ArcaMax

DEAR DR. ROACH: Why is it that when one sees the doctor, the nurse will take their weight and blood pressure but neglect to take their height? I find this very interesting as height is asked on medical forms when receiving a bone density test, MRI, scan, etc. How is one to know what their height is if it's never taken? Any information you could shed would be very enlightening! -- R.Z.

ANSWER: A doctor, nurse or medical assistant will sometimes ask for a person's height. In my opinion, neglecting to take the height is a mistake. While it is true that height does not change appreciably for healthy young adults, it is often the case that a person does not know their exact height. It is also the case that some people (especially men) exaggerate their height, with studies showing 27% to 90% of men add an average of 2 inches to their height.

When height is critical, such as in dosing some chemotherapy (both height and weight are needed to estimate body surface area, which is how some anticancer agents are dosed), the staff will measure a person's height carefully. But even apart from this, height is an important measurement because a loss of height can indicate a vertebral fracture.

A common saying in medicine is that "vital signs are vital," and height is an often and inappropriately neglected vital sign.

DEAR DR ROACH: I am 89 years old and in reasonably good health, but I am having a very difficult time getting to sleep and sleeping during the night. I've tried a lot of sleep timing options without success. My doctor recommends taking 50-mg tablets of trazodone as follows: a 1/2 tablet daily for the first week, 1 full tablet daily for the second week, 1 1/2 tablets daily for the third week, and 2 tablets daily for the fourth week.

I would really appreciate your advice, including any questions I should ask my doctor. -- J.D.

ANSWER: Although trazodone, a medicine that is often used for depression, is safer than many other medications for insomnia in the elderly, there are still some common side effects. More importantly, a recent review showed no improvement with trazodone in older adults for the time that it takes to fall asleep or the total sleep time, compared to a placebo pill.

Common side effects include feeling groggy in the morning, as well as dry mouth and thirst. What really concerns me is a study showing that over 30% of people who take this drug suffered from a fall. (However, this study was done in long-term care facilities, where people may be more frail than those who live independently.) Side effects are less common at lower doses, which is usually defined as less than 150 mg a day, and the highest dose that your doctor recommended was 100 mg/day.

Because of the potential for side effects (a fall can be devastating in an older person) and a lack of proven benefit, trazodone isn't a good first-line treatment. If it's available, cognitive behavioral therapy for insomnia is a better option for most. If drug treatment is required, expert groups such as the American Geriatrics Society recommend safer options such as low-dose doxepin or a new agent like suvorexant (Belsomra), which still has the potential for side effects, is expensive, but has been proven to be effective in older adults.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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