor became large enough for the X-ray or echogram to verify its existence.
If the tumor is found very early, surgery can be successful, but in most cases it is not discovered in time for surgery to be of use. Nevertheless, surgery can alleviate the symptoms of vomiting and jaundice. If the tumor is blocking the bile ducts, stomach, or small intestine, the surgeon can perform a bypass operation to redirect the passage of food and bile around the tumor and delay these symptoms.
A nonsurgical technique allows a temporary improvement in the symptoms caused by jaundice due to blockage of the bile ducts. A thin plastic tube is inserted through the skin into the liver or from the duodenum with a special gastro-scope and then directed to pass through the biliary ducts, past the pancreatic cancer so that the bile can drain into the duodenum. The procedure can be done under local anesthetic and often allows relief of the itching, nausea, and drowsiness caused by the jaundice.
Such operations or procedures can allow months of comfort that otherwise would not be possible. It would be a mistake to say that the operation is not successful because it does not cure the disease. The relief of symptoms and giving a period of comfort are of great importance and should be attempted whenever pancreatic cancer is diagnosed.
*196\166\2*
Many women become very worried if vaginal bleeding occurs long after their periods have stopped. If the bleeding stops by itself, you might be tempted to postpone consulting your physician. If you use female hormones, bleeding may occasionally occur as a result. However, there may be other, more serious causes of bleeding even if you take these hormones. In all cases you should report any bleeding or any change in amount of bleeding or predictability to your doctor.
Sometimes the wall of the vagina becomes thin because of a lack of hormonal (estrogen) stimulation and causes bleeding, itching, or irritation. This is called senile vaginitis. Often a small amount of estrogen cream applied to the area relieves the symptoms. For those women already receiving cyclical hormone therapy this is usually not necessary. Prevention of and treatment of senile vaginitis decreases the pain that might be associated with intercourse during the later years.
An important cause of bleeding is the presence of tumors, either benign or malignant. Unless the cause is obvious from a gynecological examination, many physicians will recommend a dilatation and curettage (D and C) to diagnose the cause and ensure that no tumors are present. The D and C consists of widening the entrance to the cervix while you are anesthetized and “scraping” the lining of the uterus to obtain tissue for analysis. With this procedure the cause of the bleeding can usually be identified and proper treatment recommended.
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Before the AIDS virus was identified, some people received blood and blood products (for example, plasma, serum to treat hemophilia) that was tainted with the AIDS virus. Since the discovery of methods to test donated blood for the virus, the risk of acquiring the AIDS virus from a blood transfusion is extremely small. Similar procedures have been used to screen blood for the hepatitis virus, thereby reducing the risk of this virus as well, which on occasion can cause a lethal form of hepatitis.
In general, blood transfusions are given for illnesses of such a severity that to withhold the transfusion would be very risky. Now that blood is more carefully screened, the risk of the transfusion in terms of acquiring the AIDS or the hepatitis virus is extremely small. Concern about this possibility has led some people to donate their own blood during the period before elective (planned) surgery, to be used for a transfusion if one is needed. In some medical centers this program is already being used for elective open-heart and hip surgery. Whether this practice becomes common remains to be seen. If your physician decides that you require a blood transfusion, you can be confident that effective steps have been taken to supply you with safe, uninfected blood. There is no danger in donating blood and the Red Cross depends on reliable, healthy donors to assure a safe blood supply for the population.
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