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5A THE DAILY ASTORIAN • THURSDAY, DECEMBER 17, 2015 Too old for major treatment? Age not always a barrier By LINDSEY TANNER AP Medical Writer CHICAGO — Irwin Weiner felt so good after heart surgery a few weeks before turning 90 that he stopped for a pastrami sandwich on the way home from the hospital. Dorothy Lipkin danced after getting a new hip at age 91. And at 94, Wil- liam Gandin drives himself to the hospital for can- cer treatments. Jimmy Carter isn’t the only nonagenarian to withstand rigorous medical treatment. Very old age is no longer an automatic barrier for aggressive ther- apies, from cancer care like the former president has received, to major heart procedures, joint replace- ments and even some organ transplants. In many cases, the nation’s most senior citizens are getting the same treatments given to people their grandchildren’s age — but with different goals. “Many elderly patients don’t necessarily want a lot of years, what they want is quality of life,” said Dr. Clifford Kavinsky, a heart specialist at Rush University Medical Center in Chicago. “They want whatever time is left for them to be high quality. They don’t want to be dependent on their family. They don’t want to end up in a nurs- ing home.” Treatment for Carter, 91, has included surgery, radiation and a new cancer drug with fewer side effects than traditional chemotherapy. It seems to be working — Carter announced Dec. 6 that brain scans show no signs of the melanoma that was found in August. The nation’s 90-and-up population, about 2 million people, nearly tripled in recent decades, and the pace is expected to continue. Many are struggling with more than one age-related illness that make them poor candidates for aggressive and often costly care. But plenty remain robust enough to give it a try. Lipkin, now 93, had hip replacement surgery two years ago in the Philadelphia area. Arthritis made walking dif¿cult and painful. 6he’d been a good dancer in her younger days, and had tried to remain active, so her doctor recommended the operation. “Otherwise I was going to be in a wheelchair the rest of my life,” Lipkin said. 6oon after, she made a video doing a line dance to show how well she was healing. In the winter, she lives in Florida, walks at least half an hour daily and leads “a normal life.” Lipkin says having such major surgery at her age should be an individual decision. Doctors agree. 6ome 90-year-olds are ¿tter than some 60-year-olds but they say other consid- erations need to be in the mix. At MD Anderson Cancer Center in Houston, the oldest patients are evaluated by geriatricians — specialists in medical care of the elderly — to make sure they’re able to tolerate harsh treatments. Physical and mental health are assessed; so is so- cial support — whether there are family members or friends available to help during treatment and recovery. “We do believe that cancer care should not be limited by age,” said Dr. Beatrice Edwards. While many elderly patients are healthy enough to tolerate conventional treatments, ad- vances including more targeted, less toxic drugs and minimally invasive surgery techniques are opening the door to others. Gandin, the 94-year-old, was diagnosed more than 10 years ago with prostate cancer. Treatment with radiation and chemotherapy failed to stop cancer from spreading to his lungs and bones. He’s now on hormone treatment that he said is Branden Camp/AP Photo Former President Jimmy Carter, right, sits with his wife, Rosalynn, as they wait to pose for photos with guests at Maranatha Baptist Church, Sunday, in Plains, Ga. A recent MRI showing no cancer on Jimmy Carter’s brain is “very positive” news for the former president but will not end his medical treatment, doctors said. Carter, 91, announced last Sunday that doctors found no evidence of the four lesions discovered on his brain this summer and no signs of new cancer growth. ONLINE National Institute on Aging: www.nia.nih.gov Alan Diaz/AP Photo Aortic valve surgery patient Irwin Weiner poses for a photo with his partner, Lauree Gable, Friday, at their home in Boca Raton, Fla. Very old age is no longer an automatic barrier for aggressive therapies, from cancer care, to major heart procedures, joint replacements and even organ transplants. controlling the disease. A retired Exxon Mobil auditor, Gandin helps take care of his wife of 74 years in their assisted living home in Houston and is not ready to give up on treatment. “I’m an eternal optimist — that’s what has carried me through,” he said. Weiner, a retired furniture manufacturer rep- resentative, had a hardened, leaky aortic valve — a common condition in the elderly that can lead to disability and death. Open-heart surgery is a common option for heart-valve surgery, but some doctors hesitate to perform it in the elderly, said Kavinsky, the Chicago heart specialist. Dr. Joseph Lamelas, Weiner’s surgeon at Mount 6inai Medical Center in Miami Beach, Florida, used a newer approach, implanting a new valve through a small incision on the right side of the chest. After four days in the hospital last January, Weiner was back home in Boca Raton, Florida, and was well enough to have two big 90th birthday celebrations less than a month later. Organ transplants are less common but not un- heard of in the very old. 6ince 2013, there have been more than 100 kidney transplants in patients aged at least 80, including one in an 88-year-old, according to the United 1etwork for Organ 6har- ing. Its records show that since 1987, the nation’s oldest kidney transplant recipient was a 96-year- old. There are generally no strict age limits on trans- plants. Dr. Dorry 6egev, a Johns Hopkins Med- icine transplant specialist, said frailty is a more important factor and his center measures it rigor- ously, including assessing patients’ grip strength, walking speed and muscle mass. Ethical issues complicate decisions on provid- ing treatments costing tens of thousands of dollars to the very old and life expectancy has to be con- sidered, Kavinsky said. “When you start doing procedures on a 90-year old, you have someone who has already exceeded the average lifespan in America,” he said. “How far should we go to keep them going?” Dr. Joseph Dearani, chairman of cardiac sur- gery at the Mayo Clinic in Rochester, Minnesota, said a good gauge is whether treatment would like- ly help patients live well for at least another two years. He said costs to the patient, their family and so- ciety also should be weighed, so that treatment is given to right patients, and “for the most part, that happens.” Peter Courtney: Forestry visits Astoria to set rules Oregon on verge of ballot civil war The Daily Astorian By JONATHAN J. COOPER Associated Press PORTLAND — Oregon’s business, union and political interests risk opening a per- manent rift if they don’t come together and negotiate a plan to withdraw contentious ballot measures slated for next year’s election, 6enate President Pe- ter Courtney said Monday. The 6alem Democrat warned that “Oregon is on the verge of its own civil war” pit- ting the state’s most powerful and wealthy interests against each other. “While we may not physi- cally kill one another, the con- sequences of next Nov. 8 could be our version of Antietam,” Courtney said, referring to the bloody Civil War battle. “Po- tentially the bloodiest political day in Oregon’s history.” A group backed largely by public-employee unions has proposed ballot measures to signi¿cantly increase taxes for corporations. Other groups are looking to raise the minimum wage. Various business interests are considering ballot mea- sures to weaken union rights or roll back restrictions on green- house gas emissions. The expensive ¿ght would create “wounds that will be opened and never healed,” Courtney told the annual Or- egon Leadership 6ummit, which brings together business executives, lawmakers and lobbyists. Courtney, who is Oregon’s longest-serving legislative leader, is known for using ¿ery and dramatic language to spur action on the issues that con- cern him. Rather than pursuing multi-million-dollar campaigns over ballot measures, Court- ney encouraged interest groups to come up with compromise ideas that the Legislature could consider in the ¿ve-week ses- sion that begins in February. Last year, then-Gov. John Kitzhaber convinced labor and business interests to stand down from similar contentious ballot ¿ghts they’d planned. Instead of a contentious election, Kitzhaber hoped to broker an ambitious reform of Oregon’s volatile tax system, but he resigned amid ethics questions surrounding his ¿ancpe’s consulting work. Meanwhile, House 6peaker Tina Kotek said business of- ¿cials need to concern them- selves with the state’s rapidly rising housing prices. Parents priced out of their rentals are forced to change their chil- dren’s school, or endure a long commute to take them to and from campus, she said. “Housing affordability is a headwind that we must take on,” said Kotek, D-Portland. “Policy changes and public investments are important, but they will not solve this crisis on their own. We need the pri- vate sector.” The Oregon Department of Forestry visits Astoria Jan. 15 for a public hearing about proposed changes to recre- ation on state forests. The department says de- mand for state forest rec- reation opportunities have outpaced available capacity and resources in recent years, often resulting in conÀicts be- tween users and major issues with sanitation, safety and vandalism. The proposed rule changes include several new rules re- garding commercial events, including permitting, health and safety standards. They also address a number of oth- er topics, including: • Fees for park usage and penalties. • Allowing loaded guns and banning nudity in certain areas. • Public conduct issues such as waste, unattended property, ¿ghting, indecency and weed-free foraging. • 6ervice animals and stock animals, and to address the occupancy of campsites. • How unattended property will be removed. The hearings will also cover proposed new rules for permitting, health and safe- ty standards for large com- mercial events, as outlined in House Bill 2453. The bill came about after several large, unpermitted commer- cial events, such as concerts, raves and festivals drew hun- dreds of attendees and vehi- cles into state forests. The public hearing will be from 6 to 8 p.m. Jan. 15 at the department of forest- ry’s Astoria District Of¿ce at 92219 Oregon Highway 202. For a full list of proposed rule changes, visit http://tinyurl. com/nl6fmzs Written comments on the proposed rule changes may be submitted by 5 p.m. Feb. 8 to odf.sfcomments@oregon.gov or by mail to: Justin Butteris, state forests policy analyst, Oregon Department of For- State of Oregon to match local school bonds The Daily Astorian The state of Oregon will provide matching grants for local dollars for school im- provement efforts through the 6chool Capital Improve- ment Matching program. Communities that pass general obligation bonds to improve local school build- ings will be eligible for matching grants of up to $8 million. The Oregon Legis- lature authorized the sale of state-backed general obliga- tion bonds for this program, which will provide about $123 million overall. The state estimates there is $7.6 billion in deferred school maintenance costs. “Our students need and deserve schools that are safe, healthy, and promote learn- ing,” said Deputy 6uperinten- dent 6alam Noor in a release last week. “This grant program can help communities address critical maintenance needs, upgrade aging buildings, and improve learning conditions for our students. Through le- veraging both state and local resources, we can maximize our impact and remove barri- ers to student success by im- proving our schools.” Districts will have three opportunities to apply for these matching funds. Ap- plications are due before the May and November gen- eral elections through May 2017. The ¿rst round of applications will be accept- ed starting Jan. 15. Grant funding will be contingent on passage of a local bond to improve school facilities. 6ixty percent of funds will be prioritized for dis- tricts with low-assessed property value and a higher rate of student poverty to en- courage poorer communities to support local school bonds. The remaining 40 percent will be available on a ¿rst-come, ¿rst-served basis. The Of¿ce of 6chool Fa- cilities will provide technical assistance grants to districts, helping them conduct assess- ments of their school build- ings. Funding for the grants will be available to districts beginning in summer 2016. W A NTED Alder and Maple Saw Logs & Standing Timber N orth w es t H a rdw oods • Lon gview , W A Contact: Steve Axtell • 360-430-0885 or John Anderson • 360-269-2500 ACCE P T IN G N E W P AT IE N T S As to ria Ch iro p ra ct i c B ARRY SE ARS, D .C. AU TO ACCIDEN TS W ORK -RELATED IN JU RIES D on ’t dela y! Ca ll toda y! 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