REAL   AGE    --  the  right   medicine

The Youngest Patient

HOW THE RIGHT MEDICINE CAN KEEP YOU YOUNG

The whole point of RealAge is to keep you out of the doctor's office. Yet, now and again, all of us need to visit the doctor. Learning how to obtain the best possible care will keep your RealAge younger. Those who patrol their own health, learn how to manage a chronic condition, get regular checkups, and demand high-quality care can have a RealAge as much as nine years younger than those who do not. Evaluate your family disease history and your genetic risks. Knowing which diseases you may be predisposed to develop can help you counteract those conditions before they begin. If you do develop a chronic medical condition, properly managing the illness can save you from much of the ageing that it can cause. Being a savvy patient will help make you a younger patient.

• The best person to monitor your health is you. You know your own body better than your doctor ever will. You know if it aches, if something isn't working right, or if something has changed. Even if it's just a subtle change. Patrolling your health can reduce your RealAge by as much as nine years.

Difficulty rating: Moderately difficult

• How long did your parents live? How long did your grandparents live? And do the lengths of their life spans help predict the length of yours?'' What is the correlation between heredity and longevity? Learn how to evaluate your inherited biological risks.

Difficulty rating: Moderate

• Mixing and matching prescriptions or taking medicines erratically or beyond the prescribed time can age you. Taking too many drugs can make you as much as 4 and 1/2 years older. However, don't stop taking a medicine without consulting your doctor first. Deciding not to take necessary medicines can make you more than 1 year older.

Difficulty rating: Moderately easy

• Eighty percent of us will have a chronic illness at some time in our lives. Diseases such as diabetes, arthritis, heart disease, kidney disease, and asthma are common, and all increase the rate at which we age. In most instances, learning to manage that disease properly means that you will be able to live healthily in spite of it. Depending on the condition, proper management can reduce the ageing effect of a chronic illness by 80 percent and, in some cases, even more.

Difficulty rating: Moderately difficult

By reading this book you have learned what you can do to keep as far away from the doctor's office as possible. But every now and again, all of us need to visit the doctor. Keeping a clean bill of health helps us stay young, and detecting and managing new conditions in the early stages are the best ways to prevent the ageing the conditions can cause. Learn to patrol your own health, looking for any early warning signs that something is amiss. Evaluate your family history, so you know what diseases you may be genetically predisposed to develop. By knowing your risks, you are in the best position to counteract them. Carefully monitoring any chronic conditions that do exist can save you years of unnecessary ageing.

Patrolling Your Health: Learning How to Be a Member of the Age Police      

I met Nathan R. on the way to the operating room. I was his anesthesiologist. He had a small tumor on a nerve just below his skull near his ear: a potentially deadly condition if not caught in time. Lucky for him, it was discovered early—and because of bis own persistence.

Nathan was fifty-five when he began to notice that his hearing wasn't quite right and that his equilibrium was off. He noticed dizziness and vertigo when he stood up suddenly. He kept having the sensation that he was going to faint, particularly whenever he did anything energetic. He went to one doctor after another. The doctors ran him through all the tests they thought appropriate, but couldn't find anything wrong.

Just because they couldn't find anything wrong didn't mean that something wasn't wrong. Nathan, who was feeling worse and worse, kept persisting. After going to several specialized clinics and seven different doctors, Nathan finally went to a doctor who took another MRI (magnetic resonance image-ing) scan, a kind of three-dimensional X ray, of Nathan's brain. At first the doctor, just like all the others, said that he couldn't find anything wrong.

Nathan was so insistent that something was wrong that the doctor went back over the images again, showing Nathan exactly what doctors look for when reading an MRI. Explaining to him how to read the images, pointing to the different lobes of the brain pictured on the screen, the doctor began to study the image very carefully. Nathan asked lots of questions. Suddenly, the doctor finally spotted it. A small bump on a nerve, a telltale tumor. 'It's so small that I can't believe I even saw it,' the doctor told me when he called me to do the anesthesia. Normally brain tumors aren't detected until they are well over 1 centimeter; Nathan's was one-third that size. Two days later, Nathan went into surgery.  

'You're one heck of a lucky guy,' I told Nathan in the recovery room as he came out of anesthesia. The tumor that was removed proved to be fast-growing—and cancerous. It might well have killed Nathan in a matter of months had it not been discovered, but because it was discovered early enough, Nathan suffered virtually no consequences. After a few weeks of recovery, he went right back to life as usual. Since he already exercised, ate right, and took care of himself, his RealAge was more than ten years younger than his chronological age, around forty-five. The only side effect of the surgery was some hearing loss in one ear. It's not much, considering the danger he had barely escaped.

Although Nathan was indeed lucky, he had created his own luck. He was enough in tune with his body to know when something was amiss and to take it seriously. Nathan was saved by his own persistence and savvy.

It's a great story. One that makes us feel good. But it raises the question: If something small and vague began to affect you and lasted several weeks, would you see a doctor to find out what was wrong? Or would you hope that it would go away by itself or just try to live with it?

Stop and ask yourself: Are you healthy? Compared with the health of others your age, would you rank your health as excellent, good, fair, or poor? If you say 'excellent' or 'good,' then your RealAge is probably a bit younger than calculated. If you say 'poor,' then your RealAge is a bit older. Studies show that most people can assess the general state of their own health relatively accurately. That is, when something's not right with our bodies, most of us know it. One study found that those who ranked their overall health as poor were as much as twenty times more likely to die in the next year as those who ranked their health as good. This finding is not surprising. If you are sick, chances are that you already know it. However, this statistic held true even for people who didn't know that they had anything wrong with them; they just had a sense that their general health was not very good. Furthermore, at least seven studies, including the recent report of the Baltimore Longitudinal Ageing Study, have shown that this result is consistently true: patients who suspect that something is wrong, even though their physicians have diagnosed them as being disease-free, are generally right: something is wrong.

How much does patrolling your own health affect your RealAge? It is difficult to quantify exactly. If you spot an early cancer and have it removed before it has a chance to metastasize, you may save yourself ten, twenty, even thirty years of RealAge ageing.

The health care industry has undergone tremendous changes in the past decade. Health maintenance organizations (HMOs) and budget cutbacks have made time and costs extremely important considerations in the practice of medicine. Most doctors have considerably less time to spend with their patients than they did just a decade ago. Hence, doctors have less time to get a 'feel' for their patients before they diagnose them. In addition, the changing nature of the insurance industry, and of the health care industry itself, means there is less chance that you will see just one doctor all the time. Many news reports lament the 'sorry state of health care.' But the news isn't all bad. We now have better facilities, better treatments, and better diagnostic tools, which means that the best possible care is better than it's ever been. The trick is to get that care for yourself.

How do you do that? By being a proactive patient. 

First find a doctor you like and trust. Choose someone who is competent, conscientious, and attentive to you and your problems. Your primary care physician should make you feel comfortable. (If you don't feel comfortable, find someone else.) Also, he or she should listen to you and be able to explain clearly what is going on with your body. Ask friends, neighbors, or pharmacists about the doctors they use and consider listings, such as the 'top physicians' guides. Also, you might want to find out where your doctor went to medical school and how well he or she did there. For example, membership in Alpha Omega Alpha indicates that your doctor graduated in the top of his or her class. Many HMOs or health service networks have services that provide information about their physicians. If a particular condition runs in your family, consider getting a specialist physician who is board certified in that field.

Second, get regular checkups. A clean bill of health provides a baseline for how you are when everything is 'normal.' Then, if something does arise, you have a better framework for knowing what is wrong and when it started to go wrong. In addition, the more information your doctor has about you when you are healthy, the easier it will be for him or her to know when you are sick. If, you, like Nathan, sense that something is wrong but your doctor doesn't find anything, don't be afraid to ask your doctor, 'What does this test tell you?' or 'What does this number mean?' And don't forget this one: 'Is there anything else that it could be? Something we're not thinking about?' Part of your doctor's job is to explain to you exactly what is going on inside your body. If you don't understand what's ailing you, you won't be prepared to take the best care of yourself. Also, don't hesitate to get a second opinion. Or a third or fourth. If the second opinion agrees with the first, you can relax and feel more comfortable about the diagnosis you have been given. If the opinions differ, you will have a chance to compare them and to reconsider your options.

Remember, modern medicine can't cure everything. Although we are discovering more about the ways our bodies work every day, many aspects of human biology remain elusive. It may take time for a condition to manifest itself in such a way that it can be diagnosed. But the more aware of your body you are, the more likely you will be to catch a serious illness in its early stages.

How can you be a better patient when you do go to the doctor? By being prepared and informed. Write down questions before you go so you won't forget any important points. If you've noticed a particular problem, write down your symptoms. Make a copy to give your doctor. If you are going to see the doctor for a condition that is chronic, keep a log. If you have a pain that comes and goes, note when it comes and how long it lasts. Keep track of the foods you eat, the activities you perform, and anything else that seems relevant. Write down all the medicines, including herbs and vitamins, that you take and their dosages. The more information your doctor has, the better he or she will be able to help you.

Even if a symptom seems too minor to be mentioned, don't treat it yourself. Tell your doctor. Some conditions manifest in very odd ways. When something hasn't felt right for a while, it's probably not all in your head.

Don't be afraid to do your own research. Go to the library and look up a basic medical textbook or use the Internet to find information on whatever ails you. A number of health-information Web sites are run by major medical centers, and hundreds more are sponsored by organizations of varying credibility. Perhaps you will stumble across a description of exactly what you are experiencing but haven't been able to put into words. On the other hand, don't be a gullible reader: Not everything you read is true, especially information that doesn't come from well-respected research institutions or hospitals. But as you learn more about your health, you will also learn how to distinguish what's likely to be true from what's likely to be rubbish.

A final reason that people stay away from the doctor is cost. Health care is expensive, and not all of us can afford health insurance. This issue is clearly too complicated to discuss here. However, do not ignore a health problem to save a few dollars. The longer you wait to seek proper health care, the more likely the condition will worsen. Not only will it be more expensive to treat in the long run, but you will also be more likely to have experienced the ageing and illness that the condition can cause. Prevention is almost always the cheapest health care option.

It's All in the Genes? The Impact of Family Heredity

At the beginning of the book, I pointed out that more than 70 percent of ageing can be linked to behavior and other environmental factors, meaning that you exert enormous power over how you will age. But what about the other 30 percent? Exactly how should you view your genetic inheritance? And how can you avoid the ageing associated with it?

Although many studies have investigated the family history of disease in relation to the onset of disease, only three major studies have correlated overall longevity trends between parents and their children. The Framingham Study, the Termite Study, and the Alameda County Study looked at the ages of parental death to determine if they predicted the longevity of the offspring. Did the two correlate? Yes, but mimanally. Each study showed a minor relationship. The Framingham Study, the most comprehensive of the three, found about a 6 percent correlation between the ages of the parents at the time of their deaths and the longevity of the offspring, meaning that many other factors affect longevity as well. If both your parents lived past age seventy-five, then the odds that you will live past seventy-five increase to some extent. But to what extent?

If both your parents died before age seventy-five, your RealAge will be as much as 4.2 years older if you are a man and as much as 3.5 years older if you are a woman. If both your parents lived past age seventy-five, then your RealAge will be 4.2 years younger if you are man and 3.5 years younger if you are a woman. If no first-degree relative (parent, brother, or sister) had breast, colon, or ovarian cancer diagnosed early, you are an additional 0.2 to 11 years younger, depending on the disease, than if your siblings or parents had those diagnoses. Some genetic conditions, such as being a carrier of the BRCA-1 breast cancer gene, can make your RealAge as much as 17 years older. This is one of the instances in which genetics can make a big difference.

When you calculate the role of family history, remember that many factors complicate the issue. What, for example, was the cause of death? If a parent dies at age forty in an accident, it provides little information about how long you will live, since that parent didn't die of biologic causes. If a parent dies at age forty of breast cancer, it may mean that you have an increased risk of developing the disease. The genetic predisposition is not always negative, either. For example, in many instances, we inherit a gene from our parents that can actually help us live longer. Some people have a gene that boosts HDL (healthy) cholesterol levels. Because they have high they are often diagnosed as having a cholesterol problem. But the diagnosis is wrong. This gene is a trump. All that HDL cholesterol helps prevent arterial ageing to such an extent that the gene gives carriers a RealAge benefit of as much as twenty-six years! Remember, too, that just because there is a familial tendency for a certain kind of ageing does not mean that that kind of ageing is genetically; inherited. For example, a family history of heart attacks may or may not be genetically coded.

In general, you should review your family history for three conditions: (1) a history of cardiovascular disease; (2) a history of a particular type of cancer, such as breast cancer or colon cancer; and (3) a history of rare genetic illnesses, such as Huntington's disease, Parkinson's disease, multiple sclerosis, or even Alzheimer's disease. If you know of more than one case of these diseases on one side of the family, you may have a genetic predisposition to that condition. The first step in determining whether there might be a family history of an illness is to count the number of occurrences of that condition. Then determine how these individuals are related to each other and to you. Everyone must be related by blood, not marriage.

A family history of a certain disease does not necessarily mean that you are genetically predisposed to develop that condition. It indicates a possibility, not a certainty. Even if a genetic illness does run in the family, there is no way of knowing if you have inherited the disease gene (or genes). In most instances, your odds of inheriting any condition are less than 50 percent. Even if you have inherited a predisposition for a specific biological condition that can cause ageing, you may very well not do those things that trigger the onset of the disease.

For example, it is known that certain people have an inherited predisposition to develop Type II diabetes. On the other hand, almost 90 percent of those who are diagnosed with the disease are also excessively overweight. Many do not exercise, and a large percentage smoke. When a person is genetically predisposed to develop the disease, environmental factors, such as weight gain, lack of exercise, and smoking, can trigger the disease. A slim and fit person may well have the genetic predisposition but never know it because the conditions that trigger the disease never occur. Indeed, taking care to protect your 'youth' is the very best disease management. Living in a youthful manner can offset the genetic predisposition before a disease develops at all.

Cardiovascular ageing is another example. As doctors have begun targeting high-risk patients (those who have a long family history of arterial disease and ageing), they have seen the onset of premature ageing diminish. By exercising, eating a low-fat diet, taking an aspirin a day, and taking folate regularly, anyone—-no matter what his or her inherited risk—can reduce the rate of arterial ageing. If a risk factor applies to you, you will want to do what you can to offset it. For example, if you are a man and your father, grandfather, and great-grandfather died of heart attacks before age fifty, you will want to pay extra special attention to preventing arterial ageing, not allowing the conditions that would make you the next heart attack victim.

Pill Popping: Too Much Medicine and Mixing

Medicines Can Cause Ageing

It happens all the time: One doctor prescribes a medicine for a patient without knowing that another doctor has prescribed another medicine for that same person. Somehow the information isn't communicated—the patient either forgets to tell the doctor what he or she is taking or tells the doctor the wrong name for the medication (something that is easy to do). The result can be a potentially life-threatening drug combination. Mixing drugs, taking medicines beyond their prescribed time, or taking them erratically can be hard on your body-—and make you older. Be an informed patient; ask your doctors why you should be on any drug they prescribe and be sure to tell them what you are already taking, even simple things like aspirin, over-the-counter drugs, vitamins, and supplements. Many patients forget to mention these over-the-counter drugs and supplements, thinking that because they can be bought by anyone, they must be harmless. This is not true. Don't forget to mention recent vaccinations you've had and antibiotics you've taken.

Statistics show that people who take too many pills without proper supervision have a RealAge as much as 4 and 1/2 years older. But the fact that taking more pills makes your RealAge older doesn't mean you shouldn't take any medications. It's important to take the medicines you need and to take them as instructed. Not taking necessary drugs-—or not taking them correctly—can make you more than one year older.

When Sue C, one of my wife's good friends, phoned, she was in a near panic about her mother.

'Mike,' she said, 'Mom's blood pressure is completely out of control. Sometimes it's at 150/80; at other times it's as high as 220/150. She's on all this medication to control it, and she's good about taking them, but she gets a lot of side effects. Headaches that completely incapacitate her. It seems like the medicine is just making things worse.'

'Sue,' I said, 'if her blood pressure's as high as you say it is, it could be life threatening. How soon can you get her here?' 'Right away,' she responded.

Sue brought her mother, June D., to my office. Sue was right June's blood pressure was 220/150—-so high that it was a medical emergency.

'June,' I said, after examining her, 'if we can't bring your blood pressure down in the next four hours, I'm checking you into the hospital. Your blood pressure is off the charts.'

'I can't understand why. I'm on five different medicines to bring my blood pressure down.'

'Well, that may be the problem. Drugs can often interact, causing an unintended effect. Tell me everything you're on.'

She listed-the five medications that she took regularly.

I was puzzled. There were two drugs on the list that could cause a negative drug reaction when taken together. However, her symptoms—extremely high blood pressure and severe headaches—were not the ones that this interaction should have caused. I asked her, 'Are you sure that you've told me everything you're taking? What about vitamins, over-the-counter drugs, food supplements, herbal remedies, or herbal teas?'

'Oh, I didn't even think of that. I'm taking several vitamins and three kinds of herbal pills. Two of them I read helped prevent headaches, and one is supposed to clear my sinuses. But they're natural. They can't hurt me, can they?' Then she told me what they were.

 'Bingo,' I said. 'We've found the culprit.' The herbal remedy she was taking to alleviate her sinus symptoms interacted with one of her medications, causing both her terrible headaches and her erratic blood pressure. She was playing around with an explosive mixture that could cause a heart attack or a stroke. 'First, we are going to do something to bring your blood pressure down,' I told her. 'Then I want you to go home and throw away that bottle of herbs.' 

'I'm so surprised. I thought these supplements were harmless,' June said.

'That's exactly the problem,' I replied. 'Natural remedies seem so innocuous, but when mixed with the wrong medicine, they can be dangerous.'

I gave June some medication to bring her blood pressure down immediately. I told her to take the drugs exactly as instructed. Then I cut her blood pressure medications to just three, to eliminate the possible interactions. The new medication worked. Within a week her blood pressure was close to normal, ranging from 110/70 to 130/90. Her body adjusted to the medicine, and she started to feel great.

Then the second phone call came. It was Sue again. 'Mike, Mom's been feeling super on her new blood pressure routine. In fact, she feels so good that she told me this morning that she thought she would stop taking her medicine. I just wanted to double-check with you to make sure it's okay.'

'You're kidding me!' I cried, not believing that I hadn't gotten my point across. 'Going off that medicine so suddenly could put tremendous stress on her heart or the blood vessels in her brain. She could have a stroke or heart attack. Give me her phone number because I want to call her right now.'

Luckily, I got June just in time. And I did something I rarely do: I yelled at a patient. I scolded her for putting herself in a possibly life-threatening situation, and I told her, in no uncertain terms, that she had to take her pills right away.

Although the proportions vary from locale to locale, on average more than 15 percent of all hospital admissions are due to the improper use of prescribed medications and to adverse interactions between drugs or drugs and supplements. In fact, one study calculated that, in 1994, Americans spent $73 billion oil prescription drugs, but that the costs that were due to adverse effects exceeded $100 billion. Hard to believe, isn't it? Does this mean we should quit prescribing—or taking—drugs? No. Drugs have saved a lot of dollars and years of life by controlling illness and preventing ageing. It just means we all need to be more attentive to the problem of mixing drugs with other drugs and supplements.

It is interesting to note that the problem of drug interactions has gotten worse. The Food and Drag Administration (FDA), in an attempt to lower drug costs to consumers and to make medications more readily available, has increased the number of medications available without prescription. Drugs that just a few years ago required a prescription are now available over the counter, including such popular medicines as fepcid (famotidine), Tagamet (cimetidine), nonsteroidal anti-inflammatory drugs like ibuprofen (Advil, Motrin), Rogaine (minoxidil), Imodium Ooperamide), and nicotine chewing gum. Make sure to ask your doctor about these drugs, since they can have substantial adverse effects when mixed with various prescription drugs, herbs, or supplements.

The problem with drug interactions is partly the fault of doctors. The classic stereotype of the hurried doctor with incomprehensible handwriting is not far off: Prescriptions can be hard to read, and doctors and patients do not always communicate effectively. Doctors frequently think that they are explaining things clearly but use technical terms and jargon that patients don't understand. Several years ago, a patient wrote on her basic information form that she had undergone a hysterectomy. When I asked her about it, she told me she had her tonsils out when she was six! I knew then that we were miscommunicating. Patients are often afraid to ask if they don't understand something, or they forget to ask, mainly because they are not feeling well or because being in a doctor's office can be a nerve-racking experience.

Remember, the best patients are informed patients. Do not hesitate to ask your doctor about medication that he or she has prescribed. In addition, ask about interactions with over-the-counter drags or herbal remedies you take regularly. Don't feel self-conscious about taking up the doctor's time. You and your doctor should be partners in preserving your youth and health. If there is something you forgot to ask while you were at the doctor's office, call your doctor back. Or ask your pharmacist when you get your prescription filled. Pharmacists know about each drug and can help advise you on your overall medication. Use your doctor and your pharmacist as cross-checks for each other for one may catch something the other one doesn't. Because the channels of information are different, one may have recently learned something the other doesn't yet know. And, besides, the pharmacist who fills your prescriptions may be aware of medications you are taking that are prescribed by another physician.

Becoming a 'home pharmacist' is a surefire way to get older. Once you have used a drug for what it was prescribed for and no longer need that drug, throw away the remaining pills. Pills can change their composition if allowed to sit around too long. Also, by getting rid of extra bottles, you reduce the risk that you or the people you live with will take the wrong pill accidentally. Prescription medications should not be used for anything other than what they were prescribed for. Never assume that because something was good for one condition, it would be good for another. Don't take two pills when the instructions advise one; just because one is good doesn't mean that two will be better.

And never go off a drug just because you are feeling better. If you are prescribed antibiotics, for example, it is very important that you take the entire amount prescribed. Do not stop after just a couple of days because you feel better. This is an exceedingly common and potentially very dangerous mistake because the illness often comes back quickly and in a more virulent form. Because the bacteria causing the disease have already been exposed to the antibiotic, they often develop resistance to it, and the drug no longer works effectively.

Similarly, people who take blood pressure medicine often quit taking it the minute their blood pressure dips into the normal range. Going off blood pressure medicine can be extremely dangerous—even life threatening. Stopping suddenly can cause rebound tachycardia and hypertension, a condition in which your heart rate and blood pressure suddenly rise to levels higher than they were before you started taking the medication. These changes can put enormous strain on your arteries and can trigger a heart attack or stroke. Even if they don't they cause significant arterial ageing.

Remember, doctors need feedback. They can't know that a drug is causing a side effect unless you tell them. Hormone-replacement therapy is a perfect example. Approximately 50 percent of women who quit taking hormone-replacement therapy do so without telling their doctors. The treatment is a tricky one: Different women react differently to different doses and combinations, so often the dose needs to be adjusted until one is found that works. However, by working with her doctor, a woman can usually find the right dosage for her.

Two common side effects of various drugs that can be difficult to discuss with a doctor are impotence and loss of sexual desire. Several blood pressure medicines and depression medications, such as Prozac, have these side effects, as do other medications. Even though patients don't mention impotence and the lack of sexual desire to me often, I try to search tactfully for the occurrence of these conditions. Male patients say impotence makes them feel and act older. Female patients also report changes in libido from various medications. Impotence and the lack of sexual desire are extremely frequent, but they are treatable conditions. If you notice that a medication is affecting you in this way, talk to your doctor. Don't be embarrassed. Usually, a different medicine can be prescribed.

In summary, how can you keep your medications from ageing you? 

Keep your drug regimen simple. Ask your doctor if you can reduce the number of medications you take. One study showed taking twenty-three or more pills a day can make a person as much as 4  years older than taking four or fewer pills a day. The more pills you take, the greater the potential for an adverse drug interaction that can cause you to age unnecessarily.

Here are some simple steps for making sure that you get the RealAge benefit associated with taking medications.

Develop a good relationship with your primary care doctor.

Make sure that you keep him or her updated on everything you're taking.

Keep a list of medicines and dosages that you take either regularly or occasionally and bring it with you when you visit any doctor, drop-in clinic, or emergency room.

Choose a pharmacist you can trust and develop a long-term relationship with him or her. Your pharmacist will also have a record of all the drugs you are on or have been on and can warn you about possible drug interactions. (Although many HMOs now provide pharmaceuticals by mail, I prefer the old-fashioned drugstore with a new-fashioned computer, one where the pharmacist both knows the patient and has an up-to-the-minute record of his or her medication history.)

Now, of course, we must turn to the larger question: What if you have one of those conditions—-heart disease, arthritis, kidney malfunction—-that require a lot of medicines and a lot of medical care? How can you prevent the ageing effects of chronic illnesses?

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TO  BE  CONTINUED