Dear Dr. Roach: I’m writing regarding my 92-year-old father. He has always been active, still plays golf and had played softball up until the age of 88. He has a history of blood clots, so he is on blood thinners. Nowadays, my father is constantly fatigued; walking out to the garage or attempting to play nine holes of golf leaves him drained. He sleeps a lot during the day. All the doctors say is: “Hey, your dad is 92 years old.” So, my question is, is this a normal part of aging?
J.N.
While it is true that we all slow down a little bit as we get older, and 92 is certainly a very respectable age, I would not rush to blame this on his age, especially if these changes are relatively sudden. I certainly would not diagnose this as normal aging without, at least, a careful history and physical examination, as well as some judicious laboratory studies.
Fatigue is a very nonspecific symptom that can be caused by abnormalities of virtually all your major organs, especially the heart, liver, kidney, lungs and bone marrow. Thyroid problems are another common issue, and depression is a frequently overlooked possibility, especially in older men.
Dear Dr. Roach: What is your recommendation for weight gain supplements?
H.B.
I don’t recommend weight gain supplements, except under unusual circumstances. Most people do better eating food than using supplements such as protein powders, food replacement drinks, vitamins, minerals, herbal supplements or other over-the-counter medications purported to help people gain weight.
There are some exceptions to my lack of enthusiasm for these products. Many medical conditions can cause poor absorption of nutrients, and people might be prescribed supplements by their physician, which can be completely appropriate for them. One example is in people with very severe lung disease, such as emphysema, who often lose a lot of weight.
Dear Dr. Roach: I read your recent column about Raynaud’s, and I’m a bit confused. My fingers and toes tend to get cold, so I always wear socks in the winter, even though I live in Southern California. Sometimes I put on two pairs of socks.
This past winter, I noticed that my toes would sometimes be red when I took the socks off. There didn’t seem to be any reason as to when it happened. My doctor then diagnosed me with Raynaud’s. You wrote that with Raynaud’s, toes can turn white or blue. Is there some other medical condition that would cause them to turn red?
M.F.
The classical progression in an attack of Raynaud’s is the affected fingers or toes will turn white, then blue, then red. However, not everybody has the classical colour change, and you might be missing the white or blue colour change, since your feet are in your socks (I recommend wool) and shoes.
Your doctor’s diagnosis seems likely to me; though, of course, I can’t be sure there isn’t something else. Blockages in the circulation to your toes are worth considering.
Some people are so sensitive that the temperature doesn’t need to be very cold at all to cause an attack. While warmer footwear will help, keeping your entire body warm is important.
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