This article was written by Dr.Joe Pellicer, who works in the Emergency Center at Providence St. Peter Hospital. www.notesfromtheer.com

" Dad doesn't want to eat anymore. He's losing weight, he's getting weaker and weaker. There are days when he's pretty confused. What should we do."

He's 94 years old, I thought to myself, I should probably do very little, in terms of what doctors are usually expected to do. What I really needed to do was to figure out what this family's needs were as their father approached his final days.

I knew that they had brought him more than 80 miles from his home up in the mountains down to the big-city hospital to seek our professional opinions. That usually means one of two things, either his previous doctor was not adequately addressing the family's questions, or they were not ready to accept what they have been told

" Are you hurting anywhere?" I asked him. The answer I got was difficult to decipher, it sounded like maybe his belly hurt him sometimes, but I couldn't get a sense of the details. He was clearly suffering some loss of memory. I tried several other questions, then gave up, the details of his illness were hidden behind the veil of dementia.

After getting some more history from his family, I asked, " Who is caring for him?" " We take turns." From the look in their eyes, I sensed that this was not an easy task. I learned that he had lost control of his bowels and bladder and was in diapers full time.

I was impressed. In our busy culture, caring for one's failing parents or grand parents is an increasing rarity. It is often the menial task of cleaning up the body's excretions that pushes families into the decision to seek a nursing facility to care for their parent. There also is the demographic reality that few families still live in adequate proximity to share the responsibility.

After examining him, I was none the wiser, He looked old and tired, but his body yielded no sign of what was troubling him. I explained that we could do some simple tests on his blood and urine to see if there were any clues as to what might be the matter. When the normal results popped up on my computer screen, I knew I had a serious conversation ahead.

The most likely diagnosis at this point was that he had some sort of cancer and that his body was beginning the process of dying.
It is always a challenge to tell this kind of news to a patient and family that you've never met before, especially when you do not have any evidence other than the history provided by the family.

They let me know that they weren't interested in any major treatments such as surgery. I was relieved, it is always easier to have this conversation when the family has realistic expectations. As we get old, our bodies are less able to stand the stress of surgery, less able to heal afterward. If the surgery fails or leads to new complications, decisions to withhold treatment can become increasingly difficult.

I acknowledged that I had access to some of the fancy technology that lets us peer into the body and prognosticate. But I could think of no good medical reason to do so. We talked about the fact that sometimes people ( and sometimes doctors ) just " have to know," and that this is why many tests get done. I did my best to explain that there comes a time in life when it is OK to die without knowing why.

Throughout it all, the old man just wanted to go home. I'll never know if he understood any of what we discussed. His family and I agreed that we shouldn't do anything else. There were some tears shed, some hugs shared and then it was time to see my next patient.

For those of you who are in a situation similar to this or know someone struggling with these issues, I highly recommend the recently published book, " My Mother, Your Mother." written by Dr. Dennis McCullough, one of my professors during residency. It is a poignant story as well as an excellent resource about the many issues surrounding the care of the elderly.

Little Johnny is going to bed, and as he is walking past his mother's room, he hears noises coming from in there. So he stops and opens the door, only to find his dad on top of his mother , giving her some wild sex. His dad turns around and gives him the thumbs up, and a big smile. Johnny just hangs his head, and heads off to bed.

The next night Johnny's dad is going to bed when he hears noise coming from johnny's room. He opens the door and finds johnny on top of his grandma. He yells at Johnny, " What are you Doing ?"

Johnny looks up at his dad and says, " not so funny when it's your mom, is it?"

Sherry is going to like this one.

By Dr. Sheila Brown.

When I was in college, the term " free radical " brought to mind Vietnam War protesters and Woodstock attendees. I still see " peace and love " signs in my minds eye when I hear that phrase, but today it has another meaning.

Normally, oxygen exists paired with something else, either with itself as O2 in oxygen, or, for example, with hydrogen molecules in H2O (water). However, occasionally an unpaired " O " gets loose, and when it does, it is a highly reractive free radical that will attach to the first thing it encounters.

A common example is seen with objects made of steel or iron. When oxygen combines with iron, it produces iron oxide, more commonly known as rust. Similar reactions are seen with aluminum and house paint, which are said to " oxidize. " With silver or brass, we call it tarnish. When the cut surface of avocado, apple or banana turn brown, that also is due to this oxidation caused by the free radicals of oxygen.

There are ways to reduce the oxidation, such as coating surfaces with oil that prevents the oxygen in the air from attaching to the object. anotherway is to remove the oxygen by vacuum packing or replacing the air (which is 21 percent oxygen and 79 percent nitrogen) with 100 percent nitrogen. Still another option is to use compounds called antioxidants to prevent the oxidation. Lemon juice, which contains the antioxidant Vitamin C, is commonly used in cooking. Everyone knows the way to keep fruit from darkening is to squeeze lemon juice over it.

Since every cell of the body uses oxygen, it should come as no surprise that an occasional free radical pops up and attacks the cell wall, DNA or some of the little organelles in the cell itself. Each of the 75 trillion to 100 trillion cells of the human body take about 10,000 free radical hits per day. In a way, one can say that our bodies are " rusting " from the inside out. (Maybe that's why I sometimes feel like the Tin Man in " The Wizard of Oz. "

So, what can we do about this rust or oxidative damage to ourselves? What sort of damage do free radicals do? All sorts of damage. They are behind inflammation, which is the root cause of many degenerative diseases such as arthritis, heart disease, asthma, Alzheimers's and strokes. What are antioxidants? They are compounds that glom on to one of these crazy free radicals and convert it to a harmless stable molecule and, in some instances, safely escort them out. Commonly known antioxidants are Vitamins C, D, and E, coenzyme Q, and many plant-based compounds, such as the polyphenols in teas and other leafy vegetables, as well as olive oil, the sulfur compounds in garlic, the cruciferous vegetables, and proanthocyanidins in fruits, especially concentrated in grape seeds.

Uncontrolled and unbalanced free radical damage at the cellular level leads to damage of the organs, compromising the system as a whole. What else contributes to free radical damage.? Air and water pollution are a big source of free radical damage. Thousands of chemicals have been introduced into our environment in the past 75 years. And cigarettes cause severe free radical damage in those who smoke them or breathe the smoke from them.

Consuming antioxidants in the form of fresh fruits or vegetables or supplements can minimize some of this free radical damage. For example, eating barbecued meat with its crispy fat full of dioxins produces enough free radical release to cause the blood vessels of the body to go into spasm for 4 to 6 hours. The same thing happens when one eats refined carbohydrates that spike the blood sugar. Consuming a healthy dose of Vitamin E and C beforehand can reduce that spasm to 4 to 6 minutes. that is a big difference if you are counting on oxygen delivery to your brain and muscles, and really can't affortd an afternoon nap.

If given the right building blocks through eating nutrient rich foods in sufficient quantities, minimizing consumption of harmful foods and avoiding as much toxin exposure as possible, we can help our bodies heal and regenerate healthy cells, which in turn will improve our health, sense of well being, energy, stamina and ability to resist infection.