I was taught that the process of homeostasis (the ability of an organism or cell to maintain internal equilibrium by adjusting its physiological processes) maintains a regulatory control over our biological system, working like a feedback mechanism. For instance, when sugars are digested, certain cells within the pancreas release insulin. The insulin promotes incorporation of this food source (glucose) within the body’s cells. When this is accomplished, a feedback mechanism decreases the further secretion of insulin. The body is wired and controlled by these feedback mechanisms, allowing us to maintain a healthy, functional state. For some reason, however, a slow deterioration of function eventually leads to death.
I believe the ultimate challenge in medicine is to not merely alleviate unhealthy symptoms and disease, but to cure functional deterioration and thus prevent death. What a radical concept! The idea of attempting to maintain health while gracefully dying is like a half-hearted attempt to deal with the basic problem. Naturally, I am limited in my area of expertise, but based on a sound background in the science of biology, my thinking process leads me to obvious conclusions regarding “ultimate health.” The book’s final chapter on the future will explore this concept in more detail. For now, let’s look at the aging process regarding dental health.

Is there confusion regarding proper medical care of the elderly?
The most likely etiology for this patient’s recurrence of dental decay is reduced salivary flow (xerostomia or dry mouth) as a result of medications that she is taking. This is a widespread problem, especially among the elderly.
Upon upgrading this patient’s medical history it was determined that she is being treated by a primary physician, a neurologist, a gastroenterologist and an ophthalmologist.
The patient is currently taking the following medications:

1. Pepcid: antacid
2. Mestinon: for treatment of myasthenia gravis, a muscular-neurologic disease
3. Nitro-Dur Patch: designed to provide continuous, controlled release of nitroglycerine through the intact skin; indicated for the prevention of angina pectoris due to coronary artery disease.
4. Remeron: an anti-depressant
5. Xanax: anti-anxiety medication
6. Buspar: anti-anxiety medication
7. Flonace Nasal Spray: for management of allergic rhinitis (rhinitis: inflammation of the nasal mucous membranes)
8. Allegra: for relief of symptoms associated with seasonal allergic rhinitis
9. Prozac: for depression
10. An eye lubricant
11. A nasal spray
12. Centrum Silver: a multi-vitamin
13. B-complex vitamin
14. Calcium citrate

Is this really a coordinated and well thought out treatment plan? When I asked this very intelligent and alert 93 year old patient about this degree of medication, she said that it was “keeping me out of the hospital”.

NEXT CHAPTER: Finances

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