Listed cause of death upsets family

DEAR DR. ROACH: My 89-year-old husband died two years ago, and it has been a great sorrow and puzzlement to me and his family that his death certificate listed the cause of death as Lewy body disease.

Yes, he had some dementia for the last two and a half months of his life, when he was in the hospital and then in a nursing home (where he got C-diff), and hospice, where he died.

However, at that time, he had an extremely low body temperature and was taking a lot of medication.

After his death, I asked hospice and our family doctor why such a cause of death was given, and they said that they get their records from the hospital.

They said that there’s no way to put “failure to thrive” or other such causes now, and intimated that something precise has to be stated.

My family and friends have been mystified. My husband was a calm, loving man of good judgment. He never raised his voice or lost his temper, even in the last few months of his life. If he had shown any symptoms of Lewy body, I would not question the cause of death.

All I want is the truth. Can Lewy body be diagnosed before death? Is there such a test? Is it ever possible to have the cause of death changed?

ANSWER: I am sorry you are still in pain after two years, and hope I can help.

Let me start off with explaining Lewy body dementia. Many people have not heard of it, but it is one of the most common forms of dementia, after Alzheimer’s disease.

In Lewy body disease, dementia — especially with early loss of visual-spatial abilities (trouble driving and getting lost are common and early symptoms) — is necessary for the diagnosis.

The dementia routinely gets better and worse, sometimes over seconds, sometimes over days. Symptoms can include drowsiness or naps, staring spells and episodes of disorganized speech.

In addition to the fluctuations in mental ability, sleep disturbances, symptoms that resemble those of Parkinson’s disease and visual hallucinations are now called “core clinical features” of this condition.

People with two or more of these core features are likely to have Lewy body disease. There are new, specialized brain, sleep and heart tests that can support the diagnosis.

Making the diagnosis early is important, since some medications that sometimes are used for people with Alzheimer’s disease (such as haloperidol, often used for severe agitation) are dangerous in people with Lewy body disease.

I don’t have enough information to say whether Lewy body dementia was likely to be present in your husband.

However, I would ask you not to let what is written on his death certificate affect your memory of him. Death certificates are, unfortunately, not always accurate. Dementia often leads to overall body frailty and susceptibility to infections. I would not recommend that you spend your energy worrying about what his death certificate says. Your memories of him mean more. Even if he did have Lewy body disease, the fact that he remained a calm, loving man to the end is the appropriate testament to his life.

DEAR DR. ROACH: I am a 70-year-old senior in fairly good health, but I am losing my teeth and need many implants. I read in a well-known U.S. newspaper and on the internet that full-mouth X-ray can cause brain cancer.

My dentist does not give me a direct answer, and I am afraid. Does the old-fashioned dental X-ray have a lower intensity?

ANSWER: The amount of radiation in a dental X-ray is very, very low. The unit of radiation in this context is the millisievert (mSv), and a regular, old-fashioned bitewing X-ray in your dentist’s office is about 0.005 mSv.

Just walking around in a day, we get about that amount from natural sources. A full-mouth or panoramic dental X-ray is about 0.01 mSv, but that is still less than a chest X-ray, which is 0.1 mSv. By comparison, a CT scan is equivalent to 4,000 or so dental X-rays.

While it is wise to be concerned about radiation from medical procedures, the radiation in dental X-rays is very small, and the risk of developing brain or other cancer is extremely small.

The thought should not keep you from getting the dental work that is so necessary for the quality of life of many people, including seniors. I’d advise taking whatever X-ray the dentist thinks is best.

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