DEAR DR. ROACH: I am a 91-year-old male. When I switched primary care physicians, my new doctor shook his head because my previous doctor had never told me about my low GFR readings and being borderline diabetic.
In the past I had assumed that if the doctor didn't mention any low or high blood test results, everything must be OK. I no longer assume: I ask for a copy of the results and question them.
The new doctor referred me to a nephrologist. My blood pressure at the time was usually in the 130-140/60-70 range. He told me that for a person of my age, that was too low. He gave me a target of 159/89. Then on my next visit to primary care, I was told that my blood pressure was too high; I was prescribed losartan. I am testing my blood pressure daily, and the past few days it has been in the 170s. So, what is a good target for my blood pressure? Which doctor is correct? — A.L.
ANSWER: There is no absolute right answer to your question. On the one hand, overaggressive treatment of blood pressure in a 91-year-old is unnecessary and may lead to symptoms of lightheadedness, especially upon standing. Other blood pressure drugs may have additional side effects.
On the other hand, a 91-year-old has a higher risk for heart disease and stroke, and in someone with a low GFR reading (a measurement of kidney function) and borderline diabetes (which further increases the risk of heart attack and stroke), most experts would aim for a blood pressure goal that is closer to 120-130/80-85, as long as it isn't causing annoying symptoms. I'm not clear why the doctor wasn't happy with your usual blood pressure, since a level of 130-140/60s seems very reasonable for a man your age if you aren't having side effects. If 170 is the usual systolic pressure on your new regimen, I would ask about going back to the old one.
DEAR DR. ROACH: I always have had small breasts. Suddenly, in my mid-70s, my breasts grew, and now at 80 I have outgrown most of my clothes. My doctor said that it is fat, but I have gained only a few pounds. Could this be hormonal? Have you addressed this issue before? — S.F.
ANSWER: I haven't addressed this before. Breasts change size during a woman's life for many reasons. Breast tissue is a mixture of fat and glandular tissue. For young women, there's proportionally more glandular tissue, the amount of which tends to decrease over time. After menopause, the breasts become less glandular; what is lost is replaced by fat, as there is less estrogen.
About 20% of women will notice significantly larger breasts after menopause; however, this usually occurs along with overall weight gain. Significant breast enlargement without much weight gain is not common in my experience.
Hopefully, your doctor did a thorough examination. However, I think it is very unlikely that your breast size changes represent a tumor. Very rarely, there are estrogen-producing tumors, so if there were other reasons to be concerned, your doctor might check blood levels of hormones, including estrogen.