ALSO LAST WEEK, A STORY ABOUT SENIOR CITIZENS USING THE INTERNET FAILED TO INCLUDE THE NAME OF THE ILLUSTRATOR, MARTHA C. VAUGHAN. (PUBLISHED 09/07/99)

Last winter, Marian Fischell vacationed in the Grand Cayman Islands with her children and grandchildren, played tennis in Hawaii and cruised from Buenos Aires to Puerto Rico.

She owes her trips to the Internet--but not because she discovered good air fares. She found medical advice there.

Diagnosed for the second time with breast cancer last October, Fischell, 68, had sought recommendations first from her doctor, who outlined two difficult and time-consuming treatment options that would have forced her to cancel her travel plans. She went home and spent several days searching the World Wide Web to find an alternative that would accommodate her lifestyle.

Fischell, a former nursery school teacher from Howard County, is among the growing number of older people who are going outside the physician's office to find cutting-edge treatments and prescription drugs on the Web.

Fischell's generation has been the slowest to embrace the Internet. Only 22 percent of people online are 50 years of age or older, according to an America Online/Roper Starch study published last December. But in anticipation of future generations of computer-savvy seniors, government agencies, health care and pharmaceutical companies, hospitals and physicians are beginning to view seniors as a growing market to attract over the Internet.

"We'd have to be hibernating not to recognize the power of the Internet to convey information more immediately and efficiently than a publication and to allow for instant feedback from its users," said John Eisenberg, a physician and administrator of the federal Agency for Health Care Policy and Research. "Sure, the elderly may be slower to pick up on the Internet, but every piece of evidence I've seen says that many of the elderly are embracing electronic communication.

"Today's elderly are learning how to use the Web, and tomorrow's elderly already know how."

Donald Lindberg, director of the National Library of Medicine at the National Institutes of Health, agreed. "The World Wide Web and Internet is the most efficient telecommunications system the world has ever known," he said.

Lindberg cites June 1997 as a historical marker. That month the library gave the public free Internet access to its medical database, MEDLINE, which consists of millions of records and abstracts from more than 3,500 medical journals worldwide. Within a year, the number of MEDLINE searches grew from a pace of 7 million annually to 75 million, Lindberg said. Now, the level of searching has reached 140 million, and 34 percent of those searches are done by the public, people who are neither doctors nor scientists.

The Internet offers health and medical sites that include research publications, information on government programs, databases, chat rooms, support groups, health insurance company Web pages, advertisers and newspaper and magazine articles.

The amount of information consumers now get online is "an explosion. It's a deluge," said Rob Enelow, an internist who practices in Fairfax. "The number of journal studies and data that comes out exponentially increases more and more each year at a faster rate." It can be difficult to stay on top of all the changes, but by making more information available to patients, they can become full partners in their care, he said.

Too Much Information

Terrie Wetle, deputy director of the National Institute on Aging, said, "There is a tremendous increase in purchases of computers and entry into the Internet by people over the age of 55. A primary reason for wanting to get on the Internet is to get health information."

Of course, there can be a downside to the flood of information. "Our concerns are that the information is not filtered," Wetle said. "Some of the information online is very, very good and some of it is very, very bad, and the question is how do we help seniors to make distinctions. . . .

"The elderly are a particularly sensitive target. They have multiple health concerns and chronic illnesses and they need information. Also, older people today tend to have lower educational levels, and they may be less able to make distinctions between good and bad information."

The task of searching can be overwhelming, especially if, like Fischell, you don't know if what you want exists. Her goal was to find an alternative to the options her doctor had given her. The first option was a mastectomy.

"I had a mastectomy 12 years ago," she said. "When I thought about how long the recovery was for me then, I decided that at this point in my life, I couldn't do it again."

The second option was a lumpectomy, removal of the malignant lump and surrounding tissue. She had that surgery, but her doctor advised that it would require six weeks of follow-up radiation to significantly lower her odds of recurrence. Six weeks of radiation, though, would ruin her vacation plans.

Fischell says that if she hadn't found an acceptable alternative, she would have accepted six weeks of radiation. But as an educated consumer, she wanted to find a better deal.

She began her search simply with two words--breast cancer. For the first two days, she says, "I was just wandering around, and then I began to pick up some thoughts, some ideas. There was a doctor from Oklahoma who was advertising that 'You don't need six weeks of radiation, you can do it in one week.' When I spoke to the doctor, I asked, 'How many have you done?' When he answered, 'About four,' I thought that wasn't for me. I wasn't willing to be a guinea pig."

Fischell also sought advice from a radiation oncologist at Johns Hopkins Hospital in Baltimore who was familiar with clinical trials that used a shorter course of follow-up radiation.

She found a doctor in New Orleans who had treated 150 patients with radiation administered through catheters surgically inserted in the breast. The doctor told her that 50 patients had reached the five-year mark with no evidence of cancer at the original site. This radiation process, called brachytherapy, also is used to treat prostate cancer, but it is still in an experimental stage. Nonetheless, Fischell flew to New Orleans for treatment.

"My husband is a scientist who works with radiation and felt that intellectually, the process of putting radiation inside the breast made sense," she recalled. "The problem was finding someone who had experience in it. When we met with the doctor in New Orleans, we felt confident that he was the person. He had a good reputation."

Although the surgery to implant the catheters caused Fischell a few days of discomfort, brachytherapy was a fast way to deal with her problem. "I feel very positive about this. In the past six months I've been able to live my life the way I wanted to," she said. "I feel like I took control of my life. I have great confidence that this will prevent a recurrence of cancer in this site, and that is what radiation is supposed to do."

Trouble Using the Net

Despite Fischell's success, other seniors have trouble using the Internet. The technology demands acute vision, dexterity and speed skills that can deteriorate as people age.

"One thing that you don't want to do with older adults is present them with too much information at the same time, because they have difficulty ignoring irrelevant information," said Roger Morrell, assistant director of the Gerontology Center at the University of Georgia.

"The way to build a Web site for older adults is to simplify the Web site," he said. "Stop all the blinking stuff and make the icons large enough to see."

Ruth Kettl is 83, and she is definitely not technophobic or intimidated by the limitations her age may present. A retired government worker, Kettl fine-tuned her skills by attending a computer class at the Jewish Council for the Aging's SeniorNet Computer Learning Center in Bethesda. More than 6,000 seniors have taken courses at the center in the past seven years, according to Micki Gordon, director of the council's Center for Productive Aging.

"The computer becomes a friend," Gordon said. "You have the ability to get online night and day. Older people don't sleep as much. Somebody who is alone, who has lost a spouse--who else are they going to be able to talk to at 3 o'clock in the morning?"

Kettl, a widow who lives in Bethesda, bought a computer two years ago, mainly to correspond by e-mail with her children. While searching for health information is important to many older adults, Kettl and other people in her class said they were tackling the technology primarily as a way to communicate with family and friends.

"There's a whole wonderful world out there through the computer," said Kettl. "A phone call doesn't always go through, but e-mail always gets there."

Ed Ruebush is a 77-year-old retired veterinarian from Rockville who got online because "I felt like I was being left out of the world. My grandchildren are going to college. They are more or less computer experts and they hassled me for six months to buy a computer. Now I see the computer is so alive . . . . The social benefits of learning are wonderful."