By Tedler D. Depaynos, MD
The patient had 5 children and although they are now all employed and with stable income, she cannot break the habit of working hard. Actually 2 of her daughters are abroad and they have been sending her regular allowance especially for her medicines.
She felt bored just staying at home so that she still visited her neighbors, friends and town mates to clean their yards. Her children observed that there were times when she appeared to be having difficulty of climbing the high steps leading to their barangay road so that they cautioned her on working and carrying heavy loads. As usual, just like most elderlies, she was always in denial and refused to follow her children’s advice.
Actually there were times when she experienced left chest pains radiating to her left shoulder and arm. Because they lasted only for a few seconds and were tolerable, she did not mind them at all. Even when the attacks worsened in severity and became more often, she just attributed them to her tired muscles because of her work. She just let her younger sister massage her before going to bed.
One of her daughters working abroad when she came home for vacation actually brought her to their non-ageing Family MD who referred her to a well known Cardiologist. She had hypertension (HPN) and her heart was diagnosed to be enlarged with occasional irregular beats or arrhythmia seen on her Electrocardiogram or ECG. Although she appeared to be fit and not obese, her cholesterol, lipids and triglycerides were significantly elevated. She was also found to be diabetic. After an “extensive work-up”, she was warned of a possible “heart attack” or failure of the heart to function and what she was feeling might be the early signs.
Actually the Cardiologist took time explaining in layman’s terms that her uncontrolled diabetis may have already affected her kidneys despite the normal laboratory tests and may be the cause of her high blood pressure (HPN). It is also possible that because of her HPN, her heart enlarged and when it is enlarged it obviously needs more oxygen. The inefficient oxygen supply may have caused her “chest pains” or angina pectoris and arrhythmia. With her increased lipids, triglycerides and cholesterol together with her diabetis, the blood vessels of the heart (coronary) may have decreased their lumen so that it may have contributed to the inadequate oxygen supply. A portion attached in the inner walls can be dislodged and may cause complete blockage, hence, necrosis may occur to the heart muscle being supplied causing “heart failure”. Likewise the arrhythmia may cause the formation of blood clots which may also block the coronary arteries.
She was then prescribed various medications for her HPN, diabetis mellitus, abnormal lipids, cholesterol and triglycerides, blood clot prevention, etc. which despite her senior citizen privileges cost a lot. She was advised regular follow-ups which initially she adhered to faithfully. Because of the medical expenses her daughters working abroad increased her allowance.
After many months, when she was washing some of her clothes outside the house one morning, she was discovered unconscious and slumped in the yard. She was rushed to a near-by hospital and despite the aggressive resuscitation, she never recovered. She was diagnosed to have had a “heart attack”.
She used to take all her prescribed medications but because she soon was not feeling anything, she stopped taking them. Besides she was always complaining that they were too many and got tired taking a handful of different tablets twice a day. She also refused to return for follow-ups.
All her children were very regretful that they did not force her to follow the advice of the Cardiologist. The two daughters when they arrived were visibly angry why their siblings allowed their mother to stop taking her medicines when they all agreed that her difficulty of breathing and slight chest pains were early signs of “heart attack”.
When the sad event was mentioned to the Cardiologist by the Family MD who used to be his professor, she said that this is one of the problems she had been encountering nowadays with many of her elderly patients. Several of them do not continue their maintenance medicines because they are not feeling anything anymore. A number of her patients also shifted to “herbal” medicines even with the label, “No Therapeutic Value” because probably it made them feel good. They may be much cheaper but from her experience they would not cure the diseases. She then inquired innocently with a smile if the Family MD was also taking his medicines regularly.
The Family MD then answered, “of course” with emphasis. He then mentioned that the children promised themselves that they will not be hard headed like their mother when they someday would also require a lot of medicines. **