Q: I am a 76-year-old man who has A fib. To control this problem, I am taking Tikosyn, metoprolol, warfarin and aspirin. For exercise, I walk or run at least five miles, five days a week. During that five miles, I jog rapidly at least three to four miles. I push myself pretty hard. Am I putting myself in jeopardy by exercising in this manner?

A: There are three parts to your question. Is vigorous exercise dangerous for: someone with A fib on a rhythm-control medication; someone on anticoagulation; and a 76-year-old man in general.

Tikosyn (dofetilide) is an antiarrhythmic drug used to stop A fib (a chaotic heart beat) and keep people in normal heart rhythm. Exercise generally is considered safe with this medication, but I think a pulse monitor might be a good idea to make sure you aren’t going into a dangerously high range. The metoprolol tends to keep heart rate low, but exercise can overwhelm that effect. The American Heart Association would recommend a heart rate no higher than 125-130; however, some healthy 76-year-olds can exceed that safely.

Exercise while on anticoagulation medicine also is safe, with reasonable precautions. You shouldn’t be in a sport that is likely to cause significant trauma. Fortunately, running is safe, unless you have had falls.

I am a big believer in the value of exercise for all ages. Regular exercise makes us feel better and have fewer falls, and it helps reduce heart risk and cancer risk.

Overdoing it, however, is never a good idea. Stay with a moderate, not extreme effort, and build yourself up gradually. It sounds like you are exercising safely, but I would want to double-check your pulse rate at maximum effort.

Q: I know you’re not a psychiatrist, but I hope you can help. My dad was a single parent raising us kids, and he was always clean when it came to housework. Every room in our house was almost spotless. But lately, we have noticed him becoming a hoarder and being more disorganized. He’s 79. Could it be a sign of senility or Alzheimer’s disease?

A: Hoarding behavior can have several psychiatric causes, and, indeed, a psychiatrist may be necessary to make the diagnosis. However, odds are that your dad always had some form of obsessive-compulsive disorder, and with age has become worse.

There are other possibilities. Fronto-temporal dementia, a type of dementia that is distinct from Alzheimer’s disease, has a variant in which personality and behavior changes are prominent, but given the history of what sounds like unusual cleanliness habits, I would suspect that OCD is the most likely diagnosis.

There usually is a long delay from the time symptoms begin until the time the diagnosis is made. A diagnosis needs to be made before treatment — be it medications, psychotherapy or some combination — can begin. Treatment can improve not only the hoarding behavior but also the distress your dad is feeling. A psychiatrist or psychologist is the expert in making the diagnosis and for treatment.

Q: I am a 17-year-old cross-country and track runner. I had a stress fracture of my shin. I have not been running and have been on crutches for one month. Are there foods I should eat or exercises I should do to promote healing? All the doctor said was to not walk on it.


Q: I am an 84-year-old woman who increasingly is talking to herself. Wherever I am — grocery store, home, etc. — I speak or murmur to myself constantly. As I type this, I am whispering the words. Is there something wrong with me? Is this the start of a serious dementia?

A: My experience is that talking to oneself probably is not the start of a serious dementia. Talking to oneself is common. I do see it in people with dementia, but I believe that is the minority of cases.


Diagnosing early dementia can be a challenge. The best way we know of is neuropsychiatric testing, a battery of tests usually administered by a neurologist or psychiatrist. Most people don’t need that. Your regular doctor should have the tools necessary to look for early dementia, and can refer you to a specialist if necessary.

It also is my experience that people who come in worried about dementia are at far less risk than those whose families bring them in.

Q: Can high blood pressure cause blood clots, blindness and strokes? Or is this caused by taking the wrong combination of blood pressure medicines?

A: High blood pressure over months or years causes damage to the lining of blood vessels. This can predispose a person to a stroke. Reducing blood pressure gradually reduces risk of stroke.

Blood clots also can cause strokes, but these usually are not linked to blood pressure, high or low, and instead are linked to conditions that affect the blood itself or that affect the rhythm of the heart. Some medicines, such as estrogen, make blood clots more likely.

In people with very high blood pressure, lowering it too much, too quickly can cause strokes. The blood pressure needs to be reduced gradually, which usually can be done as an outpatient. There are still a few times when people with extremely high blood pressure are admitted to the hospital, where blood pressure can be brought down very slowly in a controlled environment.

Q: I would like your opinion on enlarged prostate. My primary-care doctor sent me for a blood test and said my PSA number was too high, then sent me to a urologist. He said my bladder is not emptying and that I am having urine retention in the bladder. After one week of medication (Rapaflo), I had a catheter inserted for another week. He measured the urine in the bladder, and it was 880 ml. Now, he is suggesting surgery. Is he going too fast?

A: The bladder is drained via a tube called the urethra, and in men, the urethra runs right through the middle of the prostate. As men get older, the prostate commonly enlarges, and this can cause resistance to flow. The symptoms can range from mildly annoying to complete obstruction. Complete obstruction is an emergency, since the kidneys will fail within a few days of being unable to drain urine at all.

But the obstruction does not need to be complete in order to cause kidney damage. It’s the high pressure in the urethra, bladder and ureters (the tubes that allow urine to flow from the kidneys to the bladder) that causes kidney damage. Placing a catheter allows the urine to drain at low pressure if the problem is in the urethra.

Normal bladder capacity is between 300-400 ml. At 880 ml, you would experience very abnormal bladder drainage and would be at high risk for ongoing kidney damage. I completely agree with your urologist that something, probably surgical, needs to be done quickly.

It’s not completely clear to me whether your inability to drain the bladder is due to obstruction from enlarged prostate, even though an elevated PSA suggests that this might be the case. It also is possible that there is something wrong with the nerves that go to or from the bladder. I suspect your urologist has done additional bladder tests to help sort this out.

Q: I haven’t had to shave my legs for a few years, because I never get growth anymore. My doctor said it may be a side effect of hormones. I’m 78. Could that be the reason?

A: Lack of hair can result from several reasons, including hormonal changes, but also from “poor circulation” — specifically, peripheral artery disease.

Unrecognized peripheral artery disease is important because it predicts increased risk of heart disease and stroke.

A physical exam is sometimes enough to make the diagnosis; however, if your doctor’s suspicion is high, he or she might order a Doppler ultrasound to evaluate the blood flow.

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