June 5, 2013


There’s only one thing that a patient over 65 silently frets about when they start to lose weight – cancer.


It’s a physician’s concern as well, so it took no time at all to cover the critical questions of how much weight loss my patient had experienced, over what period of time, whether she was trying to lose weight, lack of appetite, nausea, feeling bloated or lacking energy. Then we explored whether there was any change in her exercise capacity, any shift in mood, sleeping difficulties.


This Q & A was all done with the speed of a TV advertisement for the side effects of Ambien. All of her answers were reassuring. Her usual breakfast was a bowl of porridge with raisins, yogurt and pineapple. Lunch was soup and a sandwich, and dinner was a joint effort  prepared with her husband. She walks three miles a day and swims pool lengths twice weekly as well as one vigorous aqua fit program.


Nothing seemed amiss. Indeed, I checked her chart, and she weighed no less than when I saw her last.


So I had to ask what the real issue was.


“Well, I weigh 52 K and I don’t think I have much more that I can afford to lose. Everything is hanging on me – I feel like one of those dogs you can pull up the skin.”


“A sharpai?” I asked.


“Yes. Look at my skin here on my arm,” she said, pointing to her forearm. “I can pull it up, and it falls down. It’s ugly.”


The cause is easily explained – the sharpai effect is an age-related loss of the subcutaneous layer under the skin surface. Even if you do the Super-Buns workout to create muscles where there were none before,  you’ll still only manage to achieve a barbecued chicken thigh look rather than the smooth contour of chiselled flesh.


We chuckled together, reassured with this sudden shared realization that this change that won’t be denied no matter how fit or hale you are.


In other words, that “hanging” look will only get worse as you age. You can try to hide it and feel ashamed about it. Or …


CBC Radio’s Terry O’Reilly did a brilliant episode of his program Under the Influence. He called it “The Shame of Age.”  It analyzed from a marketers’ perspective our attempts to defy the onward march of aging.


It seems from the early 1920s, marketers were manipulating two elements of North America’s emerging urban industrial culture. For the first time ever, we were able to focus on our “personal image.” That led to a raft of products focused on health and well-being. But it quickly rolled into hygiene and beauty products.


Second came the manipulation of the response to negative judgment of others – what we call shame.  O’Reilly pointed out that deodorant and mouthwash are a 100-year-old testament to what was a crafted demand that then required a product to be supplied in order to satisfy it. By the 1950s, America’s might and her radiant future shoved visible aging into the closet never to be seen again.


Thus, we children of the 60s grew up infused with Clairol’s ads that demand:

“Does she or doesn’t she?”


Then came the tsunami of anti-aging cosmetics, covers and enhancers and serums that marketers create to stimulate demand where there once was none, reaching all the way back to 30-year-olds whose “lives are over” if they don’t look under 30 when their next birthday arrives.


We may be appalled but we shouldn’t be surprised. From a marketer’s point of view, selling the dream of eternal youthfulness is a much more lucrative proposition than mounting a campaign that tries to erase the shame and powerlessness of aging.


Today’s version of the response to aging, aside from the billion dollar cosmetic industry, is America’s position as the world’s leader in plastic surgical procedures – with Canada not far behind.  In 2011, there were 14 million procedures in the U.S., up 87 per cent since 2000; 91 per cent of these patients are women aged 40 to 55.


In my practice, most of these procedures are for breast augmentation or, if OHIP covers it, breast reductions. Fewer are for facelifts, chin tucks and lid revisions since they are all paid for by the patient and no one has to go through their family doctor to get a referral anyway.


Nevertheless, my patients sometimes come by to get my tentative approval for their plastic surgery. Happily, I can most often accommodate them in praising the results, even if it’s only to comment on seeing no difference whatsoever, which is indeed high praise from my standpoint.


But – and it is a very big but – it is very difficult to abolish the crepey neck folds that are the telltale giveaway of that persistent onward wizening of your subcutaneous layer. You can have a 50-year-old’s face in your 70-year-old body. But you’ll only have a 50-year-old’s neck when you’re 50 years old!


By 70, though, most women don’t line up for facelifts, especially first-timers. That said, if you work in the media or public life, one of my patients said ruefully: “If they know you’re over 70, you’re finished.” Once committed to the process of tinkering, women are often compelled to pursue re-dos, though results are certainly better now than the “X-ray grimace” product of the ’90s.


Just how sensitive we are to ageist commentary hit home in my office last month when one of my patients relayed her experience in the emergency department of a Toronto hospital.  She had gone in with severe abdominal pain. In the course of the investigation, a CT of her abdomen was proposed as a means to rule out appendicitis. Not wishing to subject herself to such an amount of radiation, she asked the young ER doctor if an ultrasound wouldn’t give the same information. “At your age, it isn’t as good” came his reply.


It was the first passing reference she had ever heard about being old – at least, that was how she took it, since her comment as she retold the story was that he didn’t seem ageist when he was examining her. In truth, and subtle as it was, the slur of ageism came from her. Did I know of any reason why being over 65 would have made a test less sensitive? “None that come to mind” was my response though I considered lax abdominal wall, increased bloating, redundant bowel loops all as potentials and all as more likely considerations as you age.


Still, none of these states applied to my patient or any other elderly person for that matter, so we were at a loss to account for his comment. The doctor’s reference to what she took as old age had introduced a new vulnerability, a shade of helplessness.


I laughed with her, reflecting that we cope with these glancing references to ageism in those myriads of tiny exchanges because we spend a lot of effort anticipating and preparing for them. I remember marching up to the subway booth to claim my first Senior Citizens subway tickets, certain I would have to produce some proof of age. No such luck!  The same procedure occurred when I bought a movie ticket. Did I look so past my 65 years that no one cared to confirm that I wasn’t just taking advantage of even a year or two?


I take great joy in my senior rights to reduced fares as much as I own my chagrin at having to line up to put a paper ticket in the toll-box in lieu of the much faster token access. It slows me down and in a rich perverseness on my part, makes me feel too young to be held up by dawdling lines.


Dr. Jean



Doctor. Writer. Athlete.

Advocate. Adventurer.