Ask Dr. Etingin: Involuntary weight loss; Surgery concerns; Douching and cancer risk
My mother, who is 75, has lost weight recently. She says she feels fine, but she’s not overweight and she hasn’t been trying to lose weight. Could her weight loss signal a health problem?
Involuntary weight loss in seniors often occurs due to an underlying illness (for example, depression, cancer, or gastrointestinal or thyroid issues) that affects appetite, food absorption, or metabolism. Weight loss also may be a side effect of conditions that affect chewing and swallowing, such as dysphagia (difficulty swallowing), a dry mouth, and poor dental health. Your sense of taste and smell also lessen as you age, and this can affect your appetite, as can some medications. An unintentional loss of more than 5 percent of your body weight during one year should be investigated, since involuntary weight loss is associated with a decline in function and poor health outcomes. If no underlying illness is identified, ask her doctor for a referral to a registered dietitian who will work with her to formulate an eating plan and teach her strategies that help her stabilize her weight.
I have a medical issue that could be solved with surgery, but I’m not sure if I should have surgery at my age—I am 82. What do you think?
Discuss your concerns with your surgeon and/or your primary care physician. Older adults have less physiological reserve to fall back on at times when their bodies are under great stress, and this can make a fairly routine operation a potentially risky prospect. It isn’t just the surgery itself that is a concern; general anesthesia is associated with a greater risk for postoperative delirium (a sudden alteration in mental status) and postoperative cognitive dysfunction (a short-term decline in brain function that may last from a few days to a few weeks). Preoperative tests can assess your physical and functional status, as well as your cognition. The test results can help you and your doctor make a decision about how well you’re likely to come through the surgery. Also ask how surgery might affect your quality of life, and if there are nonsurgical treatment options that might provide the same or similar results. And find out what your insurance will and will not cover and what your financial responsibility will be for the services you receive. If you do choose surgery, before your procedure, make sure you understand what you will need following surgery—for example, if you’ll require a walker, or if you’ll need special equipment such as a shower bench or a raised toilet seat. Will you require physical rehabilitation and, if so, will that be provided at your home, or will you have to travel to appointments? If you will need transportation or help with shopping, cooking, or any normal activities of daily living, enlist the help of family and friends. The more information you have, the easier it will be to make a decision about whether or not surgery is the best choice for you.
Does douching raise the risk of ovarian cancer?
A few years ago, a study found that women who douched had almost twice the risk of ovarian cancer as women who did not douche. However, the number of study participants with ovarian cancer and a history of douching was small, and the study did not account for some of the factors that influence ovarian cancer risk. However, in general, douching is not recommended, since it flushes out normal bacteria that help keep the vagina healthy, and it increases the risk of infection. Instead, use plain, unscented soap to wash the surrounding areas, but do not put soap in your vagina—the vagina cleans itself with natural secretions. If you have a persistent problem with vaginal odor, see your gynecologist to be evaluated for possible causes, such as vaginosis, an infection caused by an overgrowth of certain types of bacteria.
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