Geriatrican may not be necessary
Dear Dr. Roach: My husband is 77, and I am 68. Our health deteriorated during the pandemic. When should we switch to a gerontologist for our general care? A.M.P.
Answer: There is no one right answer to your question. If your regular primary care doctor is handling all your medical needs, there may be no reason to switch. A geriatrician is most valuable in older patients who have multiple medical problems, patients who take a lot of medications, or patients whose functioning has recently deteriorated. Some geriatricians assume primary care for their patients, while others work collaboratively as consultants.
Again, though, if your regular doctor is treating your issues well, a person satisfied with their care doesn’t need to leave. But if they aren’t, a geriatrician is an excellent resource.
Dear Dr. Roach: I was recently diagnosed with complex regional pain syndrome (CRPS), and I’m undergoing continuous testing. It was recommended by one of the many doctors that I might want to try ketamine infusion therapy. But I’m getting mixed reviews. Do you have any thoughts on this approach?
R.S.
Answer: CRPS is a poorly understood pain disorder that usually begins after trauma, such as a fracture, surgery or another injury. There are many drugs that are shown to be useful in some people with CRPS, although there is no single treatment that is effective for everyone. Pain management specialists will often try an injection called a sympathetic block. Topical treatments may also be used.
Ketamine is not a first-line treatment. The evidence supporting its use is limited to small studies and suggests that the benefit lasts around one to three months. Most experts use ketamine as an infusion under observation instead of oral ketamine, which has a significant potential for harm. In the few patients I have known who received benefit from ketamine, the infusions are repeated every three months. Unfortunately, not everyone responds to it.