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Ask Dr. Gott 8/15

Plan early for late-life medical issues

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Posted: August 14, 2007 4:49 p.m.
Updated: August 29, 2007 5:00 a.m.
    DEAR DR. GOTT: I am deeply concerned about my 85-year-old mother. She was in very good health until four years ago when, in quick succession, she had to have a heart stent and later developed colon cancer. She has become adverse to eating since the chemotherapy for the cancer. She also will not consume water or most any other liquid in any amount to maintain her fluid levels. Her thinking is becoming erratic. She is on a cholesterol drug and vitamins, and as far as I know, that is all.
    DEAR READER: Your elderly mother has had serious health problems to deal with, including the predictable consequences of chemotherapy. I cannot speculate whether her behavior and erratic thinking are her way of welcoming a dignified and painless death or whether she requires aggressive management — such as intravenous fluid replacement, a feeding tube and so forth.
    This might be a good time for the family members to sit down with your mother's primary care physician to develop an approach that meets her wishes and needs. If the consensus is that she is a candidate for palliative care, a hospice facility should be brought in to relieve family caregivers and make your mother comfortable. If the decision is not for palliation, your mother should be hospitalized until she is stable.

    DEAR DR. GOTT: My wife and I both have high cholesterol and triglyceride levels. She is a heart patient, and her doctor has her on Pravachol. I have a different doctor, and he has just switched me from Pravacol to Zocor.
    Breakfast is our vitamins, plus toasted wheat bread (one slice for me) with jelly. I have one container of packaged oatmeal with hot water. We drink 1 cup of black tea in the morning.
    We eat our big meal at noon, which usually consists of a salad of tomatoes, zucchini, radishes, lettuce, and maybe cottage cheese or yogurt.
    Our evening meal usually consists of pasta, occasional beef or skinless chicken. Sometimes we have a potato or yam cooked in the microwave. Most of our food is nonfat or low-fat. Noon and evening, I have herbal tea, and she has decaffeinated tea. No coffee.
    Our snack in the evening is melon (cantaloupe or honeydew) plus nonfat pudding and animal crackers.
    Our doctor has told us to cut down on sugar, so we have cut out cookies and ice cream. We eat out once a week. I most often have salmon, and she has fish also. I'm 84 and she is 78. With all we're doing, please advise how we can get our cholesterol levels down.
    DEAR READER: You are following an appropriate low-fat diet. If this fails to lower your cholesterol levels, consider adding niacin plus omega-3 fish-oil capsules. You may be able to avoid taking higher doses of expensive statin drugs, which can cause serious side effects. I do not know what your cholesterol levels are and cannot offer much more than a broad generalization. Work out a monitoring schedule with your family doctor.
    To give you related information, I am sending you a copy of my Health Report "Understanding Cholesterol."
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