By Fred Cicetti

Q: I’m getting heartburn a lot since I turned 60. Is more heartburn something that comes with more years?

A: More than 60 million Americans experience heartburn at least once a month and more than 15 million Americans experience heartburn daily. Heartburn is more common among the elderly.

Seniors have a greater risk of GERD.

Heartburn two or more times weekly may be caused by gastroesophageal reflux disease or GERD. See a doctor if you have heartburn too often. The doctor can test for GERD.

GERD makes stomach acid flow up into your esophagus. There is a valve at the lower end of the esophagus that is designed to keep acid in the stomach. In GERD, the valve relaxes too frequently, which allows acid to reflux, or flow backward.

A hiatal hernia may contribute to GERD. A hiatal hernia occurs when the upper part of the stomach is above the diaphragm, which is the muscle wall separating the stomach from the chest. The diaphragm helps the valve keep acid from coming up into the esophagus.

When GERD is not treated, you can suffer severe chest pain, narrowing or obstruction of the esophagus, bleeding, or a pre-malignant change in the lining of the esophagus. One study showed that patients with chronic, untreated heartburn were at a substantially greater risk of developing esophageal cancer.

The following are some symptoms that may mean there has been damage to your esophagus: difficulty swallowing, a feeling that food is trapped behind the breast bone, bleeding, black bowel movements, choking, shortness of breath, coughing, hoarseness and weight loss.

You can control infrequent heartburn by changing your habits and using over-the-counter medicines.

For example, you should avoid heartburn-producers such as chocolate, coffee, peppermint, tomato products, alcoholic beverages, and greasy or spicy dishes. Quit smoking because tobacco inhibits saliva that helps with digestion. Tobacco may also stimulate acid production and relax the esophageal valve. Lose weight. And don’t eat two hours before you go to sleep.

For infrequent episodes of heartburn, take over-the-counter antacids, such as Alka-Seltzer and Rolaids. Or, you can take an H2 blocker. H2 blockers are available in both over-the-counter and prescription forms. For example, Pepcid and Zantac are over-the-counter H2 blockers, which are available by prescription at higher doses.

There are also proton pump inhibitors (PPIs), prescription medications that prevent the release of acid in the stomach and intestines. Doctors prescribe PPIs to treat people with heartburn, ulcers of the stomach or intestine, or excess stomach acid. PPIs include Prilosec and Prevacid.

GERD is a chronic disease that calls for continuous long-term therapy. To decrease the acid in your esophagus, raise the head of your bed or place a foam wedge under the mattress to elevate the head about 6 to 10 inches. Avoid lying down for two hours after eating. And don’t wear tight clothing.

Prescription medications to treat GERD include the H2 blockers and the PPIs, which help to reduce the stomach acid and work to promote healing at prescription strength. In addition, there are agents that help clear acid from the esophagus.

Surgery is an option if other measures fail. A surgeon can improve the natural barrier between the stomach and the esophagus that prevents acid reflux.

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All Rights Reserved © 2010 by Fred Cicetti

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By Fred Cicetti

Q: I’m a geezer planning to have surgery in a few months. I was wondering if I can donate blood to myself in advance?

A: Yes you can. This is called “autologous” blood donation. It’s done in the weeks before non-emergency surgery. The blood is stored until the operation. Autologous donation is most often employed in surgery on bones, blood vessels, the urinary tract and the heart, when the likelihood of transfusion is high.

This form of blood donation is good for the patient, but it’s beneficial to society, too.

Seniors can donate blood ahead of time in cases of non-emergency surgery.

People over the age of 69 require half of all whole blood and red blood cells transfused, according to the National Blood Data Resource Center (NBDRC). Giving blood to yourself cuts down on the demand for blood.

Typically, each donated unit of blood, referred to as whole blood, is separated into multiple components, such as red blood cells, plasma, platelets and antihemophilic factor, for transfusion to individuals with different needs.

With an aging population and advances in medical treatments requiring blood transfusions, the demand for blood is increasing. On any given day, an average of 38,000 units of red blood cells are needed.

Volunteers donate almost all the blood transfused in the United States using current screening and donation procedures. A growing number of blood banks have found blood donation by seniors to be safe and practical; if you’re a geezer, you probably can help the cause.

To be eligible to donate blood, a person must be in good health. In general, donors must weigh at least 110 pounds. Most blood banks have no upper age limit. Donors are screened for AIDS, hepatitis, other diseases and other possible problems.

Adult males have about 12 pints of blood in their circulation and adult females have about 9 pints. The donor’s body replenishes the fluid lost from donation in about 24 hours. The red blood cells that are lost are generally replaced in a few weeks. Whole blood can be donated once every eight weeks.

What is the most common blood type?

The approximate distribution of blood types in the U.S. population is as follows. Distribution may be different for specific racial and ethnic groups:

O Rh-positive: 38 percent
O Rh-negative: 7 percent
A Rh-positive: 34 percent
A Rh-negative: 6 percent
B Rh-positive: 9 percent
B Rh-negative: 2 percent
AB Rh-positive: 3 percent
AB Rh-negative: 1 percent

In an emergency, anyone can receive type O red blood cells, and type AB individuals can receive red blood cells of any ABO type. Therefore, people with type O blood are known as “universal donors,” and those with type AB blood are known as “universal recipients.”

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A: The American Academy of Orthopaedic Surgeons says joint replacement surgery is successful in more than 9 out of 10 people. And replacement of a hip or knee lasts at least 20 years in about 80 percent of those who have the surgery.

In the procedure, an arthritic or damaged joint is removed and replaced with an artificial joint called a prosthesis.

The goal of surgery is to relieve the pain in the joint caused by the damage done to cartilage, the tissue that serves as a protective cushion and allows smooth, low-friction movement of the joint. Total joint replacement is considered if other treatment options will not bring relief.

In an arthritic knee, the damaged ends of the bones and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee function. In an arthritic hip, the damaged ball and socket of this joint are replaced by a metal ball and plastic socket.

The two most common joints requiring this form of surgery are the knee and hip, which are weight-bearing. But replacements can also be performed on other joints, including the ankle, foot, shoulder, elbow and fingers.

After total hip or knee replacement, you will often stand and begin walking the day after surgery. Initially, you will walk with a walker, crutches or a cane. Most patients have some temporary pain in the replaced joint because the surrounding muscles are weak from inactivity and the tissues are healing, but it will end in a few weeks or months.

Exercise is an important part of the recovery process. After your surgery, you may be permitted to play golf, walk and dance. However, more strenuous sports, such as tennis or running, may be discouraged.

There can be complications from joint-replacement surgery. These include infection, blood clots, loosening of the prosthesis, dislocation of the joint, excessive wear, prosthetic breakage and nerve injury. There are remedies for all of these complications, but sometimes the correction will take more surgery.

Surgeons are refining techniques and developing new ones, such as minimal-incision surgery. Instead of a 6- to 12-inch-long incision used in a standard total knee replacement, some surgeons are using a 4- to 5-inch incision. And instead of the typical 10- to 12-inch incision in a total hip replacement, surgeons are operating through one 4-inch cut or two 2-inch cuts.

Minimal incisions reduce trauma, pain and hospital stays. Not all patients are candidates for minimal-incision surgery.

There is a surgical alternative to total hip replacement. It’s called hip resurfacing. The primary difference in hip resurfacing is that the surgeon doesn’t remove the ball at the top of the thigh bone. Instead, the damaged ball is reshaped, and then a metal cap is anchored over it.

Hip resurfacing, unlike hip replacement, preserves enough bone to permit a total replacement if it is necessary later. Resurfacing is not recommended for patients with osteoporosis, a disease that makes bones porous and vulnerable to fractures. Some healthcare experts advise getting a replacement hip joint, not a resurfacing, if you are older than 65.

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All Rights Reserved © 2010 by Fred Cicetti

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Q: What is acetaminophen and why do I see it listed on so many products in my medicine cabinet?

A: Acetaminophen is the most widely used pain-reliever and fever-reducer in the world. It is contained in more than 100 products. Tylenol is the best-known over-the-counter (OTC) acetaminophen product. The drug is also a component of well-known prescription drugs such as Darvocet and Percocet. Acetaminophen also is known as paracetamol and N-acetyl-p-aminophenol (APAP).

Acetaminophen is available without a prescription. Follow the directions on the package label carefully. If your doctor prescribes it for you, the prescription label will tell you how often to take it.

Taking too much acetaminophen can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines that contain acetaminophen.

The maximum daily dose of acetaminophen is 4 grams in adults. The toxic dose of acetaminophen after a single acute ingestion is about 7 grams in adults. The at-risk dose may be lower in some susceptible populations, such as alcohol abusers. When dosing recommendations are followed, the risk of liver toxicity is extremely small.

Acetaminophen is one of the most common pharmaceutical agents involved in overdose, as reported to the American Association of Poison Control Centers.

One of the problems with acetaminophen is its widespread use. You have to check your medicine cabinet to see what products contain acetaminophen. Then, if you’re taking more than one medication, be sure you don’t exceed the maximum daily dose.

Adults should not take acetaminophen for pain for more than 10 days without talking to a doctor. Acetaminophen should not be taken for high fever, for a fever lasting more than three days or for a recurrent fever without a doctor’s supervision.

There are basically two types of over-the-counter pain relievers. Some contain acetaminophen and others contain non-
steroidal anti-inflammatory drugs, often called NSAIDs. Examples of over-the-counter types of these drugs are aspirin, ibuprofen (Advil), naproxen sodium (Aleve) and ketoprofen (Orudis).

NSAIDs are associated with stomach distress. You should talk to your doctor before using NSAIDS if you are older than 60, taking prescription blood thinners or if you have stomach ulcers or other bleeding problems.

NSAIDs can also cause reversible damage to the kidneys. The risk of kidney damage may increase in people who are older than 60, have high blood pressure, heart disease or pre-existing kidney disease, and people who are taking a diuretic.

You should talk with your healthcare professional if you have questions about using an over-the-counter medicine before using it in combination with other medicines—either other over-the-counter drugs or prescription medicine. Combining these two types of medicines can lead to problematic drug interactions.

All older adults should consult their doctors before taking any over-the-counter medication or herbal supplement.

Often, older adults use many drugs at the same time, including prescription and over-the-counter drugs. They also process drugs differently than younger adults. This is why older adults need to be especially careful about drug-drug interactions.

If you’re a senior, talk with your doctor about all of the drugs and herbal health products you take. He or she can tell you whether you are at risk for having a bad reaction from taking an over-the-counter drug.

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If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2010 by Fred Cicetti

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A: Yes, men do get osteoporosis, but women are at greater risk.

Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue. This condition creates an increased risk of fractures.

Osteoporosis is a major public health threat for 44 million Americans; about 68 percent of them are women. One out of every two women and one in four men older than 50 will have an osteoporosis-related fracture in their lifetime.

Our bodies remove old bone and replace it with new bone. During our growth stage, new bone is added faster than old bone is removed. We hit peak bone mass around age 30. After that age, we lose more bone than we form.

Who is at risk of getting osteoporosis?

The chances are greater if you are a woman. Women have less bone tissue and lose bone faster than men because of changes from menopause. Small, thin-boned women are at greater risk. Caucasian and Asian women are at highest risk. Age is a major risk factor because bones become thinner and weaker as you age. Heredity can also increase fracture risk.

Low calcium intake appears to be associated with bone loss. Good sources of calcium include low-fat dairy products, dark-green leafy vegetables, almonds and foods fortified with calcium, such as orange juice. Some people may need to take a calcium supplement.

Vitamin D plays an important role in calcium absorption and in bone health. It is made in the skin through exposure to sunlight. Vitamin D production decreases in the elderly, in people who are housebound and for people in general during the winter. Depending on your situation, you may need to take vitamin D supplements.

Bone responds to exercise by becoming stronger. Weight-bearing exercise is the best for your bones. Get off the sofa.

Women who smoke have lower levels of estrogen compared to nonsmokers, and they often go through menopause earlier. Smokers also may absorb less calcium from their diets. Quit.

Regular consumption of two to three ounces of alcohol a day may be damaging to the skeleton. Heavy drinkers are more prone to bone loss and fractures because of poor nutrition and increased risk of falling. Quit, or at least cut down.

People may not know they have osteoporosis until their bones become so weak that a bump or fall causes a hip to fracture or a vertebra to collapse. See your doctor for a check-up.

Following a comprehensive medical assessment, your doctor may recommend that you have your bone mass measured. A bone mineral density (BMD) test is the best way to determine your bone health. BMD tests can identify osteoporosis, determine your risk for fractures and measure your response to osteoporosis treatment. The most widely recognized bone mineral density test is called a dual-energy X-ray absorptiometry, or DXA, test.

A comprehensive osteoporosis treatment program includes a focus on proper nutrition, exercise and safety issues to prevent falls that may result in fractures. In addition, your physician may prescribe a medication to slow or stop bone loss, increase bone density and reduce fracture risk.

If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2010 by Fred Cicetti.

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A: Radon and asbestos are causes, too. Radon is an invisible, odorless and radioactive gas that occurs naturally in soil and rocks. Asbestos has been used for fireproofing, electrical insulation, building materials, brake linings and chemical filters.

But cigarette smoking is the number one cause of lung cancer. Before cigarette smoking became popular in the early part of the 20th century, doctors rarely saw patients with lung cancer. Nearly 90 percent of people with lung cancer developed it because they smoked cigarettes.

The good news is that smoking is not as popular as it used to be. In 1965, about 42 percent of all adults smoked, but by 1997, only 25 percent did. Also, there has been a sharp drop in lung cancer deaths among men, mainly because fewer men are smoking.

Lung cancer is the leading cause of cancer death in men and women in the United States. It occurs most often between the ages of 55 and 65.

Common symptoms of lung cancer include: a persistent cough that worsens, constant chest pain, coughing up blood, shortness of breath, wheezing or hoarseness, repeated problems with pneumonia or bronchitis, swelling of the neck and face, loss of appetite or weight loss and fatigue.

If you have any of these symptoms, it is important to check with a doctor immediately. If tests show that you have cancer, you should make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes.

The standard treatments for lung cancer are surgery to remove a tumor, chemotherapy with anti-cancer drugs, radiation to kill cancer cells and photodynamic therapy, a newer technique that uses a laser with a chemical to kill cancer cells.

There are two major types of lung cancer: non-small cell lung cancer and small cell lung cancer. Each type of lung cancer grows and spreads in different ways, and each is treated differently.

Non-small cell lung cancer is more common than small cell lung cancer. Doctors treat patients with non-small cell lung cancer in several ways. Surgery is a common treatment. Cryosurgery, a treatment that freezes and destroys cancer tissue, may be used to control symptoms in the later stages of non-small cell lung cancer. Doctors may also use radiation therapy and chemotherapy to slow the progress of the disease and to manage symptoms.

Small cell lung cancer grows more quickly and is more likely to spread to other organs in the body. In many cases, cancer cells have already spread to other parts of the body when the disease is diagnosed. In order to reach cancer cells throughout the body, doctors almost always use chemotherapy.

Treatment for small cell lung cancer may also include radiation therapy aimed at the tumor in the lung or tumors in other parts of the body, such as in the brain. Surgery is part of the treatment plan for a small number of patients with small cell lung cancer.

Some patients with small cell lung cancer have radiation therapy to the brain even though no cancer is found there. This treatment is given to prevent tumors from forming in the brain.

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If you have dry mouth, your doctor may adjust your medication or prescribe a medication to stimulate saliva production.

Other symptoms of this problem are: saliva that seems thick, sores or split skin at the corners of your mouth, difficulty speaking and swallowing, a change in your sense of taste, increased plaque, tooth decay and gum disease.
Everyone experiences dry mouth occasionally. We get it when we are under stress. But if you have dry mouth all or most of the time, you need medical help.
Most cases of xerostomia are related to the medications taken by older adults rather than to the effects of aging. More than 400 medicines can affect the salivary glands. These include drugs for urinary incontinence, allergies, high blood pressure, depression, diarrhea and Parkinson’s disease. Also, some over-the-counter medications often cause dry mouth.
Dry mouth can also be caused by cancer treatments, such as chemotherapy and radiation, nerve damage in the head or neck, the autoimmune disease Sjögren’s syndrome, endocrine disorders, Alzheimer’s disease, stroke, anxiety disorders and depression.
Sjögren’s syndrome can occur either by itself or with another autoimmune disease, such as rheumatoid arthritis or lupus. Salivary and tear glands are the major targets of the syndrome. The result of the syndrome is a decrease in production of saliva and tears.
The disorder can occur at any age, but the average person with the disorder at the Sjögren’s Syndrome Clinic of the National Institute of Dental and Craniofacial Research (NIDCR) is in his or her late fifties. Women with the disorder outnumber men 9 to 1.
In addition, tobacco, alcohol (in beverages and mouthwash), drinks with caffeine, snoring and breathing with your mouth open can aggravate dry mouth.
If you think you have dry mouth, go to your doctor or dentist. Your doctor may adjust your medication that is suspected of causing the problem. Or your doctor may prescribe a medication to stimulate saliva production.
There are other ways to improve saliva flow. Try sugar-free hard candy or chewing gum. Avoid lemon-flavored hard candy, because it makes saliva acidic, increasing the possibility of tooth decay. You can also sip water regularly, try over-the-counter saliva substitutes, avoid breathing through your mouth and use a humidifier in your bedroom.
If you have dry mouth, you have to pay greater attention to your teeth. Brush your teeth with an extra-soft toothbrush after every meal and at bedtime. If brushing hurts, soften the bristles in warm water. Floss your teeth gently every day. Always use toothpaste with fluoride in it. If you have a sweet snack, brush right away.

If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2010 by Fred Cicetti.

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• Eat a varied diet with plenty of fruits and vegetables

• Maintain a healthy weight

• Exercise daily

• Go to the doctor when you’re sick

• Go to the doctor when you’re well to get screened for disease

• Don’t smoke

• Use sunscreen

• Stay close to your friends and family

Now let’s get into some of the potions that are being marketed through drugstores. We’ll start with antioxidants.

As your body processes food, it makes substances called “free radicals,” which are believed to contribute to aging and certain diseases. To neutralize free radicals, your body uses antioxidants that come from your food. Proponents believe that antioxidants can prevent chronic diseases.

The following are some antioxidants: vitamin A, vitamin B-6, vitamin B-12, vitamin C, vitamin E, beta carotene, folic acid and selenium.

The best way to give your body the antioxidants it needs is to eat a variety of fruits and vegetables. There’s no proof that antioxidants in pill form can improve your general health or extend your life.

Because some hormone levels drop with age, there’s a theory that this decline causes us to age. But can you reverse aging by restoring your hormones?

DHEA, testosterone, melatonin and HGH are some popular hormone supplements.

Your body converts DHEA into the sex hormones estrogen and testosterone. Proponents say it also slows aging, increases muscle and bone strength, burns fat, improves cognition, bolsters immunity and protects against chronic diseases.

Declining levels of testosterone, the male sex hormone, have been linked with decreased energy and sex drive, muscle weakness and osteoporosis.

Melatonin is produced in your brain. It helps regulate sleep. Some claim it can slow or reverse aging, fight cancer and enhance sexuality.

Human growth hormone (HGH) is responsible for growth spurts in children. Advocates say injections of prescription-only HGH can burn fat, build muscle and renew energy.

There is no convincing medical evidence to support claims about these hormone supplements. And they are risky. For instance, even short-term use of DHEA or testosterone may cause liver damage.

Don’t believe advertisements that tell you supplements are “natural” remedies, implying that they can’t hurt you. Some people try supplements, such as coral calcium, ginseng and Echinacea, to stop aging. There isn’t any evidence to support the claims for these supplements either.

Talk to your doctor before taking any supplement. Ingredients in supplements can cause harmful interactions with your medications and serious side effects.

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If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2008 by Fred Cicetti

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But unrelenting depression is not normal. If you feel this way, you should seek medical attention. Most people get better if they treat their depression.

There are many causes of depression. Some of them are the natural consequences of being older: a health crisis or death, the loss of physical or mental capacities or being a stressed-out caregiver.

Seniors usually rebound from a period of sadness. However, if you are suffering from “clinical depression” and you don’t get help, your symptoms might last months, or even years.

The following are common signs of depression. If you have several of these, and they last for more than two weeks, get treatment: anxiety, fatigue, loss of interest or pleasure, sleep problems, eating too much or too little, abnormal crying, aches that can’t be treated successfully, diminished concentration or memory, irritability, thoughts of death or suicide and feelings of despair, guilt and being worthless.

Depression is a serious illness. It can lead to suicide. Don’t waste time; find help.

Start with your family doctor. The doctor should check to see if your depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or a medicine you are taking.

After a complete exam, your doctor may suggest you talk to a social worker, mental health counselor, psychologist or psychiatrist. Doctors specially trained to treat depression in older people are called “geriatric psychiatrists.”

Support groups can provide new coping skills or social support if you are dealing with a major life change. A doctor might suggest that you go to a local senior center, volunteer service or nutrition program. Several kinds of talk therapies work well.

Antidepressant drugs can help. These medications can improve your mood, sleep, appetite and concentration.

Electroconvulsive therapy (ECT) is an option. It may be recommended when medicines can’t be tolerated or when a quick response is needed.

What can be done to lower the risk of depression? Nurture your family ties and friendships; they are your lifelines. Hobbies keep your mind and body active. Exercise is a mood-elevator. Eat a balanced diet. Get outdoors to absorb sunlight and breathe fresh air. Take naps.

Remember, with treatment, most people will find positive thoughts gradually replacing negative thoughts. And you can help this process by catching yourself when you are dwelling on the negative and shifting gears to sunnier thoughts.
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If you have a question, please write to fred@healthygeezer.com.

All Rights Reserved © 2009 by Fred Cicetti

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A: Have this checked immediately by an eye care practitioner. What you describe is a symptom of age-related macular degeneration (AMD), a leading cause of vision loss in Americans 60 years of age and older.

The macula is at the center of the retina in the back of your eye. The retina transmits light from the eye to the brain. The macula allows us to perform tasks that require central vision, such as reading and driving.

In some cases, age-related macular degeneration advances so slowly that people notice little change in their vision. In others, the disease progresses faster and may lead to a loss of vision in both eyes. It comes in two forms—wet and dry.

Wet age-related macular degeneration occurs when blood vessels behind the retina start to leak and raise the macula. An early symptom of this form of the disease is straight lines that appear wavy. Wet age-related macular degeneration is considered advanced and is more severe than the dry form. However, dry AMD can turn into wet AMD at any time.

Dry age-related macular degeneration occurs when macular cells break down, gradually blurring central vision in the affected eye. Central vision in the affected eye can be lost. The dry form generally affects both eyes, but vision can be lost in one eye.

The risk of getting age-related macular degeneration increases with age. Other risk factors include smoking, obesity, race (whites are at higher risk), a family history of AMD and gender (women are at higher risk).

The disease is detected through a comprehensive eye exam that includes a visual acuity test, a dilated eye exam and tonometry. Visual acuity is measured with an eye chart test. In the dilated eye exam, drops are placed in your eyes to enlarge the pupils. Then, a magnifying lens is used to examine your retina. Tonometry measures the pressure inside the eye.

You may also be asked to look at an Amsler grid. With one eye, you will stare at a black dot in the center of the grid. You may notice that the straight lines in the pattern appear wavy or are missing. These may be signs of age-related macular degeneration.

Once the dry form of this disease is in the advanced stage, no treatment can prevent vision loss. However, treatment can delay and possibly prevent age-related macular degeneration from progressing to the advanced stage. Some vitamins and minerals may reduce the risk of developing advanced AMD.

The wet form can be treated with surgery, therapy and injections into the eye. None of these treatments is a cure for wet AMD. Each treatment may slow the rate of vision decline, but the disease may progress anyway.

If you have lost some sight from age-related macular degeneration, don’t be afraid to use your eyes for reading, watching TV and other routine activities. Normal use of your eyes will not damage your vision further.

If you have a question, please write to fred@healthygeezer.com.
All Rights Reserved © 2009 by Fred Cicetti

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