Dear Dr. Roach: I have been a pretty regular blood donor for decades. At times, I’m rejected because I just miss the minimum iron count necessary. My question is if I should continue to be a blood donor, as I am 84. My health is excellent, and I’m not taking any medications for any ailments. I have no blood pressure problems or diabetes. I still work part-time in a job that keeps me on my feet all day.
I know the system takes a few weeks to “replenish” after giving blood, and that has started to concern me, considering my age. Being a regular donor, all the information is in the record, but no one has ever said anything about an age limit. What is your opinion?
There is no age limit on donating blood. That is, if you are healthy and have no medical conditions that would keep you from donating.
If you are borderline on iron in the blood, it could be that you are donating more often than is optimal for you. I also have been trained to think of the worst possibility, which is that you might have hidden iron loss, so I would want to be sure you have had your colonoscopy as recommended (colonoscopies are generally recommended against in people over 85, and given only after careful consideration after age 80).
Dear Dr. Roach: About six months ago, I was told I needed a hip replacement, but they were unable to do surgery because of my medical conditions. I am 78, weigh 240 pounds, have diabetes, sleep apnea, mitral valve prolapse and congestive heart failure. The doctor said I had only a 50/50 chance of coming out of the surgery OK.
A hip replacement is a big, invasive surgery that most people do well after and that improves quality of life for most people who need it. However, it isn’t right or safe for everyone. Some of the issues you have are found routinely in people your age. Diabetes, sleep apnea and mitral valve prolapse are, in most cases, able to be kept under control around the operative time and do not prevent a person from getting surgery.
Congestive heart failure, however, is a very broad diagnosis that can include people with a very mild decrease in their heart function to people with acutely life-threatening disease to people with severe chronic disability.
Congestive heart failure isn’t a specific diagnosis, it’s a syndrome with many possible causes. I don’t know enough about you to comment on the “50/50” comment, but it is certainly true that many people with CHF are not considered safe for an elective surgery such as joint replacement. Having additional medical conditions can increase your risk further.
However, there are many new treatments for CHF, and if it’s the CHF that makes your doctors hesitate about surgery, and you are not seeing a specialist for it, you should.
It’s possible that with more aggressive treatment, your CHF would be better controlled, possibly enough to reconsider surgery.
Although mild cases of CHF often can be managed by a generalist, more severe cases benefit from the experience of a cardiologist, or even a cardiologist with specific expertise in CHF.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. You can email questions to ToYourGoodHealth@med.cornell.edu.