By Richard P. Holm MD
Caring for the elderly my whole clinical life has been an honor and a pleasure, but some experiences have been terribly heartbreaking. Elder abuse is one of the saddest, and it can come in the form of physical harm and neglect, emotional cruelty, or financial exploitation.
A couple of years ago a frail, confused, elderly person arrived in the emergency room with a fractured bone, bruises, sores, and was quite unclean. His family described that the patient had fallen multiple times recently, and I could see his needs were overwhelming his care providers. If there hadn't been physical abuse, there was at least neglect. After surgery and hospital care, we were able to send the patient to a nursing home. We all need to be aware when there might be possible physical abuse, and call for help when we see it.
Another case was one of emotional abuse with much blaming, shouting, and anger put upon an incapacitated elder. It was by a visiting, emotionally-ill family member who had arrived from afar and was unloading his own emotional baggage upon their frail and defenseless parent. The patient had been admitted for a medical issue, and the nurses were the first to recognize the emotional abuse. Police were notified and the visitor was banished from visiting the patient in the hospital during their stay or at their home after they were discharged.
On instance of financial abuse was evident in another case, when a son informed me that his 80-plus-year-old mother and her new boyfriend had recently been going to the bank and removing large sums from the mother’s savings account. The son believed his mother was “losing it”, and informed me that she had been spending thousands of dollars for herbal and supplemental cures for her memory problems She had several unpaid bills and was now was being manipulated by an opportunist. He asked me how to protect his mother’s money.
I saw the patient in my office; obviously the mother was demented and incapacitated. A judge confirmed her incompetence and determined the son was to have power of attorney. Problems could have been avoided had the son been more watchful, had the mother made financial plans before her mental health problems, and had a bank’s trust department or a bookkeeping business been asked to pay bills.
None of us are safe from abuse. When people become frail or lose their mental capacity, then bad people can take advantage of them. Elder abuse can come in the form of physical harm and neglect, emotional cruelty, or financial exploitation, and is more common than you would expect.
Be aware, and take precautions.
On the way home from Rochester I wrote an absolutely beautiful and humble comment here, and lost it when I sent it not connected, and could not seem to recover it. You are going to have to be satisfied with a shorter and less beautiful and less humble message... sorry.
We stayed at Dave and Joleen Nelson's home, and had brunch with Phil Lombardo. We couldn't be more thankful for the support that we had from the Lombardos and the Nelsons during this ordeal.
It was good news from Dr. Truty on Tuesday afternoon, who explained no evidence for spread, infection, or problems. He said measure improvement by the week not by the day... expect 2-3mo... and he added pancreatic digestion enzymes before meals of snacks. And then he removed the feeding tube. Said exercise and nutrition...
The next morning we met with Oncologist Thor Halfdanerson, (Icelandic) who explained that the neuro-endocrine part of the tumor is low grade tumor and not a great threat. The accinar part of the tumor, however, is something had we know in advance we would have treated exactly the same way with the same chemo and radiation that I had. He said there is no scientific data to treat at this time, leaving me with no further plans except follow-up. He said I have a 50-50 chance for cure, better than lots of other options out there.
As I was thinking about the meaning of all this yesterday, I settled in on "FRIENDSHIP." That includes the love within family members. It is the spiritual sharing one has with another that seems to give everything color, humor, joy.
Here's to our friendship. Love you.
By Richard P. Holm
There is something about that word “cancer”; the big C.
When the pathology report displays those abnormal type cells on biopsy and the report spells out those six black letters, then, whether it is a simple treatable condition or one that will most certainly predict an earlier death, the patient hears cancer and it changes everything.
Through the years, I have had to inform too many patients about a diagnosis of cancer. I have learned there is often a paralyzing fear that comes with the word. Due to advancements in science, many more people are winning the fight against cancer compared to when I first started practicing medicine. Still, whenever I have to say, “you have cancer", often the word “cancer” is the only thing they’ll think about for next several days.
Unfortunately, some people who hear the word come to face their mortality for the very first time, even when the chance of cure is good. I dare say this goes for too many of us, resulting both from unrealistic expectations in this scientifically advanced world, and the cover-up of the dying process in this everything-is-going-to-be-alright society.
This week a friend told me she and her husband were preparing to sell their house by thinning out their stuff collected over 15 years and remodeling with that new carpet they've needed for a long time. It reminded me of a how a realtor friend of mine once told me how he keeps his house ready for sale at all times, even if he has no intention of selling it. Why not put in the carpet, paint the bedroom, and fix the steps so that he can enjoy it right now? Why put off until tomorrow what can be done today?
In a similar vein, I have heard it said that every once in a while, perhaps yearly, we should all have some kind of significant brush with death and then be rescued. Maybe that would help us to remember how impermanent life really is; maybe that would help us to get and keep our house in order. Then, when each of us has our turn to cross the river into that land of the Sweet Bye and Bye, we can feel what the young neurosurgeon, Paul Kalanithi, said before dying of cancer, "(I have found a joy)...unknown to me in prior years... a joy that does not hunger for more and more, but rests... satisfied in this time, right now..."*
We shouldn't have to come down with cancer to get our house in order.
*Paul Kalanithi MD, Before I go: A Stanford neurosurgeon's parting wisdom about life and time. The Washington Post, March 12, 2015
It’s Not Nice to Mess with Normal Flora
By Richard P. Holm, MD
An elderly hospitalized pneumonia patient was getting better after three days on powerful antibiotics when bloody diarrhea, cramping, and fever began and his overall condition started to deteriorate. His stool test was positive for C. difficile and he got better on a different type of antibiotic. This happened because the abundance of microscopic organisms which normally lived, grew, and replicated within his body were weakened or destroyed by the pneumonia antibiotics, resulting in the loss of an important balance of nature within our bodies.
It sounds like a sci-fi movie, but this is NOT fiction. Scientists have discovered large numbers of micro-communities around and within every living plant and animal. Surprisingly many of these ‘invaders’ are necessary and helpful to the host, although some have no known benefit and some are harmful. These microscopic organisms include bacteria, fungi, viruses, and parasites and are called the ‘normal flora’ or ‘microbiota’ (like oat-uh).
Helpful non-human examples of microbiota include bacteria that fix nitrogen on alfalfa, fertilizing plant and surrounding soil; or organisms living in the rumen of cattle that make grass turn into absorbable nutritious food. There are about 10X as many non-human microbial cells in our body as human cells, and they exist almost everywhere, including mammary glands, skin cells, lungs, mouth, and eyes. The area where most microbiota reside, however, is within the gut or gastro-intestinal (GI) tract.
From the first minute after birth, the baby’s gut is exposed to a microorganism-rich world following their travel through the vaginal canal, followed by exposure to skin and milk flora while suckling at mama’s breasts. Over the next year, the baby’s microbiota develops and helps the infant break down dietary fiber and fat while simultaneously serving as a barrier to invasive organisms. It also helps synthesize vitamins, metabolize harmful toxins, reduce inflammation, enhance immune activity, and produce hormones.
When human flora encounters radical changes, often resulting from non-specific destruction by antibiotics, inflammatory and autoimmune disorders may occur; antibiotics can cause overgrowth of invasive bacteria, the most common of which is called Clostridium difficile, or C. dif. This type of invasive overgrowth was responsible for about a half million infections in 2011, with 29,000 of those dying within the first month.
Take home message: avoid antibiotics unless necessary. It’s not nice to mess with normal flora.