{"id":6197,"date":"2014-01-20T10:36:14","date_gmt":"2014-01-20T16:36:14","guid":{"rendered":"http:\/\/wholehealthchicago.com\/?p=6002"},"modified":"2021-09-12T22:32:08","modified_gmt":"2021-09-13T03:32:08","slug":"take-these-pills-or-youll-die","status":"publish","type":"post","link":"https:\/\/wholehealthchicago.com\/blog\/2014\/01\/20\/take-these-pills-or-youll-die","title":{"rendered":"\u201cTake These Pills Or You\u2019ll Die!\u201d"},"content":{"rendered":"\n

Six months ago, while visiting my 90-year-old Fox News\/Don Imus devotee aunt in Florida, I was working out at the local health club and got into a conversation with a lean, muscular older guy who\u2019d just finished his bench presses. I bemoaned the fact that there was so little to do in that part of Florida except visit doctors, eat dinner at restaurants as the afternoon sun poured through the windows, watch TV commercials for bladder catheters, and vote Republican.<\/span> <\/span><\/p>\n\n\n\n

Steve said, \u201cNot at all. In fact, there\u2019s a decent nightclub life. You just have to know where to go.\u201d And sure enough, that very night, as I accompanied Steve to a variety of venues, I discovered that he went clubbing several nights a week with (or without) one of his girlfriends. When he went alone, he was a veritable chick magnet–though hen magnet is probably more accurate–and an excellent dancer. Steve was also fond of going up to the bandstand and leading the crowd in 1940s tunes.<\/p>\n\n\n\n

In short, he was vigorous, lively, and unabashed. \u201cDon\u2019t ask my age,\u201d he said firmly. I guessed 75 and later learned he was 85.<\/p>\n\n\n\n

Back in July, Steve was having some problems with sciatica, back pain radiating down his leg to his foot. Yes, it slowed him down. Yes, the diagnosis had been confirmed on an MRI. He was taking steroids, which helped with the pain, and was being considered for surgery. No, he told me, no one had suggested a chiropractor.<\/p>\n\n\n\n

I located a good chiro for him in Vero Beach, wished him luck, and said I\u2019d see him in six months. When I returned recently and saw him, my first thought was that Steve was in the final weeks of some devastating illness. He looked 40 pounds thinner and moved slowly, his voice hoarse and subdued. Steve had almost overnight become very old. He was clearly depressed, even though he was being well cared for at home by one of his mother hens.<\/p>\n\n\n\n

\u201cI had it pretty bad just a few weeks after you left, doc\u201d he said. \u201cEverything just went downhill\u2026\u201d<\/p>\n\n\n\n

Let me stop here and say I\u2019ve never cared much for medical care in Florida. From the moment you step off the plane you\u2019re bombarded with physicians advertising themselves as the best this, the best that. You go to a movie and the previews include ads for orthopedists, urologists, ophthalmologists. Combine this with an aged population that has nearly unlimited medical insurance (Medicare and supplemental coverage) and a state reimbursement system that rewards doctors who perform the most surgical procedures and you end up with lots and lots of unnecessary surgery.<\/p>\n\n\n\n

Maybe worst of all you\u2019ve got a geriatric generation that maintains perfect faith in the medical profession. \u201cI do whatever my doctor tells me\u201d is the watchword in Florida.<\/p>\n\n\n\n

Let\u2019s be conservative<\/b><\/h3>\n\n\n\n

And while the phrase \u201cLet\u2019s be conservative about this\u201d might apply to their politics, it definitely does not apply to slowing the income stream from surgical procedures.<\/p>\n\n\n\n

If your doctor doesn\u2019t do the surgery he\u2019s recommending now<\/i>, in his heart he knows someone else will beat him to it. Get those cataracts out now<\/i> or you\u2019ll be blind, those hammertoes fixed now<\/i> or you\u2019ll trip, break your hip, and die. Fix that hernia you\u2019ve been dragging around for decades now<\/i> or it will strangulate and you\u2019ll die!<\/p>\n\n\n\n

In relating Steve\u2019s decline from suave foxtrot dancer to decrepit old man with one foot in the grave, I\u2019m going to pause to comment on the conservative medical options that were never once mentioned to him. Keep in mind that Steve is 85 and except for his annoying sciatica is in perfect health. Believe me, I know. I heard more about his sex life that evening six months ago when we toured the nightclubs than I ever wanted to know: Cialis, Viagra, Barbara, Melanie, Astroglide. We doctors are used to this.<\/p>\n\n\n\n

Here\u2019s what happened to Steve<\/b><\/h3>\n\n\n\n

After just four treatments with the chiropractor I\u2019d sent him to, Steve became impatient and decided that since he had back pain, maybe this was a kidney stone. After all, he\u2019d had kidney stones in the past, and while this particular pain was completely different he decided to see the urologist whose billboard he drove past every day.<\/p>\n\n\n\n

The ultrasound of his kidney did show a stone, but not in a location that would be causing his current pain. The stone probably had been there for years. Nevertheless, the new urologist suggested immediate removal using lithotripsy (sound waves to break up the stone) because it \u201cmight cause trouble in the future.\u201d<\/p>\n\n\n\n

Pause:<\/b> most stones in locations like these cause no symptoms and people are unaware of their existence. You might have one or two yourself. If everyone in America had a kidney ultrasound, there\u2019d be a pyramid of removed stones. In other words, this procedure<\/a> would have been unnecessary.<\/p>\n\n\n\n

But Steve never made it to the lithotripsy because at the urologist\u2019s office his EKG showed he had atrial fibrillation. This is a common heart rhythm abnormality, generally treated with medications to keep the heart beating in a coordinated way. Doctors also recommend adding a blood thinner to prevent a stroke.<\/p>\n\n\n\n

Sometimes when people are in atrial fibrillation, the heart rate speeds up to potentially dangerous speeds–over 120 beats per minute, for example. But Steve was told that his heart rate was completely normal, which means his was somewhere between 65 and 95 beats per minute. No treatment is needed for this. My Aunt Hildy has been in atrial fibrillation for decades, blaming it, strangely but insistently, on moving to Florida. \u201cI never had any fibrillation in Chicago when I lived on Kedvale Avenue.\u201d<\/p>\n\n\n\n

Discovering this relatively benign heart rhythm abnormality, Steve\u2019s urologist actually called an ambulance and had him whisked to the hospital, where he remained for a week having lots of tests that are usually done on an outpatient basis. Ultimately, Steve was told he had \u201ca serious problem\u201d with one of his heart valves and they recommended surgery as soon as possible.<\/p>\n\n\n\n

Remember, not only did Steve feel fine, but, ironically, one morning in the hospital his back pain went away by itself, never to return. \u201cI guess I was wrong about the kidney stone,\u201d Steve told me. (Likely a slipped disc shifted back into place, a common occurrence.) Steve was convinced to undergo surgical repair of his mitral valve because of \u201cwhat might happen in the future,\u201d even though he had absolutely no symptoms. Keep in mind this is a man approaching his 86th birthday.<\/p>\n\n\n\n

Pause:<\/b> standard treatment for mild mitral valve leakage (called mitral regurgitation) is taking medicine rather than having surgery, especially for essentially healthy patients like Steve. At this point, with the non-life-threatening atrial fibrillation and no evidence of anything actually wrong with his circulation, the only medication he\u2019d really need would be a blood thinner<\/a>.<\/p>\n\n\n\n

However, one week later Steve was in the operating room. The valve surgery did not go well. During the procedure, his heart stopped twice and as a result his surgeon inserted a permanent electrical defibrillator in his chest. After the operation Steve still had his once-non-threatening atrial fibrillation, but now his heart rate was lurching badly out of control and fluid started backing up into his lungs (called congestive heart failure).<\/p>\n\n\n\n

The next day, Steve found himself swollen up like a balloon. In an attempt to get his heart rhythm under control, he was sent back to the OR for \u201cthe paddles,\u201d electrical cardioversion like you see on TV to jolt the patient\u2019s heart rhythm back to normal. Steve\u2019s was precisely the situation this wouldn\u2019t be effective in (longstanding atrial fibrillation, congestive heart failure) and it wasn\u2019t, lucky for him as sudden conversion from atrial fibrillation to normal rhythm could potentially dislodge a clot and he might have awakened half paralyzed with a stroke.<\/p>\n\n\n\n

Finally, bloodied but unbowed, Steve staggered out of the hospital, still shaped like a balloon and into the care of one of his mother hens. After taking water pills for a week and \u201cpeeing like a racehorse,\u201d he\u2019d lost a total of 40 pounds and barely had the energy to climb the stairs. Steve doesn\u2019t think he\u2019ll be dancing for a while and his sex life is a memory. Recently, his cardiologist said that Steve still had congestive heart failure along with the atrial fibrillation, so he\u2019s returning regularly to the doctor\u2019s office to get his meds adjusted. Last week he saw his urologist, who said, \u201cWe still need to get that stone out\u201d and scheduled him for lithotripsy next month.<\/p>\n\n\n\n

Today Steve takes a handful of prescription drugs every morning. \u201cI hate them. They make me sick, I\u2019m dizzy all the time, and I sometimes pee blood because of the blood thinner. I begged my cardiologist to stop at least a few of them. You know what he said? \u2018Take these pills or you\u2019ll die!\u2019\u201d<\/p>\n\n\n\n

Life lessons from Steve\u2019s tsuris<\/a> for you, Health Tip reader<\/b><\/h3>\n\n\n\n