{"id":1192,"date":"2017-03-09T12:26:15","date_gmt":"2017-03-09T17:26:15","guid":{"rendered":"http:\/\/www.healthinaging.org\/blog\/?p=1192"},"modified":"2017-03-09T12:26:15","modified_gmt":"2017-03-09T17:26:15","slug":"older-adults-and-medication-a-geriatricians-experience","status":"publish","type":"post","link":"https:\/\/www.healthinaging.org\/blog\/older-adults-and-medication-a-geriatricians-experience\/","title":{"rendered":"Older Adults and Medication: A Geriatrician’s Experience"},"content":{"rendered":"

\"ST<\/a>Stephanie Trifoglio, MD, FACP<\/strong><\/span>
\nAGS Member<\/strong><\/span>
\nPrivate Practice Internist & Geriatrician\u00a0<\/strong><\/span><\/p>\n

As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC).\u00a0 One patient\u2019s story highlights why this is still very important and worth the time and effort.<\/p>\n

A new patient, Mrs. B, came to me for help in managing her dementia. Her husband was remodeling their home to make it accessible as she was now barely able to walk.\u00a0 She was becoming more confused.\u00a0 She had previously seen an internist and two neurologists.\u00a0 Her husband gave a history of Parkinson\u2019s disease, along with a several-year history of colitis and longstanding diarrhea.<\/p>\n

The initial history revealed that Mrs. B. had progressive weakness, unsteady gait, and confusion.\u00a0 She had muscle jerks at night.\u00a0 She had three recent car crashes and subsequently stopped driving.\u00a0 She had even lost her ability to do sudoku. This was significant as she had been a doctorate-level biologist.\u00a0 A review of her medications showed that she had four years of taking Pepto-Bismol, two tablets, four times per day, prescribed for collagenous colitis.\u00a0 She took this dose consistently.<\/p>\n

The active ingredient in Pepto-Bismol is bismuth, and I have never before had a patient take this much bismuth.\u00a0 Being naturally curious, and always looking for potentially reversible causes of dementia, I did a bit of research and ran basic blood tests on Mrs. B.\u00a0 I also instructed her to stop taking the bismuth.<\/p>\n

Her initial bismuth level was 189 micrograms per liter (mcg\/L).\u00a0 Normal levels of bismuth go up only to 9 mcg\/L.\u00a0 This was confirmed in follow-up tests.<\/p>\n

Telephone consultations were sought with the US Food and Drug Administration (FDA), Poison Control, and a kidney specialist.\u00a0 There are not a lot of data available on high bismuth levels, but the recommended treatment was to allow the bismuth to clear out of Mrs. B\u2019s system naturally and monitor her over time.<\/p>\n

Over the next three years, Mrs. B. had steady, progressive improvement in mental status and physical coordination.\u00a0 Her dementia completely reversed.\u00a0 She no longer required a cane to walk.\u00a0 She returned to writing the household bills and doing sudoku.\u00a0 She had no further falls. Her bismuth level became zero.<\/p>\n

\u00a0<\/strong>According to the FDA, this patient\u2019s dose of Pepto-Bismol was not toxic and should not have been absorbed.\u00a0 Yet it clearly was.\u00a0 Most probably, the collagenous colitis led to increased absorption of the bismuth.<\/p>\n

This patient\u2019s story is important to me for several reasons.\u00a0 Taking a complete medical history takes time and attention to detail.\u00a0 It remains one of the most important things that I do for my patients, especially the elderly patients with multiple medical problems.<\/p>\n

Getting a clear list of all medications that a patient takes is critical.\u00a0 As a physician, I need to know all the prescribed, over-the-counter, and herbal medications the patient is taking so that I can check for possible side effects and interactions.<\/p>\n

There is absolute joy in helping and changing a person\u2019s life for the better.\u00a0 That is why I continue to love being a geriatrician.\u00a0 Every time I see Mrs. B and her husband, I glow.\u00a0 Simple medicine, done right, still matters.<\/p>\n","protected":false},"excerpt":{"rendered":"

Stephanie Trifoglio, MD, FACP AGS Member Private Practice Internist & Geriatrician\u00a0 As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC).\u00a0 One patient\u2019s … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[4,1,9],"tags":[72,38,73],"_links":{"self":[{"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/posts\/1192"}],"collection":[{"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/comments?post=1192"}],"version-history":[{"count":2,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/posts\/1192\/revisions"}],"predecessor-version":[{"id":1194,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/posts\/1192\/revisions\/1194"}],"wp:attachment":[{"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/media?parent=1192"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/categories?post=1192"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.healthinaging.org\/blog\/wp-json\/wp\/v2\/tags?post=1192"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}