Lately, well maybe the last half dozen years, I startle myself when I happen to look at my hands – woah! whose hands are those? – and I see my dad’s hands. I remember when my dad was getting on in years – into his seventies though it might have been earlier, (funny how you don’t really absorb this sort of information at once, it just gradually appears until, one day, you notice) – and noticing Dad’s hands were dappled in liver spots, just as mine are now.
(Why are they called liver spots??? Funny how words creep into usage and we use them long after realizing where they originated. Liver spots of course refer to the darkening of skin, especially on those with light pigmentation, in patches on the hands and arms, and many other areas, due to exposure to sunlight. It is more prevalent in aging people because the usual melanin response (tanning) in skin has been compromised. Before the 17th century the cause was presumed to be liver disease. These days cosmetic blemishes are more delicately called age spots, but does that really help? (Paradoxically, melanin failure has the opposite effect in hair colour in older folks.)
Ageing happens every day of course but we don’t tend to notice, until one day we see something that surely wasn’t there yesterday. Somewhere around age 70 I began to notice changes in Dad’s skin, brown spots on his hands, and face. And jowls. Clear signs of ageing. And it bothered me.
His skin also became increasingly wrinkled. He’d take off his perma-pressed shirt and remark his skin needed ironing. Miraculously, his hair never went gray!
My dad was 25 years older than I; that is, until he died; I guess now I’m catching up to him: he died when he was 79; I turned 75 last year. Of course that can’t possibly be true but I’ve noticed for a while now liver spots, and wrinkles, and lots of gray hair.
Lately I’m bothered anew – I see even more signs of aging in me, and wonder how many of these ailments dad had too.
They say age is just a number – humbug. This little euphemism is most often quoted in May-December relationships. It’s only a number so long as health and fitness continue strong, but there is no escaping the effects of time on hormonal decline and slowing metabolism. Everyone knows this but live in denial so long as the present has no consequences. But as soon as the future is taken into account, ‘the number’ takes on true relevance, it starts to show its reality: age spots, and high blood pressure, ED issues, a walker, encroaching end. The girlfriend begins to recalibrate.
I’m not sure if The Beatles intended this meaning, especially when 64 is not quite as ‘old’ today as it was fifty years ago: “will you still need me, will you still feed me, when I’m 64”.
Dad played golf; quite a lot actually, and he was a good golfer, but he didn’t do much else for fitness; and he liked sweets. Eventually lifestyle, and likely genetics, caught up with him in the form of diabetes, and gradually, more and more complications. His life became a carousel of daily pills. Now I find myself taking daily handfuls of pills, all in some attempt, possibly misguided, to hang on to vigourous health and extend a life.
I don’t know if Dad had kidney disease early but he certainly had it late as a complication of diabetes; in the end he was three times a week to hospitals for dialysis; ultimately he died of congestive heart failure.
Quite amazing really, the way our various body systems are inter-related. It may start with hyperglycaemia, but it becomes kidney disease, and then heart failure. It may start with hypertension, but eventually results in compromised kidney function, and maybe stroke. It may start with benign prostate hyperplasia, but this leads to backed-up bladder and then kidney problems. Notice a common thread here? Right – kidneys, a much unappreciated organ, unnoticed, until it fails.
If you want to know more about the joys and sorrows of this human body we inhabit you should read Bill Bryson’s book, The Body, A Guide for Occupants. One of my favourite lines, much more immediate now than when I read it half a dozen years ago, is this (and I paraphrase): a man of 27 is barely aware he has a prostate, when he’s 72 he barely thinks of anything else!
I don’t know if Dad had BPH but probably – my urologist says it’s a familial ailment.
And there’s another thing with aging. If you’ve been lucky enough to have had a GP you come to realize he/she seeks to care for the whole person. But as you age, you end up with specific ailments, and these need the attention of specialists: a dermatologist (If you can get one); a nephrologist, who in turn refers you to a urologist, ultimately a cardiologist. Or maybe you end up in the oncology class.
I first was alerted to having elevated measures of hypertension in my early 30s. I was working for AECL at the time and we had a number of medical doctors on staff or contract – proactive monitoring of employees for radiation exposure. The doctor who examined me noted the higher than the ’normal range’ for blood pressure readings, especially for someone in his 30s; but he wasn’t alarmed, particularly, as he noted that the American standard of 120/80 is lower than the British standard of 130/90. He was British. Nevertheless, he advised frequent monitoring. Luckily, or perhaps unduly, the company Health & Safety staff (including doctors) reported to me in my late AECL days and then into my Mitel days in the 1980s. I would routinely check in with them as any attentive supervisor might, and they would routinely slap the cuff on me and then tell me to go for a walk!
In the 1990s – I would be in my mid-40s by then – my GP enrolled me in a drug study for a new hypertension med. Turns out I was not on a placebo and the calcium blocker was making a difference in my routine readings. Thus began my life-long regime of pharmaceutical use.
At first it was a once a day calcium blocker; then. as it lost efficacy, it was an ACE inhibiter; that progressed to a combination ACE inhibiter plus diuretic; then an additional calcium blocker. A daily dose of tadafil was prescribed for, ahem, prostate. Then came my kidney specialist who advised the ACE inhibiter was not good for kidneys and put me on another different diuretic. Next my urologist put me on an anti-androgen and an alpha-blocker. My GP is wondering if a new diabetes med may be helpful for kidney function but we’re holding off on that one. We’ve ruled out an SNRI for ameliorating my increasing depression.
So I have a daily regime of meds to contain the symptoms of my various aging ailments. And I have to coordinate the scripts between my various specialists and my GP, because the left hand doesn’t always know what the right hand has been doing. These meds mostly only contain the symptoms, there seems to be no cure for age-related conditions. For all our medical marvels, there is no clear understanding of what, exactly, causes hypertension; and the cause of prostate hyperplasia apparently is still a medical mystery. (But wait, view this video on YouTube before Big Pharma takes it down!)
These days things are beginning to get out of hand. Now my daily consumption count of prescription meds is approaching all ten fingers, more if we add in the over-the-counter supplements. I have to pay attention to when and which meds I should be taking; at least I still have enough cognitive capacity to keep track without the aid of a pill box organizer (I think – but how would I know?).
Here’s my daily ritual (spoiler alert – if this is beginning to sound like t m i to you, well, maybe skip to the end):
Morning: Tadafil, 5 mg – for BPH;
Breakfast: Chlorthalidone, 25 mg (half 50) – diuretic for kidney function and hypertension; Multi-vitamin, D3, Q-10
Lunch: Amlodipine, 10mg – calcium blocker for hypertension; Atorvastatin (Lipitor), 10 mg – statin for controlling LDL cholesterol but apparently off-label for kidney function;
Dinner: Dutasteride 0.5 mg – hormonal treatment for BPH (yikes!); Calcium/Magnesium supplement (ironic that I take a calcium blocker and then take a calcium supplement!)
Bedtime: Tamsulosin, 0.4 mg – an alpha blocker for relaxing enlarged prostate; Tramadol (half) occasionally – for sleep! Acetaminophen for hip and back pain (possibly caused by the statin!) and arthritic fingers. Aspirin would be more effective for these inflammatory afflictions but are contra-indicated for kidneys!
My dad used to lay out his tray of daily doses (duly organized by his doting wife) and study the array of meds with classical irony. He’d remark, ‘good thing I have an accountant to keep track for me’. I truly have become my dad, except I am my own accountant.
I’m beginning to wonder about the side effects of all these meds. Are the benefits still exceeding the adverse consequences? and how do you even calculate that? What would happen if I just stopped taking them? Hasten the inevitable? And is that really such a bad thing?
It all comes down, ultimately, to the same outcome in the end; as my dad used to say: shortage of breath, stoppage of heart.
Next Post, naturally enough, MAID.
Doug Jordan, reporting to you from Kanata, Canada
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