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ByMarthaRoss BayAreaNewsGroup WhengeriatricianMehr- dad Ayati first met Lee Katz in 2011, he encountered yet another patient — and her spouse — who were in de- spair over the conflicting and contradictory infor- mation they received in her care. The Menlo Park woman was in a downward spiral of multiple chronic conditions that would lead to her death in April 2013 at age 84. But the different special- ists who rotated in and out of her case made things worse, with mix-ups and questionable interventions that took her in and out of the hospital and added to her suffering, husband Mar- tin Katz says. "They didn't know what one another was doing, " says Katz, who is a retired a pharmaceutical researcher and executive. "Then Dr. Ayati appeared on the scene. He started looking at the entire patient, her per- sonal and social history, all her medical problems." Ayati coordinated Lee Katz's care and the infor- mation coming at them from different directions. "He put it all together, " Katz says. What Ayati did for Lee Katz, he is now doing for everyone in his new book, "Paths to Healthy Aging." This "guidebook, " as Ayati calls it, is designed as a con- cise overview of the basic ways people can improve their physical and men- tal health and enjoy life as they age. Focusonprevention Ayati is an assistant professor at the Stanford School of Medicine and treats geriatric patients at the Stanford Medical Cen- ter and the Veteran's Ad- ministration hospital in Palo Alto. He specializes in providing comprehensive care with a focus on pre- vention. With his wife and co-au- thor, Arezou Azarani, who has a Ph.D. in physiology, he synthesizes his experience and the latest research on nutrition, exercise and ge- riatric medicine into a book that emphasizes healthy lifestyle choices. Ayati says those choices can be just as important as cutting-edge medicine in fending off many com- mon complaints, from high blood pressure to sleep dis- orders, from depression to frailty. These choices in- clude eating a balanced diet, exercising regularly, being socially involved and pursuing creative, stimulat- ing activities. Ayati also is a fan of keeping things sim- ple and affordable when it comes to eating better and exercising. People don't need to join expensive gyms or start a strenuous program, he says. "Physical health is achieved by persistent and enjoyableworkouts,"hesays. Keeping it simple Ayati's book similarly tries to keep things simple with how it uses concise ex- planations and short chap- ters to acquaint people with key concepts. "There is so much infor- mation out there, but it's hard to know which infor- mation is valid, " Ayati says. "My goal is to simplify the journey." Ayati loves working with older patients, in part be- cause he was born and raised in Iran, where the culture reveres its elders. "They are considered very sage, are highly re- spected and have a central position in the family and their community, " Ayati says. "Gray hair is consid- ered an asset, and the day you get your first gray hair, you don't dye it — you brag about it." Unfortunately, he works in a specialty facing a short- age of experienced practi- tioners. About 80 percent of adults 65 and older, require care for chronic conditions. To meet their needs, the United States would need about 17,000 more geria- tricians, according to the American Geriatrics Soci- ety. When students show an interest in geriatrics, Ayati gives them all the encour- agement he can. One thing he especially likes about ge- riatrics is that doctors are encouraged to spend much more than just 10 minutes with patients, who typically have a complex set of med- ical issues. For Ayati, some of that time is spent just talking to patients and learning their work and family his- tory and how the live. "I learn a lot from my ge- riatric patients, " he says. Conversational style Ayati uses that same con- versational approach in his book to correct misconcep- tions, including his view that people should stay away from nutritional and vitamin supplements unless a doctor has found a seri- ous deficiency that needs to be addressed. Taking too much vitamin D, for exam- ple, can be toxic, he says. Generally, people can get all the nutrients they need by eating a balanced diet. Ayati devotes a chapter to the problem of over medi- cation, because he has seen too many patients suffer- ing the ill effects of taking drugs they don't need. Sometimes misdiagnosis can lead to the "drug cas- cade syndrome, " where doctors pile on medications to treat the side effects of other medications. He recalls one patient who ended up in a skilled nursing facility after fall- ing at home and breaking his hip. This downward spi- ral started sometime earlier when the man went to see his primary care doctor for depression. The doctor prescribed anti-depressants, but failed to get to the root cause of the depression. The man had restless leg syndrome, which caused him to lose sleep and go through his days exhausted, unable to concentrate or remember things. The anti-depressants didn't alleviate his depres- sion. They only made his leg cramps worse, so he lost more sleep. He became disoriented and fell, break- ing his hip. By weaning him off the anti-depressants and treating the restless leg syn- drome, Ayati was able to help the man fully recover from both his hip injury and his depression. Finding help The last chapter of Aya- ti's book offers tips on how to find a geriatrician, which he knows can be a daunt- ing task. He points out that most patients don't need to see a geriatrician too often, sometimes just once a year. After his wife died, Mar- tin Katz, 87, signed Ayati as his geriatrician. The two have also become friends, with Katz endorsing Ayati's book and its tips for healthy aging. Katz says he is in excel- lent health and admits he is "genetically blessed." Despite his background in pharmaceuticals, Katz shares Ayati's belief that less is better when it comes to drugs. Katz may be one of Aya- ti's model patients, eating right, exercising regularly and staying active. Katz be- longs to two senior centers that provide wonderful "so- cial interaction, friends and activities." Most importantly, he has "an avocation." He has taken up sculpting, and this artistic endeavor keeps him physically active, chal- lenges him mentally and constantly introduces him to new people. He began learning to sculpt in the early 1990s, even before he retired. He had never thought of him- self as artistically inclined; he was just curious. Many workshops and classes later, he has launched a second career as a professional artist. "I dreaded seeing those retired guys following their wives around at the super- market, " he says. In late October, he un- veiled his newest bronze work, "Kaddish, " at Con- gregation Beth Am in Los Altos Hills. Long before meeting Ayati, he put into practice one of Ayati's favorite tips: He signs up for classes. "My mantra is, if you don't join a class, you're not going to do it, " Katz says. "I tend to be a Type A, highly motivated, but with all that self-motivation, if I'm not signed up for a class, and unless it's on my calendar for 9 a.m. Thursday, I'm not going to do it." LIFESTYLES AGINGBETTER PHOTOSBYPATRICKTEHAN—BAYAREANEWSGROUP Dr. Mehrdad Ayati's new book, 'Paths to Healthy Aging,' is a step-by-step guide for older people on how to age in a healthy way. Doctor'sbookoffers ways for seniors to improve physical, mental health Below are prescriptions for mental and physical health from Stanford geriatrician Mehrdad Ayati in his book "Paths to Healthy Aging." available at www.pathsto- healthyaging.com. • Avoid trendy and drastic diets or exercise programs, especially rigorous programs you won't stick to. • Vitamins aren't necessary unless a doctor identifies a deficiency, and be wary of nutritional supplements. You can generally get all your nutrients through a bal- anced diet of mostly whole, organic foods; limit your intake of canned, frozen or instant foods, as well as alcohol and caffeine. • Find a hobby, or sign up for a class. Trying a new subject or activity can challenge you mentally and physically. • Don't just hang out with seniors; find ways to spend time with people of all ages. • Keep in touch with your network of friends. • Find a geriatrician. While there is a shortage of geri- atricians, you won't neces- sarily have to see one o en. This specialist will offer care that is comprehensive and focuses on prevention. TIPSFORHEALTHYAGING Martin Katz with his sculpture, 'Kaddish,' at Congregation Beth Am in Los Altos Hills. He lives up to the principles Ayati discusses in his book. By Marilynn Marchione The Associated Press Stroke experts are re- porting a major advance: Stents similar to the ones used to open clogged heart arteries also can be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled. Patients treated with these brain stents were far more likely to be alive and able to live indepen- dently three months after their stroke, doctors said Wednesday at an Ameri- can Stroke Association con- ference in Nashville. The treatment was so success- ful that three studies test- ing it were stopped early, so it could be offered to more patients. One study also found survival was nearly twice as high for those given the treatment. "This is a once-in-a-gen- eration advance in stroke care," said the head of one study, Dr. Jeffrey Saver, stroke chief at UCLA. An independent expert, Dr. Lee Schwamm of Mas- sachusetts General Hospi- tal, called it "a real turn- ing point in the field." For many patients, "this is the difference between return- ing home and not return- ing home," although only certain types of patients can be offered it, he said. Stroke care "needs to be completely changed" to make the treatment more widely available, said Dr. Walter Koroshetz, acting director of the National In- stitute of Neurological Dis- orders and Stroke. "This has taken stroke therapy to the same place that heart attack therapy is now," he said. Most of the 800,000 strokes in the U.S. each year are caused by a blood clot lodged in the brain. The usual treat- ment is clot-dissolving medicine called tPA. When that doesn't work, doctors sometimes try devices pushed through blood ves- sels to pluck out the clot, but several studies found they didn't help. However, newer devices — metal mesh cages called stent retrievers — open an artery much faster and with less damage to the blood vessel. Unlike heart stents, which stay in place to prop the artery open, the brain stents flatten the clot, trap it and are re- moved with it. Two brands are sold in the U.S. — Trevo, made by Stryker Corp. of Kalama- zoo, Michigan, and Soli- taire, made by Covidien, now part of Minneapo- lis-based Medtronic Inc. They won approval in 2012 based on their ability to re- move a clot — not because there was evidence they made patients better. Some people who got them had dramatic re- sults. Don Sadoway, 64, a chemistry professor at Massachusetts Institute of Technology, was having a holiday lunch on Dec. 23, 2012, at a Boston res- taurant when he suddenly found he couldn't lift his wine glass for a toast. His wife was perplexed. "I said something unin- telligible to her and all of a sudden my right side col- lapsed," he said. Doctors at Massachu- setts General gave him tPA but it didn't work, so they tried a Solitaire stent. "Two hours later I was sitting up, talking to my kids," said Sadoway, who is fine now except for small problems with memory and fine motor skills. Last fall, the first solid evidence that these de- vices helped patients ar- rived. A study in the Neth- erlands that tested a va- riety of clot removers, mostly stents, found these treatments greatly lowered the risk of disability in pa- tients whose clots were not dissolved by tPA. HEALTH Brain stents show promise for some stroke patients Highlights • A study Saver led in the U.S. and Europe on 196 patients found 60percent of those treated with a Solitaire stent were free of major disability versus 35 percent of those given just tPA. Covidien sponsored the trial. • A study led by Australian researchers of 70patients found 71percent of those given a Solitaire stent were free of major disabil- ity versus 40percent of those given tPA alone. The Australian National Health and Medical Research Council and others paid for the trial. • A study led by Canadian doctors of 316patients found 53percent treated with a stent or other clot- removing devices were free of major disability versus 29percent of those given just tPA. Ten percent of patients given both treatments died versus 19percent of those given just tPA. Covidien and others paid for the study, and some study leaders have financial ties to the companies. The Canadian and Austra- lian studies were published online Wednesday by the New England Journal of Medicine. Stent treatment is not for everyone, and it won't help people who had a stroke some time ago. It is not known if stents would help people not given tPA first, or those who seek help too late to get it. 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