Tuesday, April 29, 2008

Stiff feet and Yoga Toes

Twenty-six bones in the feet, and all 26 of my Mom's moved as one. Zero flexibility in her old feet, and I'm here to tell you that was no small part of her mobility challenges.

As so many aging children of elderly parents do, I kept close watch on the physical changes my parents endured through the years with an eye towards my future. And I decided as I followed Mom down many a hallway, I do NOT want wood for feet.

No surprise that my arches had already fallen, they did so painfully about 8 years ago. As I researched this stiff foot thing, I discovered the too many toes sign and posterior tibial tendon dysfunction. I went to an orthopedic specialist in feet who assured me that while I had the first, I did not have the second. That's all I got from him for my $45 copay, but a little reassurance is always helpful. For quite a bit more, I bought Good Feet arch supports which resulted in 2 of the most painful months of walking I've ever experienced.

But now, color me green with 'range-of-motion' envy. I had a patient in recently with the most flexible forefeet I've ever seen. She could wave bye-bye with those toes in great sweeping motions so freely mobile her digits. And her secret? "Oh no," says she, "I didn't always have such clever feet. I owe it all to Yoga Toes.

Shoot, I had to get me a pair of those Yoga Toes. The picture on Amazon is inscrutable--they're actually clear plastic toe separators (and no longer available on Amazon!). When I put them on at work, my medical assistant declared them the very thing for painting your nails without smudging them.

Will they restore range of motion to my tired dogs? I'll keep you posted.

Sunday, April 27, 2008

Leftover life: Stowed!

Mom's condo is empty at long last. Two station wagon loadfuls, and a final truck's trip for the couch to another family's living room with the same color decor as Mom's.

I just spoke with a young woman from Craigslist who is delighted with the 1950's style Smith Corona manual typewriter and rapturous over the prospect of the vintage black Singer sewing machine. All of Mom's life lovingly tucked away in hearts and homes.

I sometimes wondered if I'd lost my mind (or perhaps would lose it) handling each and everything with care as to the perfect disposition. Now I know it was the best way to honor her life and say good-bye.

Thursday, April 24, 2008

Hemorrhoids and spicy foods

Are you a PLWH? Chances are good that you are as about 50% of adult persons are indeed living with hemorrhoids. Does the thought of spicy in (like, say, red hot chili peppers) leading to hot out (now I don't have to explain that, do I?) make your hemorrhoids cringe? Rest easy and indulge; research* indicates your hemorrhoids are not a risk from your spicy excesses.

Italian researchers, about 50% of whom doubtless had hemorrhoids, randomized 50 adults with big-time 'rhoids to receive two blue capsules at two different meals either packed with red hot chili pepper powder or placebo powder with no kick at all. They prepared the real deal capsules with the amount of spice needed to achieve "spicy enough" status (as defined by the Association of Teachers of Italian Cuisine) if the contents had been added to a normal dish rather than the colons of the test subjects.

One week, half the group popped hot and the other half downed not. The following week, the capsule allocation was reversed. On a visual scale of 0 to 10 (can you picture the visuals here?), the subjects were asked to rate the situation down under with respect to bleeding, swelling, itching, and burning before and after.

The results? Spice in is not a problem at the end of the line.
*Altomare DF, et al. Red hot chili pepper and hemorrhoids: the explosion of a myth: results of a prospective, randomized, placebo-controlled, crossover trial. Dis Colon Rectum. 2006 Jul;49(7):1018-23.

Sunday, April 20, 2008

When can you stop having mammograms?

I mentioned in a previous post that the American Cancer Society identified age 70 as the end of the line for low risk women to get Paps. Ducking the date with the speculum (the first of which, incidentally, was fashioned out of a pewter spoon) is one of those age DOES have its privileges things.

What about ending the annual encounter with the mammogram machine? European investigators presented the results of two large studies at last week's 6th European Breast Cancer Conference that address the ideal interval and cut-off age for older women and breast cancer screening.

In 1998, The Netherlands extended the national breast cancer-screening program to women up to age 75 from the previous age limit of 70. Investigators tracked the incidence of death from breast cancer in women ages 75-79 during the time period 2003-2006, five years after the expanded screening offering began. Compared with a ten year period beginning in the mid '80s, the breast cancer mortality for this age group dropped nearly 30%. Clearly, mammograms done on women in their late 70s were picking up breast cancers that would have otherwise proved lethal if not detected.

Researchers on the UK Breast Screening Frequency Trial randomized 100,000 women ages 50-62 to receive mammograms either annually or every 3 years. The two groups were followed over 13 years, and the risk of breast cancer death was virtually the same whether the women were annually squashed in the mammo machine or submitted to the test once per 3 years.

One of the reasons, investigators theorized, that women over 70 benefitted from screening is that their breast tissue was less dense, and thus mammograms were easier to read and more accurate at detecting early cancers. Senior researcher Jacques Fracheboud noted, however, that "it is not necessarily an argument for continuing screening beyond 75 because many tumors found at this stage are slow growing and may never reach the stage of causing a problem."

Breast density is a consideration for the somewhat younger group as well. Those women ages 50-62 with dense breasts--i.e. hard to image with mammograms--may well be doing themselves a disservice to embrace the every 3 year embrace of the mammogram plates. Before you decide that this interval is for you, or before you chuck the test at 75, check with your doctor to see if these decisions are appropriate in your case.

Friday, April 18, 2008

Leftover life to stow, Part II

I posted some time ago about the difficult but important task of shutting down a life. At that time, my Mom was still alive, newly in the nursing home, and I was taking the first few passes through her beloved condo. The best experiences then were giving away her plants, her craft supplies, and her books to people who were so excited to receive these bits of her life into theirs.

So now I'm down to the hard stuff, all the things that I'd look at and think ohnotnow, maybelater. Later is here. A wonderful friend joined me today, a woman long on organization and free of the emotional baggage that I bring to the task. Whenever I dithered and gave her the ohnotnow on a vase or a piece of art, she'd gently bring me to the ohyeahnow place.

So everything is sorted, stacked, and ready for transport. Some advertised on Craigslist, some ready for the art or natural history museum, a stack for me, a stack for my brother, one for charity, and one for the wonderful friend who spent the day holding my hand and honoring my Mom's leftover stuff.

Wednesday, April 16, 2008

Make friends and sleep

If you can't sleep, connect with an endearing community of insomniacs. There's bound to be such a chat room somewhere on the Internet. And if a great night's snooze leaves you little time to bond with friends over dinner, don't lie awake worrying that your health will suffer. Matters not whether you're sleeping or networking, researchers have proven that either activity will enhance your health.

Previous research has shown that poor sleep raises body levels of an inflammatory molecule called interleukin-6 (IL-6). On the other hand, another study found that old guys who hung out with their buddies had less IL-6 than the isolated curmudgeons. IL-6 levels are directly correlated with an increased risk of cardiovascular disease.*

Dr. Elliot Friedman and colleagues asked 135 aging Wisconsin women about their relationships with their friends and their beds. They then correlated those results with blood levels of IL-6. Those women who enjoyed both early evenings with others AND late evenings with covers had almost no IL-6 noted compared to their sleepless, disconnected colleagues. Fortunately, either good friends or great sleep was also enough to reduce IL-6 to "virtually undetectable" levels.
*Cardiologists at the University of Pittsburgh reported in the November, 2005 issue of the American Heart Journal that women at risk for heart disease with the highest levels of two or more inflammatory markers (C-reactive protein, IL-6, or serum amyloid A) were more than four times as likely to die during their 5 year study compared with similar women who had no such laboratory signs of increased inflammation.

Tuesday, April 15, 2008

Estring and breast cancer

"If you run out of estrogen," a menopausal expert once told me, "you WILL dry up." As in symptomatic-genital-shrink-and-shorten sort of dry up. Yet many women are uncomfortable about the use of estrogen, particularly as it is associated with a slightly increased risk of breast cancer. For those of you passing up hormones or for those of you with a personal history of breast cancer, here's some important information.

Estring is a product that delivers estradiol locally right into the appropriate female passage via a silastic ring which is left in place for 3 months. During this time, the ring releases 2 mg of estradiol which is the equivalent of 1-2 days' worth of full-dose, oral estrogen therapy.

Menopause experts Drs. Nicole Brooks and Andrew Kaunitz note that they prescribe this treatment to a number of patients in their practices who are breast cancer survivors due to the ultra-low levels of estrogen that are absorbed via this route. Estradiol tablets--sold as Vagifem--are also effective in improving vaginal symptoms, but estrogen absorption into the general circulation is higher with their use compared to that with the ring. Some women complain of breast tenderness with the use of Vagifem. Estrogen creams produce the highest systemic levels of estrogen of all the local treatments and are sort of gooey.

While the estrogen absorption of Estring is ultra-low, the price is ultra-high.

Sunday, April 13, 2008

When can you quit having Pap tests?

Age has its privileges. Per the American Cancer Society, no more Paps needed:

  1. When you're over 70 AND
  2. You've had no abnormal tests in 10 years AND
  3. You've no new risk factors for cervical cancer such as a new partner.

Saturday, April 12, 2008

An Aged Athlete

From a simpler time, when old was old, and physically fit was not (old that is):

An old-time champion pedestrian, whose record 30 or 40 years ago aroused the country, has recently at the age of nearly 70 performed the feat of walking from Philadelphia to New York, a distance of 96 miles, in a little over 23 hours and finished the task in excellent physical condition. This is a good example of the fact that the physical organization of man need not necessarily go to pieces before the allotted three score and ten, when, according to some, the system is worn out and useless. Of course, this man is an exceoptional case, but he shows what the possibilities are, and probably a great man other individuals of as great age could do likewise.

----JAMA, June 23, 1906

Sympathy cards

Cards, notes, calls, these expressions of sympathy are simply the best. Whether they share a wonderful memory or just say "Sorry to hear about your loss," they are a source of enormous comfort. I won't let another passing of a friend's loved one pass without sending my thoughts along.

Monday, April 07, 2008

Fall prevention

My friend Anita has suggested a mantra for growing older (nofallingnofallingnofalling). Having spent more than a little time trailing after an extraordinarily shaky old lady, I do not believe that this mantra has the proper rhythm to keep an old person upright. I found that singing "The Hokey Pokey" with gentle taps to the appropriate foot had just the rhythm for easy ambulation.

Dr. Frederick Carrick of the Carrick Institute searched for music to stay upright by, registering one clinical trail with the NIH under the title "Fall Prevention in a Geriatric Nursing Home Setting Using the Music of Nolwenn Leroy."* Who then is Nolwenn Leroy?

She is a 25 year old French pop star who's shuffle along music can be found at Nolwenn Sings for the Unsteady. While Dr. Carrick found her tuneskys superior to other musicians including Mozart for modulating the gait of walkers walking with walkers, I don't get it. I'd sooner do the Hokey Pokey myself.
*"Music to stand bolt upright to."

Saturday, April 05, 2008

Just lost that post-colonscopy glow!

There's nothing, or very little, like the pleasure of viewing one's colonoscopy in retrospect. Most immediately, there's that leftover Versed glow, but in a more lasting sense, there's that 'just for now the colon's clean' (in more ways than one) feeling. That is until I read this item from JAMA* summarized in the March 28 edition of Science.

According to a study of 1800 veterans screened for colorectal cancer via colonscopy, nearly 10% of them had 'morphologically subtle flat lesions.' As in not-heaped-up, icky looking polyps but boring-flattish plaques. Subtle but dangerous plaques that don't leap up into the colonoscopist's line of sight in a 'whoa that doesn't look good; let's biopsy that sucker' sort of way. And when this particular group of investigators did biopsy these areas, the tissue was five times as likely as polyps to show cancerous features.

Well, dang, now don't I feel underscreened! But another group of researchers are hot on the trail of these flat colonic plaques. They've found that if you spray the colon's inner surface with a certain kind of little protein that likes to bind to premalignant colonic tissue, and if you make that peptide glow in the dark by hooking it up with fluorescein, then you can snag those hummers 81% of the time.

And you may enjoy viewing your post-procedure movements under black light!
*J Am Med Assoc. 299, 1027(2008)

I cry too much...

(or Better Mourning through Chemistry)

I cry easily and often. Certainly over the morning comics--who doesn't? For Better or Worse and Funky Winkerbean rival any soap opera or Greek tragedy for tear jerk potential. I cry when small children sing more or less in unison, I cry when other people cry, and, most distressingly, I cry when I'm mad.

Now don't get me wrong, there's nothing wrong with crying (cut to "It's alright to cry" from Marlo Thomas's "Free to Be You and Me" album which, incidentally, is a song that also makes me cry). But sometimes, crying gets in the way of effectively doing that which you want to do. Years ago, I wrote a eulogy for my Dad's memorial service, and I couldn't get through one word of it due to tears so my good friend Janice read it for me.

Last week, I threw a marvelous memorial service for my Mom, complete with a sing-along hootenanny of old favorites like "Down in the Valley" and "You are My Sunshine." I wanted to sing along and, more than anything, I wanted to speak my good-bye piece to Mom and tell her friends about the wonderful times she and I shared even up until the last week of her life.

Prior to the service, I took a little bit of Paxil (an older antidepressant/anti-anxiety drug) and a little bit of propranolol (a beta-blocker that stops some of the adrenalin outflow from the sympathethic nervous system that sets off the heart-pounding, shaky body feeling like when you battle a saber-toothed tiger or say good-bye to your mother). I wasn't tranquilized, I was still awash in emotion, but I was NOT awash in tears. I sang my songs (and I am not generally one to sing in front of a crowd) and I said my piece. It was wonderful.

I cried like mad the next day.

Thursday, April 03, 2008

"What do you do when your small toe hurts?"

I am always interested in the google searches that bring readers to my blog. This question has brought more than one along. The answer, of course, is nearly always "Wear wider shoes."