CHANGE

BB G-LOVED
THE GRUMPIES
The inhalants, inheritants,
insufficients and incomp-batants
BY DR BB G-LOVED
Many of my patients are elderly,
some are grumpy, grouching
with sharp cynicism towards
the world at large and ‘those that want
to have it all now’, those Gen X’s and
Y-ers who have grown up expecting
to be given it all on a plate – or else!
The Grumpies I refer to are usually
baby boomers, who grew up protesting
against war, the bomb, working
conditions, racism, and the world
economy, then emerged from their 20’s
to cut or coiffure their hair, dropped the
pot, rolled up their sleeves, and became
fat cats with pensions to purr for. Now,
with greying white hair, or even lack
of hair, their head-dress above sagging,
once proud shoulders, the pot is back
but as a protruding belly matured over
decades, that belies distant memories
of the fling through their 20’s with slim
flat abdos or muscular six-packs.
So why are Grand-py and Mampy
so grumpy? This is what I was
asked recently by Dr A N Oyd who
was suffering from what some call
grandparent-itis. They were visiting
and [over]staying for weeks. Can you
prescribe something to de-pepper
them? I am not fond of being asked to
provide behaviour controlling drugs
for active toddlers, and now I was being
asked to do something similar for
grumpy grandparents!
I explained that Grumpies come
in four main types: the inhalants,
inherents, the insufficients and the
incomp-batants.
In their home setting old men and
women are usually no more grumpy
than the tired toddlers they love to hand
back after a day of child minding, and
probably less so. Their temper tantrums
are certainly much more controlled and
calculated, though some are ingrained.
Toddlers get tired, so do the elderly. But
is their tiredness normal? That depends.
To recognise that one is tired requires
insight, never present in the toddler, and
often not in the Grumpies.
I like to ask each Grumpie about how
they and their significant other sleeps.
Although Nana naps are common and
even pleasurable, tiredness as a result
of heavy [and loud] snoring and sleep
apnoea represent nocturnal hypoxia.
Add some obesity, allergic rhinitis or
circadian disturbance and you are all
the more likely to have the inhalant
whose tongue spends the night across
their pharynx or whose nasal passages
are reacting to some congesting allergen.
Approaching the grumpies holistically,
their world view [positive or negative]
needs to be considered – are they
grateful or frustrated with the cards
that life has dealt them. Some people
can never be happy or not for long;
they have an inner sense of being
unjustly treated no matter how many
blessings they might be able to count.
People hold different perspectives on
the same experiences or events. Even
the two persons in a couple may not
agree whether their glass is half full
or half empty. The inherents behave
like they’ve always behaved –irritated,
negative, bitter and recalcitrant. They are
probably incurable.
Next comes the insufficients - there
are many possible insufficiencies or
deficiencies. I assess their clinical
status, including current medications.
Significant (not mild) hypertension,
hyperlipidaemia or hyperglycaemia
may obtund their quality of life and
temporarily affect their mood. Are they
being treated with sedatives or antidepressants?
I consider their cognitive
state, at least with a mini-mental;
though even the mini-mental can
make one grumpy. The early stages of
dementia can be very frustrating for
both the affected and the partner in the
couple. Grumpiness can be a sign of
failing to cope, not remembering, or fear.
I have a series of tiredness or
insufficiency screening investigations.
These include Hb and Iron studies,
Thyrotropin, B12, calcium [too
many hypercalcaemic patients suffer
undiagnosed for years], magnesium,
UEC [esp to exclude hypokalaemia in
those on diuretics]. Vitamin D levels
should be 70ng/L or more and sunshine
without sunburn generally improves
mood.
Then one needs to address the
relationship. Some couples can co-exist
during their decades of work and family
responsibilities, but later annoy each
other intensely by standing on each
others toes at home, one following the
other through the activities of daily
living. In retirement Grand-py and
Mam-py have no space to escape from
each other, space and freedom they
needed to survive each other earlier in
life. They might be grumpy because
they make each other so. These are the
incomp-batants. Prognosis variable.
All said and done their grumpiness
might related to being away from
home, living with the irritations and
quirkiness of the Oyds, and having
to suck up their style and pace. But if
you’ll excuse me I’m having a bad day,
too many patients are irritating …. So
who’s next to see Dr Grumpy?
Making the best of this difficult situation...
Date: Friday, 13 November 2015
Time: 9am to 5pm.
Venue:
Translational Research Institute (adjoins Princess Alexandra Hospital)
37 Kent Street, Woolloongabba, QLD 4102 (Brisbane)
Guest speakers include:
Prof David Watters
Dr George Hopkins
Dr Michael Donovan
Register NOW: email qasmseminar@surgeons.org
(note: places are limited for this FREE seminar)
28 SURGICAL NEWS OCTOBER 2015 SURGICAL NEWS OCTOBER 2015 29