Dear Dr. Roach: I am a 79-year-old man and in good shape. The only medication I take is 20 mg of Lipitor daily. Approximately five years ago, I fell off a small ladder. The fall was caused because I lost my balance. From that time on, my balance has worsened. I notice that when I lose my balance, most of the time I fall backward. I consulted an ear, nose and throat specialist, whose results came back negative. I met with a neurologist, who arranged for an MRI of my brain, which came back normal. Have you any suggestions?
Balance problems are extremely common in older adults, and often, a single cause cannot be found. Falls happen in about a third of older adults in the community every year.
A comprehensive evaluation is appropriate. This includes not only the studies of balance and strength that I’m sure your ENT and neurologist did, but a vision assessment, checking the heart and the blood pressure both standing and laying down, a foot inspection and review of medications (Lipitor is NOT one of the many drugs commonly associated with falls). A vitamin D blood level may be useful, with supplementation for those with low levels.
If the evaluation yields no identifiable cause for falls, my personal practice is to refer to physical and/or occupational therapy. These professionals have expertise in helping prevent recurrent falls. They may also recommend strength and balance exercise. Tai chi, in particular, has been shown to reduce fall risk.
Geriatricians have special expertise in preventing falls, as well as improving overall function in older adults.
Dear Dr. Roach: One of my New Age friends claims that our food (meat, fish and even highly processed food) is full of unspecified parasites, therefore a regular cleansing of the digestive system is desired. Wormwood has been mentioned as a treatment. Is there any truth to it? Do we need regular “dewormings”?
Parasitic infections are uncommon in the United States and Canada. Many parasites diagnosed in the U.S. are brought from international travel. Others, such as Giardia, are found in contaminated (untreated) water. Foodborne parasitic infections, such as tapeworms, can be found in beef, pork and fish, but these are rare. Parasitic infections from highly processed foods would be vanishingly rare, which may be the best thing you can say about consuming ultraprocessed foods.
Symptoms of intestinal parasitic infections may include nausea and weight loss. Vitamin B12 deficiency is common with the fish tapeworm. People may notice passing part of the worm in the stool.
Wormwood is used as a flavouring in alcoholic beverages (Absinthe) and is said to be hallucinogenic, although the dose needed for that toxicity is much higher than one can drink without getting very ill from the alcohol. The name does come from ancient descriptions of the use of Artemisia absinthium as a treatment for worms. Interestingly, a recent trial did show that wormwood extract is effective for schistosomiasis in Africa, which is caused by a type of worm that is not found in the U.S.
Medication to treat worms is not necessary and potentially toxic and therefore not recommended. Since these infections are rare, neither screening nor prophylactic treatment is needed.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu