Parents Are Hard To Raise S02 E75 Show Transcript
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[00:00:37] Announcer: In the elderly, things like falls, confusion, agitation, loss of appetite or incompetence are often passed over as a normal part of ageing. But they could be the silent symptoms of a very serious medical condition which, left untreated, could be fatal.
[00:00:55] This week on Parents Are Hard To Raise Dr. Felice Gersh tells us how to spot and prevent this silent menace from taking hold.
[00:01:15] Welcome to Parents Are Hard To Raise, helping families grow old together without losing their minds. I am elder care expert Diane Berardi.
Diane: [00:01:25] You know, one of the most common concerns clinical gerontologists like myself face in our day to day practice is also one of the most furtive and often mis diagnosed medical issues facing our aging parents today. Because they often mask themselves as other things. Urinary tract infections can go unnoticed for long periods of time and can often result in serious problems including delirium, debilitating falls and even fatal blood infections. Which is why I wanted to bring in the best expert I know, to help us identify and prevent them from wreaking havoc on the lives and health of our parents. And at our age, they can also affect us as well.
[00:02:07] Longtime listeners will recognize my next guest, mostly because she’s among my favorite guests medical experts. Dr. Felice Gersh is a true pioneer in her field. A rare combination of an award winning physician double board certified both in OBGYN and integrative medicine, and a tireless champion of women’s health, focusing her knowledge and skills on those aspects of women’s health that are unique, underappreciated and poorly managed. She holds degrees from Princeton University, the University of Southern California School of Medicine and the University of Arizona School of Medicine. Dr. Gersh serves as medical director of the integrative medical group of Irvine California where she leads a team of skilled holistic practitioners. She writes and speaks internationally on integrative medicine and women’s health and is a favorite guest expert on numerous radio programs and web summits. You can also hear her weekly broadcast, a healthy perspective, on KRLA radio AM 870 in Los Angeles. Dr. Felice Gersch welcome to Parents Are Hard to Raise.
Dr Felice Gersh: [00:03:13] Well thank you I’m so pleased to be back.
Diane: [00:03:16] We’re so happy to have you back. And this is, urinary tract infections is such an important topic for us as children of aging parents to understand and also for ourselves as women or men as we age. And I hear constantly from children of aging parents, clients saying to me you know my mom she suddenly, you know she was confused or she was agitated. And my mind always goes to Geez UTI. I’m not a physician but I always say to people call your doctor, you know. Well my mom was just at the doctors. I’ll say, why don’t you just call your doctor and tell him what’s happening and he or she decide. They’re just so common in the elderly. Can you tell us why.
Dr Felice Gersh: [00:04:06] Sure. Well the way I look at aging it’s sort of an accumulation of deficiencies and the biggest deficiency in women of course develops as menopause ensues and then progresses and that’s the biggest deficiency of the master hormone which is estrogen. So estrogen has receptors in virtually every organ, every site in the body. And the reproductive organs and the urinary tract are no exceptions.
[00:04:35] So when women age and their estrogen of course declines the atrophy occurs and the virginal tissues are altered and along with that the bladder. And so that you can think of the vagina as the guardian of the bladder and it’s actually very interesting. We now know that there are microbiomes and we’ve touched on this and these are the incredible microbial civilizations that live virtually on every surface in our body. And we were taught when we were in medical school when I was way back in medical school I was taught that the bladder was a sterile environment and that is so untrue. We now know that there are microbes living in everybody’s bladders and we need to have a healthy microbial environment. And the microbial environments of the vagina and the bladder are intimately linked and as the estrogen levels go down the microbial environment because the whole environment of the vagina changes and then of the bladder as well. And it becomes very very receptive to hostile bacteria growing, leading to these sort of stealth infections, these urinary tract infections that can really creep up in and cause havoc in women as they age.
Diane: [00:05:52] Boy we women. [laughing].
Dr Felice Gersh: [00:05:59] I know. Poor us…[laughing].
Diane: [00:06:00] Now Do men, as they age also are they you know inclined to have urinary tract infections as well?
Dr Felice Gersh: [00:06:07] So it’s a very different mechanism in men. In women, it’s all this atrophy that changes the microbial environment. In men, it’s about obstruction with their prostate. And that’s where the problem ensues.
[00:06:22] And that’s an inflammatory process that a lot of people don’t realize that prostate enlarging in men is not a natural phenomenon. It’s actually an inflammatory phenomenon that occurs when estrogen levels are actually up in the prostate, and we think well what’s going on there? Is that when you have inflammation in any organs, many many organs in the body make estrogen. It’s so important for modulating the immune system and for reducing inflammation. And so in the prostate, as men age, things become inflamed. The same thing in women and then the prostate becomes enlarged and estrogen actually is increased in production in the prostate. And a lot of data is showing that the prostate as it inflames like any inflammatory state it leads to DNA breakage. And when you have DNA breakage then you can have cancer and that can lead to of course prostate cancer, which is the most common cancer of males. And then the estrogen is which is actually produced in the prostate, the prostate is like the analogous organ to the uterus and the uterus can make estrogen on its own as well. And that’s one of the things that can be involved in women getting uterine cancer but in males, the prostate can get enlarged, it gets inflamed. And of course it can lead to prostate cancer but it can just lead to what they called benign prosthetic hypertrophy. But all of this process going on can cause blockage and hard difficulty in urination for men. And then you get this blockage and if the bladder doesn’t completely empty it becomes sort of a medium for growing bacteria and that’s how men can get , which can be fatal in them.
[00:08:09] It’s a terrible thing. So men have a lot of problems with urinary tract issues and infections are less common in males than in females but when it happens it can be very devastating and even fatal. So it’s really important to keep inflammation down. And in and in males of course, that that means having adequate levels of testosterone which is a whole neglected area. Because testosterone does decline with age, but so does a lot of other things that happen with age but we address them. But you know testosterone helps maintain healthy organs in males. And without that you get all these other problems. But of course it has to do with getting adequate nutrients of course. In a lot of elderly people, I’m sure you talk about it all the time, their diets are not adequate, in terms of getting enough vegetables and enough protein and getting exercise and sunlight. So these things happen. And it’s part of aging. But these are very modifiable parts of aging, they’re not inevitable parts of aging.
Diane: [00:09:15] Now you can have no symptoms and then have a bladder UTI. So what do we do? How do we know? You know, my mind always goes to well, you know, sudden change in behavior. Is that what we should look for in our parents?
[00:09:37] Well that certainly should be one of the things to think about. So because the vagina in the female has an altered microbiome it’s an altered environment because of lack of estrogen. Then the bladder’s environment changes and many many women have high growth of bacteria that are normally not found in the bladder. They’re normally found in the stool, right? Like e coli and klebsiella. So the bacteria from the rectum get they come up and colonize the vagina into the bladder. And so something like over 70 percent of women as they age, once you get to around 70 and older, it’s very high it’s the vast majority of women, become colonized. What that means is that these bacteria from the colon they become the permanent inhabitants of the vagina and the bladder. And in many women it sort of becomes an equilibrium like the body’s immune system sort of handles it. So it’s sort of like a subclinical but chronic infection. And if you get a urine culture on a lot of women who are over 70 you will find that they do have higher than would be normal amounts of these colon rectal bacteria growing in there in their urine. So it’s a very delicate balance when it can actually was over the line and go from what they called these asymptomatic bacteriuria to a true full-blown infection.
Diane: [00:11:13] Well we’re going to come back and talk to Dr. Felice Gersh. But if you’re are a woman. I want to tell you something. If you’re a woman or there’s a woman in your life I’m going to tell you about something that you absolutely need to know.
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Announcer: [00:13:30] You’re listening to Parents Are Hard To Raise. Now, Thanks to you, The number one elder care talk show on planet earth. Listen to this and other episodes using the iHeart Radio app. iPhone users can also subscribe on Apple Podcasts and Android users on Google Podcasts.
Diane: [00:13:46] I’m so happy you’re listening. And it just really touches my heart that people are listening to our show. And if you are listening to the show on our iHeart Radio app or through our podcast, I’d ask you if you would please show one other person how to listen. Some of us are technologically not… Like myself… Not enabled, I guess is the word, so…. But if you have figured it out, how to do it, if you would please show someone else, that would be really wonderful. Because there’s so many people who can be helped by all these guest experts that we’re having, like Dr. Felice Gersh. And we are talking with her about urinary tract infections. So, Dr. Gersh, if there is someone’s mom who keeps developing these reoccurring infections, what can be done? What can they do?
Dr Felice Gersh: [00:14:49] Yes. Of course if possible, you should be, and this is good for all the children of the parents, to be for the women to be proactive and whether or not they’re using systemic estrogen. They should be using that vaginal estrogen to help maintain the environment of that area to keep it protected and strong and healthy. But even in later years, you can still use some of these products like Estadiol or compounded estriol or one of my favorites is vaginal DHEA which is actually an adrenal hormone it’s an androgen, but locally in the vagina, remember I mentioned that lot of organs can make their own estrogen, it can actually convert in the cells, it can convert DHEA into estrogen in the cells of the vagina and the bladder to help create that healthier barrier and recreate the normal microbiome.
[00:15:47] So I would definitely prevention. I would definitely speak to your doctor about having the women who are postmenopausal. Really I think all women postmenopausal on this is actually fortunately getting a lot more attention by the medical organizations like the North American Menopause Society and the American College of OBGYN, and they’re actually now endorsing. And they’re really looking at this more closely. It’s really become a hot topic. And so using prophylactic hormones in the vagina to help the bladder and the vagina stay healthier is really a good move. Once a woman has a bladder infection you really have no choice but, especially in the elderly, so in a younger woman you can actually watch it for a few days and treat symptomatically and give a lot of fluids and hopefully the natural immune system will help to fight it off. But you can’t really expect that to happen in an older woman. You know you really have to use antibiotics which we’re trying to avoid. But sometimes they can be life saving, right, because the urosepsis, and you mentioned this in your introduction, where the bacteria can actually leak into the blood stream and create sepsis. And of course that can be that’s what actually is triggering the cognitive changes that you notice when the older women that it’s related to the urinary tract that’s actual bacteria and inflammation that ensues in the brain, from this inflammatory process. So we definitely want to avoid that. And so we have to use antibiotics once you have a full blown infection.
[00:17:26] So we have to be very very active in terms of getting on top of that and then we have to look at, of course, what is growing, because there’s so much resistance now to different types of bacteria that’s really becoming hard to know what to treat with. But we have to be careful because a lot of the antibiotics now have gotten a bad rap because we know that that they can interfere with collagen like the like Levaquin and Cipro which have always been used very readily. They can create havoc with cardiac arrhythmias and they can cause tendons and ligaments actually stretch and break. And so you have to use them very cautiously.
[00:18:06] So I try to use Macrodantin, nitrofurantoin as my number one for a local, that’s not for if you get a kidney infection, that’s for a bladder infection. And that is one of the safer antibiotics for elderly for the elderly to use.
Diane: [00:18:25] Now, if your mom is like in her 80s… It’s not too late to start those vaginal hormones?
Dr Felice Gersh: [00:18:35] No no no. It’s never too late.
Diane: [00:18:39] Okay.
Dr Felice Gersh: [00:18:39] We now know that estrogen receptors. Unfortunately as time goes by, if they don’t get used it’s kind of use it or lose it so the receptors will somewhat shrivel and not be as effective as time goes by. But they never completely die and they can be rejuvenated quite a bit. So it’s actually never too late.
[00:18:59] And we now know that if you are pro active, you might help to prevent one of the other causes of urinary tract infection which are cystoceles. That’s like the bladder prolapsing. And I’m sure lots of people have heard about that.
[00:19:13] So what happens when the tissues become so weak and the connective tissue really starts to almost like shred and the tissues are so fragile they can’t hold. It’s like a really a hernia. So the bladder can actually herniate and pooch down into the vagina. And what happens is when they empty their bladder they don’t fully empty. So just like in the male I mention the prostate acts as an obstruction and then the urine doesn’t fully empty and it acts as a medium to grow bacteria when it just sits there.
[00:19:44] The same thing can happen in women when they empty their bladders, because of this like big Poochie thing of bladder coming down. They don’t fully empty it and they have a reservoir of urine that stays in the bladder and then acts as a medium growth medium for bacteria, and then could make things that much worse. So being pro-active, the younger the better, to start on veginal hormones.
[00:20:09] Absolutely. And then you know these are big problems because you don’t want to have to go to surgery. But sometimes you have no choice. You can also use pessaries but pessaries are not always very pleasant for every woman. And they can’t take them in and out, especially as they get older. But I’ve had some women get great responses. A pessary is sort of like a structure that pushes back the bladder up, and holds it up. But you have to be careful too, because sometimes they can act as their own obstruction in women.
[00:20:39] So you have to really check to make sure that they really can empty their bladder. Because you don’t want to create a problem when you’re trying to fix a problem.
Diane: [00:20:48] Right. Which a lot of… You’ll see those commercials on TV. Some of those drug commercials. OK. This helps this and then oh my gosh. But… And you have like 14 side effects.
Dr Felice Gersh: [00:21:03] You know I wanted to… I’m so glad you mentioned that. Because one of the family of drugs that are so used in elderly women in particular are the drugs for a so-called over active bladders. Where women have urge inconstancy where they can’t hold it and it just comes out… Like they’ve gotta go… gotta go… and it just all pours out. And these drugs can increase risk of dementia!
Diane: [00:21:26] Really?
Dr Felice Gersh: [00:21:27] They block acetylcholine, which is a neurotransmitter which in the bladder access what they call a muscarinic, it actually can close the bladder to contract. So they want to block it in the bladder. But unfortunately when you block it in the brain you’re blocking your ability to create memories and in fact the drug for dementia are trying to increase acetylcholine. And then we’re giving drugs that block acetylcholine. So I see women, they come in and they’re on a drug that increases and another drug that decreases the same neurotransmitter. And it’s so crazy because they’re trying to block it in the bladder and increase it in the brain. But it doesn’t quite work that way. So we have to be so careful about giving medications that can increase dementia in the elderly. Like how crazy is that?
Diane: [00:22:15] And that is really crazy. I know. This is so scary. And that’s why I always say to people, you have to go to a professional.
[00:22:25] You know, don’t just try… There are so many people who just say, oh I just go to the doc-in-the-box or something. And I say, a geriatric patient is a specialty. It’s a special patient, so…
Dr Felice Gersh: [00:22:43] Absolutely. You know what I’m seeing the growth of is? Talk About Doc-in-the-box how about Doc and the phone? So that telemedicine, where you can buy a doctor for five minutes and you don’t know who you’re getting. There’s no continuity of care. So you know great red flags there. You know definitely not for the elderly.
Diane: [00:23:02] No definitely. Oh my gosh. Now, could you tell us just why do so many elderly women develop incontinence?
Dr Felice Gersh: [00:23:14] Well it gets right back to that same thing, loss of estrogen.
[00:23:18] So there’s two different basic types of incontinence. And often women, of course, have a blend of both. So one which I mentioned which is very very common is what’s called Urge Incontinence and that’s where the bladder literally goes into a spasm. When women are going to have like the letdown, like you know the reaction to allow the bladder neck to relax and then the bladder contracts and the urine comes out. It becomes disregulated. Because this whole neurological system of the bladder becomes disregulated, and so it just goes into spasm at the wrong time. And the women can’t control it. And that’s urge incontinence.
[00:23:57] Stress incontinence, which is most commonly associated with in women who had vaginal deliveries, but not always, but that’s the most common, is where a woman coughs or laughs or takes a little jump or something and then suddenly the urine just flows out. They don’t feel like they have to void. They don’t have any sensation it just comes out and that’s called stress incontinence.
[00:24:21] So the stress incontinence is really about loss of tissue structure and relaxation of the sphincter muscle and it’s just not things are just structurally altered. And it also has to do with neurological. Everything somehow relates to neurological as well. And then the urge is about the bladder itself having these spasms.
[00:24:43] But they both are related to loss of estrogen with menopause. That’s why I urge all women who were right in the early stages of menopause to get on some therapy at least local therapy for the vaginal health, because it’s all one. The vaginal health and the bladder health are all one. Once a woman has these problems it becomes more difficult. In terms of the urge, I really hate those medications, as you can tell, because anything that increases dementia, I’m not going to be in favor of. So I go more with some of the neuro-feedback that you can get.
[00:25:19] A really good pelvic floor Physical Therapist can work with women and they can work with doing like Kegel exercises and for women that can’t do that on their own or a little electrical-stim devices that can be approved by Medicare that can be placed in the vagina and they’re not hard to use. And they create their own little electrical stimulus that can sort of help exercise the bladder and really have tremendous benefits. I’ve seen great benefits and it can actually work for both stress and urge incontinence.
[00:25:49] So that’s one of my favorites, is using pelvic floor physical therapy and these electrical-stim devices. No drugs side effects.
[00:25:57] Perfect. Dr. Gersh, how can people reach you?
Dr Felice Gersh: [00:26:03] Well, I have a very old-fashioned brick and mortar practice in Irvine California where I see patients, sometimes come from around the world. And that’s in Irvine California. So my phone number is there is 9 4 9- 7 5 3- 7 4 7 5. And I have a Web site and people can also check me out on my Web site which is FeliceLGershMD.com.
Dr Felice Gersh: [00:26:32] Dr. Gersh Thank you so much for being here. And I know this episode helped people that are listening.
[00:26:37] Please keep emailing your questions and comments and tell me as much as you can, because what you share can help someone else.
[00:26:43] You can reach me at Diane@ParentsAreHardToRaise.org. Or just click the green button on our home page.
[00:26:49] Subscribe to our show on iHeart Radio. IPhone users can also subscribe on Apple Podcasts and Android users on Google Podcasts. And, please give it a five star rating. That helps other people find the show. Thank you so much for listening.
[00:27:04] Till then, May you forget everything you don’t want to remember and remember everything you don’t want to forget. See you again next week!