Things are GONNA Change

Today we will cover changes in Seniors from the outside of the body to the inside of the body. Dr. Pam Tronetti is a geriatrician specializing in the care of senior citizens with Parrish Healthcare. We also have the expertise of Janet Rooks who is a social worker with a background in psychology and a dementia care specialist bringing their expertise in all things "head to toe". We chat about everything from the skin, height (do you actually shrink?), gaining and loosing weight, heart, lungs and so much more!

*This podcast represents the opinions of Dr. Tronetti and her guests. The content here is for informational, educational and entertainment purposes only, and should not be taken as medical advice. Please consult your healthcare professional for any medical questions or before making any changes in your personal health regimen. No other use, including without limitation, reproduction, retransmission or editing, of this podcast may be made without the prior written permission of Parrish Medical Center. This podcast is HIPPA compliant. All people, places, and scenarios mentioned in this podcast have been changed to protect patient confidentiality. This website and podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standards of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on this podcast. In no way does listening, reading, emailing or interacting on social media with our content establish a doctor-patient relationship. Dr. Tronetti does not receive any money from the pharmaceutical industry 

Transcript

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SPEAKER_09 0:03

Hi, thank you for joining us. This is Senior Living Guide.com Podcast sponsored by Parish Medical and Healthcare. Senior Living Guide.com is a senior focused website providing seniors and their caregivers with an opportunity to find the best senior housing and resources that best suits them in assisted living, home health care, independent, retirement, and other senior resource options. Visit us online today at seniorlivingguide.com. So today we have uh Dr. Pam and Janet as our guests. Dr. Pamela Trinetti is a geo geriatrician, a physician who specializes in the care of senior citizens. And we also have Janet Rooks as well. Um she's a social worker with a background in psychology and dementia care specialist. Um they work together at the Parish Senior Consultation Center, where they focus on the care of uh patients with dementia. Uh Dr. Chinetti is the director of aging services at Parish, and Janet Rooks coordinates Parish Senior Solutions, which provides education, resources, and support for seniors and their caregivers. Welcome, ladies. Thank you. Thank you. Happy to be here. Yeah, we're so excited to have you here today. Um, so I wanted to talk to you. One of the things that we're gonna talk about today, or the title of our podcast today, is Things Are Gonna Change and You Gotta Change With Them. That's life, right? It is. That's it. No one gets out of that. No. Like my mom always said, you know, nobody nobody gets out of it. It's just it is what it is. There's there's nobody. I know some some of the 20-year-olds think it's not gonna happen to them, but it is. Yeah.

SPEAKER_03 1:48

And that's the big difference is as people get older, it's Doc, is something wrong with me? Or am I just getting older?

SPEAKER_07 1:55

Right.

unknown 1:56

Yeah.

SPEAKER_07 1:57

Or I'm old. I'm old. I'm just old. Yeah.

SPEAKER_03 2:01

And maybe there's something we can fix.

SPEAKER_09 2:03

Yeah. Well, I mean, technology is getting better. There's a lot more things you can fix on different different sides of the body for sure, I'm sure. But um, so we're gonna talk about literally everything today.

SPEAKER_03 2:17

Inside out.

SPEAKER_09 2:18

Inside and out. So let's start with the outside, um, talking a little bit about the obvious signs of aging, which would be the skin. Yes, the wrinkles, all that kind of fun stuff. So um give me a little bit of idea on what are the things that the the changing of the skin and things like that, what are some things that you can do or signs of aging that you address?

SPEAKER_03 2:50

Well, you know, there's a lot of changes on the skin and a lot of little growths and a lot of little new stuff popping out here and there. And when a physician looks at things, we can often tell, okay, yeah, this is just a normal change of aging, don't worry about that little mark. Uh but they did a study years ago where they had all these chairmen of departments of dermatology from all these universities, and they had these patients come in and they had to look and say, is it cancer or is it not? Is it cancer or is it not? And only 50% of the time they were right. So if you have something on your skin that you're a little bit worried about, show it to somebody. Let them take care of it.

SPEAKER_09 3:33

Better safe than sorry.

SPEAKER_03 3:35

Better safe than sorry.

SPEAKER_07 3:36

Yeah, exactly. Yeah, and you know, we're in Florida and the you know, the sun's out there. But the damage was done years ago. Right. Back when sunscreen was not something that we used. So the damage is there. You know, I grew up, you worked, you lathered on the baby oil with iodine, or the Hawaiian tropic with no sunscreen in it whatsoever. I can still smell it. I can too. Oh, it takes me to a tropical island. The amplifier. Yeah. Uh huh. Yeah. And you know, or you laid on the the aluminum foil, the thing, and you know, and it was like, oh, you know. And um, you know, so it was, you know, we and you got that first burn, and if it peeled, then that was you that was your base for your suntan. And you know, that's when the damage was done. Right. But that's no reason not to use the sunscreen now.

SPEAKER_09 4:30

Are more are more people prone based on hair color? You know, if you have more freight freckles, that type of stuff, is that something that maybe would predetermine whether you're more likely to get you you are more likely for sun damage, but uh i it does you're not totally immune.

SPEAKER_03 4:51

Okay. Yeah, you can have olive colored skin and still have a skin cancer, so don't discount that. Yeah.

SPEAKER_09 4:58

Oh wow.

SPEAKER_03 4:59

And you mentioned what what does the sun do and what did smoking do? Because everybody smoked for generations. And yes, that's the wrinkles for a variety of reasons. You know, as we get older, our skin gets a little bit thinner. And so we're more prone to little tears of our skin, little uh yeah, little micro damage and bruising.

SPEAKER_09 5:22

Right, right. Is there anything you can do to help combat that? Well, some natural?

SPEAKER_03 5:29

As we get older, our skin dries out too. So the key is moisturize, moisturize, moisturize. Uh a moisturizing soap and a moisturizing shampoo, and then a good thick lotion.

SPEAKER_09 5:45

Okay. Yeah, is there anything specific in the lotion like shea butter or anything, or is it just any kind of moisturizing lotion?

SPEAKER_03 5:53

Well, I'm a big fan of use and cream that's in a jar. It is like frosting to put it on. But it does give you that deep moisturizing.

SPEAKER_07 6:01

And I can say it works. I use it, I use it. It's a little difficult to get on initially. I mean, when you start it's like, oh my this stuff, but then it's like, oh, it feels so good. Okay, very you know, and it because the skin does I mean it it takes very little as seniors as people age when the skin is so thin and they'll have the skin tears, and it's just bumping up against something will cause the skin to tear. Right. And you know, and with those skin tears, it's like peeling off a peach. Right. Just peeling off the the skin of a peach and it just lays open. Right. And they'll say, Oh, I'll I'll just put a bandage on it. Well, you know, because the skin needs to be put back where it was for it to heal correctly. Right. And we've seen some pretty nasty skin tears.

SPEAKER_09 6:50

And then it bruises. Oh, yeah. Yeah, yeah. Yeah. I know my mom, my dog loved my mom. Loved, but she'd always jump on my mom and I would like stop, stop, stop. Because it doesn't even matter. Just even a little, a little scratch on my mom with my dog's nails would turn into it, would always tear her skin and she would bruise, and um, that would be like my mom's worst tears. And I'm like, my dog, but my dog loved her, my mom loved my dog, but you have to be really careful of that. So yeah, I understand that completely.

SPEAKER_03 7:22

Yeah, because you're worried about infection then coming into the skin.

SPEAKER_09 7:25

Absolutely. So it's little things like that. You don't think about in everyday life just a dog jumping on an older person. You have to be really careful about that, even. Yeah.

SPEAKER_07 7:35

Or even, you know, a child climbing up in their laps because it can cause the skin to kind of peel away. Oh my gosh. If it's, you know, depending upon they've got their tennis shoes on and they're climbing up in there and it just kind of peels. So you have to be really careful.

SPEAKER_09 7:47

Yeah, exactly. Exactly. So another thing that, you know, you always joke about, you know, I think there was a TV show and I can't even remember which one it was, but she I think it was a Golden Girls episode, is Sophia, where she said, I'm shrinking. I don't know. Do you remember that episode? Um, does that actually happen? Do people like shrink in their height as they get older?

SPEAKER_03 8:09

They do. It's one centimeter, which is about a half an inch, per decade after age 40.

SPEAKER_05 8:16

Oh.

SPEAKER_03 8:16

So you get a little bit shorter, and there's a couple of reasons for that.

SPEAKER_05 8:21

Okay.

SPEAKER_03 8:22

One, your feet flatten, generally speaking, you lose your arch. So people will come in and say, My feet are growing. Well, no, it's just your feet are flat.

SPEAKER_06 8:29

Oh.

SPEAKER_03 8:30

So now you're a half-size different. The other thing is the discs, which are like the little gumdroppy cushions between your vertebrae, the little backbones, they dry out and they flatten. So it's just as if you squeezed down on a gumdrop. So that's that little bit of height loss. Those discs dry out. That's kind of the theme for the day. Everything dries out as we get on. Just keep that in mind throughout our little discussion here.

SPEAKER_09 9:02

So keeping those really mo even your feet really moisturized is helpful.

SPEAKER_03 9:08

Well, it's not going to help the fact that your arch is going to flatten. You know, there's a few things that are going to change. You know, there's seasons to our life, just like your nose continues to grow. Your earlobes get bigger as you get older. That's I used to think that all my elderly ants just had those big, clunky earrings, and they were pulling on the ears, and that's why their earlobes were so big. No. The earlobes of the nose continue to grow.

SPEAKER_07 9:32

Did not know that. And the bridge of the nose gets broader. Oh wow.

SPEAKER_03 9:37

So yes, you're shorter, your nose is bigger, your earlobes are bigger.

SPEAKER_09 9:40

Right. So you so you literally change.

SPEAKER_03 9:42

You do. Okay.

SPEAKER_09 9:43

Yeah. Very cool. So, or not cool, but interesting, I guess I should say. And then you and then also there's a like weight change that happens. And I know that anytime, especially women focus on this, even just going into like the menopause phase of life, um, there's the weight change. So, does that continue as you get into more of a senior phase, or does that something that just transitions in that stage of life? And is it the same for men? Well, there's the body fat.

SPEAKER_03 10:12

Yeah, there's always body fat. You know, we have to have body fat.

SPEAKER_05 10:16

Right.

SPEAKER_03 10:17

You know, uh, women have more body fat than men. Um men usually run about 20%, women are closer to 25%. Uh all depends if you're a bodybuilder, that kind of thing.

SPEAKER_04 10:29

Right.

SPEAKER_03 10:29

But again, after age 40, you can increase body fat percentage by 1% per year. So if you're 25% at age 40, by the time you're 70, now you're 55% body fat. You know, it's just pretty much downhill from here, I want to tell you.

SPEAKER_07 10:51

I don't have a very uplifting uh get your tissues and uh but yeah, right.

SPEAKER_03 10:58

But that's if you don't do anything to change it. Right. If you continue to try to exercise and eat right, that can help reverse some of the expected increased body fat as we get older.

SPEAKER_07 11:12

It's just like a couple, you know, they can, you know, say you got 20 pounds, they want to lose. The man can change his diet and in 10, you know, he can drop that 10 pounds easy. The woman, we've all seen those little characters, the cartoon things, the woman can do change her diet, do the exercises, and lose two pounds. Exactly. So, you know, men lose it quicker, they have more fat to l, you know, and it just it just happens. We like to hold on to our fat.

SPEAKER_03 11:40

Well, that's because we need it because that's where estrogen is basically processed. So, you know, like uh people will say, well, what would happen uh like to the women who were in the concentration camps? What did they do when they had their periods? They didn't have them.

SPEAKER_02 11:56

Right.

SPEAKER_03 11:57

Because as you lose that body fat, your estrogen isn't produced. And that's what we're seeing in our young girls who are gymnasts and ballerinas, they don't have enough body fat. So they are getting osteoporosis at very young ages, which as we go back to height, we said, okay, one centimeter per decade, and you say, Well, gee, I know people who are like six inches shorter than when they were in their 30s and 40s. That's because they have osteoporosis. So the little change in height, no, we can't do much about that. The osteoporosis is something, yes, we can try to prevent that and maintain our height. Yeah. Janet and I are very depressed because we've just had our bone density tested and we're getting shorter, aren't we, Jim?

SPEAKER_07 12:45

I'm a textbook uh I I'm right there with that. I mean, I I walked in the I had my DEXA scan, my bone density uh scan yesterday, day before yesterday. And um I was five nine in the seventh grade and I am now an inch and a half shorter than I was then. And I'm not happy. Yeah. I have accepted it, but I'm not happy. And I do, you know, I do a lot of walking, I do the um, you know, I I did the Space Coast half marathon. I do a lot of 5Ks. I'm an active woman and I take the over the counter stuff that my doctor has prescribed to me, told me to take. And I'm hoping that the DEXA scan is not um that it that it's okay. Right. But, you know, I'll do what the doctor tells me to do.

SPEAKER_09 13:40

Right, exactly.

SPEAKER_07 13:41

Because I trust my doctor.

SPEAKER_09 13:42

Exactly. And that's that's the right approach.

SPEAKER_07 13:44

But I am classic.

SPEAKER_09 13:46

Yeah. I'm normal. I'm normal. I'm very afraid I'm five three. I'm gonna be like super short. Uh-huh. Petite. Petite. Petite.

SPEAKER_07 13:55

Dynot comes in small packages. Keep that in mind.

SPEAKER_09 13:58

This is true. I'm small but feisty.

SPEAKER_03 14:01

But you see that that all cha how changes how our body looks because as we get shorter, you know, you should be able to take your hand and put it between your ribs and your hips. As we get older, maybe you can only get two fingers, one finger. So now your ribs are literally on your hips, so you've become short waisted all of a sudden. You say, Wow, my clothes don't fit right. And my belly is pooching out now. Why? Because there's less room for all those internal organs. All they can do is go forward.

SPEAKER_09 14:33

That is the best explanation that I've ever heard. For that is that's act that's absolutely excellent because I've never heard that explanation. It's always been based on something, metabolism, all kinds of different things, but that actually makes more sense.

SPEAKER_07 14:48

And we've seen the um I uh well the individuals that have the like the hump on the back. Right. It's not because of bad posture. It has to do with the vertebrae in the back.

SPEAKER_09 15:00

Very interesting. So, question on the osteoporosis side. When would you recommend someone start getting checked for that? Uh, the bone density. I'm assuming that's what you're referring to with with osteoporosis. You would have a bone density test. Is that correct?

SPEAKER_03 15:16

Yes. And you know, the um there's also the National Osteoporosis Foundation, the American College of Gynecologists, they all have different levels. Usually it's by menopause, unless there's an earlier uh reason to do so. Uh and I I've seen numbers from 45 to 55. So it's something to start thinking about during those menopause years, and you know, along with your mammogram, which is so important. Ask for a bone density every couple of years.

SPEAKER_09 15:47

Yeah, so that's something that really should be started before you enter those senior years. Absolutely. So if you're a senior, you should already have been actively having that checked. Yes. Okay. Yeah. Are most seniors on medication for osteoporosis osteoporosis? Is that something that's normal or is that something that you know some seniors are on, some seniors aren't?

SPEAKER_03 16:10

Is that it's something that's common. Okay. And again, it's individualized. Some people you just recommend, you know what, we need to check your vitamin D level, make sure you have vitamin D. We need to make sure you enough have enough calcium so you have the building blocks for your bone. We want to make sure you do weight-bearing exercise, which is walking, dancing, marching. And then there's a subset of people that you say, you know what, we really need to have you on a medication. Why? To prevent fracture. Okay. So those are the folks that we choose carefully, choose wisely, monitor, and you know, match the right medication if needed to the right patient.

SPEAKER_09 16:52

So vitamin D and calcium are good vitamins to take. Double check with your physician if you're taking other medications, um, like we've discussed in a previous podcast. We can definitely touch on that again in case anyone from a previous has missed our previous podcast. Um so do you want to talk about that for just a minute?

SPEAKER_07 17:12

Well, they they bind together, they work together, but you need to talk to your doctor. If you if you need to have a good physician that you have a good relationship with. And if you have that candid conversation with if you've noticed that you're, you know, you need that preventative annual physical, and that should be part of your physical, is you know, your weight and to see how tall you are. But you also, you know, there's certain preventatives or uh annual things that you should be doing, your lab work and this sort of thing. But as you get older is, you know, certain things that the doctor may or may not order, but that's a conversation you need to have with them. And um so yeah, ask them, you know, it would it be appropriate for me to do this. I heard it on a podcast, you know, would it be appropriate for me to have that? And if so, but they may want to do some lab work because you don't just go out and start taking medication and the the supplements are a form of medication because you could get in trouble with it.

SPEAKER_09 18:13

Right, exactly.

SPEAKER_07 18:14

And we have seen people in our office that have taken copious amounts of over-the-counter meds and it's either they've got expensive urine or they've messed themselves up. Gotcha, gotcha.

SPEAKER_03 18:25

So your doctor, your PA, your nurse practitioner, all good sources.

SPEAKER_09 18:30

Exactly.

SPEAKER_03 18:31

Because they know what other medicines you're on, what else is wrong with you.

SPEAKER_09 18:36

Right. And another thing that we talked about is making sure that you're getting all your medications at one pharmacy. Yeah. So if you're ordering them online and then you're going to another pharmacy, make sure that the pharmacies um that you're going to, maybe taking all your medications into the pharmacy you're doing a pickup to make sure that they know everything that you're on. So the interaction. I know you talked about that before. Absolutely. Yeah. So that's really great information. I don't think people always think about that because they're they're they don't realize not everyone's talking to each other or there might be interaction. So that's always good information.

SPEAKER_07 19:13

And one thing um that and I've learned this from Dr. Tri uh Dr. Pam is that uh sodas, the carbonation in sodas leaches the um calcium out of your bones. Yeah, the phosphorus. The phosphorus, yeah, out of your bones.

SPEAKER_03 19:28

Yeah, so people who have a six-pack of sodas a day, and there are people out there doing that, they have uh greatly increased risk of hip fracture.

SPEAKER_09 19:39

Oh my gracious. So that's good to know, like way ahead of your senior years. Absolutely. Yeah, for sure. And I know that the 80s babies who are entering that, you know, getting ready to get those AARP cards were raised on a lot of soda. Oh yeah. So they're they're going to be more prime for that, most likely, I would imagine.

SPEAKER_07 20:06

That that carbonation and yeah, absolutely.

SPEAKER_09 20:09

Yeah. So because I remember those. Um interesting. So we s we said we were gonna talk about everything. So let's talk a little bit about probably one of the most vital, well, I would say the vital organ. You need a heart. Um, so let's talk a little bit about the changes that happen in the heart as you age.

SPEAKER_03 20:33

Well, your heart is a muscle. Okay. And you know that muscle under your upper arm that's kind of a little bigger now than it was because it's kind of hanging down just a tiny bit. Same with your heart. It's a little bigger, maybe not as strong as it used to be. Okay. So it's common. Is it something you can do something about?

SPEAKER_06 20:58

Mm-hmm.

SPEAKER_03 20:59

Yes, you can, because we just said the heart's a muscle.

SPEAKER_06 21:01

Right.

SPEAKER_03 21:02

So again, exercise. Keep that heart moving, keep it pumping. But don't put extra strain on it. For every extra five pounds that you're carrying around, that's an extra mile of blood vessels that your heart has to pump through. So you're making your heart work harder. So we're right back to diet and exercise is the key to health. Wow.

SPEAKER_07 21:27

Yeah, exactly. And a healthy diet. You know, there's a lot of diets out there that aren't healthy. You know, I but i uh there's uh heart healthy diets, American Heart Association. But you know, know your numbers, cholesterol, try to triglycerides, know your numbers and find a uh a good healthy diet to to uh support what your body needs.

SPEAKER_09 21:54

Right. So basically, when you say diet, you don't mean like go on a diet, you mean a well balanced daily diet. Diet lifestyle diet.

SPEAKER_07 22:01

Well it could be both. Okay. Or either. It could be either.

SPEAKER_09 22:04

If you've got a if you've got a if you're over the recommended weight. Okay.

SPEAKER_07 22:09

There there's folks out there that could lose a few pounds. Absolutely. Absolutely.

SPEAKER_03 22:15

To take that workload off the heart. Off the heart. The heart's a muscle, but it also has an electrical system. And you know, you've heard of older people they need a pacemaker, and a pacemaker is a light switch because as we get older that electrical system can kind of you know those old uh toasters with the cloth uh outlet or plug in.

SPEAKER_07 22:37

Plug-in.

SPEAKER_03 22:38

Yeah, the cord. Yeah. The cloth cord. And they kind of unravel a little bit. Think of that. That that electrical system gets little calcium deposits. So older people might be more prone to an irregular heartbeat. I absolutely love the little watches that can do the EKGs because that might tell you, hey, my heart is skipping a beat here. Uh it's a little irregular. And that way you could get it checked early and either get on the right medicine or make some changes that might help that.

SPEAKER_07 23:09

And part of the uh your preventative physical, Medicare physical is for to look at what your heart is doing. The EKG.

SPEAKER_09 23:20

Okay, so every year you are eligible through Medicare to get an EKG? In the doctor's office. In the doctor's office. Oh, that's very good to know.

SPEAKER_07 23:29

I can look at the rhythm of your heart.

SPEAKER_09 23:31

Okay, very good. And does that provide a really good baseline for how healthy it is in order to know if there's medications you need to go on or how at risk you are for a potential heart attack or anything of that nature?

SPEAKER_03 23:46

Is that what that well and EKG is looking at the rhythm of your heart, and sometimes by looking at it we can tell, okay, the heart looks a little bit enlarged. The next step is what's called an echocardiogram, an ultrasound of the heart. Very easy, just like you do an ultrasound on a pregnant woman. You do it on the chest, and you can see the strength of the heart, the valves in the heart that open and close. It's absolutely fascinating. And then you can do, of course, stress tests and the cardiac catheterizations to get a really good look at the arteries that feed the muscles of the heart.

SPEAKER_09 24:25

Oh wow. Okay. So that would just be the first step.

SPEAKER_03 24:27

Step one.

SPEAKER_09 24:28

Step one to knowing if you need the additional steps or not. Exactly. Okay, once a year. It's like just on your regular checkup. So if you do some of the dieting and the exercise based on the recommendations of your physician and you're successful, does that heal the heart? Does it, you know, strengthen that muscle, or does it just stop the deterioration of the muscle?

SPEAKER_03 24:49

You know, I can't even say yes to any of those because time marches on. We're gonna have those changes. And one person gets to be a hundred smoking and drinking, and they have a great heart, and then the next person does everything absolutely right, but because of genetics, whatever, their heart just isn't as good.

SPEAKER_09 25:11

Okay. So it's just preventative, doing the best that you can do can do to continue to maintain as healthy as healthy lifestyle, healthy heart as possible.

SPEAKER_03 25:20

Well put.

SPEAKER_09 25:20

Yeah, exactly. Okay, there you go. Very, very end of story. End of story. So on some of the heart healthy side is is like working out like lift lift lifting weights, or are you more recommending or would you recommend uh more a cardio? Like that's why they call it cardio.

SPEAKER_03 25:39

Okay.

SPEAKER_09 25:40

That's what I was getting at. So like maybe walking, like just take you know, taking your dog for a walk or just walking around the neighborhood, anything like that would probably be a really good exercise versus just like you know, you're not recommending like weight lifting, anything like that.

SPEAKER_03 25:54

But I am for something else.

SPEAKER_09 25:56

Okay.

SPEAKER_03 25:57

So we we do our uh walking or our belly dancing, of course, which is also another big favorite exercise of ours. But why would we lift weights? Because along with that fat going up one percent per year, we lose one percent of our muscle mass per year every year after age 40. So again, you could lose uh 30% of your muscle mass as you get older. That's why uh when older people fall, half of them can't get up off the floor because they've lost the muscle mass in the upper body. So you do the weight lifting, and I really recommend you get somebody who knows what they're doing to make sure you don't injure yourself, but you're building up that upper body, and of course there's back and lower body. What does it do? Well, it's burning calories and it's building the muscle so that if you do fall, you're a little stronger, you can get yourself up. If you have it more muscle mass, maybe you'll protect those bones from breaking because they're more supported. And if you're a caregiver, you can provide better care.

SPEAKER_07 27:05

You're not gonna injure yourself caring for the your loved one if they if they need assistance getting from say from the chair into the bed or out of the bed into a chair, or assistance in the shower or anything like that. You have the body strength that you can help them without hurting yourself. So it's very, very important to build those muscles, keep them lean and strong, and y not only are you taking care of yourself, but you're gonna be a better caregiver to care for someone else.

SPEAKER_09 27:34

Yeah, absolutely. Yeah, and even some of these exercises can be done sitting with just simple like um what do you call them? Dum dumbbells, dumbbells, dumbbells, just simple dumbbells, really lightweight, just to keep, you know, you don't have to be a bodybuilder, but just keep them strong so that you have that muscle mass that you need to maintain.

SPEAKER_07 27:56

We recommend, you know, there's a lot of good shows on TV, you know, the sit and fit, even the yoga, and just you know, 30 minutes. Thirty minutes. You know, even I'll tell my caregivers, get up if you're sitting and watching TV, get up and do something during the commercials. Some type of exercise during the commercials because you'll find that eventually you'll turn that TV off. Because it it just it gets the blood flowing. You're gonna feel better. And um but just just do something.

SPEAKER_03 28:25

Right. And and that's a great start, 'cause we'll tell people because nobody has time to exercise. Right. So, okay, can you give me a minute a day? Well, I guess I can give you a minute a day. Okay, now three days later can give me two minutes. How about five minutes? And the next thing you know, you're exercising the twenty or thirty minutes three times a week that they recommend you get.

SPEAKER_09 28:45

I really like the commercial idea. Because er especially for people that are stationary watching a lot of television in the commercials, let's be real. Who really cares about the commercials? I won't say that in front of sponsors. But you know, I mean, at the end of the day, and you can exercise and keep the commercial on. It's just background noise for the most part, anyway. Uh, and you can get that in and then you can take that break. And that can really be if you're getting up and doing an exercise every commercial break, that's really actually pretty good. You're getting quite a bit of exercise in, and you're right. I will bet you money. You start doing that, you're gonna forget about that television program that pops back on because you're gonna start getting more and more into what you're doing because you're gonna feel really good once you get that adrenaline going.

SPEAKER_07 29:30

I have one caregiver in my group. She only puts one thing away at a time. Instead of carrying a stack of like the towels, the washcloths, and the hand towels, she'll carry just the washcloths and put them away, and then she goes back and gets the other. So she's making multiple trips, but she's doing it intentionally. So that she's she's caring for her loved one, but she's walking a lot inside the home because she can't get out and do a lot of other things. But she's purposefully doing things in the house because she can. Right. Uh while she's cooking, she's using cans of soup and doing the exercises there. And it's comical because we've laughed at her, but she's demonstrated in in the group how she's doing this. So she's making the best of what would seem like a bad situation, but she's actually shown us what she's doing. She's doing um, you know, leg lifts while the microwave's going, you know, other things like that. Um when she goes out to the mailbox, she does three trips out to the mailbox and to the driveway and back. And uh so you can make do your own little exercise routine, and you'll find that it you can build off of it. Exactly. But there's a well, there's a way. But always get clearance from your doctor before you start any exercise program.

SPEAKER_09 30:45

Yes, always want to preface that. Absolutely. Yes. Well, ladies, we are at the bottom of the hour. We're gonna take a quick break, and then we're gonna be right back. Okay.

SPEAKER_02 31:15

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SPEAKER_09 33:33

Thank you for joining us again on the Senior Living Guide.com podcast, sponsored by Parish Medical Center and Healthcare. We have Dr. Payam Trinetti and Janet in the house. Again, thank you, ladies. So we've been talking about our topic is basically everything is going to change and you gotta change with it. And um so we've been talking a little bit about all kinds of different things on your body, all the way from skin to heart. Um let's talk a little bit about uh we just finished talking about the heart. So another vital organ clearly are your lungs. So what are some changes that happen as you ate with your lungs?

SPEAKER_03 34:19

Well, you know, when before I went to medical school, I thought the lungs were like balloons, you know, you filled them up. They're sponges. Oh. And as we get older, everything does what? It dries out. So is that the word of the day?

SPEAKER_09 34:36

It is the word of the day.

SPEAKER_03 34:37

It dries out. So the lung tissue actually kind of dries out, and you have the same kind of changes as somebody with emphysema. And so you don't have that reserve. You don't maybe have that ability to cough deeply, plus with your loss of muscle mass in your chest wall. So you uh might get something in your throat and you can't quite cough it up the way you once did. The other thing we talk about, what did the lungs do? They absorb oxygen. Well, did you ever find that sponge underneath the sink and it's really hard and crackly? You can't wipe anything up with it. So if your lungs are the tissue is a little crackly, it doesn't absorb the oxygen and then transfer it into the blood the way it did.

SPEAKER_09 35:26

This is really awesome information because it's not some you always think of the lung like a balloon. And you don't realize that any of what you just said, because I I honestly never knew any of that. So it never makes any sense that your lung would age really any differently than anyone else's. Um, but that is definitely not something I've ever thought about as to why it definitely decreases in strength as you age and ability to I I guess has infection issues and things like that.

SPEAKER_03 36:01

It it does. And just, you know, why can't I run as fast? I used to be a marathon runner, why can't I do that? I seem to be getting a little more short of breath. Now here's where we walk between, hey, if you're getting short of breath, you don't just say, Oh, well, it's because I'm older. It's you go figure out if something is wrong. And the other jumping off point for me is I'll read somebody's chest x ray and say, Oh, I see you have some changes for CO that look like COPD, chronic obstructive pulmonary disease, emphysema, and they go, I have what now? Well, this chest x-ray was done two years ago. We tell everybody as our seniors, if you get a test, you get a copy of the test. Uh and you look at it, and you have somebody, if you don't know what it means, have somebody explain it to you and keep a little file folder of this was my CAT scan from two years ago, this was my echocardiogram from last year. So you understand and have control about what's going on with your body. If you get a blood test, the answer is not it's fine. Fine is not a blood test answer. So we want to empower people to get copies, know what's going on.

SPEAKER_09 37:10

So uh you mentioned COPD. Is that something that just smokers would typically get?

SPEAKER_03 37:17

It's something that smokers get, but it's the same changes we see in people in their late 70s, eighties, and nineties. Most of the checks chest x-rays look like a COPD patient.

SPEAKER_09 37:30

Okay, but but they're not. No, they're not. It's just an aging.

SPEAKER_03 37:34

Right. And the people are shocked because they say, but I was never a smoker. You don't have to be. It's the aging changes.

SPEAKER_09 37:39

Oh bless their hearts when they hear that they they maybe think they were like exposed to something, right? Yeah, I can see where that completely is. Or they may have been exposed to something. Right. So is there a way to t is that treatable? Is that something you treat, or is that just something that it is kind of what it is?

SPEAKER_03 37:56

It's a little of both. Okay. Because maybe you need an inhaler, maybe uh you need to take some weight off to help those lungs not have to work so hard. Uh or maybe it's just, okay, I've got to modify, I've got to cope and compensate. So instead of being a runner, maybe I have to be a walker.

SPEAKER_09 38:15

Okay. So we go back to diet again. So a little bit of diet in in there is a heavier person that has COPD taking a little bit of that weight makes the lungs work less harder. Exactly. That's what you're saying. Okay. That makes sense as well. Every would the body weight always makes the body work harder on probably most organs, correct?

SPEAKER_03 38:37

Well, here's another fun fact, and that's that with every step you take, it's three times your body weight per square inch on your knee joints. So if you weigh a hundred pounds, it's three hundred pounds per square inch on your knees with every step you take. If you weigh three hundred pounds, then it's nine hundred pounds per square inch. So that's why when people say, gee, I have some arthritis in my knees, my knees hurt, again, take that workload off the knees.

SPEAKER_09 39:07

World of difference, right?

SPEAKER_03 39:08

Mm-hmm.

SPEAKER_09 39:08

Yeah, very, very interesting. So we talked a little bit about the lungs, and we're gonna talk more about what you actually specialize in, um, the brain, and a little bit about memory and dementia, which is something that really does plague our senior, um, our seniors in general. Um, I know it's something that I know they're very fearful as people age that that's something that they may um get, especially if it's something that maybe ran in their families, because it it can be um inherited from what I understand. Um I think maybe more on the Alzheimer's side, and I could be missp misspoke misspeaking on that. But so tell us a little bit about the brain and how it ages and how it can um affect seniors.

SPEAKER_03 39:59

Well, maybe my friend, um um, what's your name?

SPEAKER_07 40:03

Uh uh uh Janet.

SPEAKER_03 40:04

Yeah, exactly. Just like all the other things we talked about, that there are normal changes with age, and then there is disease that affects. As you get older, you get better and better at forgetting. Uh, one of my patients said, My rememberer isn't working anymore. So, yes, normal changes of aging is you forget words. You forget your friend's name. Um, we tell a story about a lady went to her pastor, they were talking, and he's like, you know, at your age you should think about the hereafter. And she said, Oh, I do all the time. I go in the garage, I go in the pantry, and I say, What am I hereafter?

SPEAKER_07 40:47

That is hilarious. That's funny. So, but that's normal to walk into a room and say, Now, what did I come in here for? And then you walk out and it clicks, and you think, okay, but to know that you walked in there for something and you had a purpose, that is normal to make a meal and you sit there and go, Okay, there's something missing. Oh yeah.

SPEAKER_03 41:16

Left the biscuits in the oven.

SPEAKER_07 41:18

I left the biscuits in the oven or the coleslaws in the fridge, that's normal. But to forget that you even had coleslaw or that family's even coming over to eat, that's not normal. Right. You deserve an evaluation, and that's what we do in our office. You know, one in three people over the age of eighty will have some type of some form of memory issues. You mentioned Alzheimer's, that's one type of dementia. Dementia is not a diagnosis, it's a condition. So Alzheimer's is like a ball rolling down a hill. It goes kind of slow. It can be up to 20, 25 years. And there there's there's a whole bunch of different types of dementia.

SPEAKER_03 42:03

About 50.

SPEAKER_07 42:04

Yeah. And so what we do in our office, Dr. Trinetti is a geriatrician. She specializes in um determining, diagnosing memory issues. She's board certified and just she's phenomenal. I'll say that. I love her. Um but and so but you need you deserve an evaluation. If you've got memory, uh memory loss, you deserve it. I as a social worker and a certified dementia practitioner, I'm there for the family to provide education, support, and resources because they don't know. They don't know, their their heart's broken. Or they're frustrated and their heart's broken. But to find out what support they can give, because nine times out of ten or ninety-nine percent of the time, the person that has the memory loss is not doing it on purpose. Right. They're not doing it because they want attention. They're doing it because they can't help it.

SPEAKER_09 43:01

So the earlier diagnosis is the best, because I know that that is definitely from my personal experience and experience I've learned over some period of time. People try or people avoid or acknowledging that it's happening. So instead of jumping in and getting it diagnosed quickly, they'll try to not they don't want to acknowledge that it's happening, so they don't get it diagnosed early. So d you definitely recommend or do you recommend getting an early diagnosis and treatment as early as possible if you think it's a it's a possibility.

SPEAKER_03 43:39

Yes, because we'd rather tell people, you know what, we're not seeing any signs, you know, this is normal aging. And yeah, back when I started doing this 30 years ago, people didn't bring their loved one to me until they got to the point where they they couldn't fix a meal, they couldn't get dressed. Now folks are coming in saying, you know what, my husband was a an engineer at NASA and now he's struggling to use the computer. Things are difficult for him that shouldn't be. And we make the diagnosis early because there are things that can make it look like dementia that aren't. We often tell about people who've actually come to our office being told they had dementia and you know what they had? Their ears were full of wax. And they weren't hearing what was being said. So that's why they didn't know they were going to lunch the next day. There are people who have sleep apnea and so they're foggy. They're not thinking clearly. So you treat the sleep apnea, you get the ears cleaned out or you change the medication that they've been on that's now causing a side effect. And guess what? It's it's back to that normal aging. You know, the brain changes just like everything else we've talked about. There's shrinkage of the brain uh loss of brain tissue hardening of the arteries so there's less oxygen and nutrition going to the brain. The electrical system just like in the heart there's an electrical system in the brain so the uh little messages from one brain cell to the other aren't quite as fast as maybe they used to be. If you do intelligence tests on older people versus younger people, if you time them, the older people don't do as well.

SPEAKER_05 45:26

Right.

SPEAKER_03 45:26

If you take the time limits off and give them all the time they want it's about equal. Sometimes Janet and I we talk about the filing cabinet. That it when you're 20 and you get your first filing cabinet what's in it? There's like three or four files you know your your school grades and your car loan by the time you're our age it's a it's packed.

SPEAKER_07 45:49

Yeah right and and you know we've got a little cartoon thing to where it's a filing cabinet we do with one of the presentations we do the file the cabinet drawer is not even closed. It's just paper sticking out of it. So you think you know you ask somebody a question that's a senior and they're going now wait a minute I know that answer but to go back through all those files and to pull it out it's like they can't pull it out. Right. So to to be able to do that, you know, uh yeah well you know I don't know. Right. Like Dr. Pound was doing trying to remember my name.

SPEAKER_03 46:26

I really do it Jenny do it.

SPEAKER_07 46:28

But I'll just you know but it's like okay I I I know that um you know but also with our patients or with some seniors that may have the dementia they can tell you in detail about what happened when they were in high school, when they played football when they did whatever they made raising their kids but they can't tell you what they had for dinner last night. They can't tell you um what they had for breakfast. But you get into talking about their military service something that happened years ago that's deep in the brain those those memories are deep seated and um so you know the brain may be shrieking and gaps in the memory but those deep seated memories are there.

SPEAKER_09 47:17

Does i does anxiety and depression ever play a role into progressing Alzheimer's or dementia at all? Is that something that or can anxiety and depression mimic a dementia?

SPEAKER_03 47:34

Both. Oh wow somebody can have depression and gee they're not eating right they're not bathing they're not paying their bills because they're just too depressed and not motivated. Vascular dementia little tiny mini strokes in the brain are is really associated with depression quite a bit. So you can have them go along together.

SPEAKER_07 47:56

And they can have behavior problems to where that they're so frustrated they can't remember something. Right. And so they will strike out and they'll strike out a lot of times at the people they love, the people that are there. And it's not because they're angry at them they're angry and frustrated because they can't remember. No what is that? Don't bring me that right you know right exactly.

SPEAKER_09 48:18

Interesting. So it really is a proper diagnosis. So how so with the different types of dementia you said there's fifty um how is that difficult to diagnose and treat those different types of dementia or are they all treated basically the same as just understanding how they all work as far as being able to work with that patient to meet their specific needs?

SPEAKER_03 48:45

Well we say if you know one dementia patient you know one dementia patient. Everybody is such a unique individual so uh the workup is a history a physical exam look at the medications look at the medical problems blood work brain imaging like an MRI you know sometimes a a test for sleep apnea you make your exact diagnosis and then uh there are specific uh treatments for specific types of dementia but we generally will use the memory medicines that we have for all of them. You know some some some of these are so rare and unusual that we will send people to the Mayo clinic or another tertiary care unit because they'll do spinal taps. They'll do really precise imaging studies of the area of the brain and they can tell us exactly what's wrong.

SPEAKER_07 49:42

And it's very important for also with us we get a good history from the family. You know did uh the their education level what what you know the the the reporting from the family often refer to it as puzzle pieces. You know we do a memory test but that's one puzzle piece. And we just kind of put the puzzle pieces together and that's how Dr. Pound gets the diagnosis. Sometimes it may be ruling something else out in some of the testing but to kind of put it all together and um and and it's when it's when it's there it's it's a relief for the family. You know it it's difficult when you know when she has to go in and tell them that but you also see a relief because it's like oh well I I knew something was wrong. I knew it and you know and and also the answer. And also for the patient you know I knew something was wrong. I know I know now.

SPEAKER_09 50:48

Yeah. So I definitely want to dig in on the dementia on a whole podcast at some point. But so let's move on a little bit um so we're talking about because we were going to do a whole podcast on um from you know the outer to the inner um so we want to talk a little bit more about seeing hearing smelling and tasting so that's quite a gamut. That is yeah so tell me a little bit about how all those are affected as you're aging and I definitely want to talk a little bit about the hearing part because hearing can definitely be a pistol with seniors. I want to I almost want to say and I maybe just like spitballing but I feel like men are a little bit more difficult with the hearing side as far as acknowledging that maybe they have issues am I right?

SPEAKER_03 51:36

It is but it it's and it's a little of both because as we get older our voice changes too and especially women the vocal cords change so maybe our voice is more like this and our husbands can't hear us as opposed to this. So yes what always uh kind of puts me over the edge is nobody would say you know what I really don't want to wear glasses. I'm just gonna walk around and not see but I hear so many times I I don't need a hearing aid I don't want to wear a hearing aid what what you don't realize is that if you don't have that stimulus going into those ears the whole area of the brain that processes sound starts shriveling because it's not getting any input. So it is crucial if you have hearing loss wear your hearing aids get tested find something you can afford and realize that you're worth it. Exactly so okay I'm gonna spend a thousand dollars but I'm gonna live ten years. So is it worth a hundred dollars a year for me to be able to hear?

SPEAKER_09 52:41

And there's a lot of affordable hearing solutions out there. There are now yes there are so many even getting diagnosed and then ordering by mail I know that there's so many different things that you can do if you feel like it's something that is is a cost issue. So it's just finding some of those answers and exploring them I think you can really but yeah so um so your does your ta your taste and your smell does that change?

SPEAKER_03 53:06

Yes.

SPEAKER_09 53:07

Yeah it takes for the better or for the worst?

SPEAKER_03 53:10

So far so far uh what have I been telling you? If it's been better or worse. I don't know does it help with the diet side No it it it usually takes uh about three times the amount of salt as in a younger person to even identify it as salt. So a lot of people will say my this food doesn't taste like anything and I'm supposed to be on this low salt, low fat diet and I don't even want to eat because it doesn't taste very good. So it's worse. Yeah it makes it tougher and fruit flavors it might take seven or eight times the concentration of fruit flavors to even identify the taste. So wow um so a lot of times again this is for a patient that I know and I know their whole dietary history and I might say you know what go ahead and put salt on homemade food. Because that'll make the egg taste better or uh it'll just make you eat a healthier diet if you enjoy the flavor.

SPEAKER_09 54:09

Right. Now is there a salt substitute that you can utilize that works yeah Mrs.

SPEAKER_03 54:15

Dash is one brand there's all kinds of spices out there that you know give the foods a little different flavor and intensify the taste.

SPEAKER_09 54:24

Yeah that's a good idea to do some Mrs. Dash and and kind of work with that. So we'll talk a little bit our next subject I think would be good would be the GI tract this is obviously very important and something that maybe some people aren't super comfortable talking about but it is really really important. So tell us a little bit about how that changes and how important it is to um have your physician talk have that conversation with your physician well let's start right in the mouth yeah we've seen people who have problems actually swallowing that all the muscles in the back of the throat have to coordinate to get the food down.

SPEAKER_03 55:05

We just take it for granted and then we think that the esophagus the tube between the mouth and the stomach is like an empty elevator shaft but it's not it's all muscle.

SPEAKER_09 55:15

Okay.

SPEAKER_03 55:15

So it's literally squeezing the bolus as we call it of food down into your stomach.

SPEAKER_07 55:22

And let's And what you were talking about earlier as far as everything drying out the mouth is drying out too and you know we drink a lot of water. I've heard so many seniors say I don't like the way it tastes well you know to me water doesn't have a taste and but to get a senior to drink water sometimes is as bad as pulling teeth because they do not want to drink water.

SPEAKER_09 55:47

So do when they come to you and talk to you about some of these things is this something you have to kind of talk to them about or is this something that they're willing to talk to you about because they really are having a problem that they acknowledge or are you asking this when they're coming in for an evaluation?

SPEAKER_03 56:06

A a little of both because we talk about are you having any problems with your stomach? Are you having refluxes food getting stuck? And other times folks come in and say hey I've got this new problem my stomach hurts and uh you know of of all the age groups older people are the ones who are having more ulcers bleeding ulcers. Wow because the lining of the stomach thins. You know did you you ever do a science class project where you put a nail in a beaker and then you poured a cola product over it and it kind of dissolved it how come it doesn't dissolve a hole in your stomach because you have this lining that's always replenishing itself as you get older it doesn't do that as efficiently plus all of the anti-inflammatory all the arthritis pills motrin and a leave I hate to use the brand name but ibuprofen and neproxin all those things if you just take them they could be chewing a hole in your stomach and causing an ulcer and you're not feeling it because you're not feeling that pain.

SPEAKER_09 57:12

Interesting now does diet if you've been someone that ate a lot of spicy food or drank a lot of coffee anything like that does that contribute to that as well or no?

SPEAKER_03 57:23

Not not so much. Those contribute to a lot of acid reflux going up into the esophagus.

SPEAKER_09 57:29

Okay.

SPEAKER_03 57:30

So you definitely would want to cut that out if you have if you have symptoms that'll be part what that would be part of your treatment plan.

SPEAKER_09 57:36

Okay. All right I'm sure there's probably a whole list of foods that cause the acid reflux discomfort. Discomfort yes I'm sure um so let's talk a little bit about um something that I definitely know happens in seniors quite a bit and it's um constipation um and I know you're probably talking to them quite a bit about how to solve some of those issues so what causes that to be more frequent with seniors? Is it going back to the diet or is it something different?

SPEAKER_07 58:08

Well I think a little of both I mean you know things are drying out they're not eating a healthy diet uh lack of mobility you know just sitting around um due to a physical limitation or safety the safety concerns they're they're home um and n no appetite so they're just eating sweets eating a Danish eating a s a piece of toast one cup of coffee lack of fruit or whatever it may be and so the gut's not moving right and not enough fiber not enough fiber how how much does uh fiber does the American Cancer Society want you to eat a day?

SPEAKER_03 58:48

I have no idea. It's about 30 grams now how many grams of fiber in a tablespoon of like a metamucle product? I have no idea. About three. Okay. So you now not that you go out and drink we have 10 spoonfuls of metamucil that'll that'll cause something we call a bowel blockage. Don't want to do that. But it it tells you that you have to find this fiber in very many pla places. Cereals, prunes, fruits, vegetables. And you're right Janet that folks are eating tea and toast or or Danishes. And then water water fiber exercise.

SPEAKER_07 59:28

You know we've all I grew up hearing the the term or the phrase apple a day keeps a doctor away. Well you know you bite into an apple and you chew it up and this sort of thing. But you know seniors may have dentures may have you know the teeth they're not gonna bite into an apple. Mm-hmm if they do you know and so it's yeah it's lack of that pectin or that solvable fiber. Right. So their sets the the guts are going to it's gonna get constipated. Right. And if they load up on the metamucil that sort of thing then it's just gonna sit there. There's nothing to push it through. So it goes back to diet and exercise.

SPEAKER_09 1:00:04

Yeah it kind of does. Yeah. Theme of the day so going back to the um other issues that we have and I don't know if this is gonna hit the uh theme of the day of the diet and the exercise but the bladder control issues and it very well might. So this is definitely an issue with seniors and I know it's an issue that they probably don't like to talk about. I know that sometimes it's a very hard subject but one that clearly needs to be addressed. So what causes some of these bladder control issues um as as seniors grow older?

SPEAKER_03 1:00:38

Some of it is the musculature that it just doesn't hold things in as well as it used to some of it is actually some of the foods and and drinks that we take in. We don't realize that caffeine containing beverages and artificial sweeteners, sodas are all bladder irritants and they can cause the bladder to kind of spasm and you lose control. I think sometimes people have other reasons for lack of bladder control like if you have arthritis and you say gee I have to go to the bathroom but I can't get there in time then you you have a little bit of dribbling.

SPEAKER_09 1:01:23

Right. Yeah and and and people that are less mobile they may just not be able to get there because just the time frame is just yeah.

SPEAKER_07 1:01:35

And also dementia. You know someone that has dementia they think oh I need to go stand up what was I doing? And then you add the lack of control stand up the bladder lack of control. Oh what was I doing? Oh and then get distracted set back down and so it all kind of plays in there together. So yeah I we had a little demonstration in the office I was demonstrating to Dr. Trinetti earlier this week on uh just that exact same thing.

SPEAKER_03 1:02:10

Right and you know which she knew what I was doing but you know we we had to do a little game role playing along that but it happens you know and uh you know there's a lot of um pads uh adult garments and this sort of thing we never say the word diapers no right protective undergarments right or little pads and the other problem is the urinary tract infections that can cause irritation of the bladder and then the person loses control.

SPEAKER_09 1:02:41

Exactly um well that's good to know and and the protective undergarments they're making them so seamless oh gosh they you would never know that you're wearing them and there's nothing to be ashamed if you need to wear them. So I just you know I want seniors and elderly and caregivers to know that that's something that never discourage someone that needs to wear them to wear them.

SPEAKER_03 1:03:04

But the flip side of that is I've had people come in and say well doc I'm old and I'll say why are you old you weren't old three months ago what happened well I can't control my bladder so I'm wearing these undergarments. Well wait a minute maybe there's something wrong right maybe there's something we can fix. Let's find out what's causing the problem and then it's okay to wear the supportive garments if you need to but let's see if it's something we can help you with.

SPEAKER_09 1:03:33

Exactly so if tell somebody so if it's starting to happen check with your doctor see if there's something that's causing it before you just say I'm old and that's the end of it.

SPEAKER_03 1:03:42

Yeah exactly a urologist a urogynecologist we have marvelous medications and procedures that can help strengthen that bladder.

SPEAKER_09 1:03:53

Yeah that's good to know well thank you ladies we are at the end of this week's podcast um thank you everyone for joining us with SeniorLivingguide.com podcast sponsored by Parish Medical and Healthcare and we will see you next time