Jeannette Guerrasio, MD, is a primary care internal medicine physician in private practice in Denver, Colorado. She graduated from Albany Medical College and completed her residency at the University of Connecticut and a mini-geriatrics fellowship through the Reynolds Foundation at the University of California Los Angeles. While practicing at the University of Colorado, in the Department of Medicine, for thirteen years, she became a Professor of Medicine and was inducted into the Academy of Medical Educators. She is committed to the clinical care of patients, with expertise in both adult medicine and geriatrics, having done research to improve geriatric assessments and to decrease delirium, functional decline, and urinary tract infections.
Dr. Guerrasio is also an internationally known teacher and educator. She pioneered an approach to improve the educational experience of medical students and residents. She is the author of Remediation of the Struggling Medical Learner, editions 1 and 2, Remediation Case Studies, and countless book chapters and journal articles.
Visit her online at www.jeannetteguerrasiomd.com.
M y sincerest thank you to my biggest fan, who has supported my personal and professional development in innumerable ways. Lara Juliusson gets full credit for drawing and digitizing all of the illustrations, which I then labelled. She also managed our small zoo of dogs and cat in the evenings so that I could have less interrupted time to complete this writing project. Every moment with you is a treasure, and I want to thank you for sharing our time for the benefit of others.
I am deeply grateful to all of my patients who I truly enjoy and from whom I have learned so much. You have been so generous in your sharing over the years. Special thank you to my friends: David Mellman, MD, who is the best colleague to collaborate with and human being to spend every day with; photographer Sarah Pollock who not only took my headshot while standing precariously on a windowsill but for also helping me manage my practice of patients at the same time; poet and editor Max Regan, MFA, who sparked my interest in writing and who has been a great guide; Ethan Cumbler, MD, who helped foster my love of geriatrics and has a solution to every problem; Nancy Novosad Bader for reviewing all of my writing and engaging me in the most stimulating conversations; and Barbara Stanton for reviewing my very rough first draft and for your ever thoughtful comments that have made this book so much better. Of course, thank you to my mom and dad who also helped review the first draft and, as the proud and supportive parents that they are, commented Everyone should get a copy! Thank you to them for my sense of humor, my love of people and medicine. Thank you to nephew and niece, Jared and Hailey, and cousin Janice (one of my many amazing cousins) for letting me use some of their personal stories.
With much gratitude, I wish to thank my literary agent, Joan Parker from Parker Literary Agency, LLC, who has worked tirelessly to guide me through the publication process (yet again!) and to find the perfect publisher to represent this work. Its been a pleasure working with Suzanne Staszak-Silva and the entire crew at Rowman & Littlefield, and I am honored to be working with such a great publishing company.
The information in this book is comprised of years of study. To stay current on the latest medical discoveries and innovations, I read:
For Medical Professionals
The New England Journal of Medicine : www.nejm.org
New England Journal Watch, which alerts me to thousands of the most influential scientific studies that come out each year across all of the medical journals: www.jwatch.org
Up-to-date medical resource: www.uptodate.com
For a General Audience
General Medicinal Information
- CDC.gov
- Mayoclinic.org
- Clevelandclinic.org
- Medscape.com
- WebMD.com
- MDConsult.com
- Emedicine.com
Advance Directives Tools
- www.fivewishes.org
- www.theconversationproject.org
- www.prepareforyourcare.org
- med.stanford.edu/letter.html
- www.getyourshittogether.org
- www.GoWish.org
Disease Society Specific Information
- Alzheimers Associationwww.alz.org
- American Association of Clinical Endocrinologywww.aace.com
- The North American Menopause Societywww.menopause.org/for-women
- Urology Care Foundationwww.urologyhealth.org
Information Specific to Aging
- Health in Agingwww.healthinaging.org
Living with Osteoarthritis
I have dozens of patients that are lucky enough to have lived ninety-five years without any serious health problems. They take no medications, except an occasional acetaminophen (Tylenol). They have never had surgery or been hospitalized, yet they all have the same complaintEverything hurts. Years of wear and tear on their joints have led to osteo-arthritis. The soft cartilage cushions that once existed between the bones in their joints have been slowly filed away with every bend and release.
One of my eighty-three-year-old patients, who is still an active skier, has a great saying: If you rest, you rust! The activity that keeps her vital organs healthy, her brain functioning in tip-top shape, and has allowed her to maintain an active life, unfortunately, has also resulted in arthritis. Her goal and my goal for her is to find a way to overcome this challenge so that she can continue to participate in her activities without pain limiting her. I was confident in our success when she passed me on the ski slopes this winter.
A Universal Challenge
If you are over fifty, chances are you have some nagging arthritis somewhere in your body that flares up from time to time. Do your knees remind you that you went hiking yesterday? Does your lower back remember the heavy box you carried this morning? Are your thumb joints as angry with the Pickleball racket as you are? The truth is you dont have to be old to experience arthritic pains. Osteoarthritis begins developing at the age of thirty. How you have used your bony skeleton over the years will determine when you start to feel that early morning achy joint stiffness, which joints will be involved and how quickly it will progress. If you were a linebacker on a football team or a catcher for your softball team, you would likely develop arthritis in your knees before your friend who joined the band instead. Genetics also plays a large role in how your arthritis develops. Take a look at your hands. Do they look like moms hands or dads? If they look like moms and she had very little arthritis, then you are lucky. If they look like moms and she had terrible arthritis, lets talk about being prepared.
Osteoarthritis Is Not Inflammatory
Before we move on, I want to clarify that osteoarthritis is very different from other types of inflammatory arthritides, like rheumatoid arthritis, psoriatic arthritis, or gouty arthritis. In these types of arthritides, ones own immune system attacks their joints or crystals form in the joints as with gout, causing an inflammatory reaction that erodes the joint. I like to think of osteoarthritis as more of a mechanical problem. Eventually, the tire treads on your car, the brake pads on your bike, and/or the soles of your shoes just wear out.