I’m reading Atul Gawande’s book Mortality and thought I’d share a story about how I care for my patients as they continue on life’s journey.
Katherine was one of my favorite patients. I met her when she was in her early 70’s and cared for her well into her 90’s. She was a breast cancer survivor and we were monitoring her bone health because she, like 1 in ?? women after menopause had developed osteoporosis. As she aged, our conversations changed. At each visit, she not only provided updates of her medical history, all of her new medications but I also heard the latest on her kids, saw the school photos of her grandkids, and best of all, listened to some of the best travel stories and advice before Trip Advisor was ever created. She and her husband took full advantage of retirement and managed 2- 3 trips each year to exotic locations I could only dream of.
I learned from caring for Katherine to live every moment. She brought in smudged black and white photos of her family smiling in their black rubber boots about to board a sea-plane in the early 60’s in the wilds of Alaska. I remember her telling me about a trip to St. Petersburg when she was 92, and how much she loved going back to visit Paris. “I love to walk wherever I go, the only thing that stops me now, is sometimes I get out of breath as I get older.”
Katherine was like many women today, who were able to enjoy life well past the time their mothers or grandmothers could. She had beaten the odds by doing everything possible to stay as healthy as possible, even though she had osteoporosis and was at risk for fracturing a bone.
Literally – porous bone. When we think of bone, we usually think that it’s solid like a rock, however normal healthy bone looks more like a sponge than you might guess. Every day, our bones are constantly remodeling, by replacing older bone with new bone. Our bones are in a constant state of turnover. (Learn more in my blog Standing Tall and Straight with Healthy Bones)
As we age, the process of bone turnover is altered, and slightly more bone is lost than is replaced. For women after menopause, that process is accelerated. In the first 5 -7 years after menopause, women can lose up to 20% of their bone mass.
What was different for Katherine?
Because of her breast cancer diagnosis, Katherine was not a candidate for an Estrogen treatment, and so was at higher risk for bone loss. Her osteoporosis had been identified early with screening through Bone Mineral Density testing, with a DEXA test.
Years of taking extra calcium, Vitamin D, getting plenty of exercise was Katherine’s reason for her initial reluctance to use prescription medication to treat her osteoporosis. Then things shifted. I respected her decision, but over time, she saw that not only was her Bone Mineral Testing showing less and less bone mass, but her sight was also worsening and her bladder was becoming smaller, and insisting that she get up frequently at night. Though she was taking a yoga class to help with her balance and strength, she was also noticing how much height she was losing and what was worse, a few friends had fractured their hips and ended up in nursing homes.
The visits to the nursing homes and rehab facilities were what brought her in to see me. “I’m ready for medication now. I want something I can take once a month. Let’s try it for 6 months and see how I do.”
Here’s what happened
Katherine started a monthly prescription medication and had no side effects, though she kept expecting them. She didn’t get taller, but what did happen was she decided to stay on the medication. About 2 years after starting, we did another Bone Mineral Density Test and found that she had improved in both her lumbar spine and in her hip. And, one day, when she was in her late 80’s, Katherine called me from home. She had just returned from the ER. She had slipped and taken a hard fall in her garden. The doctor couldn’t believe it because, get this….she had not fractured any bones, none! She had a nice bruise on her backside and arm, but no broken bones. Her decision to start prescription treatment had helped prevent a fracture.
Disclosure: I do not work for any companies that market or produce medications that treat osteoporosis.