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August, 2016:

Age Is Not a Disease

Granted, sometimes it feels that way. When my left thumb joint aches from holding pots and pans while my right hand scrubs them. When the first few steps out of bed in the morning are on shuffling, surprisingly stiff feet. When I can’t avoid a glimpse of my sadly lax skin. However cliché it is to say it, though, my age is just a number. It is certainly not a diagnosis.

Medically speaking, age is part of what we call the patient’s signalment. It is a descriptive term. In people that means the patient’s age, sex and race. In veterinary medicine: age, sex, breed and species. We start with the signalment because right away that begins to narrow our focus. For instance, once you know you are dealing with a female, prostate cancer is off the table. No reason to even entertain the possibility. A Doberman isn’t going to have Feline Leukemia but probably has some degree of heart muscle disease. A 12-year old dog with vomiting and a palpable mass in his abdomen is more likely to have cancer while a puppy with those same symptoms and findings is more likely to have eaten a rock.

To illustrate: I will always remember a case in my early years of practice. I was called up to the lobby to triage an emergency because all of the examination rooms were already occupied. The owner was frantically cradling a cat all wrapped up in a towel. What seems to be the problem? All of a sudden he can’t move his back legs. OK, I said. Trauma it is. Let me take him to the treatment area. He was probably hit by a car. The owner protested. Absolutely not, he is 14 years old and never goes outside. Ok, then. Heart disease and a blood clot to his legs. A quick 180 degree turn and I was off and running again. That is why medical professionals are encouraged to obtain the signalment and medical history BEFORE making their diagnosis. Not my finest professional moment, but I think you see my point.

And getting back to that point, age is a starting place. It should not be the final conclusion. Yet I find people using age that way here in the islands. From other medical professionals asking me, “Do you really want to put an old dog through that?” (whether ‘that’ is surgery or a simple blood test) To owners debating, “Is it really worth doing – fill in the blank – at her age?” To the casual conversation with someone on the street discussing their sick pet and concluding with “Well, my wife says he’s just old.” (And here pets can be considered old at the ripe age of 7.) I honestly don’t remember this being the case in my previous practice life in the States. Of course, in all fairness that was 15 years ago. I am older myself now so it might be that (1) I am more sensitive to the inherent gravity (pun intended) of aging and/or (b) I am losing my memory. Nevertheless it bears repeating.

Age is not a disease.

Furthermore, age is absolutely not a death sentence. Contrary to popular opinion, nobody ever actually dies of old age. Something else happens. At the very least, their heart stops beating. Even dying of natural causes is the manner of death (as in not a homicide, for instance), but there still has to be a cause. Aging simply shifts the diagnostic focus. Again, it makes certain diseases less likely and makes others more likely; and, as ridiculously frustrating as it may be, as we age there are more diagnoses that don’t have ‘cures’ but only the hope of management and mitigation.

Let’s face it, as the years go by most everything gets harder…. scrubbing my pots and simply living another day included. But age is not, in and of itself, reason not to look or to treat or to try. One might find plenty of other such reasons, but age is not one of them. And as I am lucky enough to get older and older and hopefully older, I personally take comfort in that. Consider that I have been with Michael through lots of doctors’ visits and even two weeks of serious illness in a hospital in New York. Doctors recommended myriad numbers of tests, a few surgeries and prescribed beaucoup different medications, and never once did I take one of those physicians aside and not-so-subtly suggest, “yeah, well, but he is pretty old……..” I’m just saying.Birthday cake