UCD Doc walks Road Less Traveled

Dr. McCloud talks with a
Mini-Med student

Dr. Michael McCloud is a member of a very exclusive club, a club he wishes was much larger and more diverse. He is one of a small number of board certified geriatricians in Northern California, a medical specialty that’s desperately needed, but nonetheless, a rarity. 

Dr. McCloud is a clinical professor of medicine with the UC Davis Health System, Department of Internal Medicine, and founder of Aging and Medical Science: A Mini Medical School to Prepare for Life's Second Half, the annual community program that features in-depth weekly seminars to educate people about health and the aging process. There is no charge for the program which is taught by a team of eminent physicians and health educators who volunteer their time and expertise. Now in its 10th year, Mini Med School has become so popular that reservations for the 500 seats are filled six months in advance with a waiting list at least as large.

Medical Facts, Peppered with Fun

 

Central to the success of the program is Dr. McCloud whose sharp sense of humor and engaging personality provide a counterpoint to serious medical talks about cardiology, gastroenterology, medications, neurology and other weighty topics. That said, Dr. McCloud makes sure some serious fun is part of the curriculum with an occasional dancing doctor and a very popular session on the bounteous benefits of beer.



Dr. McCloud watches
as 2012 class gets
set to graduate

With the avalanche of baby boomers looking forward to creating healthy and active older years, expertise in geriatric medicine will be in high demand. However, as a medical specialty it has not been a popular choice. For every one geriatrician graduated, there are nine cardiologists entering practice. For every 8,000 people in California, there is one geriatrician. Why then, did Michael McCloud, a graduate of Duke University, choose the road less traveled? It was actually a detour.

 “I had a private general internal medicine practice in San Francisco for 15 years and thoroughly enjoyed it,” he explains. “Because I did a lot of house calls and nursing home calls, my practice base gradually became older than most primary care practices. And, I did enjoy the patient population a great deal.”

Consequently, when he had the opportunity, he completed a geriatric specialty at Duke and Yale universities, planting the seeds for his distinguished career in the Sacramento region. The choice has further enriched Dr. McCloud’s appreciation for the gifts that only come with time.

“The patients are far more interesting and enjoyable than younger patients,” says Dr. McCloud. “There is a saying in geriatrics - ‘If you've seen one 80-year-old, you've seen one 80-year-old.’  They are such textured fabrics. I never, ever have a boring day.”

Healthy Senior is “Work of Art”

In an era characterized by eight-minute, impersonal visits with our family physicians, Dr. McCloud’s approach is a welcome anachronism. Older patients inspire a different approach to health care. “Geriatrics also allows me to practice truly holistic medicine. We are really treating people and not diseases,” he says. “I tell my medical students and residents that geriatrics is the mostly highly remunerated of all medical specialties. It's just not remunerated in money, but something far better.”

It’s an unfortunate reality that aging in America is often seen as a time of physical and mental decline when, in fact, science and medicine prove that both body and mind are capable of robust health into very old age - if we pay attention and follow “doctor’s orders.”

“The positive of aging, to me, is that we have a great deal of control over the outcome, if we only invest the time and interest,” advises Dr. McCloud. “I think of a newborn child as a gift of nature, a healthy young adult as a product of good genes and good parenting. The healthy senior is a work of art.”



Wearing cap and gown, Dr. McCloud
congratulates class of 2012

Prescribing Lifelong Health Education

Mini Medical School is a resource for learning how to control the medical and emotional variables in the aging process. But, since there is but one program a year - and one that’s subject to space limitations, it’s incumbent on today’s baby boomers (and people who want to one day enjoy advanced age) to engage in lifelong learning. Dr. McCloud, naturally, agrees and says “Improve your healthcare literacy, and the rest will fall into line.”

Baby boomers are fortunate to be full members of the digital era - meaning that we have free educational resources at our fingertips. Online information about healthy aging is very accessible from prestigious institutions such as Harvard, Yale, the Mayo Clinic, the National Institute of Heath and scores of credible nonprofits and research hubs.  It’s simply a matter of using our mature judgment in sifting the Internet hype from trustworthy sources.

Of course, we could always hope the Mini Medical School model proliferates and is someday able to serve many more “returning” students, although even Dr. McCloud admits that we need deeper understanding and ownership of our personal aging process. 

“The reality is, of course, that we don't actually teach what individuals need to know to age successfully.  We only give a sampler platter to taste what they need to know, and the enthusiasm to want to learn more,” he says, adding that Mini Med School holds value for people from all walks of life.“ I have now moderated 65 consecutive classes. If I weren't the course director and host, I would probably be sitting in the classroom.”

If he ever does enjoy the role of a student, there’s a good chance he will have contributed even more to our knowledge of what it means to grow older. “I actually keep a diary of some of my patient's reflections, wisdom and humor,” says Dr. McCloud. “A book is on my bucket list, but for now I am selfishly hoarding the wisdom.” 

Whole Body Scan ... or Scam?

He certainly looks trustworthy, but how about the
'breakthrough' technology he's hawking?

Mondays are “Med Days” in our daily paper. Large advertisements devoted to fast, relatively affordable, noninvasive testing of body parts - from heart to whole body - invite us to explore the inner sanctums of physiology in the hope of turning up “nothing” or perhaps finding something early enough to get treatment that avoids disability or death. Who hasn’t wondered and been tempted?

Our final UCDMini-Med School  seminar focused on the technology used in scanning machines, the accuracy of such testing and, importantly, the impact results can have upon the individual tested. Dr. Richard Kravitz  is a professor of Medicine at UC Davis Medical school who is highly published and focuses on the doctor-patient relationship. His advice about jumping into this new arena of discovery? “Maybe not,” he says.

And, here’s why. In general, there are some assumptions made about the publicly available technology that are simply wrong. For example, patients tend to trust technology and most medical personnel in a white coat and, thus, the results of testing. But, studies now show that the accuracy of such scanning tests is questionable. There is a significant percentage of false-positives as well as tagging disease free people incorrectly. “It’s quite common in the real world,” the Doctor said. “No test is perfect.”

 There is also a belief that early detection leads to better outcomes. However, in the case of prostate cancer in which some abnormal cells never become life threatening, the discovery of benign cells can send a patient on a long, painful and costly journey of further medical testing - tests and medications that carry their own set of health risks.

Father of Mini-Med School, Dr. Michael McCloud agrees. “…whole body CT scans can indeed hurt you. That is the very frequent finding of an "incidentaloma" -- a little lump or funny shadow on this or that organ. These very commonly lead to additional, sometimes invasive tests, not to mention angst and expense,” the geriatrician writes in an email. “In most case, they prove to be benign anomalies.”

And, the scans have varying reliability for different parts of the body. Dr. Kravitz reported that whole body CT scans are fairly effective for certain ovarian cancers but don’t have a good record for detecting liver cancers. They are “okay” for lung cancer but not so good at showing coronary artery disease. Those of us checking out the ads in the paper have no way of knowing these variations when slapping down the credit card for a whole body scan.

Then, there is the technology itself. I’d heard some information that CT scans did emit high radiation. But, I thought a momentary zap of radioactivity once in a lifetime was no big deal. After all, the procedure is FDA approved , right? Dr. Kravits set my thinking straight. The radiation delivered during a body scan is “close to the range of exposure” that survivors of the nuclear bomb dropped on Hiroshima received. Whew! Compare that to exposure from an ordinary chest Xray which is equivalent to a couple of days outdoors. A CT scan of the abdomen racks up 400 days of the same exposure to the sun’s radiation.

If that information alone isn’t disincentive enough, there’s something Dr. Kravitz calls “the cascade effect” and Dr. McCLoud referred to earlier as “incidentaloma.”  Seeing potential trouble spots can put a patient on an emotional roller coaster and even bring on a host of new medical problems. Remember, the results could be false-positive or a minor blip that will never turn onto a major disease.

The U.S. spends $8,000 per person on health care, the Doc said. This is much more than any other industrialized country. “It doesn’t show a benefit. It actually produces lower quality care, not higher,” he concluded. Unnecessary testing accounts for a significant chunk of these costs and, with such widely available scanning tests available and being aggressively marketed, that figure is bound to rise as the quality of care falls.

How to proceed when considering tests? Dr. Kravits pointed out the decision

should not be made lightly. He advises talking to our personal doctors first, thinking about what we’d do differently depending on test results and considering what the downstream affects might mean in our lives. Ask “Am I prepared to take on the risks of a false positive”.

To this I will add my own caveat - any time I see a full page ad for a medical miracle - be it a full body scan, a magical back treatment, a weight loss breakthrough or any such quick fix, I hit the “caution” button. I figure the cost of the weekly ad, fly to the Internet and do some serious homework and always apply the old adage “if it sounds too good to be true, it probably is”.

 

Note: We are not done blogging about the important lessons of MMS. More to come next week!

Like Falling in Love - It’s Never Too Late to Exercise

Dr. Calvin Hirsch, a dignified physician of a certain age, started his Mini-Medical School  lecture by dropping to the floor and pumping out a dozen push ups. Appropriately, Dr. Hirsch, professor of Clinical Internal Medicine at UCD medical Health Center, spoke to our class of 500 eager ‘returning’ students about exercise.

Prevent Disease, live longer? Yes!

Charles King and Kim Rhinehelder pay rapt attention at
Mini-Med School. Kim is VP of Philanthropy
with the Eskaton Foundation in Sacramento.

His handout began with the title to a Johns Hopkins article on health after 50 - “Exercise: the universal antidote for Aging.” Indeed, there is a substantial body of evidence that shows exercise is very effective in preventing or ameliorating a host of diseases and conditions that tend to accompany the aging process. On that growing list is heart disease, diabetes, arthritis, cognition and cancers. Nonetheless, so many of us over the age of 50 refuse to become active and take the evidence to heart by making exercise a regular life style practice. According to Dr. Hirsch, the percentage of people in this age range who exercise has fallen in recent years, rather than rising  through increased awareness of the many benefits. Go figure.

Our excuses are many: not interested, no time, exercise is not going to help, it’s too painful, not safe, and embarrassment over going to a gym. I have to admit this last excuse has plagued me - all those spandex-covered young bodies make me want to run for the Senior center! However, there are plenty of alternatives in both the environment for exercising, as well as the style we choose.

An Easy Pill to Swallow

Dr. Hirsch quickly pointed out that exercise does not have to be a formal practice that takes us away from daily life. In addition, all we really need to get health benefits is about one-half hour a day - which can be done in 10 minute segments of vigorous movement. So, think about using the vacuum cleaner for both weight resistance as well as aerobics, or climbing stairs with purpose that exercises the quadriceps (top of the thigh of the leg) - critical to getting up from a chair or climbing stairs. By thinking creatively and taking advantage of opportunities, we can reach that 30-minute daily goal. (One of my practices is to always refuse help with my groceries and, if I am carrying bags, do arm lifts on my way to the car).

 The Doc cited several studies showing that even people with some debilitating conditions that can cause pain and immobility can benefit from the right kinds of exercise. Supervised programs offered in many senior centers can be the ticket to extra added years of life that are not ruled by disability.

The exercise prescription is strongly supported by my friend who recently celebrated her 90th birthday. (She hired a professional ballroom dancer for her party because she still can’t stand to dance with a rookie). Exercise is her mantra - daily stretching, balance and weight resistance. There are many people half her age who cannot keep up with dynamic woman who will remain anonymous because I value my life.

Interestingly, according to Dr. Hirsh, is that the biggest gain for years of life and continued health is in people over the age of 75 who adopt an exercise routine. There’s truth in the adage, “It’s never too late.”

Choose Your Flavor

What kinds of exercise can we do to promote health and longevity? Unless we are training for the Senior Olympics or trying to impress a potential mate who is inappropriately young for us, the choices are simple, accessible and affordable. For great aerobic benefits we can walk - vigorously so that the heart rate rises and there’s a bit of sweat involved. Same for biking, swimming and dancing.  Walking, however, has the added plus of spying on neighbors for garden do’s and don’t’s and decorating faux pas.

 A person doesn’t have to have a history of being a fitness nut to start at any age and get some gains. Being devoted Mimi-Med students we were pleased to learn that Sarcopenia is reversible, even at later age. (Sorry about the jargon - that’s muscle loss for people who missed Mini-Med School).

Balance training is clearly an important element of the after 50 workout. Falls account for 66% of accidental deaths in older adults, according to fall prevention specialists. Try yoga or the gentler forms of Pilates to enhance balance. In addition, dance lessons, Tai Chi and informal opportunities (like standing on one leg) are also helpful practices.

 For simple maintenance that can have significant payoffs in health and longevity, the prescription is not a bitter pill. Dr. Hirsch says walking just 28 blocks a week will positively impact health. In general, about 2.5 hours a week of exercise is a good minimum to shoot for, and remember, it doesn’t have to be performed in hour-long segments or at a gym. For best effect combine aerobic activity with some weight resistance and stretching to keep the body flexible.

I was very pleased to hear Dr. Hirsh validate my personal practice of grabbing opportunities where I find them - the grocery store, climbing stairs, doing household chores and enhancing vapid TV time by stretching muscles and rotating joints while flipping through channels.

The usual caveat - don’t do things without your physician’s advice And, before jumping into my “casual” exercise opportunities learn how to bend, lift and stretch properly from a trained professional (Yes, I did do this).

Here’s a link to lots of exercise opportunities for older adults in the Sacramento Region - there are similar resources in most communities: EXERCISE

 

Exercise for Seniors: Benefits,Risks, and How To Begin

Calvin H. Hirsch, M.D