Polypharmacy, polydocs

One of my favorite eighty-somethings came in today to talk about simplification of her medical care. She was on six drugs, five supplements, and visited at least nine doctors including me.


The drugs were gold--two for hypertension, one for cholesterol, one to duck a second stroke, one for depression, and one for osteoporosis. She also took vitamins E and C. As I've mentioned before, the evidence in favor of these antioxidants is weak; in fact they may decrease the efficacy of the lovastatin she takes to lower cholesterol(1) and E may increase her risk of congestive heart failure(2).


The docs? A veritable medical village to support this senior! She had four(!) orthopedic specialists to hold up her skeleton alone--a podiatrist for the feet, a hand specialist for her trigger finger, a back-up man to prop up her spine, and slightly more general type orthopedist who graciously agreed to care for her knees as well as her hips.


No way to to pare this roster down to a pair o' docs. Now how ironic was this--after her visit to simplify her care, she hit her leg on her car door as she left and tore a huge flap of skin up off her leg. I would've sent her to a surgeon, but skin that fragile can't be sutured. We steri-stripped her leg and sent her home.
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1. Cheung, MC et al. Arterioscler Thromb Vasc Biol. 2001 Aug;21(8):1320-6.
2. Marchioli, R et al. J Cardiovasc Med (Hagerstown). 2006 May;7(5):347-50.

Not bad for a short person

I recently went out to the waiting room to retrieve my first patient of the day. "Whoa Judy," she hooted from her seat, "Have you gotten shorter?"

Argh, do not tell a middle-aged woman she's getting shorter. My face must've fallen because she quickly backtracked: "It's just that you look so tiny." As if that improved the situation--she may as well have remarked 'But you don't sweat much for a small woman.'

The entire incident made me feel a little short with her.

I give up...

two blogs are too many for this busy midlife. While I will occasionally park a thought here in the future, please visit Denver Doc Online for up-to-date health news for the young and aged alike.

Your momma is so tired...

she couldn't even climb up the Iowa Fatigue Scale. Actually, my momma is so tired she can't even turn on the computer.

If you are dragging your sorry back end through this summer and wondering if it's more than just the heat, check out The Iowa Fatigue Scale and see if you pass or fail. Life's too short to be so tired.

Too many toes sign...

Get a buddy to stand behind you and look at your feet. A positive 'too many toes sign' is present if more than the pinky toe can be viewed from the back. This toeful look is created by the outward splay of a foot caving inward due to a fallen arch.

Who knew? I knew my arches went to ground years ago following months of burning pain. Today I found out that my acquired flatfeet, right worse than left, are taking my knees on an inward collapsing course which is painfully grinding away the outside compartment of the joint.

The good news is that getting my arches off the ground and my ankles back in alignment may save my knees from degenerative destruction.