Do I Have a Real Medical Problem, or Am I Just Old?

October 4th, 2011 By Steven Knope, MD

The following blog post originally appeared as Dr. Knope’s October 2011 edition of The Pearl, his monthly email newsletter. To subscribe, click here.

Welcome to our new monthly medical newsletter, The Pearl. Over the past couple of months, I’ve asked many of you to tell me what you want from future newsletters. Several of you said that you wanted a shorter, more frequent letter, preferably sent via e-mail.

In response to this request, I’ve decided that each month I will select one or two medical questions that I believe to be important to you. I will attempt to provide what we call “medical pearls” — answers to meaningful medical questions — that may actually improve your quality of life.

I would like to thank all of you who sent me topic ideas for future newsletters. I will use these ideas in future installments.

For this first edition of The Pearl, I’ve decided to print an e-mail that I received from an 80-year-old, very active patient. In his frank e-mail to me, I found many important questions that other patients have raised over the years.

Here it is:

Dear Dr. Knope,
Your newsletter is a nice idea. I do have something of interest, but I think it is too broad a topic for the letter. I raise it now because your e-mail brought it to mind. The topic is “geriatrics.” As our population ages, the area of geriatric medicine should be growing in importance and size. Yet the irony is that geriatrics, as a specialty, seems not to be responding to the demand. Why? When my former doctor retired (for his own health reasons) I actually asked the local medical association for a reference for a gerontologist. I was told that there were only two geriatric specialists in Tucson and they were not taking new patients.

From my own experience, (you know some of it), it is clear that both body and mind change with age — and in many different ways! What is not so clear is that medicine, as it is currently taught and practiced, is doing much to keep up with the day-to-day concerns of older patients. It’s a long story, but the raw facts are that with old guys, things do feel different all of all sudden, and sometimes it is difficult to know just what’s going on. Are you sick? Or are you just getting old? When I exercise and feel pain, how do I know if this is a good pain or a bad pain? When you feel lousy, you don’t know if you have a real problem or are just a hypochondriac. I often wonder if what I am experiencing is “normal aging,” a defeatist attitude, or a new medical problem.

I realize you are well aware of all this stuff and the importance of the area. I bring it up because your letter just got me thinking about it; the idea that medical issues with older folks are, or can be, a whole different ball of wax than dealing with a younger person. This may be too much for a newsletter, but I would like to see it addressed.

Questions Raised by this E-mail

Question 1: As I get older, which of my symptoms are due to the ‘inevitable effects of aging’ and which symptoms are due to factors such as physical deconditioning, a simple overuse injury or a serious orthopedic problem?

Question 2: Additionally, “When should I push through my pain and ignore symptoms and when should I call the doctor?”

Pearl One
Overwhelmingly, the majority of aches and pains, or perceived limitations of function that people attribute to “aging” are due to physical deconditioning, a mild overuse injury or a mechanical problem that could be corrected by a doctor’s visit.

Let me give you an example. People will often come to see me, very concerned that they have arthritis of the hip. They have delayed a visit because they were afraid that it was time for a hip replacement. When I take their history and examine them, they have pain on the outside of their hip – not in the groin, where most hip arthritis is felt. What they have is a benign, easily treatable problem called trochanteric bursitis. A stretching program, some medications and a simple injection done in my office usually solves the problem.

There are many such problems in medicine. The point is that you should not stew at home and worry about something that I may well be able to help you with.

Pearl Two
Many people who have a chronic medical problem, such as arthritis, heart disease or even emphysema, attribute a loss of energy and stamina to their underlying primary medical problem. However, in many such cases, their chronic fatigue is due — in large part — to physical deconditioning, superimposed upon their chronic medical problem. If they were to engage in a medically supervised exercise program, their fatigue and lack of stamina could be improved, if not eliminated.

There is a tendency among both patients and doctors to attribute fatigue, malaise and loss of function to a chronic underlying medical condition. However, the medical literature clearly shows that people with serious medical problems such as heart failure, COPD, arthritis and even depression respond very well to exercise programs. Furthermore, there is recent, good evidence to show that bursts of exercise, called interval training, improves stamina and fitness much more than continuous, moderate activity — even in patients with heart disease and congestive heart failure.

The good news is that we know far more about the relatively minimal effects of aging on human performance attributable to aging than we did even a decade ago. Studies have shown that even elite athletes demonstrate very little drop off in their performance until people reach the age of about 64, provided that they continue to do relatively intense training once per week.

As we age, we cannot workout as often as we once did. Our body requires a little more time to repair from vigorous exercise than it did when we were 20. So you should exercise fewer days of the week than you once did. However, if you want to stay physiologically young, and maintain an optimal level of health, some dose of moderately-intense, interval training will make you feel and function better. So as not to overdo it, and injure yourself, you should meet with me before you start an interval training program on your own.

Final Note
This may sound like an obvious comment, but if you have some nagging problem, SEE ME! One of the statements I never like to hear in my practice is, “I really feel silly bothering you about this problem. I know you’ve got a lot sicker people to take care of, but I’ve got this pain in my knee.” As you all know, I am a strong advocate of people maintaining robust health and fitness throughout their lives. I am a student of exercise physiology and the effects of movement on health. I enjoy helping my patients to get stronger and to feel better. Do not hesitate to see me to discuss a nagging pain or to put together a plan to get you feeling better.

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