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DEAR DR. ROACH: My question regards the results of my fasting glucose tests for the past couple of years. I am 81 and weigh around 150 pounds. The medications I am tak-ing concern me, with relevance to the A1C levels of my quarterly blood work. My A1C levels have mostly been near mid-5%; the last showed 6%. Medications relevant to this that I am suspicious of are 100-12.5 mg of losartan/hydrochlorothiazide (HCTZ) and 20 mg of simvastatin. I have read that these medications can have an effect of raising blood glucose. My doctor is adamant that this does not exist, but it seems to me that there is a conflict on this.
Should I perhaps ask him to change those medications because of my blood sugar? I am concerned about issues with the thiazide and the statin. — P.R.
ANSWER: There isn’t a conflict. You are absolutely right that both sim-vastatin (like all statins) and HCTZ (like all thiazides) increase blood sugar and the risk of diabetes. The risk, however, is small. For thiazides, the risk of high blood sugar seems tied to potassium levels — the lower the potassium, the higher the risk of diabe-tes. Interestingly, the losartan in com-bination with the HCTZ you are taking tend to raise potassium levels, so that combination may have a lower risk of worsening blood sugar levels than taking HCTZ alone. You are already taking the smallest effective dose of thiazide.
The risk of statins seems greater in higher doses and with more potent statins, like atorvastatin and rosuvastatin; however, the risk is still small. About one person in 100 treated with a high-dose intensive statin, such as 40 mg of atorvastatin for five years, would be expected to get diabetes, while a dosage of 20 mg of simvastatin would be expected to have an even lower risk.
The conflict isn’t whether the increased risk exists (it does), but whether the treatments to prevent heart attack and stroke are worth the increased risk. For nearly all people, the benefit of keeping blood pressure and cholesterol under control greatly outweighs the small increased risk of diabetes.
Given your normal A1C level, I would say your risk is low, and I do not generally recommend changing treatment based on your concern over blood sugar.
DEAR DR. ROACH: I am a 64-
year-old man who recently had an ultrasound of my kidney to rule out any kidney stones. The utlra-sound was negative for stones, but the radiologist noted a 2.3-cm echo-genic nodule in the right lobe of my liver. The final impression was an incidental hemangioma in the liver. I was concerned, so I received an AFP (alfa-fetoprotein) test, which came back at 1.8 ng/mL.
Is an echogenic nodule/incidental hemangioma a reason to have fur-ther testing? — M.S.
ANSWER: Sensitive imaging studies, especially CT scans and MRIs, often reveal abnormalities that lead to a quandary of whether to get additional testing. For a mass found in the liver by ultra-sound, if it is less than 3 cm and meets the radiologic criteria for a hemangio-ma, no further testing needs to be done in people at low risk for liver cancer (such as people with hepatitis C or cirrhosis). As long as these hemangiomas cause no symptoms, they do not get treated.
The alfa-fetoprotein test is a blood test that, when producing abnormally high results, helps signify several types of cancers, including hepatocellular car-cinoma (classic liver cancer) as well as germ cell tumors (cancers of the repro-ductive cells, which usually occur in the gonads but can occur in the liver or else-where in the body). Your level is normal and not concerning.
Dr. Roach regrets that he is unable to answer individual questions, but will incorporate them in the column whenever possible. Readers may email questions
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By Tiffany Porter
Many people think that becoming a nomadic traveler when you are 50 is impossible. All the fault is the stereotypes the modern world is driven by. Indeed, the younger generation prevails among the nomads.
However, your age shouldn’t be an obstacle. After all, if to consider the understanding of the term nomadic, then there is no indication of age. This is just a person who moves from one place to another.
But where to start this journey and in which direction to move? In this article, you will find actionable tips, so that you can take the first step into a new world.
What Do You Need to Know If You Want to Become a Nomadic?
As you already understood, nomads aren’t people of a strictly specified age, and anyone can become one of them. But there will still be some differences in the lives of younger and older travelers. Below you will find tips to help you plan your travel, working hours, and new lifestyle properly.
Start by Getting Insurance Coverage
Traveling and moving is always romantic and full of adventure, which is why you better have full insurance coverage. Distant counties may always hide some unpredictable surprises and your insurance is one more way to stay calm in any situation. Also, having insurance is important for your health since, unfortunately, age increases the risk of such problems.
Balance Between Work and Personal Life
As you get older, you probably begin to grasp the full value of work-life balance. Nomadism and writing is the perfect formula for you to constantly feel the freedom of your time. Work as long as you feel comfortable so you don’t feel like writing is exhausting you. Set yourself an acceptable number of hours of work per day and follow this schedule. You may have to spend the first time trying to find the optimal amount of working time, but it’s worth it.
Also, keep in mind that writing has room for delegating responsibilities. If you begin to feel that you are not able to do something or you are failing at something, there is no need to spend all your time and energy on solving this issue. You can find good and inexpensive freelance writers to get help. Find a suitable assistant and delegate your responsibilities from time to time in order to save energy and enjoy life and not sit for several sleepless nights writing a new article.
Plan Your Budget Wisely
You need to be well aware that it will be difficult for you to follow the same budget destinations that students take. Agree, sleeping at the train station, hitchhiking, or begging for a little change on the bus is not the best fun to travel after 50.
Therefore, if you want to follow a route that many other travelers have taken, consider every moment and recalculate the costs. Since most likely you will have to spend a lot more money than young nomads.
What to Do If You Are Not a Traveler Yet?
If you still do not know whether you are ready to become nomadic 100%, then no one says that you immediately need to leave your home and go thousands of kilometers for a year. You can try to explore your state or nearby towns.
Local tourism is a good opportunity to find out if the travel writer lifestyle is right for you or not. It is also a good way to understand in practice what you really need in a new place and how best to organize your life and work process in such conditions.
Also, do not forget about all of the above points, as they apply to local tourism too. By starting small, you can learn a lot in a year and travel as far from your home as possible with a clear understanding of what you need. Extreme is certainly good, but still, give preference to safer and more comfortable options.
Turn Your Age into Your Unique Advantage
The last word of advice to a new lifestyle is that you have a great opportunity to become popular and earn extra money just because of your age. Most likely, when you first began to explore the issue of nomadism and writing as a new way of life, you noticed that young people follow this way of life. Your age is your unique opportunity to stay out of the crowd.
For example, you can start a blog not about “where to start nomadism” but about “nomadism and work after 50”. Besides blogging, don’t forget about social media and YouTube. Show off your new life on video, share valuable tips, and become the number 1 nomadic for another generation of future nomads. This niche is freer in the context of your age, which means that it will be much easier to achieve success and popularity than when you are 22-30 years old.
Also, in addition to a new lifestyle, start creating content that will also relate to your professional activities. Tell your audience how they can make money from writing if they are retired and have never done this before. Such topics will also be very relevant, and then you will be able to capture two target audiences and not one. That is, you will be interesting not only for those who want to change their lifestyle but also for those who are looking for new options for earning money in retirement.
Therefore, change your attitude towards your age and make your age a business card that will soon bring you a great income.
The Final Verdict
As John Galsworthy said that “love has no age” we want to say that the nomadic writer shouldn’t be squeezed into any age frameworks. Forget about all stereotypes and start living the way you want at the moment. Well, if you are tormented by doubts about whether you will succeed or not, then start small. Local tourism erases many of the risks but does not deprive you of the opportunity to get everything that young travelers get!
By Tiffany Porter
Tiffany Porter has been working as a Chief Writer at Online Writers Rating reviewing a variety of writing services websites. She is a professional writing expert on such topics as digital marketing, blogging, design. She also provides consultations and creates expert writing materials for the Best Writers Online review website.