Healthy Aging – Adjustments for Living & Reality

For several years now my wife has been complaining that I do not hear her when she talks.  I have gone for regular ENT checkups with audiology testing and while there is clearly a drop in hearing certain frequencies, my word discrimination and comprehension put me in a position of delaying using hearing aids for another year.

I was aware I had trouble hearing my middle adult daughter’s voice frequency.  I was missing words on TV especially when foreign accents were present leading to the purchase of TV Ears which solved the problem.  Still I knew that without auditory stimulation your brain deteriorates at a faster rate.

Last year the ENT doctor sent me home with a pair of hearing aids to try.  “Your wife called and said that if you don’t try them she may find me and kill me in my sleep.”  I was so angry with my wife for interfering that I made a point of pretending not to hear her every time she addressed me and I had the hearing aides in.  Those hearing aids were returned within the 30-day trial period because I could not use my stethoscope with them in.

One year later I was back again and this time my hearing test showed some drop in my word discrimination. They suggested trying a blue tooth compatible pair of hearing aids and even took out a stethoscope to show me how my hearing was enhanced using the stethoscope thus eliminating my favorite argument.   I wore them home and frankly they are wonderful.

The next day I had an appointment for my six-month eye exam. My acuity was off and I suspected my visual field in one eye had diminished based on driving and athletic pursuits.  The test confirmed my suspicions with my ophthalmologist diagnosing “normal pressure glaucoma” in my right eye.  “We need to lower the pressure by 3% with the drops I am prescribing and if the pressure doesn’t decrease we will recommend a laser surgery procedure in three weeks.  You are not going blind, but we want to preserve your visual field.”

The look on my face advertised my disappointment.  “It’s not so bad, you have sent me hundreds of patients with this situation and we helped them all. Why are you so troubled over this?  Looking at your med sheet and problem list at least you aren’t complaining about ED.”    When I didn’t answer her there was a long pause and she said, “Oh, I am sorry if I brought up a difficult topic.”   The best I could mutter was that in geometry what was once an acute angle is now an obtuse one.”

I tried to sell the fact that my dermatologist had me on a short-term course of prednisone which was raising the ocular pressure, but she wasn’t buying that argument.  New glasses, nightly eye drops and hearing aides all in a 72-hour period.

Instead of being grateful and thankful that I had minor correctable issues, and I could afford to spend the $6000 plus dollars for hearing aides and new trifocal lenses, I was moaning and groaning about the trials and tribulations of healthy aging. It was like running into the ocean surf on a hot day preparing to dive in to the surf and cool off and an unexpected wave smacks you down and stuns you before you can dive below its crest and avoid the strong impact.  I was devastated.

It took about 72 hours to adjust.  At my regular Friday night dinner with friends my buddy said, “Steve you seem to be hearing much better tonight. We did not have to repeat anything. What are you doing?”   I told him I was wearing new hearing aids which he had not noticed.  I hear better through my stethoscope than I did before.  When I walk my dogs or take my daily walk I hear the birds chirping, the children playing, the sprinklers initiating their watering cycle. These are all sounds I had forgotten about.  At lectures and movies I am hearing clearer. The blue tooth connection to my cellphone makes calls easier to complete.  My new trifocals allow me to read up close far more easily and see distance much better.

As a physician and geriatrician, I stress eye exams, hearing tests and evaluations to determine our ability to stay independent and functional. I cannot explain why I was so resistant to applying the same principles to my own health.

My day-to-day life has improved markedly with the hearing enhancement and new glasses. I hope my patients and students will look at my stubbornness and reluctance to accept healthy age-related changes as an example of how hard we cling to our independence and how reluctant we are to give up pieces of it even when we know it is for the best.

Aspirin Use for Prevention of Cardiovascular Disease

A study by the Veterans Administration in the 1970’s on veterans over age 45 showed that if they were given aspirin they had fewer heart attacks and strokes.  This study didn’t divide the participants into men and women or patients who never had a heart attack or stroke versus patients who had known cardiac, Cerebrovascular and or Vascular Disease already.  The exact dosage of aspirin to take was never quite clarified either. For years physicians prescribed “baby aspirin” to patients over 45 to prevent heart attacks and strokes. While no definitive evidence existed to show the benefit was present in women as well as men, we tended to recommend the low dose aspirin in that group as well unless they were a high risk for bleeding.

Recent studies have questioned whether daily aspirin use for primary prevention of vascular disease is beneficial.  The current opinion is that a daily aspirin may cause more harm than good in women.  There is a feeling that the risk of bleeding may outweigh any benefit. The data is not quite as clear in men.  To add to the confusion, an article published in the journal Ophthalmology asserts that in a European study aspirin use was associated with an increased risk of developing wet, age related macular degeneration (AMD). Of the 4691 participants in the study, 36.4 % developed early AMD and 17% of that group took aspirin on a daily basis.  This is not the first study to raise this question with equivocal findings on several previous studies concerning the relationship between aspirin intake and AMD.  It is clear that further research is needed in this area.

The study is one of many that raise conflicts in approaching AMD and eye disease versus systemic health. This is especially a problem since these older AMD patients are the same ones who are more likely to already have cardiac, Cerebrovascular or Peripheral Vascular Disease and this is the very group that we know and agree that aspirin is beneficial in.

Clearly more studies are needed. I will continue to take my daily 81 mg of enteric coated aspirins unless I develop aspirin related gastritis, ulcers or GI Bleeding. My male patients over 45 years old with low or few risks of GI bleeding will continue to be advised to consider aspirin. With no studies showing a clear cut advantage for women taking aspirin for primary prevention of heart disease and stroke, I will present the pros and cons of therapy and advise it less frequently if the patient has a low risk of vascular disease or a high risk of bleeding.