Sunday 2/8 and 2/15 at 11:30am Dr. Fisher will appear on channel 28 in Raleigh/Durham/Chapel Hill.
Community Matters will speak to Dr. Fisher about strategies for healthy aging. Please tune in!

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A recent study in the journal Aging Cell examined the effect of human growth hormone (hGH) levels on lifespan.  It turns out that people in their 90's with LOWER hGH live longer than those with higher hGH levels.  Why does this matter?  It flies in the face of the "anti-aging" therapies offered by "anti-aging" doctors who inject their patients with hormones, claiming to help them achieve "normal" levels when those hormones begin to drop.

The theory behind these "anti-aging" treatments is this: your body maintains a certain level of hormones like growth hormone, estrogen, and testosterone through your 40's and 50's, but then these hormones begin to diminish.  Around this same time, your body begins to feel the effects of aging.  If we could just boost those hormone levels back to what they were when you were 20, you would feel younger and live longer, right?

Wrong.

This study supports what many of us in geriatric medicine have suspected all along: the hormonal changes that come with aging are adaptive and protective.   In other words, it may be good for you to have lower levels of these hormones as you enter your 70's, 80's, 90's and beyond.

We can't avoid aging, so how can we avoid its effects?  What frightens us most about aging is the frailty that comes with it.  There are simple things that we can do every day to fight frailty.  I outlined them in my book, How to Keep Mom (and Yourself) Out of a Nursing Home.  They are simple- keep moving, eat fresh, maintain social connections, and pay attention to crucial systems like your urinary and circulatory system.  I wish there were a "magic shot" that would keep us all young, but hGH is not it.  The only proven way to remain vital as we age is to keep taking common sense steps like exercising and eating right.  Your body will respond, at any age.  It was designed to.

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A recent NY Times article by Dr. Pauline Chen blasts the emergency room as the worst place for older adults to seek medical care.  I agree- my practice has been proclaiming this message for years- but we disagree on the solution.  The article recommends we try to “geriatricize” the emergency room, by training doctors, nurses and health care workers in methods that will cater to older adults’ unique needs.  Dr. Chen references a study in Health Affairs that offers some suggestions: building separate emergency rooms dedicated to geriatric patients, training thousands of discharge planners who are skilled at coordinating complex care, and utilizing telemedicine technology to prevent rehospitalizations.  It sounds wonderful, and costly.

Shockingly, neither the Health Affairs study nor Dr. Chen mention the best and least expensive solution to this issue: home care medicine.  No matter how “senior-friendly” a hospital tries to make its emergency room, ERs will never be able to shake the pressure to “treat ‘em and street ‘em.”  As the article correctly points out, speed is required in a functional emergency room, sabotaging any chance for quality geriatric care.  The ER can never match the home as the ideal setting for providing urgent medical care to the older adult.  Concerned that the patient with cognitive impairment can’t give an accurate history in the hectic ER?  Keep him in his familiar home environment and enjoy the luxury of time to ask good questions.  Worried about adequate coordination of follow-up care?  Talk to the daughter who is sitting on the couch next to the patient.  Nervous that the discharged patient may fall at home, or fail to take her medications properly?  Look around for fall risks, and inspect her pillbox on the kitchen table.  These solutions are already in place, if one chooses a doctor who makes house calls.  We do exist, and we even have our own professional organization.

My practice, Doctors Making Housecalls, recently looked at our internal data, and found that we have reduced ER visits among our older patients by more than 40% over a 16 month period, when compared to a similar group who did not have a doctor who makes house calls.  Efforts are being made nationwide to prove the value of home care medicine.  The new health care law includes a demonstration project, Independence at Home, which seeks to do just that.  The best way to improve an older adult’s ER experience is to keep them from going there in the first place.  Rather than spending our limited resources trying to transform frenzied emergency rooms into comfortable senior citizen hangouts, let’s focus on providing better access to care in the place where seniors are most comfortable: their own homes.

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Dr Fisher speaks to Bill Lumaye on 850AM WPTF about dementia.

What is dementia?  What causes it?  Is it treatable?  How do I recognize it?  Can I prevent it?

Listen below for answers to these questions and more.


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aplaceI came across a frightening blog post by A Place for Mom, praising the easy access their senior living sites grant to Compassion and Choices, the nation's most vocal assisted suicide advocacy group.  The article boasted about the "choices" available to seniors who live in their facilities, and the author was especially proud that A Place For Mom would ensure that the families of these seniors were informed of Mom and Dad's right to kill themselves. (The article was written in Washington State, where assisted suicide is legal).  We were first made aware of the post by Wesley J. Smith whose outstanding blog Human Exceptionalism at National Review offers consistently coherent arguments for life and dignity.  He brought our attention to the blog post here and here.

I made the following comment at the post today:

"I am a geriatrician and I think end-of-life planning is very important. I am appalled that A Place for Mom promotes an assisted suicide advocacy group in this article, without presenting the other side of the issue. You are certainly not "neutral" as you claim, and I will never refer my family or any of my patients to A Place for Mom after reading this."

2 hours later, the blog entry was gone.  I'd like to take credit, or give credit to Wesley, or dozens of irate callers, or National Right to Life who also exposed the agenda.  However, it's more likely that the blog entry made its own "choice" to request "aid in dying" from its author at A Place for Mom.  After all, every blog entry has a right to know about this option.  It's cruel to force these blogs to go on living, when their anemic existence is only taking up space on the internet.  Whatever this blog's reason for choosing death, it must have been a good one.  Perhaps it felt that it had become a burden to its fellow blog posts, as it was creating negative press for A Place for Mom.  Maybe it had no sense of purpose, depressed about its pathetic number of visits.  Or maybe it knew that its existence was costing too much bandwidth, and it recognized that the most compassionate choice it could make would be to just go away.  Yes, compassion won in the end.  How wonderful that the blog entry was presented with all of its end-of-life options.  I'm certain that, in its already frail and threatened state, when authoritative end-of-life experts gave the option to commit suicide, it never would have interpreted that as a subtle suggestion.  Never.

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Monday on Special Report with Bret Baier, correspondent Jim Angle did a story about home health care and possible job losses due to the new health care law.  The segment featured one of my home care patients and her daughter who cares for her.  I also appeared in the segment.  Watch it here.

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ramis

I was sad to learn of the death of Harold Ramis, whose classic comedy films like "Vacation" and "Caddyshack" produced so many quotable moments.  My personal favorite was "Groundhog Day."  Unfortunately, Harold Ramis died today of, his agent informed us, "Autoimmune Inflammatory Vasculitis."

You won't find this exact term in a medical dictionary.  Vasculitis is an autoimmune disease, meaning that the body attacks itself, causing inflammation ('-itis') in the blood vessels ('Vascu-').  Saying "autoimmune inflammatory vasculitis" is like saying "respiratory infective pneumonia."   It's a bit redundant, but talent agents are not medically trained, so Mr Ramis' agent gets a pass.  The important point is that vasculitis affects the blood vessels throughout the body, and it is difficult to treat.  There are many types and many causes, but usually the disease is related to a "confused" immune system that attacks the lining of the arteries and veins.  This can cause pain, and it always leads to inflammation and narrowing of the vessels.  As the vessels narrow and blood flow to critical organs is interrupted, consequences such as lung disease, kidney disease, and stroke can occur.

Treatment is often limited to medications that blunt the body's immune system, in an attempt to reduce the attacks on the blood vessels.  These medicines can be toxic and cause serious side effects.  Harold Ramis probably suffered from this disease, and its treatment, for a long time.  Thankfully, he still found a way to make us laugh through his pain.

For more detailed information on vasculitis, and how to recognize its signs, visit rheumatology.org

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