My Geria Babies

There was a time when the secretary in one of my clinics called and said "Doc, your Geria babies are here already!". True enough, I had 5 patients waiting in the clinic at the age range of 79 to 90 accompanied by their adult children. This is in contrast to the patients of the Pediatrician with me in the clinic with patients who are babies accompanied by their mothers.

Many times, elderly, particularly the old-old, are in my clinic because their children could no longer understand their behaviour. They easily forget what the doctor just told them and they easily get irritated when they forget things. Their children get irritated too because of fatigue both in work and in taking care of them. One daughter, after the consult, stayed and asked if she could talk to me for a while. While the father left, she started to become teary- eyed. She said she doesn't know what to do. She gets tired reminding her father to take his medications. She gets tired checking on the food he eats. She gets tired being reprimanded by him when he is irritated. She gets tired seeing him sleep in the morning because she knows he will be awake at night and they sleep in one room together. While narrating her misery, I listened and looked at her straight in the eyes smiling. She paused and looked at me too. Then she realized, she was complaining in the same manner that she complained when her son was still a baby. All I have to say to her was " we'll all get there and he just came before us. Just remember, he was once like that to you too, taking care of all your moves because you were once a very fragile baby.."

As children, we have to realize that our parents were once as active as us. Even if they've been too harsh at one point or another, we wouldn't be where we are if not for them. Just look at the old people and start to imagine yourself with all the skin creases and wrinkles and think how would you act if you are already 90. Think again and again.

Hypoglycemia in the Elderly

Last year I wrote that Diabetes is better treated aggressively to avoid complications. True. However, when the diabetic patient becomes an elderly, this may not be so.

I had several cases admitted in the hospital, of elderly who suffered severe hypoglycemia after diligently taking their prescribed meds. One is 90 the other is 89. Hypoglycemia should be watched out among our elderly patients. They may not manifest as simple tremors or dizziness. My 90 year old patient had a very good appetite when I left her after my rounds. She even thanked me for taking care of her. However, that night her sugar started to fluctuate. I had just discontinued her hypoglycemic drugs two days prior. Her sugar dropped down to less than 50 which prompted me to give D50's. She would respond well but after several hours, the sugar would drop again. The resident on duty just continued monitoring her glucose levels and managed accordingly. However, at 4AM, the ROD called to tell me that my patient died- suddenly- seated down. Relatives said she requested to be seated down so she can eat, after several minutes, she just closed her eyes and did not breathe. Altthough she was 90, I still felt deep inside that I should have sent her home so she could have rested in the arms of all her children.

I noticed hypoglycemic agents should be used with caution when patients become 60 and above. Their response to these agents is very unpredictable. Nowadays, when I see my elderly patients whose children complain that their sugar is high, except when there are other signs and symptoms, I tell them to observe and not to feel alarmed. It is better to have higher sugar levels when you're old old. Monitoring of sugar levels is recommended.