Thursday, August 30, 2007

Postural hypotension

Assuming the upright position is a recurrent battle against gravity. Our cardiovascular needs to adjust in order to assure an uninterrupted supply of oxygenated blood to the brain. Old people lose some of that vascular tone that allows for seamless postural transitions.

I've mentioned before that my Mom is having postural TIAs. Within 10-15 minutes of getting out of bed, parts of her brain start to shut down due to lack of blood flow. She abruptly loses the ability to find the right word, a condition known as expressive aphasia. A brief but deep sleep often restores her language function.

Susan Moon's mother blacks out from postural hypotension. Here's an excerpt from her poem in the latest issue of JAMA:

Before my mother folds inward from her knees,
I fight gravity's tug by pushing her forward--
just a few more steps to the chair--
but she is already leaving me,
hip and knee closing like books
all the way to the floor.
A few heartbeats later
she opens her eyes, gazes around as if
she's never seen this world before.

Monday, August 27, 2007

Ectopic calcifications

Right mineral (calcium), wrong spot (skin, muscles, tendons, etc.). KGMom commented on a possible connection between the class of drugs called bisphosphonates (Fosamax, Actonel, Boniva, Reclast) and calcifications in the body.

I'd not read of such a connection, so I looked it up on PubMed. No articles reported a connection between the drug and ectopic calcifications. In fact, check this out:

Bisphosphonates are an old class of compounds. They were used in the 1930s as antiscaling and anticorrosion agents in washing powders and water to prevent the deposition of calcium crystals. Those basic functions were later utilized in an attempt to prevent ectopic calcifications in humans. The early studies demonstrated that bisphosphonates had a strong affinity for bone. That property was first exploited when the compounds were used for "bone scans." Currently, the drugs are used for treatment of hypercalcemic conditions, abnormal bone remodeling, Paget disease, malignancy, and osteoporosis.
--Rodd, C. Peritoneal Dialysis Int. 2001;21 Suppl 3:S256-60.

Now how do you feel about a year-long injection of an antiscaling agent? Amazing where these drugs come from.

Thursday, August 23, 2007

The Perfect Storm of...

midlife crises begins. Son to college today. Nest empties. Husband retires and vacates office Saturday. Nest fills. Mom to nursing home Monday. Heart breaks.

Monday, August 20, 2007


Will Sally Fields jump ship from Boniva to Reclast? Maybe Meryl Streep or Susan Sarandon will be signed on instead.

The FDA just approved this once-a-year treatment for osteoporosis. One fifteen minute IV infusion, and your bones are set against untimely fractures for 12 months. A trial on more than 7,700 women of age found that Reclast decreased vertebral fracture risk by 70%.

What creeps me out, however, is the possibility that this drug, like it's chemical cousin Zolmeta which is also delivered by IV infusion, will increase risk of osteonecrosis of the jaw. This condition occurs rarely in patients who have received bisphosphonates, particularly by IV, and then undergo dental procedures. It causes dead bone in the mouth, resulting in the horrific sort of scenario that both fascinated and repelled those of us who flipped through medical textbooks when young. Also the sort of scenario that attracts personal injury lawyers.

I have no idea whatsoever if this drug is associated with ONJ. I am reluctant, however, to recommend IV drugs for osteoporosis prevention or treatment for this reason.

Sunday, August 19, 2007

Menopausal women are having less sex and it's impacting our relationships. I have heard that a lot of women would rather go shoe shopping than have sex, and that concerns me.
---Karen Giblin, Founder of the Red Hot Mamas organization

Makes me nod my head and laugh.

Saturday, August 18, 2007

At home 'til the cows came home

I give. I just can't do this home care thing anymore. Two episodes that helped me realize it was time to move Mom to a nursing home:

1) She had a TIA that took out her ability to stand and walk.

2) Those darling cows above--Elsie the Cow and Ferdinand the Bull--took up residence in the corner of her bathroom.

Hallucinations and too weak to walk is too much for me.

Sunday, August 12, 2007

Blood pressure meds and the oldest of old

[This study] is fascinating and hopefully will convert the very last knuckleheads who still argue that blood-pressure elevation in the elderly is a compensatory phenomenon serving to force blood through sclerotic arteries to the target organ.
---Franz Messerli MD, Columbia University

Dr. Messerli is referring to the HYVET, aka Hypertension in the Very Elderly Trial which studied the use of blood pressure medication in 80+ year olds with respect to decreasing the risk of stroke and dying. Preliminary results were so significantly favorable that the trial was halted, and those oldsters in the control group will now be offered the real deal meds.

Through the years, controversy has surrounded the issue of whether or not to treat hypertension in this population. Those who say nay argue that blood pressure elevations in this group are largely a result of their stiff old arteries. Furthermore, they note, lowering blood pressure diverts blood from those vessels most blocked by cholesterol schmutz.

So back off nay-saying knuckleheads and treat granny's elevated pressure with meds.