Tuesday, July 19, 2011

As one ages, one has to decide on a strategy if a major illness is ever diagosed

What’s my own game plan for my own medical issues as I get older?  It’s relevant, because I turned 68 a week ago Sunday, and celebrated Monday by riding up Mount Washington, NH.

My GP warned me about the PSA some months back, and gave me referrals to urologists.  My father died just before his 83rd birthday of metastasized prostate cancer, that spread to his lungs, liver and brain. But he was ill only the last four weeks of his life.  He was active until almost the end. At 74, he had undergone an aorta resection for an aneurysm (at age 74). My mother died in December at 97, after a very long decline. She had coronary bypass surgery in 1999 at age 85, and got about eight good years.

I can tell my own body is slowing down, and I can tell I have signs of coronary artery narrowing.  (I saw a note of concern on my doctor's chart for me a few years ago.) An uncle had a cardiac arrest at 68 and died of myopathy at 70.  The men on my mother’s side did not do nearly as well as the women.   You know what happened to David Letterman. He went to the doctor, did not come home, did not pass “Go”, was wheeled into the operating room at age 53 or so for emergency coronary bypass surgery, and joined the zipper club.

My point is, fifty years ago, older people did “what they wanted” and nobody bugged them. Some lived a long time, and some didn’t. Some even smoked (I don’t and never have).  But disability at the end of life, and the need to be cared for personally, was not perceived as an issue then. It’s true, usually there was an unmarried woman who was expected to stay close to home and take care of grandparents in their last year, but terminal illnesses usually weren’t drawn out very long. End-of-life did not become humiliating.

I think that staying active is the best plan. Go ahead and do the “Do Ask Do Tell” film.  With many conditions, the cure is worse than the disease.  I have a feeling that some people will live as long without the chemotherapy, mutilative surgery (for prostate cancer that sometimes includes castration) and humiliation as with. But of course, some of the ideas about “humiliation” come from a life of “standing alone.”  As you get older, the idea that parents are supposed to pass on the idea of social interdependency onto their kids starts to make sense (and doing so can strengthen parents’ marriages, too, although it didn’t jump-start them).
With Medicare, we face the prospect that, because of the debt situation, there will be political pressure to means test Medicare treatment, to treat it the way Medicaid is treated now. To get bypass surgery or anti-cancer treatment, some patients might have to choose poverty to stay alive, or even demand poverty of their adult children.  The numbers, however, show that these fears could be overblown.

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