Boomers cause
for worry?

Obesity and hypertension may turn out to be the undoing of the baby boomers in terms of longevity.  Half of the 54-64 age group of boomers have high blood pressure and two our five are obese.  It is a population that will reach 40 million by 2014.  Will at risk baby boomers make lifestyle changes to stave off increased morbidity and decrease life expectancy?  Can they afford not to?

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An 81 year-old applicant was discovered to have an increased white blood count from a blood test done for minor surgery.  He was diagnosed with leukocytosis (increased white count).  His medical history included hypertension (well controlled) and abnormal lipids (well controlled).  The carrier postponed the case until the applicant had an evaluation of the leukocytosis.

The applicant underwent a work up that discovered abnormal blood findings consistent with chronic lymphocytic leukemia (CLL).  But instead of having a bone marrow to diagnose the disease, he had flow cytometry of his peripheral blood.  Flow cytometry is method of measuring the number of cells in a sample, including their size, shape, and the presence of tumor markers on the cell surface.  This information combined with the clinical findings (firm, enlarged lymph nodes on his neck and no evidence of enlargement of his spleen) led to a stage I CLL diagnosis.

CLL is staged from 0 to IV.  Patients at stage 0 are considered “low risk” and have a median survival of 11 years.  Patients at stages I-II are considered “intermediate risk” and have a median survival of 5-7 years. Stage III and IV are considered “high risk” and have a median survival of less than 2 years.

Because of the applicant’s age and lack of symptoms, “watchful waiting” was the treatment of choice.  That meant that the

applicant would have serial blood counts and examinations to monitor the disease.  Other options could have included:

1. Antibody therapy
2. Chemotherapy
3. Low-dose radiation

After one year, the applicant was doing well with little change in the lymph nodes in his neck and no evidence of enlargement of his spleen.  His white count remained stable below 50,000.  He was issued a life insurance policy.

Bottom Line: Older age brings with it an increased risk for malignancies such as CLL.  What is important about this case is that a persistent elevated white blood cell count, without an obvious cause (i.e. infection), requires further evaluation.  This case also highlights an important new diagnostic tool, flow cytometry.  Lastly, producers need to appreciate that a chronic malignancy can be insurable under the right conditions.  Anther example of this is Non-Hodgkin's lymphoma, which like CLL, is not actually cured but rather can held in pseudo-remission.

One other aspect of this case needs to be appreciated given the aging U.S. population: the age of the applicant.  Applicants age 80 and over have a different time-horizon for how a disease will impact them.  Unlike younger applicants, the discovery of pathologies like CLL will generally not turn out to be the cause of their death.

Heart attack risk could be better shown by their waist-to-tallness ratio (WTR) than by their body mass index (BMI) say German and Austrian researchers. 

Research has shown that abdominal fat may be more hazardous than fat in other areas, such as around the hips.  But simply checking girth doesn’t take proportion into account. 

The upper limit of WTR is calculated by multiplying .55 for men or .53 for women times their height in inches.  For example, a male who is 6’ tall (72 inches) has an upper limit WTR waist size of 40 inches (72 X .55 = 40).  A female who is 5’6” tall

Lyrica (pregablin)

Lyrica is a new medication for the treatment of neuropathic pain.  Like Neurontin, it can also be part of a seizure management program. 

It is a Yellow Medication due to is use with diabetic peripheral neuropathy.  In addition, it is used to treat

postherpetic neuralgia (pain after having herpes zoster), which can be severe and debilitating.

Bottom Line: Neurontin has been an overwhelming success in treating neurological pain.  Lyrica should prove equally successful.  Producers need to remember the possible use of Lyrica with diabetics who are experiencing the complication of pain in their hands and feet.

Male 62, Non-smoker, $5,000,000 Individual Coverage
Height 6’ Weight 220 lbs
Current Medications: Toprol XL, Imdur, Lipitor

The applicant was declined for life insurance due to the use of Imdur following a coronary angioplasty (PTCA).  The PTCA was for a blockage of the LAD (major artery of the left side of the heart).  His medical record contain numerous references to “atypical chest pain” after the PTCA, though cardiac testing did not reveal any new problems.  The applicant refused to discontinue his Imdur.

Discussion: With nearly 900,000 PTCAs done in the United States each year, it is easy to forget that “cardiac events” are trauma experiences that affect patients in different ways.  This applicant experienced severe chest pain described as a “ripping” in his chest that was barely relieved by nitroglycerin and morphine in the ER during the acute phase of his event.  It is not uncommon for patients to develop “cardiac phobia” that can be as debilitating as the underlying condition.  This applicant was asked to undergo a stress-echo test with his cardiologist.  It was normal.  The cardiologist wrote a letter to the home office underwriter indicating that, in his opinion, the atypical chest pain was not cardiac based and the patient’s continued use of Imdur helped the patient address his intense fear of another event.  The carrier reconsidered and issued a life insurance policy.