"WHEN you are old and grey and full of sleep, And nodding by the fire, take down this book, And slowly read, and dream of the soft look Your eyes had once, and of their shadows deep;" - William Butler Yeats

Many of us, like Shakespeare, abhor old age. I am one of those who adores old age and respects it for its forbearance, compassion, understanding, and also for its maturity. Old age is a time when one has the advantage of both long standing empirical and existential wisdom (not knowledge). Some of my readers have urged me to write on old age diseases like diabetes, cancer, hypertension and heart disease etc. I normally do not replicate a medical textbook in my articles and do not like this reductionist disease concept. I agree with Professor Mary Tinnetti of Yale University when she wrote an article entitled "End of the Disease Era" in the American Journal of Medicine in 2004; 116: 179, where she says that:

"The time has come to abandon disease as the focus of medical care. The changed spectrum of health, the complex interplay of biological and nonbiological factors, the aging population, and the interindividual variability in health priorities render medical care that is centered on the diagnosis and treatment of individual diseases at best out of date and at worst harmful. A primary focus on disease may inadvertently lead to undertreatment, overtreatment, or mistreatment."

We could club them all into one class of age related maladies. In my experience of nearly half a century of treating patients, the biggest problem of old age, especially in the affluent section of society, has been the adverse drug reactions. Many of these patients have been on a long laundry list of chemical drugs for the various diseases mentioned above. Each specialist gives a few drugs of his/her choice unmindful of what his counterpart in the other specialty has given. The poor patient tries to comply with all of them at the same time little realizing that this kind of poly-pharmacy has no scientific evidence to support it even in this era of evidence based medical claptrap.

What is old age? Quantum physics tells us that matter and energy are but the two faces of the same coin. So the human mind is but the human body. Your thoughts are your body in that sense. If you always think that you are old and infirm, you WILL be old and infirm. If you think you are young and healthy, you SHOULD be so. Chronological age is only a mirage. Body cells die and get replaced regularly; so much so you are not the same person that you were three months ago. At any given time your true cell age is just about six months. But if you think you are old the thoughts get passed on to the new cells and make them old! Think young and remain young at any age.

In the elderly and the old elderly, diabetes is not serious disease. It is just the exhausted pancreas trying to cope with the demand. If one were to diet sensibly-eating small feeds six times a day avoiding frank white sugar in food and eating as much raw vegetables and fruits as is possible in the diet-and avoiding sedentary life style of sitting in front of the TV all day, exercising regularly, with a positive state of mind and enthusiasm to help another human being in distress, the blood sugars can be controlled as also the other metabolic fall outs of diabetes. The best exercise in old age is a daily walk, at one's own pace for at least half an hour a day would do wonders to your health. Do not get frightened of our medical scare mongering to get you hooked on to our drugs. Mark Twain was quite right when he wrote: "do not read health books, you might die of a misprint!" Most lay articles are either sponsored by vested interests or are copied from some medical textbook source and will invariably be scary.

DO NOT get your blood sugar checked daily. A quarterly level of glycosylated haemoglobin (A1c) level will do. Try and keep it below 7.5. Even if the sugar occasionally goes up do not panic, it will come down. Take good care of your feet, washing it daily at the end of the day with soap and water and drying it fully before retiring to bed. Have shoes which are a size bigger than normal lest you should develop pressure points in the feet. Should you develop any new symptom, however trivial it might be, see your family physician for guidance? Most of the time it might be of no consequence but do not self treat yourself or take advice from other patient's experience as your guide. Do not rush to a specialist directly bypassing your family doctor.

The specialist does not know you well and will be at a loss to size up the situation. You will end up in the circle of never ending tests and scans and referrals which might not only cost you a fortune but might damage your health as well. You MUST have a humane family doctor as your friend, philosopher and guide. Similar advice holds good for high blood pressure. The latter, however is, most of the time, a White coat effect in old people. Tudor Edward Hart followed for decades a closed group of coal miners in North Wales and found that drugs were not needed especially in women above the age of 65 for mild to moderate high blood pressure.

A recent large study did show that slightly higher blood pressure is needed in the old elderly. If your doctor decides that you need drugs discuss the pros and cons with him and ask for details as to why long term drugging is mandatory. Ask for absolute risk reduction statistics and not relative risk reduction statistics. The former would most of the time show drugs in bad light. In medicine we use two types of statistics-the ones you look up and the ones that you cook up. The drug companies use the latter statistics to sell their wares but the doctors should be able to look up the right data.

Having said what I said above I must hasten to add that if one is already on drugs DO NOT stop them suddenly without consulting your doctor first. If both of you decide to cut them down do it very gradually under the doctor's supervision. This article is not a medical prescription and the writer is not your doctor. Your doctor is your boss. Follow her/his advice correctly. Mine are only suggestions for both of you to arrive at an informed decision. The take home message is that both diabetes and high blood pressure are not serious and dangerous illnesses in old age and are a part of living long in this planet. The human mind is the boss here and fear kills faster. Please note that the treatment of most old age illnesses is based on the following simple rules:

1) Change of lifestyle to a healthy one

Eating in moderation, exercising regularly, getting enough sleep daily, avoiding alcohol and tobacco totally, loving ones near and dear ones, trying to be of some use to society if one's health permits, and enjoying life as it comes will make you healthy and fit. Greed, jealousy, anger and pride are killer risk factors which could be avoided. Love, camaraderie, universal compassion and true humility should stimulate the doctor within all of us, our immune system. Keep your body and brain working as far as possible remembering that if you do not use them you lose them!

2) Tranquility of mind

Music, yoga, praanaayaama, listening to good deeds and words of others, helping others by being a giver and not a taker keeps one healthy. Your mind becomes tranquil. Having a good hobby helps. Keeping oneself busy also keeps the mind free from negative thoughts. Needs are a must but greed kills. Have a heart to keep your heart healthy.

3) Drugs
Rarely ever, if ever, is the best advice.

Many of us believe that there is a pill for every ill. This concept is not only naive but dangerous. While certainly there is no pill for every ill, there is an illness following every pill. While pills thrill they could easily kill also. So before embarking on life long drug therapy have a friendly long chat with your doctor of the pros and cons oaf such an action and take your final decision. Medicine today is no longer a paternalistic activity. It is a partnership between a humane doctor and his patient.

In old age most people suffer from adverse drug reactions due to polypharmacy. Many of those patients do very well when we take the drugs off gradually and let hem bask in the sun light for an hour or two every day. Sunlight not only is a good germ killer but gives us the best tonic for our immune guard by supplying the pure vitamin D3 which stimulates the human immune system, the back bone of disease resistance.

I have deliberately avoided two other old age maladies-cancer and the other so called disease high cholesterol. The latter would need one sentence to dispose it off. High cholesterol is not a Disease! It is a body parameter and 90 percent of it is produced in our own liver for our own good. So each one of us has different levels and the average need not be NORMAL. Change of diet to vegetarian, avoiding too much carbohydrates and regular walk would set it right for you. Drugs never! Cancer is not a disease and is an aberration of normal cell death (apoptosis) process.

How I wish I knew more about it. Even the best Nobel Laureate biologist, Albert-Szent Gyorgyi, feels that he cannot say what cancer is as he finds no difference between the working of the cancer cell from that of the normal cell. He does not think that he could suggest any method that could selectively kill cancer cells without concurrently killing the normal body cells. There are several alternate methods of cancer management in addition to our three pronged attack, but most of them are kept under the wraps by vested interests. I suggest an informed reader to go through the Abraham Fitzgerald Report 1953 in the USA which is available on the net regarding this topic. That report was a secret document for 50 years. It is now open for all to see!

Old age is a pleasure and should be enjoyed without the fear of disease and death. Death, they say, is not the end of life but only a part of it. Our effort must be to see that death is dignified without having to go through the intensive care unit of a hospital en route to heaven. May God give wisdom to all doctors to follow the prayer of Sir Robert Hutchison.

"From inability to let well alone; from too much zeal for the new and contempt for what is old; from putting knowledge before wisdom, science before art and cleverness before common sense; from treating patients as cases; and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.

May mankind be happy and healthy to live long.
"Learning is an ornament in prosperity, a refuge in adversity, and a provision in old age." - Aristotle

REFERENCE:
Sir Robert Hutchison, 20th century physician, British Medical Journal, 1953; 1: 671.

Professor BM Hegde
Retired Vice Chancellor, Manipal University
E-mail: hegdebm@gmail.com