When I started my residency program in internal medicine, one of my favourite rotations was in hematology/oncology. Not only did one care for sick patients and make a positive contribution to their care, there was the added bonus of blood film and bone marrow examination. The teaching sessions at the microscope were highly educational and incredibly fun. It made me feel like a 'real doctor' to peer down the eyepieces, even though I was pretty weak at interpreting what I saw.
My first presentation on the service was on Preleukemia. In those pre-computer times, I labouriously hunted down references by hand, including Block's original article in the 1953 volume of JAMA (1953:152:1018-29). Today, we would call these preleukemic states myelodysplastic syndromes, and the science and taxonomy has progressed tremendously. However, the fascination with blood remains. Since my internship days, I have learned that this fascination with blood is endemic in medicine, and in society as a whole. This topic is particularly well covered in Professor Jacalyn Duffin's wonderful text on medical history, entitled: History of Medicine: A Scandalously Short Introduction. Not surprisingly, Professor Duffin is a hematologist, as well as a historian. My personal involvement with the 'preleukemic syndrome' continued in 1990 when my mother-in-law developed a myelodysplastic syndrome that rapidly evolved into fatal acute myelogenous leukemia. In an incredible bit of foreshadowing, my initial presentation in internship turned out to be on a topic that is predominantly geriatric, and one that would have a significant impact on my personal life.
In the United States, the predominance of the elderly in the field of oncology has resulted in the insertion of geriatric teaching modules in hematology/oncology training programs. One hopes that Canada will soon follow suit. In any event, there is no shortage of important hematology or oncology topics to discuss in the elderly. As noted in a previous editorial by our Senior Editor, Shabbir Alibhai, there may be many explanations for the poorer outcome for cancer in the elderly. Some of these are failure to correct for comorbidity, inadequate treatment, delay in diagnosis, and presentation at a later stage of disease. Another concern is that the elderly are prone to complications arising from cancer therapy that may not be well managed. Dr. Jeffrey Zonder and Dr. Ulka Vaishampayan, both of Wayne State University School of Medicine, address this issue in their article. Dr. D'Arcy Little covers the issue of thrombocytopenia in the elderly, and Dr. Ahmed Galal and Dr. Jeffrey Lipton from Princess Margaret Hospital discuss the topic of chronic myelogenous leukemia. Our understanding and treatment of this disease has certainly changed dramatically in the past few years. Living with cancer can be enormously stressful, and Dr. Jennifer Jones and Dr. Gary Rodin, also from Princess Margaret Hospital, discuss psychological adjustment to cancer: normative responses as well as psychopathology and treatment.
We also have articles on management of venous ulcers (Dr. Morris Kerstein and Dr. Ernane Reis from Mount Sinai School of Medicine, in New York), genetic counselling and testing for Alzheimer disease (Dr. Wendy Meschino, Toronto), rehabilitation of unilateral neglect (Dr. Gail Eskes and Dr. Beverly Butler, Dalhousie University), the impact of clinical pharmacy in nursing homes (Professor Michael Roberts, University of Queensland, Australia), and the impact of caloric restriction in the aging process (Dr. Isao Shimokawa, Nagasaki University School of Medicine, Japan).
Life is a risky business, and may become even riskier as we age. Many health care providers are intent on making sure our patients are completely 'risk free' in their living arrangements, clearly an impossibility. Harold Parker and Dr. Laura Diachun from the University of Western Ontario look at caregiver responses to the elderly living at risk.
Please do not take any risk that you might miss something important in this issue! Read and enjoy all of the articles.