Lecture on prevention and treatment of geriatric diseases

There is no universal prevention and treatment formula for geriatric diseases. The best solution is always to "prevent in advance, treat on an individual basis, do not follow the trend, and do not shoulder the burden." Don't wait for problems to arise before rushing to find miracle cures, and don't use other people's health prescriptions to impose on yourself.

Last week, I met 62-year-old Aunt Zhang at a community free clinic. She had tried three or four different antihypertensive drugs, but her blood pressure medicines were still high and low. She clutched half a bag of "thrombolytic health products" and told me that the salesperson had told me that the plaques would disappear after three courses of treatment. As a result, the carotid artery plaques were 2 mm longer and her transaminase was twice as high as the normal value during a review last month. She was just taking medicines indiscriminately. You say she doesn't pay attention to health. She is more proactive than anyone else, but she just doesn't find the right path.

Speaking of this, someone may ask, what should I pay attention to? Don’t rush to memorize the ten or eight health-preserving principles. Let me first break down a few issues that are still hotly debated in the industry, so that you don’t end up getting confused after hearing what the east says to make up for and what the west says to vent. Take the sport that everyone is most concerned about, for example. I got into an argument with two colleagues over dinner a while ago. One is an old director of orthopedics who has been working for 30 years. He said that people nowadays are blind to giving advice to the elderly, letting them climb stairs instead of climbing mountains. How many elderly people have to climb and have their meniscus worn out and need surgery? The other is a postdoctoral fellow in sports medicine. He said that the elderly must do weight-bearing exercises, otherwise they will lose muscle mass quickly. If they fall due to osteoporosis, they will fracture the femoral neck. If they lie down for half a year, all the complications will come, which is even more troublesome. Which one of them do you think is right? In fact, both are correct and both are incorrect. If you have degenerative knee disease and it hurts even when walking on a flat road, then definitely don’t carry it to climb stairs. Just choose swimming, sitting on a chair and kicking, which puts less pressure on the joints. ； If your legs and feet are usually sharp and you have enough muscle mass, it is no problem to walk briskly for half an hour every day and occasionally climb the third floor. On the contrary, it can delay bone loss. There is no need to stay at home every day and dare not move.

Let’s talk about food. Now everyone knows that it should be low in fat and salt. Last month I met a 70-year-old aunt who didn’t dare to add salt. She ate boiled vegetables every day. As a result, she felt so tired that she couldn’t stand still. She was diagnosed with hyponatremia and was almost hospitalized. There are indeed different opinions in the academic circles. It does not mean that the less salt you eat, the better. For the elderly who do not have basic diseases such as kidney disease and heart failure, it is perfectly fine to eat as much salt as a beer bottle cap (about 5g) every day. There is no need to deliberately eat salt-free meals. On the contrary, it will affect appetite. In the end, malnutrition will reduce immunity and the gain will not be worth the loss. As for those who say that "being vegetarian will not cause high blood fat", don't believe it all. I have seen an old man who eats vegetables every day, but his triglycerides are still high because he puts in two tablespoons of peanut oil every day and likes to eat steamed buns and rice. If he eats too many carbohydrates, they will be converted into fat.

By the way, some people ask me whether carotid artery plaque is a problem. Let me put it together here: Only unstable plaques with low echoes need intensive lipid reduction. If you find out that they are calcified plaques with strong echoes, you only need to control your blood lipids and blood pressure and review them every six months. You don’t need to be overly anxious and take a bunch of useless medicines, which will increase the burden on the liver and kidneys.

Let’s talk about medical treatment. Many elderly people ask when they arrive, doctor, can you prescribe the best antihypertensive drug for me? It doesn’t matter if it’s more expensive. In fact, there is no best medicine, only the medicine that is most suitable for you. Doctors of the older generation may like to prescribe you ordinary nifedipine tablets, which cost a few yuan a bottle and take effect quickly. If your blood pressure is only occasionally high and you monitor it frequently, there is no problem taking this. ； If your blood pressure fluctuates greatly and you find it troublesome to take it several times a day, long-acting controlled-release tablets are more suitable for you. They are stable and can protect target organs such as the heart, brain, and kidneys. They are more expensive, costing dozens of dollars a month. You can choose according to your financial situation and physical condition. The more expensive is not really the better. I have been practicing geriatrics for 12 years, and the most regrettable thing I have seen are two types of people: one usually thinks that there is nothing wrong with him, and carries himself when he feels dizzy, and is reluctant to spend a few dollars to register. In the end, he has a stroke and is sent here, unable to move half of his body, and the whole family suffers. ； Another way is to be too anxious and feel a little uncomfortable so you buy random medicines. Last time, there was an old man who had half a cupboard filled with health products. His liver function was abnormal after he took them. He also said that it was a detoxification reaction. Do you think he was stupid or not?

Just now I saw an old man in the back row who has been taking notes. Actually, you don’t have to remember too much. Just remember a few most practical things: First, have a physical examination at least once a year, including blood pressure, blood sugar, blood lipids, blood uric acid, and carotid artery B-ultrasound. These must be checked. If there is a problem, early diagnosis is better than anything else.； Second, don’t follow the trend. People say walking 20,000 steps a day is good. If your knees hurt after walking 10,000 steps, then walk less. Others say it’s okay to take aspirin. But if you take aspirin and your stomach bleeds, don’t take it. You know your body best. ； Third, if you are really sick, go to a doctor in a regular hospital. Don't believe in the nonsense about "miraculous medicine that can cure all diseases" or "diabetes can be cured without taking medicine". If such a thing really has won the Nobel Prize, why do you still need to hand out leaflets in the community?

What I’m talking about today are all real things that I have encountered over the years. There are no high-level theories. If you have any questions, you can raise your hands and ask them. I will answer them one by one.