A Message from Dr. Lasich

Greetings to all of you. I wish to invite you to join me on November 15th at 9:30am at Peace Lutheran Church when I speak about my book, High Heels to Hormones: A Woman’s Guide to Spine Care. In October, my book became an award-winning finalist in the Best Books 2008 Awards (USA Book News) for Women’s Health. I am very excited to be invited by the local AAUW to speak about the importance of gender-specific treatment for controlling spine problems in women.

In this newsletter, I wanted to focus on the oldest generation. This generation is often in need of care, but also has much to offer us with their wisdom. By rising to the challenge of providing safe treatments, we can be rewarded for allowing this generation to live out their days with dignity.

Please share this newsletter with others because sharing creates solutions.

On the Journal Frontline: Aging and Pain Relief
by Christina Lasich, M.D.

"Getting older is not for wimps”, the 84 year old man said to me. As more and more people live beyond the age of 65 years old, chronic painful conditions become the major reason that this population is visiting doctors. Frequently, we, as doctors, are only able to offer prescription medications and that is when things start to become challenging. Because of multiple medications and multiple doctors, many adverse events can happen. Talk about too many ingredients and too many cooks in the kitchen. Medication side effects can easily arise in the elderly due to alterations in absorption, distribution, metabolism, and excretion. Thus, it is no surprise that prescription medications are a major cause of morbidity and mortality. Of course it does not help that some of those wonderfully pleasant, older people are sometimes not the best historians and sometimes do not exactly take medications as prescribed. Even with these incredible challenges; treating the elderly can be tremendously rewarding.

Ask an 84 year old, what his primary goal is and often times you will hear the word: independence. As a doctor, the patient’s goal becomes my goal. Unfortunately, a painful condition is usually blocking the way. That pain limits a patient’s ability to do activities of daily living. Dressing, bathing, and shopping, all become exceedingly difficult as the body begins to fail. How can I help a person maintain control over his life, safely? Pain relief can be safely achieved with proper titration, careful dosing, and appropriate selection of medications.

Start low, go slow: Medication titration can deliver an individually tailored pain regimen. With a little trial and error plus a whole lot of patience, medications can give someone a comfortable, controllable life when you arrive at the lowest effective dose.

One problem, one drug: This concept is ideal. However, limiting the treatment plan to one drug can lead to higher doses for a desired effect. Knowing that adverse effects are dose dependent (the higher the dose, the more likely toxic effects will occur), an alternative, safer strategy is to use multiple medications at lower doses. This strategy may provide greater relief with less toxicity.

Find a safe sister: Sister drugs within the same family have various side effect profiles. Some drugs cause so many side effects that they are not appropriate for the elderly patient. Usually, a safer sister drug can be a suitable alternative. For example, amytriptyline is a dangerous drug for an older person. The sister drug, desipramine, is a safer alternative. Ambien or Restoril instead of Valium; Voltaren Gel instead of ibuprofen; these sister medications exist and provide safer solutions.

Ultimately, the elderly patient presents a challenge for delivering treatments that cause no harm. Prescribing medications requires vigilance against adverse effects. First, one must keep track of the cooks and the ingredients. A person should always bring a current list of medications into the doctor’s office or bring all the medications in a brown bag. Second, the risk for adverse effects in the elderly must be respected by using low doses and safe sister drugs. With a little patience, a tailored treatment plan can allow an older person maintain his independence. Getting older may not be for wimps. But if the medical world is going to sustain life beyond the age of 60, the world should be prepared to answer the need for improved, effective, and safe pain relief.

LIFE Quotes

“The greatest gifts one generation can pass to another is the wisdom it has gained from experience.”
– The Wisdom Project

In the News

The Wisdom Project

Inspired by the idea that one of the greatest gifts one generation can pass to another is the wisdom it has gained from experience, the wisdom project, produced with cooperation from Archbishop Desmod Tutu, seeks to create a record of a multicultural group of people who have made their mark on the world.

wisdombook.org

Apothecary Corner