470 posts categorized "Health"

Modern-Day Phossy Jaw and Osteoporosis Drugs

Today's post is a good deal lengthier than usual but I believe it's worth it. I hope you think so.

Like many people about my age (76 now), it did not occur to me when I was young to question my physician. If he or she said this pill or that treatment was good for what ailed me, I believed, I followed the instructions.

Life goes on and things change. For many years now, when I am unfamiliar with drugs, treatments and therapies that are recommended, I do the research first. You probably do that too.

Here is a personal story about how important this can be.

THE HISTORY
In the 19th and early 20th century, phosphorus necrosis of the jaw was a deadly condition particularly affecting people who worked in the matchstick industry (often children and young women) as a result of their exposure to yellow (now called white) phosphorus.

It was a horrible disease, eating away teeth and jawbone before, if left untreated, moving on to brain damage, organ failure and death. Not that the treatment was all that helpful. It largely involved removal of the jawbone which made eating difficult and patients then sometimes died of malnutrition.

The popular name for this disease, in England, was phossy jaw and it generally disappeared when, in the early 20th century, phosphorus matches were outlawed in most countries of the world.

Then, a century later, this:

But how can someone younger than me
have osteoporosis, and sit
googling up a substance that might
help it, or give her phossy jaw?

That is from a contemporary poem (2013) titled Match Girl by British poet, Fleur Adcock, indicating, with the reference to osteoporosis, that phossy jaw has returned to plague some people in the 21st century who use a certain prescription drug.

The only reason I know this is that I have lately been “googling up a substance that...might give ME phossy jaw.”

THE DIAGNOSIS AND PRESCRIPTION
A couple of months ago, after a bone scan, my physician noted that the results indicate that I have osteopenia (early osteoporosis) and would benefit from taking a certain bisphosphonate drug.

If you don't know that word, you undoubtedly know some of the brand names of bisphosphonates that are ubiquitously advertised in magazines and on television: Fosamax, Boniva, Actonel and less frequently, Aclasta, Aredia, Binosto, Didronel, Reclast and Zometa among a few others most of which have generic counterparts. They are common treatments for osteoporosis.

Brand name bisphosphonates

The doctor continued. Among a long list of lesser side effects, he said, between one and six percent of patients using these drugs suffer osteonecrosis of the jaw - that is, phossy jaw which is also known in the medical community shorthand as ONJ.

Even though I had not yet learned the nickname “phossy jaw,” the more medically correct designation, osteonecrosis (bone death), was frightening enough when I heard it that even without yet knowing details, I declined the prescription that day, telling the doctor I would do some homework and get back to him.

For something as ghastly as phossy jaw, one to six percent possibility does not strike me as insignificant. And there is the pesky chance, too, of spontaneous femur breakage that can result from bisphosphonate usage that the doctor had not mentioned.

THE RESEARCH
Once again, thank you Tim Berners-Lee for inventing the internet. I cannot imagine how I could have tracked down all the information I wanted without it and it took only a couple of hours to amass enough for a good overview of osteoporosis treatment.

Among the statistics for bisphosphonates is the warning that “invasive dental work” apparently increases the incidence of phossy jaw.

Invasive dental work. You might recall, as I mentioned in February, that for more than two years I have undergone tooth extractions, procedures to grow new bone in my jaw, subsequent dental implants and an over-denture.

There is no question all that qualifies as “invasive” so I emailed my dentist who is also a bone and implant specialist. He wrote back:

”I would like to chat about this with you - very complicated answer...Bottom line - my answer is no way - you grew great bone during our treatments.”

Later, we spoke on the telephone for more than an hour. I got a terrific education in bone growth and phossy jaw, and he reiterated that my new bone growth was "exceptionally successful."

Osteoporosis

He also believes that physicians overprescribe bisphosphonates to women 70 and older (far fewer men are at risk for osteoporosis) and that everyone should be asked if they have had or are expecting to have invasive dental work before deciding on the drug.

Back on the internet, I tracked down some statistics on bisphosphonate (BP) prescriptions (it isn't easy to find). As of 2014, there were 46.2 million women in the United States age 65 and older. According to the U.S. National Institutes of Health,

”...an estimated 30 million BPs prescriptions are written every year in the United States alone, and more than 190 million prescriptions are written annually worldwide.

There is no information about how those prescriptions are counted but even if they are off by a few million, somewhere in the vicinity of 65 percent of the affected age group with scripts for bisphosphonates seems wildly excessive to me.

Statistics on the incidence of bisphosphonate-related phossy jaw are even harder to come by. The apparent standard that is widely quoted - 1 in 100,000 for oral bisphosphonate and 1 in 10,000 for intravenous bisphosphonate - is sketchy.

There have been no randomized, controlled trials of long-term use of bisphosphonates (commonly prescribed for a five-year span) so claims for their safety in regard to phossy jaw are indeterminate, whatever drug companies claim.

In a paper about bisphosphonates and the risk of osteonecrosis of the jaw, the British Journal of Medical Practitioners published what is the smartest list of recommendations for all medical and dental practitioners I have seen in all my research. Before beginning a bisphosphonate regimen,

”All patients should undergo a routine dental exam to rule out any dental source of infection.

“All medical practitioners also should perform a baseline oral exam.

“Invasive dental or/and oral surgical procedures should be completed before initiating therapy.

“Practice preventive dentistry, involving procedures such as oral prophylaxis, dental restorations, and endodontic therapy, and check dentures for irritational foci.

“Schedule routine follow-up every 3 months to check for any signs of developing ONJ (osteonecrosis of the jaw).

“The risks associated with oral surgical procedures such as dental implants, extractions, and extensive periodontal surgeries must be discussed with the patient and weighted against the benefits.”

The only recommendation I question is the one about completing invasive dental work before initiating therapy because the researchers tell us in the same breath to schedule dental followups every three months after use of bisphosphonate treatment begins, strongly implying that they believe there can be continued risk of phossy jaw after dental work is finished.

There are breathtakingly long lists of other side effects ranging from sniffles to phossy jaw and broken thighs for all the bisphosphonate drugs. You can find good side effect information for brand name drugs at drugs.com or rxlist.com.

Some pharmaceutical companies that produce brand name bisphosphonates try to play down the possibility of phossy jaw and spontaneous thigh fracture by saying that occurrences are “rare.” But there are no definitive statistics and "rare" depends entirely on a patient's characterization of the word, not the drug company's.

THE DECISION
Bisphosphonates slow bone loss, strengthen bones to a degree that helps prevent further weakening and people who take a bisphosphonate are less likely to break a bone (well, if you don't count those thigh breaks that are associated with the drug).

I understand all that. I also understand that when old people break a bone, they often do not recover well or at all in too many cases, which are good reasons to think hard about this class of drugs for osteopenia and osteoporosis. (They are also used to treat certain cancers and Paget's disease.)

Osteoporosissymptoms

Nevertheless, even though I have been diagnosed with osteopenia, I have declined the drug and it was the recent dental work along with my dentist's strong caution that tipped the scales for me.

According to an article by respected science and medicine reporter, Gina Kolata, in The New York Times last year, I am not alone:

”Reports of the drugs’ causing jawbones to rot and thighbones to snap in two,” she wrote, “have shaken many osteoporosis patients so much that they say they would rather take their chances with the disease.

“Use of the most commonly prescribed osteoporosis drugs fell by 50 percent from 2008 to 2012, according to a recent paper, and doctors say the trend is continuing...

“Lawsuits over the rare side effects resulted in large jury awards and drew widespread attention.”

The decision about use of any risky drug is entirely personal, dependent on diagnosis, other medical factors, a thorough discussion with one's physician and on personal inclination. I can easily imagine, if my bone density were worse than it is now, making the opposite decision.

Many people, undoubtedly millions of them, have been saved from the worst effects of osteoporosis due to bisphosphonate drugs and god knows I am not lobbying against their use. However, what strikes me about these particular drugs is that it is mostly old people who need them and old people usually have a lot more invasive dental work than younger people.

Yet, I had to find out about the possible connection between bisphosphonates and phossy jaw only because that word "necrosis" my doctor uttered, went off in my head like a fire alarm. Bone death is worth paying close attention to.

So. All potential adverse effects should always be clearly made to patients, and we patients should always be ready with questions when a recommendation is something with which we are unfamiliar.

Although my doctor mentioned osteonecrosis, he was dismissive of the one to six percent chance of it occurring - “only,” he said of the gamble. He may believe those numbers are negligible but that is a personal calculation, different for each of us.

I'm not blaming him for not mentioning the dental work connection. Doctors cannot possibly keep up with every contraindication for every drug. But I'm sure happy that word “necrosis” leapt out at me when he was speaking or I might not have “googled a substance that might lead to [modern-day] phossy jaw” and that important discussion with my dentist who has more experience with the results of the drug than most internists would.

[NOTE: I have left off photographs of phossy jaw (osteonecrosis of the jaw, ONJ) in this report because they are really gruesome. If you are interested, here is a link.]


A Creepy Vampire Story About Anti-Ageing

UPDATE 1:30PM: I just noticed that the 3 April edition of The New Yorker has a story on this topic titled, "Silicon Valley's Quest to Live Forever," written by Tad Friend. If you have access to the magazine online, you can read it here.

* * *

It's pretty hard to go wrong investing in anti-aging products. According to a report released in 2016 by Zion Market Research of Sarasota, Florida:

”...global demand for anti-aging market was valued at USD 140.3 billion in 2015, is expected to reach USD 216.52 billion in 2021 and is anticipated to grow at a CAGR [compound annual growth rate] of 7.5% between 2016 and 2021.”

In case, like me, you wonder what the “anti-aging market” products actually are, Zion Market Research supplies a handy list of some of the most common ones:

Botox
Anti-Wrinkle Products
Anti-Stretch Mark Products
Anti-Pigmentation Therapy
Anti-Adult Acne Therapy
Breast Augmentation
Liposuction
Chemical Peel
Hair Restoration Treatment
Microdermabrasion
Laser Aesthetics
Anti-Cellulite Treatment
Anti-Aging Radio Frequency Devices

And that doesn't begin to cover the products and services that fall into categories that sound like science fiction.

Cryogenics, for example – freezing your body or even just your head to be defrosted later when, presumably, new techniques will give you additonal life although I always wonder what people who chose only to freeze their heads would do for a body to go with it.

Aubrey de Grey, a well-known British computer scientist and age researcher believes that in the not-too-distant future, medical advances will stop aging in its tracks.

Several technology billionaires are spending a lot of their money on research intending to end death entirely. Google has backed a project called Calico with the ambition of “curing death.”

As the Washington Post reported two years ago, Peter Thiel, the billionaire co-founder of Paypal

”...and the tech titans who founded Google, Facebook, eBay, Napster and Netscape are using their billions to rewrite the nation’s science agenda and transform biomedical research.

“The entrepreneurs are driven by a certitude that rebuilding, regenerating and reprogramming patients’ organs, limbs, cells and DNA will enable people to live longer and better.

The Washington Post also reported that Oracle founder Larry Ellison

”...has proclaimed his wish to live forever and donated more than $430 million to anti-aging research. 'Death has never made any sense to me,' he told his biographer, Mike Wilson. 'How can a person be there and then just vanish, just not be there?'”

Ellison says outright what other tech billionaires don't quite say aloud, that they are really looking for immortality and some of them are convinced their money will actually purchase it for them.

I'm not going anywhere near the moral, ethical and philosophical questions that raises.

Instead, after all that background, I want to tell you about the creepiest anti-aging project in existence, something I can only think of as the Vampire Project. As so much medical research does, it started with mice.

Mice

Two years ago, Nature reported how some scientists were rejuvenating old mice with the blood of young mice in a procedure called parabiosis:

”By joining the circulatory system of an old mouse to that of a young mouse, scientists have produced some remarkable results. In the heart, brain, muscles and almost every other tissue examined, the blood of young mice seems to bring new life to ageing organs, making old mice stronger, smarter and healthier. It even makes their fur shinier.”

Or so it seemed and it is not a stretch to imagine, if this research is successful, young people selling their blood to rich old folks because it certainly would not go cheap.

Farfetched? By last fall, this was reported in Time magazine:

”In the new study, the scientists created a way to exchange the blood of young and old mice so that the mixture was 50-50. They found that old mice had some improvements in muscle repair and liver fibrosis, but young mice experienced worsened cell formation in the brain and impaired coordination, and the declines happened rapidly.

“'The big result is that a single exchange hurts the young partner more than it helps the old partner,' says study co-author Michael Conboy of UC Berkeley. 'That means the negative stuff in old blood is more potent and overriding than the good stuff in young blood, at least in the short term.'”

Mouse rejuvenation

That sounds like it would put a crimp in the young/old blood transfusion theory of immortality but we would be wrong. At a private clinic called Ambrosia in Monterey, California, right now people can pay $8,000 to have blood plasma from teenagers and young adults pumped into their veins.

Ambrosia owner, Jesse Karmazin says that

"...within a month, most participants 'see improvement' from the one-time infusion of a two-liter bagful of plasma, which is blood with the blood cells removed,” MIT Technology Review reported in January.

Of course, there is a big difference between studies with plasma and studies with blood and MIT has strong reservations.

”Several scientists and clinicians say Karmazin’s trial is so poorly designed it cannot hope to provide evidence about the effects of the transfusions. And some say the pay-to-participate study, with the potential to collect up to $4.8 million from as many as 600 participants, amounts to a scam...

“Over the last decade or so, such studies have offered provocative clues that certain hallmarks of aging can be reversed or accelerated when old mice get blood from young ones. Yet these studies have come to conflicting conclusions.

“An influential 2013 paper in Cell showed that a particular component in young blood, GDF11, increased muscle strength, for example, but other researchers could not replicate the finding.”

There is a lot more science explanation in these articles than I've subjected you to but if you are interested, follow the links above. And there is more here and here and here

Mainly, I am interessted in the elitest conceit of a bunch of billionaires who fund these vampire projects for their own ends when their almost unlimited resources could be put to such great good uses in the world. Here's a video about one of these guys who ran for president last year.


Travel While Old (and Resistance Notes)

[EDITORIAL NOTE: These travel complaints have been on my mind for a couple of weeks but they aren't wildly important unless you feel as I do. The Resistance Notes at the end are important.]

Greece2

During my working life, I traveled a lot, sometimes hopping on a plane at a moment's notice to go across the country or across an ocean. I loved visiting places I'd only read about or seen in movies and the airlines, in those days, made getting there and back a pleasant, even glamorous, experience.

The 1970s and 1980s were prime time for airline travel. Plenty of room even for people with long legs, reasonably good meals served hot (even special ones if you ordered ahead), aisles wide enough that you could get up and stroll around to stretch your legs without banging into people who were napping.

Remember 747s? The middle rows were five seats wide and when I was traveling between Los Angeles and New York, there were often a few that were entirely empty so I used one as a full-length bed and slept the whole way. No objections from the flight attendants who even gently woke me when it was time to buckle up again for landing.

Best of all, the price was the price. Whatever was quoted to you was what you paid. No surprise charges for an aisle or window seat or food or checked baggage or carry-on items or, maybe soon, oxygen.

Unless you can afford first class, air travel has become torture and I don't think I need to recount all the ways it is now made so terribly difficult, even painful.

Full-aircraft-xlarge

Therefore, I was surprised to read the results of an AARP survey about baby boomers' travel plans for 2016:

”Most respondents (97%) planned at least one domestic trip and nearly half (45%) planned international ones,” reports Irene S. Levine in MarketWatch (reprinted from Next Avenue).

“While most research about over-50 travelers focuses primarily on boomers, data on the Silent Generation (those born between 1925 and 1945) suggests that with improved health and increased longevity, these folks, too, are opting to travel...”

[DISCLOSURE: Ms. Levine interviewed me for this travel story.]

The report goes on to discuss how boomers are willing to spend more money than younger people to avoid hassles, they demand better service, plan trips far in advance and are intent on checking items off their bucket lists, among other changes from their youth.

Bora-Bora

From the quotations in the article, they are gung-ho about getting out and about to seeing the world as often as possible by air.

“We take ourselves less seriously because we have lost loved ones and realize what really is important in life.”

“Life is unpredictable and I think we need to do as much as we can while we can.”

“Loving every minute of travel even when it isn’t so great. Aren’t we lucky to be able to go?”

Well, not me. Can it be that I am alone in finding being crammed into a plane seat that doesn't accommodate even my five-foot, two-inch size? Or enduring flight delays of many hours (happened on my last three flights in a row with the worst food on earth at airports)?

Crowded-terminal_Editorial

How about the literal mile and more that must be walked between flights? Worse, once you finally get to the gate, you find it's been changed to another gate half a mile from where you are standing and none of those little jitneys airports used to have to carry people from here to there are anywhere to be found.

I've turned into such an old fart that it's just too much work to contemplate a plane trip and because there isn't anywhere I want to go that isn't at least six hours from where I am, it's a full day trip when you count to and from airports which means I'll be exhausted for at least a day after I arrive.

In addition, there is something else in play that I haven't entirely worked out. I just like being home. We have mentioned here that even after too many social engagements in a row (in my case, two days worth does it), we need some down time to recharge.

For me, it's not just dinner with friends or a meeting or other kind of gathering that psychically exhausts me. Being in the vicinity of hundreds of other people for several hours, even if I don't know them or speak with them, is exhausting. I don't entirely understand but it seems to be related to the normal hubbub of being surrounded by a huge group.

Or not. I haven't sorted that out yet but the bottom line is that I'm quite happy at home and my nearby environment. And I'm amazed, given those AARP statistics, at how many people put up with what I find too odious to suffer through.

What do you think?

* * *

RESISTANCE NOTES
There is a lot going on in Washington, D.C., enough to give me a major headache AND heartburn. Here are two items that I'm sure you're aware of.

First Item: Tomorrow, unless the Republicans change their mind, the full House of Representatives will vote on Trumpcare. Or, as it is more formally known, The American Health Care Act (AHCA).

The bill devastates Medicaid, harms people age 55-64 in other ways too and undermines the financial stability of Medicare. You'll find more detail about all that at this two-page Justice in Aging fact sheet [PDF].

It would be a good thing for you to call your representative today and tell him or her what vote you prefer.

Second Item: Last week President Donald Trump released his budget plan but it's not his alone. The budget contains many of the cherished draconian dreams of Republicans.

Instead of me, let's have John Oliver, host of the HBO show, Last Week Tonight, tell you about the bill's troubling priorities:


Hot Flashes and a Resistance Note

EDITORIAL NOTE: If you are a guy or a woman who's not interested in this topic, scroll down past it for today's Resistance Note.

At first I rejected this topic when a reader suggested it. Most women who read this blog are well past that annoying life event but “Jessie” kept pestering me so I looked into it. Surprise, surprise.

The most common age range, the experts tell us, that women experience the beginning of menopause is between 48 and 55. That it lasts up to ten years or so means a lot of TGB readers may be sweating through this week's east coast blizzard.

It shocked me at age 42 when the doctor told me my period was three weeks late because menopause had begun. My reaction was one part relief that I wasn't pregnant and one part, ”Wha-a-a-a-a-a-a-t? At my age?”

Okay, I was a little young for it but obviously it's not something I could control so I moved on. We've discussed this before but “Jessie” said it was worth redoing, so here goes – on the menopause subtopic of hot flashes.

Hot-flashes1

Here's a piece of useless information about it from medicinenet:

“About 40% to 85% of women experience hot flashes at some point in the menopausal transition.”

With a range 45 percent, that tells us nothing. And i'm probably not the person to consult. I know only three or four things – anecdotes, actually - about hot flashes that may or may not be widely pertinent:

  1. It is AMAZING that your body can go from dry to soaked in under a minute. That's impressive. It frequently happened as I was just finishing my makeup before work while also soaking my hair. So I began my morning routine all over again with the hair dryer.

  2. I learned to keep a beach towel in bed with me so that when night sweats woke me, soaking the sheets, I could roll over onto the towel and go back to sleep on a dry surface.

  3. My mother dyed about 10 pieces of lace, each to match the color of a sweatshirt. She sewed the lace pieces onto the shirts, an elegant solution which became my standard top under suit jackets for work so that when I broke out in a sweat, the shirts soaked it up without showing much. My mom could be quite clever sometimes.

Real_women_dont_have_hot_flashes_they_have_power_surges_sign

During that period of hot flashes, I had a first appointment with a new gynecologist, a highly respected woman who also taught at the one of the top medical schools in New York City.

After the exam, she said she would prescribe HRT (hormone replacement therapy) to ease my hot flashes. I declined, citing a recent, widely-noted study about risks of various cancers connected with HRT.

The doctor argued with me, even raising her voice. I explained I didn't believe a few sudden sweat episodes were worth risking cancer. She argued. As I left her office, she said to me – I have never forgotten: “You'll be sorry when your face gets wrinkled before its time.”

So here I am decades later all wrinkly in the face and elsewhere but (knock wood) cancer free so far. It's a crap shoot what causes cancer in one person and not another but this a tradeoff I would make again in a – well, New York minute.

Maxinehot-flushes-sat

A lot of women complain about hot flashes but fewer are using HRT rhese days. And really – the hot flashes are only an inconvenience, not life-threatening and personally? I found them kind of funny.

The Mayo Clinic has a smart, easy section about hot flashes. (Hint: they don't mention the vinegar, secret herbs, teas, vitamins and supplement “cures” some people suggest.)

What's your experience?

* * *

RESISTANCE NOTES – OLIVER ON TRUMPCARE

(To catch up newcomers, Resistance Notes is an occasional section appended to the main story of the day to help keep track of what happens, these days, at such high speed in Washington. Even large news organizations are having trouble keeping pace so what's a little one-women website supposed to do?

The answer is now and then when the day's topic relates to ageing but I want to pass on some short, resistance-related information, I will post it here at the bottom of the main story. Extraordinary times require extraordinary measures.)

Today it is the most recent main video essay from John Oliver on his Saturday HBO program, Last Week Tonight, about the American Health Care Act (AHCA) this week.

Colbert doesn't hit a home run every week but it happens more often than not and when he does, it is magnificent. For me, it is a crime to wait seven days to show it to you as I usually do.

So here is the brilliant analysis of Trumpcare from John Oliver and his crew – serious and funny all at once, as they are so good at doing.


Elders and the Republican Healthcare Plan

EDITORIAL NOTE: This is a busy week for me so I'm writing this on Wednesday. God knows what will happen regarding the new healthcare plan by Friday morning when this is posted to TGB. If anything important changes, I'll try to update it but no promises.

* * *

Healthcare introduction

The ACHA, also known as the American Health Care Act (or Ryancare or Trumpcare if you prefer) released on Tuesday hit a firestorm of criticism from everywhere. That includes, according to ABC News,

”...AARP, the House Freedom Caucus, GOP senators including Rand Paul, Mike Lee and Ted Cruz, Heritage, the Club for Growth, tea party groups and even, yes, Breitbart News.”

In some circles, it was scorned as Obama Lite and that the “Obamacare cure is worse than the disease.” Other responses as reported in mainstream news media:

”Ryan disappoints his friends with Obamacare replacement bill. Close allies in conservative policies circles found little to love with the GOP's health care proposal.” (Politico)
”The GOP’s plan guts the Medicaid expansion, defunds Planned Parenthood, and sunsets a federal rule that requires that qualified insurance plans cover things like mental health care, maternity care, and pediatric dental and vision care, among other things.” (The Daily Beast)
”If you’re poor, you will not have the money to pay the premium, leaving you without insurance." (Newsweek)

And don't think that if you are 65 or older and a Medicare beneficiary that it doesn't affect you. As Social Security and Medicare/Medicaid expert, Nancy Altman, explains

”Seniors aged 65 and over, as well as people with serious disabilities, rely on Medicare for their basic health insurance. That program will be seriously weakened if the Republican plan to gut the ACA is enacted. It is estimated that Medicare’s revenue will drop by $346 billion.

“The Republican bill to repeal the ACA drains Medicare to gives tax breaks to wealthy Americans and corporations. In fact, even before Republicans pass a so-called 'tax reform bill,' this bill’s giveaway amounts to a whopping $525 billion tax break for the wealthiest among us.”

There is little doubt that the $346 billion drain on Medicare revenue would negatively affect these items that, with the passage of Obamacare, came into being for Medicare:

  • the ongoing reduction of the donut hole in the Part D prescription drug program

  • annual wellness visits without a copay

  • free annual flu shot

  • the extension of Medicare solvency to the year 2029.

The many TGB readers not quite old enough for Medicare would be hit particularly hard if this new healthcare bill is passed. Vox reports:

"In general, the impact of the Republican bill would be particularly severe for older individuals, ages 55 to 64. Their costs [of annual premiums] would increase by $5,269 if the bill went into effect today and by $6,971 in 2020. Individuals with income below 250 percent of the federal poverty line would see their costs increase by $2,945 today and by $4,061 in 2020."

Which brings us to effects of Medicaid changes in the bill. The estimable Nancy Altman again:

”The GOP’s bill, if enacted, will place caps on Medicaid spending, again shifting costs away from the federal balance sheet and to the balance sheets of states and individuals.

“If that is enacted, seniors needing long term care and their families may find themselves out of luck, since nursing home care is extremely expensive. It is estimated that the typical annual cost of a semi-private room in a nursing home is $80,300. Very few families can afford that huge cost on their own.

“And the impact on seniors not yet 65, and so, not yet on Medicare, will be the harshest of all. They will have more difficulty obtaining insurance and will face higher health care costs if this legislation is enacted and implemented.”

On Tuesday, the Chicago Tribune reported that Tom Price, Secretary of the Department of Health and Human Services and a physician,

”...would not commit to reporters that consumers would be able to keep their current doctors if the plan were passed, whether it would provide insurance at a lower cost, or that it would not add to the nation’s deficit. On each point he said simply that those were the administration’s goals.”

Of course not because no one knows, least of all writers of the bill. It was not been submitted to the Congressional Budget office for scoring, as is customary for any new bill.

Republicans, who control both the House and the Senate, expect Congress to vote on the bill by mid-April. President Trump supports it even though, as quoted by the Washington Post, he said in January:

“'We’re going to have insurance for everybody,' Trump said. 'There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.' People covered under the law 'can expect to have great health care. It will be in a much simplified form. Much less expensive and much better.'"

Which, like his other campaign promises so far, is apparently dead. Maybe he never meant it to begin with. It is said that the president will fly here and there across the country to promote the bill. I wonder what he will tell his voters who expected not the lose the coverage they have now.

Let's give Nancy Altman that last word today:

”The truth is that all of these cuts [in the healthcare bill] are entirely unnecessary. In fact, Medicare should be expanded to cover all of us.

“Medicare and Medicaid are more efficient than private insurance. Other nations are able to provide health care as a right, at a fraction of the cost with better health outcomes.

“We should be building on the successes of Medicare and Medicaid and the cost savings measures of the ACA. But instead, Republicans in Congress want to take us backwards.”


Do You Want to Know When You Will Die?

That headline is a more interesting question, I think, for people of the general age (50- or 60-plus) who read this blog than younger people. As it turns out, two new studies released just this week has some answers.

One involved face-to-face interviews with 1,016 adults living in Germany. The other featured similar interviews with 1,002 adults living in Spain. As reported in Pacific Standard,

”Asked if they would want to have an exact time stamp on their eventual death, 87.7 percent of Germans said no. Only 4.2 percent said yes, while 8.2 percent were uncertain.

“A similar percentage, 87.3 percent, did not want to know the cause of their death...

“Spanish participants'...answers on the negative news items were very similar to those of the Germans.”

In announcing the publication of the study, lead author, Gerd Gigerenzer of the Max Planck Institute for Human Development in Berlin wrote that “deliberate ignorance” is a “widespread state of mind” and

”...was more likely the nearer the event. For example, older adults were less likely than younger adults to want to know when they or their partner would die, and the the cause of death.”

That makes sense to me. Until 40 or so, most of us believe we are immortal so the idea of one's own death is mainly hypothetical. At my age now, nearly 76, death has become very real and recently, I find Gigerenzer's “deliberate ignorance” a state of mind I'm clinging to for - well, dear life.

Since mid-November, a mystery malady has been plaguing me. His disinterest in the many symptoms led me to fire my previous physician and I found a new one I like better. There is no obvious diagnosis so since late December, I have been undergoing the many tests he has arranged for me.

Medtests3

About once a week, sometimes twice, I drive to the giant medical center he is associated with for a screening – sometimes for blood, other times for x-rays of this or that body part and this week a bone scan.

These are not just to track down what my malady might be. It is also that because I've spent the greater part of my life avoiding doctors and most medical tests, the new doc wants a baseline for future reference.

I can't argue with that but here's the problem: I'm just about the best example you're ever going to find of Gigerenzer's “deliberate ignorance.”

In our brave new world of electronic medical records, I can find out the results of the tests almost by the time I drive home. And when that doesn't happen, they are posted by the next day when an email alerts me to their availability. It never fails – except -

Except once. And that's where my “deliberate ignorance” kicks in, leaving me now gasping in fear when I allow myself to think about that exception.

Every result so far has been in the healthy range of whatever was being tested. I've been incredibly lucky that way all my life.

But for all that good news, there was this: no email and nothing posted to my online medical records after the CT scan of my lungs for cancer two weeks ago. It's not that I've missed it. I check for it every morning.

Let's see if I can explain the emotion of this. With no posted results, I can live in (supposedly) happy “deliberate ignorance.” But not really. I smoked for many decades and three relatives died of various cancers so this test is more fraught that simple blood draws.

The question rolls around in my head: What could that anomalous missing report mean?

As my thinking goes, there must be something so terribly wrong with that CT scan that they don't want to cause a heart attack by having me read it at home alone.

I could email or phone the doctor but as much as this is eating at me, I also don't want to hear terrible news. So I wait and worry trying to be happy in my “deliberate ignorance” until my next scheduled doctor appointment in early March - which, given these circumstances I would rather skip so to remain in my "deliberate ignorance."

I'm fully aware that there could be other reasons for not posting scan results (although I can't figure what they would be). That doesn't help. And I am equally aware that my fear of a deadly diagnosis is not in keeping with my genuine relief at living in a state with an assisted suicide law, as we've discussed in these pages.

Inconsistency, thy name is human.

My uneasiness in this circumstance is not unique and the growing sophistication of medical tests and diagnoses will soon leave many more patients in similarly difficult emotional places at much younger ages, as the researchers note:

”...gene-based medicine 'will put more and more people into situations where they have to decide whether they want to know future health issues.'”

The reporter of the Pacific Standard story explained further:

”In the not-too-distant future, we’ll be able to discover whether we are prone to a variety of diseases. Knowing such information could help us make major life decisions in an informed, thoughtful way.

“But we can only take advantage of this information if we can...emotionally handle the knowledge of when and how we are likely to die. And when that subject is broached, our impulse seems to be to run as fast as we can in the other direction.”

Yup. That is exactly what I'm going through right now – terrified of a bad diagnosis that will turn me into a professional patient. I've been afraid of that for as long as I can remember.

The full study, co-authored by Rocio Garcia-Tetamero of the University of Granada, is available online in the Psychological Review. [pdf]


Elder Use of Marijuana

[DISCLOSURE: I've been smoking pot recreationally since I was in high school with no ill effects I can see. I don't do so often nowadays because in my old age, it makes me cough too much. I haven't gotten around to trying the new edibles that are available here, but I will in time.]

Marijuana

One of the most common afflictions that comes with old age is pain – from arthritis to cancer to neuropathy to back and neck pain to those random aches and pains that come and go and seem to have no known cause.

For many, pain is almost a definition of growing old and these days, increasing numbers of elders are using cannabis (also known as pot, weed, reefer, maryjane, etc.) to treat their pain. As UPI reported in January,

”A new report has found that cannabis use by people over age 50 has increased significantly and outpaced growth across all other age groups.

“The U.S. Substance Abuse and Mental Health Services Administration found that in 2000, 1 percent of Americans over 50 had used cannabis within the past year, but by 2012, that number had increased to 3.9 percent.”

In January of this year, The University of Iowa published a study looking into this increased use:

"'Some older persons have responded to changing social and legal environments, and are increasingly likely to take cannabis recreationally,' Brian Kaskie, Ph.D., a professor at the University of Iowa College of Public Health and lead author of the study, said in a press release [according to the same UPI story].

"'Other older persons are experiencing age-related health care needs and some take cannabis for symptom management, as recommended by a medical doctor.'

“...The study participants were more likely to have started using cannabis before the age of 30 and many before age 18.”

Twenty-eight states now allow limited use of marijuana for medical purposes and a half a dozen others, including my state, Oregon, allow unrestricted use of marijuana by adults. It is sold in licensed dispensaries not dissimilar to liquor stores in many states.

And now marijuana is being used in some nursing homes even in states that have not approved its use. From The New York Times:

”At the Hebrew Home in the Bronx, the medical marijuana program was years in the making. Daniel Reingold, the president and chief executive of RiverSpring Health, which operates the home, said he saw its powers firsthand when his own father, Jacob, was dying from cancer in 1999.

“To ease his father’s pain, Mr. Reingold boiled marijuana into a murky brown tea. His father loved it, and was soon laughing and eating again.

“'The only relief he got in those last two weeks was the tea,' Mr. Reingold said.

“When Mr. Reingold requested approval from the nursing home’s board members, there were no objections or concerns, he said. Instead, they joked that they would have to increase the food budget.”

The Times also reports that because federal law prohibits use of marijuana, the Hebrew Home complies with that law and although they recommend and monitor its use, “residents are responsible for buying, storing and administering it themselves.”

The University of Iowa study is titled "The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?" As Science Daily reports:

"The article also focuses on the misuse and abuse of cannabis. It then explores two other prominent public health issues - the misuse of prescription medications and the under-treatment of pain at the end of life - and considers how cannabis substitution may be a viable policy alternative to combating these problems.”

Given the reports of runaway opioid addiction in the United States, this sounds like a good idea to me. The New York Times again discussing a resident at the Hebrew Home:

"Marcia Dunetz, 80, a retired art teacher who has Parkinson’s, said she worried at first about what people would think. 'It’s got a stigma,' she said. 'People don’t really believe you’re not really getting high if you take it.'

“But she decided to try it anyway. Now, she no longer wakes up with headaches and feels less dizzy and nauseated. Her legs also do not freeze up as often.

“For [another resident], Ms. Brunn, the marijuana pills have worked so well that she has cut back on her other pain medication, morphine.”

And so what if, in addition to symptom management, users do get high? Why would anyone care.

All this movement toward cannabis legalization in more than half the U.S. states could be rolled back under the new administration and Congress in Washington.

Although President Donald Trump said during the campaign that he did not object to medical marijuana, so far he has reversed himself on almost every campaign promise.

Plus, both the new attorney general, Jeff Sessions, and the new secretary of Health and Human Services, Tom Price, have long records of opposing legalization or decriminalization of marijuana.

Without stretching one's imagination too far and with the growing use of cannabis by elders to control age-related conditions and diseases, any attempt by the federal government to remove or limit its use could be seen as withholding medication from sick and dying elders.


Elders, Stress and the U.S. Government

There is a lot to do today so let's start with the winners of the drawing for Norm Jenson's book, Mostly Anecdotal: Stories that we told you about on Wednesday. May I have a drum roll please.

And the winners are:

Estelle D
Linda
Diane

Congratulations to you all. What the three of you need to do now, is email me (use the "Contact" link at the top of the page and send me your snailmail address. I'll then get the books off to you forthwith.

Next:

TIME GOES BY 2016 DONATION WEEK REMINDER
Only two more days until this TGB donation drive for 2017 is done. You can read the details of what it is about on Monday's post.

If you have already donated, thank you – it is much appreciated. If you haven't done so and would like to help support the work that goes on here, click the button below. If not, which is perfectly fine, scroll down for today's post.

* * *

ELDERS, STRESS AND THE U.S. GOVERNMENT

Stress

When even The American Institute of Stress can't define what stress is, you know you're in trouble:

“Stress is not a useful term for scientists because it is such a highly subjective phenomenon that it defies definition.”

[Eight opaque paragraphs later:]

“While everyone can’t agree on a definition of stress, all of our experimental and clinical research confirms that the sense of having little or no control is always distressful – and that’s what stress is all about.”

Uh-huh - stress is distressful. That is what is called a tautology – defining a word by using the same word.

MedicineNet is a bit more helpful: “a physical, mental, or emotional factor that causes bodily or mental tension” but a note on a different page of that website is better:

”Due to the overabundance of stress in our modern lives, we usually think of stress as a negative experience, but from a biological point of view, stress can be a neutral, negative, or positive experience.”

If I've ever read anything about neutral or positive stress, I don't recall, but it confirms for me that sometimes stress is a good thing. In my career, for example, deadlines had me gritting my teeth but without them I would probably never have finished editing a story or video nor would my work have been as good.

Except for that one Medicinenet reference, all I ever see is how dangerous stress is. Here is one more definition of negative stress, from an article at Medical News Today, that makes the most sense to me:

”We generally use the word 'stress' when we feel that everything seems to have become too much - we are overloaded and wonder whether we really can cope with the pressures placed upon us.”

What's important about that definition and my intro to it (“makes most sense to me”) is that stress – whatever it is or isn't – is individual. You might sail through a situation that leaves me a puddle on the floor. Or vice versa.

According to my cursory reading on stress, it is brought about in elders by such factors as financial hardship, physical decline, healthcare changes, loneliness and there are many, many other “smaller” stressers. Whatever the cause, the effects on our bodies are profound and dangerous to our health. Here is a partial list of stress responses:

Anger
Anxiety
Burnout
Depression
Fatigue
Feeling of insecurity
Forgetfulness
Headache
Heart disease
Hypertension (high blood pressure)
Irritability
Lower immunity against diseases
Muscular aches
Nail biting
Nervous twitches
Pins and needles
Problem concentrating
Restlessness
Sadness
Sleeping difficulties

What brought up all this rumination on stress is that since election day, I've felt more worry, fear, anxiety and most of all, helplessness, than I can ever recall. Every day, all the time – and it is not related only to the president. It's the Republican Congress too.

Voucherize Medicare? Privatize Social Security? Repeal Obamacare? And those are almost incidental when you hear this from a White House Senior Adviser Stephen Miller:

Let's repeat the most important part of his statement:

“...the powers of the president to protect our country are very substantial, and will not be questioned."

Does that not chill you to the bone? And what can I, personally, possibly do to counter this most recent, terrifying turn toward autocratic rule in the United States?

Not much that I can see but it eats at me every day. Sometimes I can barely breathe and with each new move toward the right by the government, I am more frightened – read: stressed – and I'm not alone.

Here are some of the suggestions from the medical community for dealing with stress:

Meditation
Exercise
Good nutrition
Relaxation techniques
Cut down on caffeine
Talk with friends
Keep breathing

It is one thing if the sources of stress are from our own lives. In that case, those suggestions are useful. But what if the source of stress is your government? And what if the people comparing the Trump government to 1930's Germany are not hysterics?

So much for a quiet, fulfilling retirement. Breathe, everyone. Breathe.


Only 12 Percent of Elders Have Dental Coverage

Just two more appointments, if all goes well, and by the end of February I will be finished at last with a long, complicated dental procedure that began in 2014.

About a year ago, I told you about growing new bone in my upper and lower jaws (a medical miracle in my book), the insertion of titanium posts into the new bone when it had fused with my natural bone and then the attachment of an “overdenture” that has allowed me, as I explained then, to bite into an apple again for the for the first time in a decade.

Overdenture

At that point we were finished with my upper denture and now we are rounding the corner to the finish line on the lower one.

I chose the overdentures because I want a better eating and living experience than the traditional denture but I could not afford a full set of implants that would have allowed me to have teeth as permanent as real ones. Overdentures almost do that except that, like traditional ones, they must be removed every day for cleaning.

The implants and overdenture are an engineering marvel but there is no doubt they are wildly expensive. In total, I spent about $33,000.

Even after more than two years to become accustomed to it, that number causes me almost to stop breathing. These fancy new teeth took a great, big, giant chunk out of my end-of-life fund. (I guess I'll just have to die faster when the time comes.)

As hard as it was to make that decision, I am luckier than most elders; at least I had the money to fret over. Most old people do not. And Medicare, by law, cannot help.

When the Medicare legislation was implemented in 1965, it was a deliberate choice to leave off dental coverage (and prescription drug coverage).

According to a 2016 study from Johns Hopkins Bloomberg School of Public Health, just 12 percent of Medicare recipients (almost all old people) have dental coverage.

In contrast, according to the report of this study in Medical New Today,

”Eighty percent of Americans under the age of 65 are covered by employer-sponsored programs that offer dental insurance, which covers routine cleanings and cost-sharing on fillings and other dental work. Many of them lose that coverage when they retire or go on Medicare.”

No kidding, said she with $33K worth of dental work in her mouth. I'm going to quote this story at greater length than usual because I think these next paragraphs are important for you to know. The researchers

”...analyzed two separate proposals for adding dental benefits to Medicare, estimating how much each would cost. One was similar to the premium-financed, voluntary Medicare Part D benefit that was added to Medicare a decade ago to help cover prescription drugs for seniors.

“The other was similar to a proposal that has been introduced in Congress that would embed dental care into Medicare as a core benefit for all of the program's 56 million beneficiaries, which is not expected to pass before Congress recesses. [RB: It did not.]

“The first proposal, which would cost an average premium of $29-a-month and would come with a subsidy for low-income seniors who couldn't afford that, would run an estimated $4.4 to $5.9 billion annually depending on the number of low-income beneficiaries who participate.

“The second, with a $7 monthly premium and subsidies for low-income people, would cost between $12.8 and $16.2 billion annually. The packages would cover the full cost of one preventive care visit a year and 50 percent of allowable costs for necessary care up to a $1,500 limit per year to cover additional preventive care and treatment of acute gum disease or tooth decay.”

That wouldn't help much – actually, implants and/or overdentures and even traditional dentures would not be possible at all in that scenario. But it would be a start for basic care and here is why that is important:

”Poor dental hygiene not only contributes to gum disease, but the same bacteria linked to gum disease has also been linked to pneumonia, a serious illness that increases the risk of hospitalization and death.

“It can also contribute to difficulty eating, swallowing or speaking, all of which bring their own health challenges. Nearly one in five Medicare beneficiaries doesn't have any of his or her original teeth left, according to the Centers for Disease Control and Prevention.”

The study's author, Amber Willink, PhD, an assistant scientist in the Department of Health Policy and Management at the Bloomberg School, says that

"'...a staggering 49 million Medicare beneficiaries in this country do not have dental insurance. With fewer and fewer retiree health plans covering dental benefits, we are ushering in a population of people with less coverage and who are less likely to routinely see a dentist. We need to think about cost-effective solutions to this problem...'

“'Older adults are struggling and the current benefits structure of Medicare is not meeting their needs. We need to find the right solution,' she says. 'Otherwise, it's going to end up being so much more expensive for everyone.'"

Reading this report a few weeks ago as I was writing the final check for my dental work, gave me both a shudder (I am unaccustomed to writing checks with mid-four figures and will never get used to it) but also a strong sense of gratitude.

As much as I still carry concern about taking such a huge chunk of money out of my end-of-life fund, at least it was there for me to make the choice. How lucky is that – so many elders are not.

But why do I think incorporating even limited dental coverage into Medicare won't happen for at least the next four years?

* * *

RESISTANCE NOTES:
In related news, during the election campaign, then-candidate Donald Trump pledged to let Medicare negotiate discounts for prescription drugs as the Veterans Administration does. Then, early this week,after he met with lobbyists and executives of pharmaceutical companies, reports Matthew Yglesias at Vox:

"...he abandoned that pledge, referring to an idea he supported as recently as three weeks ago as a form of 'price fixing' that would hurt 'smaller, younger companies.' Instead of getting tough, Trump’s new plan is that he’s 'going to be lowering taxes' and 'getting rid of regulations.'"

Yglesias further reports that according to Herb Jackson who was the designated pool reporter that day, Trump told the pharmaceutical attendees:

"I'll oppose anything that makes it harder for smaller, younger companies to take the risk of bringing their product to a vibrantly competitive market. That includes price-fixing by the biggest dog in the market, Medicare, which is what's happening. But we can increase competition and bidding wars, big time.

"So what I want, we have to get lower prices, we have to get even better innovation and I want you to move your companies back into the United States. And I want you to manufacture in the United States. We're going to be lowering taxes, we're going to be getting rid of regulations that are unnecessary."

This is chilling when you extend similar thinking to Social Security and the Medicare program itself that the Republicans in Congress are planning to privatize. Recall that during the campaign, Trump repeated many times that he would not touch those two programs. Riiiiight.


Excellent Tool for Doctor Visit

Improving-your-doctor-patient-relationship

For good reasons that are not pertinent to this post, in November I fired my doctor. Five or six weeks later, after an hour with my new primary care physician, I was pleased to feel that I had found someone I can work with and whom I like.

But when I got home, I realized I had not mentioned two or three issues that while far from being critical were still things he should know and that should be in my record.

I was somewhat chagrined since before that first meeting, I had worked for a couple of days to prepare a list of items and had believed I had done a good job. So as soon as I got home, I started a running list in a computer file that I can keep up like a grocery list for the next appointment.

Since then, however, I have found an outstanding online tool from the National Institute of Aging. The NIA is division of the National Institutes of Health which for decades has funded internal and external research into many aspects of growing old.

The external program funds research and training at universities, hospitals, medical centers, and other public and private organizations nationwide. (All this is administered under the U.S. Department of Health and Human Services so we will need to keep a sharp eye on its funding and other issues once the new secretary is approved by Congress which, unfortunately, appears to be Georgia Representative Tom Price.)

I've used the NIA's extensive website for a long time but somehow missed the section I'm here to tell you about today titled, Talking to Your Doctor: A Guide for Older People.

It is amazingly thorough and informative with a long list of chapters to help you collaborate with your physician and be a full participant in your care:

”In the past, the doctor typically took the lead and the patient followed. Today, a good patient-doctor relationship is more of a partnership,” states the first sentence of the section.

“You and your doctor can work as a team, along with nurses, physician assistants, pharmacists, and other healthcare providers, to solve your medical problems and keep you healthy.”

There follow such chapters as:

Choosing a Doctor You Can Talk To
How Should I Prepare...for an Appointment
Making Decisions with Your Doctor
Discussing Sensitive Subjects

And eight more.

Throughout all the the 12 chapters are useful tips – on giving information, for example, on asking questions or providing definitions you might not know like what “board certified” means. And that barely scratches the surface.

The guide was first published in 2010 and updated in April 2016. It is a definitive guide for all things related to visits with your physician(s).

Today, however, I want to show you why I decided to devote an entire post to this guide. The Institute has created a three-part worksheet to fill in before your appointment with prompts that help ensure that you don't forget anything and that you can print to take with you.

The first section asks you to list your concerns.

The second section includes changes since your last visit, your diet, medications and lifestyle; your thoughts and feelings; and everyday living – injuries, daily activists, exercise and more.

The third section asks you to list the details of all the medications you use.

It is incredibly thorough and a professional can skim through the worksheet in a few minutes saving a lot of time that then can be used for face-to-face examination and discussion.

Here is what it looks like:

NIH Worksheet FINAL

Although it is titled for elders, I think people of all ages can benefit from this. Here are some of the links you need:

Main page, the starting place

The Worksheets

Section on additional resources

If you want a hard copy, you can print out each section or, on the left side of every page is a link to a PDF version that you can save to your computer or print.

Whether you just hang on to the URL, keep an electronic copy on your computer or print it, there are not many instruction manuals in life as good as this 44-page guide.


The New President's First Official Act

FIRST, A NOTE FOR INTERNATIONAL TGB READERS: The outpouring of protest at the Saturday Women's March in cities across the U.S. turned out to be much larger than anyone anticipated – certainly me.

USWomensMarchesNYT

And what surprised me most - in the best possible way - is that more millions of people in cities around the world joined the protests.

WomensMarchesWorld

(Both images from The New York Times.)

Something big is happening, it is worldwide and we all need to nourish it, encourage it and keep it moving forward for all the reasons the marchers took to the streets on Saturday.

I mentioned this not long ago but it bears repeating: when necessary and reasonable, Time Goes By will be part of that resistance because our democracy, my democracy (I had no idea I was so patriotic until now) may depend upon it.

First and foremost, this blog has always been about “what it's really like to get old” as it says up there on the banner, and that will never change.

Time Goes By benefits greatly from readers and commenters who live in other countries and I have always been careful to write about ageing in a general sense, for all of us wherever we live.

But by necessity now, sometimes TGB will need to be America-centric to address both threats to all Americans, and to American elders specifically (as today) which other media too often overlook. I apologize to international readers but I don't see any other way for the foreseeable future.

There will still be plenty of good conversation about growing old – just please bear with me while I try to work out a balance.

* * *

FIRST TRUMP EXECUTIVE ORDER COULD GUT OBAMACARE
On his first day in office, President Donald Trump signed an executive order (which has the force of law without Congressional approval) that will scale back parts of the Affordable Care Act.

Here is the new press secretary, Sean Spicer, making the announcement to reporters in the White House briefing room:

Well, that certainly was vague while being ominous too. Did you hear the reporters in the room asking, “What does that mean?” as Spicer left the room? Me too.

Before I get to that, let me remind you that there are a few important elements of the Affordable Care Act – Obamacare – that benefit elders specifically.

There is a full list of ACA Medicare benefits here.

In addition, Obamacare opened Medicaid to low-income adults with incomes up to 138 percent of the poverty line in states that opted to expand their Medicaid programs – so far, about 15 million people in 31 states and the District of Columbia have benefited.

What we do not know now is how this first presidential executive order (full text), signed on Friday, will affect Obamacare provisions for Medicare.

Politico calls the order “sweeping” and wrote that it

”...encourages federal agencies to dismantle large parts of Obamacare, possibly including the hugely unpopular mandate requiring most Americans to purchase insurance.

“While only Congress can repeal the law, the nine-paragraph order effectively tells the federal government to take as much leeway as possible to 'ease the burdens' on individuals, states and the health industry.”

The Washington Post offered some additional ideas of what the order may mean:

“'Potentially the biggest effect of this order could be widespread waivers from the individual mandate, which would likely create chaos in the individual insurance market,' said Larry Levitt, senior vice president at the Kaiser Family Foundation.

“In addition, he said, the order suggests that insurers may have new flexibility on the benefits they must provide.

“'This doesn’t grant any new powers to federal agencies, but it sends a clear signal that they should use whatever authority they have to scale back regulations and penalties. The Trump administration is looking to unwind the ACA, not necessarily waiting for Congress,' Levitt said.”

In a bit more detail, The New York Times suggests that the executive order should be seen more as a “mission statement” more than an “edict that can instantly change the law.”

”Mr. Trump has sent a strong signal that he intends to fight the health law...And the order, crucially, notes that agencies can act only 'to the maximum extent permitted by law.' (How the Trump administration interprets those permissions, of course, is yet untested.)

“The order spells out the various ways that a Trump administration might fight the parts of the health law until new legislation comes...Regulations can be changed, but, as the order notes, only through a legal process of 'notice and comment' that can take months or years.

“How much of the order is bluster and how much it signals a set of significant policy changes in the pipeline is unclear. The order was not specific and did not direct any particular actions.”

In other words, the order urges agencies of the federal government to try to destroy Obamacare by chipping away at provisions without actually have to use the word “repeal,” while giving them plenty of time to come up with a replacement.

There is no reason to believe that provisions for Medicare recipients won't be among the ones changed or removed. And there is nothing we can do about it. According to Wikipedia,

”...executive orders are subject to judicial review, and may be struck down if deemed by the courts to be unsupported by statute or the Constitution.”

Unlikely. We will need to use our resistance tools elsewhere.


The Long, Slow Winding Down of Old Age

Lately, I have made a few choices to do something or not do something because – well, it seems to be connected to my time dwindling down. Or, at least, that's the reason I “think” I am doing and (mostly) no longer doing some things.

That idea has some background in my life. Let me tell you about my great Aunt Edith who was born in 1895.

She left her home in Chicago at age 15 to join a traveling dance troupe.

Edith1911dancer250

A few years later, the troupe left her behind in Portland, Oregon, when she was laid up with pneumonia so she found a job in an office, eventually becoming the manager.

Those of you who live in the Portland area might like to know that in 1923, my great aunt Edith was queen of the Rose Festival. In those days, they were not chosen from high schools but more or less appointed from suggestions made to the Rosarian organization.

Here she is with her “court” from a book, Portland Rose Festival, written by George R. Miller.

QueenEdthandhercourt1023

Until she retired at age 70 in 1965, Aunt Edith worked all her life in various corporate executive positions at a time in history when hardly any women worked out of the home. Here she is at age 68:

Edithage68

In addition, she cared for her ageing and sick parents when they could no longer rely on themselves and she raised her sister's son, my father, from age 10, among other family obligations she took on as need presented itself – and there was plenty. It was always something in my family and Aunt Edith handled it all.

She was my favorite relative.

By the time she retired, I was long gone from Portland, in New York City then, and every week we spent an hour or so on the telephone together discussing cooking, books, the news, politics, telling each other funny stories and we also regularly wrote letters – remember those?

She included her recipes (she called them receipts) in those missives along with New Yorker cartoons and sometimes entire articles clipped from newspapers and magazines.

She knew everything that was going on in the world and had an opinion on all of it in addition to being funny, especially, in her later years, about the minor physical irritations of growing old. She was just great.

By the mid- to late-1970s, the letters still arrived mostly on schedule but they were shorter and there were fewer enclosures. In our phone calls, she didn't have as much to say about world affairs and increasingly repeated the same stories from her childhood in Chicago that I had heard many times.

(Thank god for telephones without video in those days: you could make faces to help yourself get through the one hundredth telling of the story about Fluffy the cat without the speaker knowing how impatient you were being.)

I don't mean to suggest that these changes were sudden. Aunt Edith's disengagement was noticeable in the beginning and it increased only gradually over a decade or more. At one point she said that she had given up reading books because her eyes tired so easily now and she lamented the fact that most of her friends were dead, even many who were younger than she.

When she made a joke about not being able to stand up after scrubbing the kitchen floor on her hands and knees (“Hello, Aunt Edith,” I said. “There is the newfangled thing called a mop with a long handle.”), my brother, who lived in Portland, arranged for a regular house cleaner.

Over time it felt to me as if, perhaps, interest in her own world and in the world at large was diminishing because they were becoming fuzzier, less clear - metaphorically, not physically - and she paid less and less attention.

Her time to leave was coming nearer and she did that in 1984, at age 89 after what was to my eyes, decade long period of preparation, an unwinding if you will, and a letting go of her attachment to the world.

Ever since then, I have believed that if Aunt Edith's “preparation” is not how it happens for everyone who doesn't die suddenly or unexpectedly, it happens to some, maybe quite a lot and without making a big deal of it, I've watched for those signs in myself.

In just the past year or so, there have a few small but, I think, telling changes. Examples:

The 2016 presidential campaign notwithstanding, I watch much less cable news which is to say political news since that is about 90 percent of what those channels cover. I'm slightly embarrassed to admit that it has taken me this long to become tired of the repetition (which was around long before Trump) and know that if anything important happens, it will be hard to miss.

Similarly, I have unsubscribed from a large number of news and commentary email newsletters. Again, it is the repetition that has made them irrelevant. Aside from a handful of commentators and columnists I respect and look forward to reading, I don't feel I need to keep up in as much detail as I did during the 40 years that it was my job to know what was going on in every area of news, politics and culture and have continued in the decade since retiring.

This applies too to a lot of reporting and commentary about ageing – I've eliminated about half of what I was reading or, lately, not reading and feeling guilty about it. (There's no more guilt if they don't show up in the inbox.) Ageing news tends to be even more repetitous than political news - if that's possible.

And I'm not proud to say that I've let the frequency of email correspondence with friends decline. It just seems that there is not as much to say as there once was. I get up, I work on the blog, I attend a couple of meetings or lunches each week, I shop, cook, read and sleep. Maybe in my old age my thinking has slowed and I use up all that kind of energy writing TGB. Or not. I don't know. But something has slowed me down.

As much as I find certain technology advances captivating, I have been hesitating for a long time before making new purchases. Most recently (for a year or more) it's the Amazon Echo Dot. I just love it. I read every new report about it and it costs only $49 - that's not a stretch for me. But I still haven't bought one.

There are some other purchases I've put off and may never make because at my age, how much will ever use them seems to be my reason although I can't be certain and it could be, unrelated to usage, that I'm simply in the earliest stages of what we might call, today, great Aunt Edith syndrome.

Not even collectively can a case be made that this list of minor changes represents the early stages of preparing to shuffle off this mortal coil, as they say. But then, maybe they are.

Maybe I am at the very earliest stages of following in Aunt Edith's steps toward the end. I wouldn't mind if that's what I'm doing now because I am going to be big-time pissed off if I die while I'm still interested and curious. I want to feel done with this life when it's time to leave and Aunt Edith's gradual letting go seems to be a good way to make that happen.

I'll update you when/if there's more to say about this.


Watching Myself Grow Old

A couple of weeks ago, we had a long discussion about cosmetic surgery in old age. The comments score pro and con, if you don't count a few who confused cosmetic and reconstructive surgery, was about 50/50.

It baffles me how anyone, particularly those no longer competing in the workforce, would spent a moment of precious time thinking about how old he or she looks, let alone spend retirement funds to achieve a facsimile of youth that fools no one.

On one level, I get it. We live in an ageist world that devalues people over the age of – oh, it starts around 40 - and the constant drumbeat in every communications media that old people are, by definition, deficient is shameful.

Quote-growing-old

Like so many, I was forced out of the workplace due to my age long before I was ready to retire. In addition, I've been made invisible in dozens of different ways. My thoughts and opinions have been dismissed merely because I'm old and wrinkled.

Actually, I complained about that last item until I was 30 or so when I finally began to look like a grownup. Until then, I had looked like a teenager and was so happy to finally be taken seriously. No one warned me then that there would be an expiration date.

Perhaps that dismissal of me in my youth accounts for never having spent a single serious moment wishing I were younger than I am (currently 75).

Mostly I got on with life and career and never thought about growing old until that day in 1995 or 1996 when I noticed that I was older by decades than the 20-somethings I worked with.

It was a turning point for me that day, the idea that I am not the one immortal on earth and that I will get old, I will die and I've spent a large portion of my days since then studying, researching and thinking about ageing - the results of which, beginning in 2004, have become this blog.

Any of you who have been hanging around here for awhile know that I often use myself as the guinea pig; if it – whatever “it” is - happens to me, it happens to thousands of you too.

So when I have a problem with urinary incontinence, so do some of you. Or with going bald, something more surprising to women, I think, than men, I'm not the only one. Or dropping things more frequently as I've gotten older, I know it's not just my problem.

I'm pretty sure – well, actually, I know I would never have been capable of confronting those (and many other) ageing issues, writing about them here and particularly, admitting to them if I were concerned about looking or even being old.

There's an old wive's tale that no matter how healthy you have been, after 75 it's all down hill. That's been on my mind this past year along with the idea – more often male than female – that you might be likely to die at the same age your father (for men) or mother (for women) did.

Both of these ideas are really stupid. What kind of idiot would believe them? Ahem, try me.

My mother died at age 75 and nine months. I have been acutely aware since my last birthday in April that this month, January 2017, I am the same age as my mother at her death. I know it's absurd but what can I say. It's there. It pops to mind regularly.

It's not growing old or looking old that bothers me anywhere near as much as losing the good health I've enjoyed all my life. I understand perfectly that I have no control over the former and I'm working on understanding the same for the latter.

Meanwhile, with great curiosity and interest, I keep watch on the signs of my ageing. They accumulate.

It was seven or eight years ago I noticed that a smile line on one side of my mouth didn't disappear anymore when I wasn't smiling. Since then I've carefully watched it grow deeper and be joined by its partner, etched on the other side of my mouth. I don't mind.

Then there is the crepe-y skin in all manner of places on my body. It increased abundantly after I lost 40 pounds four years ago - on my belly, my arms, my hands, my thighs and lately, even my knees. If I live long enough, I suppose I'll just be a saggy bag of wrinkles.

What now seems more remarkable to me is how many decades my skin remained relatively smooth. It apparently takes a long time for skin to wear out. wrinnkled hands

These days, I tire more easily compared to most of my life before now. A weariness comes over me sometimes in the afternoon that is similar to what I felt in bygone days in the late evening at bedtime.

Also, all my life I have been eager to hop out of bed as soon as I wake, to get going with the day, to see what it will bring. For the past couple of months, for the first time ever, I'm just as happy to pull the quilt over my head and snooze for another hour or two.

There is more, but you get the point and I'm not alarmed or worried about these physical changes. I'm almost four years short of 80. It's okay.

What does concern me are the changes I've noticed in my brain function, even though I know they are normal for my age.

It is harder now to organize my to-do list each day, to work out what should come first, second, etc. Sustained focus, such as finishing an article I'm reading or getting at least a rough draft of a blog post done before moving on is a goal now, not a fact.

Even I am not sure how many partly finished books, magazine stories and blog posts are floating around.

Making some types of choices has become a joke. For all my adult life, I made a distinction between a review being all I want to know about about a book's subject and others I was eager to read in full.

Now, if I read the review, the book goes on my to-read list. There are either a whole lot more better books in the world than 20, 25 years ago or I can't make make the distinction anymore. You know which of those two choices is correct.

I'm pretty sure all that I've described is how it happens, this getting old stuff. Even if like me, you jave been lucky enough so far to have no chronic illnesses or conditions (she said knocking wood), one's capabilities for ordinary things get chipped away at as the years pile up.

So far I'm having a fine ol' time watching the changes come over my life and I'm grateful I'm not burdened with a yearning for youth. I don't claim any superior level of understanding about that - I didn't earn it; it's just how I am.

My hope is that as I inevitably grow less capable in body and mind in coming years, I can accept those changes with some composure, self-possession and particularly curiosity as I have until now.

older than the internet



Coming Soon: Over-the-Counter Hearing Aids

There was a lot of movement in Washington, D.C. last week about making certain hearing aids more available and more affordable. First, some facts. According to statistics published recently by the White House:

30 million Americans suffer from hearing loss

The average cost of a hearing aid is $2,300 – twice that for two ears

Only 20 percent of Americans who would benefit from hearing aids have them, mostly due to the price

The reason for the White House interest in hearing aids was this announcement last week from the Food and Drug Administration (FDA) which on 7 December

”...issued a guidance document explaining that it does not intend to enforce the requirement that individuals 18 and up receive a medical evaluation or sign a waiver prior to purchasing most hearing aids [and]

“...also announcing its commitment to consider creating a category of over-the-counter (OTC) hearing aids that could deliver new, innovative and lower-cost products to millions of consumers.”

In addition, last week Senator Elizabeth Warren (D-Massachusetts) and Senator Chuck Grassley (R-Iowa) introduced the Over-the-Counter Hearing Aid Act of 2016 [pdf] in Congress. The bipartisan legislation would make certain types of hearing aids available over the counter.

A press release posted on Senator Warren's website notes that the Act would

”...allow hearing aids that are intended to be used by adults to compensate for mild to moderate hearing impairment to be sold over the counter, and would eliminate the requirement that people get a medical evaluation or sign a waiver in order to acquire these hearing aids...

“The bill is supported by the Hearing Loss Association of America (HLAA), the American Association of Retired Persons (AARP), the Consumer Technology Association, Bose, and the Gerontological Society of America.”

There are additional consumer-friendly provisions in the Warren/Grassley bill not included in the FDA changes.

All this is, essentially, a done deal. Before too long, under the conditions laid out above, we will be able to buy hearing aids at a reasonable price.

As I explained a couple of months ago in a post on hearing loss and Medicare – which does not cover hearing aids - this news is important to me personally. It has been decades since I could easily hear a conversation in a noisy restaurant and beginning earlier this year, the audio on certain television shows sounds like gobbledegook to me.

Well, listen to this: about three weeks ago, during a visit to the doctor, the assistant who recorded my vitals said that the wax (also known as cerumen) in my ears was impacted but they could fix that.

And wow. At the risk of indulging in too much information, I would not have believed before that the amount of wax removed could even fit into an ear. But more, I could instantly hear better.

It's not that it was hard to hear in most circumstances before but that everything was instantly more crisp. And all that gobbledegook from the teevee? Except for one show I watch fairly regularly, Elementary, I can hear the audio clearly now.

(This revelation is specific to me. It is not necessarily an answer for anyone else with mild hearing loss.)

What I have noticed since then is that although I can hear clearly, I need to work harder, pay closer attention than I remember doing for most of my life when hearing was automatic and that is why I am so happy to have the news about over-the-counter hearing aids before too long because there is no way I could afford an average price of $6400.

Of course, there are types of hearing loss that require treatment by an otolaryngologist or an audiologist and sometimes involve surgical treatment and/or aids that are more complex that what will be available over the counter.

But for many of the 80 percent who have untreated hearing loss because they can't afford the aids, this new over-the-counter remedy will be a boon. And it is more than just improved hearing: untreated hearing loss leads to depression, loneliness and isolation which can lead to further health problems.

Over-the-counter reading glasses have been available without a prescription for decades and are so inexpensive that most people can afford to have several pair. There is no reason that a remedy for simple, mild hearing loss should not be available in the same manner.

In the coming months and years, we are going to need to work our fingers to the bone to protect Social Security, Medicare and Medicaid. This change is one simple but important thing will improve the lives of millions who cannot now afford hearing aids and millions more in the future too.


Dilemma: Finding a Primary Care Physician

THE PROBLEM
About a month ago, I woke one morning with a mystery malady: randomly placed aches on the front, sides and back of my torso in about half a dozen specific locations which change from day to day.

These are entirely different from muscle pains I get when I occasionally overdo my fitness workout.

Because I hardly ever get sick and when I do, it is easily identifiable and not terribly important; and because I spend as little time with doctors as I can get away with, I followed my usual procedure when something goes wrong: wait and see.

By mid-afternoon that first day, I still hurt. I tried a pain pill, went bed and waited an endless 90 minutes for the medication to kick in.

This routine continued for next couple of weeks. The aches would be there for a day or two and then I would wake the next day feeling, unless you count general lethargy, almost my normal self again and got on with life believing that whatever had caused the aches was resolving itself.

THE PHYSICIAN
But nooo. After one pain-free day – or two sometimes – the aches returned. Finally I broke down and went to the doctor. And this is where the story I came to tell you today begins.

Over a period of 15 or 20 minutes, the pleasant and clearly competent physician's assistant took my vital signs that, she said, were all within normal range and asked about any changes from what she read out on my chart. The doctor then arrived, sat down at the computer and started typing.

I had a written list of my mystery malady symptoms so I could be concise, along with a couple of unrelated, minor symptoms I wanted to check on while I was there.

Reading off my list, I explained my mystery symptoms and noted that for the previous day and that day, I was pain free but I'd been there before and didn't think the malady had corrected itself.

The only time the doctor looked at me directly and touched me was when he felt the glands under my chin pronouncing them, after a few seconds, to be normal. He returned to the computer and, I assume, entered that information.

The following conversation ensued (paraphrased):

DOCTOR: I can't see that there is anything going on we need to be concerned about and you said that the pain has subsided so you're apparently getting better. Give the MT a urine sample so we can check for a virus.

The doctor then walked toward the door.

RONNI: Wait. I have two other small things I want to ask about.

DOCTOR: Sorry. We're out of time.

And he left after being with me for 10 minutes - probably more like seven or eight minutes.

I peed in the cup and drove home in growing fury – and a little bit of fear. (Two days later, I was informed that the urine test indicated no infection or virus.)

FINDING A NEW PRIMARY CARE PHYSICIAN
For a couple of days I thought the pains had finally gone away but they returned and have continued that haphazard schedule of a day or two on, a day or two off.

Clearly it was time to find a new primary care physician. I'm 75. There is an old folk tale I'm unwilling to dismiss entirely that no matter how healthy you are, after 75 it's one damned thing after another.

A year or so after moving here, I used online listings of both primary care physicians and geriatricians to find a new doctor. My preference was for the latter but there are fewer of them every year so there's not much chance of finding one with room in his or her schedule.

These days, the web pages of most physicians list what kinds of insurance coverage they accept and I quickly learned that if Medicare is not listed, it is not a oversight. It means they won't consider you.

It took me several days to call all the physicians who listed Medicare and in every case the phone conversation went like this:

RONNI: I'm looking for a primary care physician and would like to make an appointment.

PHONE PERSON: What kind of insurance do you have?

RONNI: Medicare.

PHONE PERSON: I'm sorry, we are not accepting new patients at this time.

I kid you not. Every single one said this.

(I did not find a doctor until I needed cataract surgery a couple of years ago that could not be performed without a full physical exam first. When I explained I did not have a primary care physician, the eye doctor made an appointment with the one I now see.)

A week or ten days ago, I asked a friend who has lived here for decades about finding a physician and she said, “Good luck with that. In this town, they all have waiting lists.” A neighbor I spoke with agreed.

Before long, I will need to repeat the exercise – it's been several years since last time – of calling the list of primary care physicians (and maybe take a stab again at the geriatricians) within a somewhat reasonable distance from my home to see if any will accept Medicare AND a new patient.

(One list is the Physician Compare Directory at the Medicare website where all the doctors do take Medicare. There are other online lists from various sources, often local, usually searchable by Zip Code in addition to specialty.)

Before that, however, another friend has offered to make an inquiry for me and we'll see how that goes.

But the point remains that if Medicare is your health coverage and you need a new physician for whatever reason, you may be out of luck. Of course, when/if I find one, there is no reason to believe he/she will spend any more time with me than my most recent encounter and we don't get to do job interviews before choosing a doctor. It's more like, if one will take you and he or she is still breathing, don't say no.

A fairly short trip around the web turned up multiple stories of elders with Medicare unable to find a physician willing to accept them.

A 2013 NPR story about this dilemma noted that between the year 2000 and 2012, the number of Texas doctors accepting Medicare dropped from 78 percent to 58 percent. There is no reason to believe it is any different in the other 49 states and god knows how low the percentage is now, four years later. Further:

”Seventy-eight-year-old Nancy Martin is one of the seniors who had a tough time finding a physician.

“'I felt frustration, disappointment and I would say, despair. A lot of days I would get to the point where I would think, I'm never going to find a doctor in Austin,' she told the NewsHour. It took a full two years for Martin to find one.

Ten thousand people a day turn age 65 so this problem isn't going away any time soon.

PRE-EMPTIVE NOTE: We are not here for any long-distance diagnoses of my mystery malady so please don't. The issue at hand is important – our experience, discussion and advice (if any) on finding a physician.


Saving Medicare and Contacting Congress

Capitol-diagram

EDITORIAL NOTE: This is a nuts-and-bolts post pulling together some information we are going to need before long. I know some readers don't want any more politics, but emboldened Republicans are hard bent on killing Medicare and they want to do it right after the New Year.

Discussion of Medicare privatization may come up sooner than we expect; Congress reconvenes today, none of the Republicans are shy about pressing their political advantage.

I spent some time over the long weekend, locking down details of one way we can make our voices heard. There will be others, but contacting your representatives is basic to the effort, and there is a right way to do it. Maybe you will want to bookmark some of these links for future use.

* * *

REFRESHER
As I wrote here last week, House Speaker Paul Ryan (R-Wisconsin) has been pushing a plan to privatize Medicare for at least half a dozen years and is willing to lie to the American public to accomplish it:

”What people don't realize,” Ryan told [Fox News host Brent] Baier, “is because of Obamacare, Medicare is going broke, medicare is going to have price controls because of Obamacare, Medicaid is in fiscal straits.

“You have to deal with those issues if you are going to repeal and replace Obamacare. Medicare has serious problems [because of] Obamacare.”

This is exactly opposite of what is true which you can read about on my most recent Medicare post here.

As it looks now, Ryan's new, private Medicare coverage would compete against traditional Medicare. New York Times reporter, Robert Pear, who has closely followed Medicare and Social Security for many years, wrote about Ryan's plan last week and noted this about how it would work:

“'Beneficiaries would have to pay much more to stay in traditional fee-for-service Medicare,' said John K. Gorman, a former Medicare official who is now a consultant to many insurers. 'Regular Medicare would become the province of affluent beneficiaries who can buy their way out of' private plans.”

According to many reports (but who knows what applies in a * administration), Ryan intends to push Medicare privatization (also called voucher plan) legislation as soon as the 115th Congress convenes in January.

Last Friday, in response to the Republican Medicare threat, Senate Minority Leader-elect, Chuck Schumer (D-New York) issued a defiant statement reminiscent of actor Clint Eastwood in a certain movie [emphasis is mine]:

“Medicare is one of the most successful government programs ever created – it’s been a success story for decades. The Republicans’ ideological and visceral hatred of government could deny millions of senior citizens across the country the care they need and deserve.

“To our Republican colleagues considering this path, Democrats say: make our day. Your effort will fail, and this attack on our seniors will not stand.”

I hope Senator Schumer is right but with a Republican-controlled Senate, he will need a lot of backup from the people of the United States and it is we, elders, who best understand the consequences of Medicare privatization.

For when that time comes – and it may be as soon as early January – I have collected some information about how to take our message to Congress and make it as effective as possible. Having this information now will keep future posts on the issue much shorter.

THE BEST WAYS TO CONTACT CONGRESS
I found instructions from a former six-year Congressional staffer, Emily Ellsworth, with an excellent list of what does and does not make the biggest impact.

Twitter and Facebook do not work. Staffers hardly ever check them.

Emailing your representatives is better, but the staffers get so many emails and are so busy, they just use an algorithm to “batch them” and send out form letters in response. (Snailmail is, apparently, dead.)

At Lifehacker where I found this information, the reporter notes that Ms. Ellsworth specifically recommends phone calls:

”...phone calls have to be dealt with when they occur and they can’t be ignored. A large volume of phone calls can be overwhelming for office staffers, but that means that their bosses hear about it.

“Which office you target also matters. Members of Congress have offices in DC, but they also have offices in their home district that they represent. Target your letters and phone calls to your local office and you’ll have an easier time getting their attention.”

Also, says Ms. Ellsworth, “If you want to talk to your rep, show up at [local] town hall meetings. Get a huge group that they can't ignore. Pack that place and ask questions.”

These and other instructions are included in Ellsworth's (irony alert) Twitter chain that is reproduced in full at Lifehacker.

CONGRESSIONAL EMAIL ADDRESSES AND PHONE NUMBERS
U.S. Senate contacts including D.C. and home district offices: You might have to search around to find the state office contacts but with a few exceptions, they are somewhere on the main page.

U.S. House of Representatives contacts including D.C. and home district offices – the latter sometimes called satellite offices: Although I have not looked at the web pages of all 435 Congress people, listings for district offices were on the pages I spot checked.

Over the years here, I've recommended other websites that list Congressional phone numbers but after my latest scrutiny, these appear to be the most thorough and best organized. New members of both the House and the Senate are sworn in on 3 January 2017. Obviously, newly-elected representatives may not have web pages yet on day one.

SCRIPTS FOR PHONE CALLS
Congressional staffers – at home and in Washington – are busy people. Another excellent suggestion is to prepare a short, to-the-point script you can read when you telephone your representatives.

A Google Doc by Kara Waite is messy but is packed with great information – especially this page of scripts (click on "Calling Scripts" at the top of the page). And in the future, I will create some sample scripts as a starting point you can personalize.


Medicare Part B Premium Increase and Normalizing *

There is a spiral-bound notebook on my desk where I keep a running list of ideas for future TimeGoesBy posts. Some of them are terrible ideas I never use (well, mostly). Others are mainstays – such things as updates or threats to Medicare and Social Security that our age group needs to know.

Mostly, the book is a reminder so I won't lose thoughts I had in passing while doing something else, and I add maybe three or four a week. Since election day, however, there are four new, tightly-hand-written pages now that there are deeply worrying potential dangers afoot in Washington, D.C. that will affect Americans of all ages.

I am telling you this in explanation for what is a new kind of post here now and then that will cover two or three unrelated items that seem to me to be important right now as opposed to having a decent shelf life or, sometimes, even being evergreen.

So here goes with the first one.

MEDICARE PART B FOR 2017
As you know, there was no increase in the Social Security cost-of-living adjustment (COLA) for the past two years. That means that for most Medicare beneficiaries there was, also, no increase in the premium for Part B which covers expenses for doctors, other outpatient care and durable medical equipment.

Now, due to the measly .3 percent COLA to Social Security for 2017 (which does not begin to cover inflation that most elders experience) an increase in the Part B Medicare premium is allowed.

The increase in the average 2017 Social Security payment is about $5. It will be wiped out for 70 percent of recipients because the Part B premium, which is deducted from the Social Security benefit each month, rises by 3.9 percent from $104.90 to about $109.

High earners will have an even larger increase in the Part B premium as will certain other categories of beneficiaries. You can see more detail at this PBS page.

It's not that I will go hungry or anything drastic, but so many other fixed expenses are increasing in the new year, by up to 10 percent in at least one case, that I will be cutting back and I expect many of you will be doing so too. This has happened every year for the decade I've received a Social Security benefit and I keep wondering in what year it will become a serious hardship.

In addition, the Part B deductible for 2017 will increase from $166 to $183. The Social Security Administration will soon be sending their annual benefit update letter so you will see your new numbers then.

NORMALIZING THE * ADMINISTRATION CONTINUES APACE
As I mentioned last week, it took less that 24 hours after the election results were in for pundits and most of the media to call for giving the president-elect “a chance” - as if we didn't already know what kind of man he is.

As Rohit Chandan, writing at FAIR (Fairness and Accuracy in Reporting) on Friday about normalization:

”The danger is that by normalizing Trump—a candidate distinguished by an embrace of political violence and open appeals to ethnic nationalism who boasted of getting away with sexual assaults — these commentators will make racist and sexist bullying an acceptable way to run for public office.”

No kidding. His way of speaking has already brutalized public discourse in general. Here is FAIR's accompanying cartoon laying out the media's excuses for normalization:

NeNormalCartoon

Over the past year, Seth Meyers, host of Late Night on NBC-TV, has become my favorite of the late night hosts – I can't stay awake that late but I record his show every night to watch the opening 10 minutes the next day. Meyers is smart, funny and fearless.

Last week, in his “A Closer Look” segment that airs at the top of each show, he pilloried the media and * associates trying to insist * is a normal person. Enjoy.

It is easy, when outrage after outrage is repeated hundreds of times a day in the media, to fall victim to accepting it as normal. Please be vigilant of yourselves and don't let it happen to you.


Medicare Open Enrollment for 2017

It's amazing how much the presidential election has changed our lives this year. In the case of an important annual event for elders that I report on here every year, it got postponed due to the third Clinton/Trump debate.

So here we are today, 10 days late with the information you need.

October 15 marked the start of the Medicare Open Enrollment period which lasts until 7 December. During this time, people 65 and older may, if they choose, make changes to their Advantage programs and their Part D prescription drug plans.

Oh joy. It shouldn't be this hard to keep up one's health care coverage year to year and it wouldn't be with a single-payer system like most western democracies have. But for now we're stuck with Medicare - and I'm awfully glad to we have it - so here is what you need to know.

(This is a long post. I am hoping I have created enough bold headers that you can skip to the information you care about and ignore the rest.)

OVERVIEW
If you currently have traditional Medicare, you are allowed to change to a private Advantage plan – or vice versa. Traditional Medicare does not provide drug coverage so you need a separate plan (Part D) for that.

Some Advantage plans cover drugs and others do not, so if you choose a plan without drug coverage you will need a stand-alone drug program as traditional Medicare enrollees do.

REMINDER OF SOME MEDICARE BASICS
• Part A covers inpatient hospital care, skilled nursing, hospice and home health care. It is free.

• Part B covers preventive care, outpatient services and doctor visits. The monthly premium is deducted from your Social Security benefit.

Optional • Medigap (or Supplemental) coverage pays for the “gap” between what Parts A and B cover and your out-of-pocket costs. You MAY NOT CHANGE this coverage during this 15 October-7 December open enrollment period.

• Part C is another name for Advantage plans. These take the place of original Medicare (Parts A, B and Medigap). Premiums are usually lower, they often cover drugs but physician choice is limited to the company's network and physicians are allowed to drop out of the program mid-year.

• 2017 Medicare Costs
As we discussed last week, there will be a .3 percent increase in Social Security benefits in 2017 but we do not yet know if or how much that will effect the Medicare Part B premium that is deducted from the monthly Social Security payment.

For the past two years, without a Social Security cost-of-living adjustment, the Part B premium has remained at $104.90. The new premium will be announced in November.

Certain people pay higher Part B premiums. Medicare costs in general for 2017 are not yet available. You can see last year's costs at this webpage where next year's costs will be available when they are released.

MY MEA CULPA
Medicare is a gigantic, complicated program with many permutations depending on individual circumstances. I cannot possibly pretend I understand it all and if I did, I could not account for them all here. What I can do, is provide some good links to help you through this year's ordeal to making changes (or not) you might want.

Remember, even if you think you are happy with your current coverage, prices change, deductibles are added, subtracted, increased, etc., and drugs are added and deleted from companies' formularies. So it is just good sense to review your plans each year at this time.

MEDICARE.GOV PLAN FINDER
The Medicare.gov website is not perfect but it gets better and easier to use each year. You can check your current enrollment, premiums, drugs list and find all sorts of general health information.

When you get there, click on the line: “Medicare Open Enrollment starts October 15 and ends December 7 Review your health and prescription drug coverage options” near the top of the home page to get into the open enrollment area with both your current coverage and options for 2017.

ONE EXAMPLE OF DRUG COVERAGE SELECTION
One of the best things about the Medicare.gov selection tool for drug coverage is that if you take the time to enter all your prescriptions and their dosages, you will get a list of plans that cover what you need and you can then compare other criteria to select the plan that works best for you.

In my case, I use no prescription drugs and since there is no way to guess what might happen to me and what kind of drugs I would need, I punt.

I choose the least expensive plan and hope (how's that for an intelligent healthcare program?) that whatever happens to me, I will be able to afford the drugs I require until next enrollment period when I can select a different plan based on my drugs.

This year, there are 27 prescription drug plans available to me. I'm lucky that my current plan has reduced the premium by 7.6 percent (whoever heard of this?). The deductible goes up by just over 11 percent but there is no increase in the in-network co-pays.

It's a no brainer for me this year; I stay with the plan I have.

CAUTION
The annual open enrollment period is open season for scammers. You will likely receive many snailmail advertisements for Advantage and drug plans, and phone calls too. Be smart.

Never give out personal information such as Medicare and Social Security numbers, account numbers, etc. to anyone who has telephoned you. Ever. Medicare representatives never call to ask this kind of information.

If you are due a refund for any reason from a private insurer, it will be sent to you via postal mail. If anyone calls asking for personal information to receive your refund, it is probably a scam. Hang up.

Many legitimate companies are offering a variety of health coverage plans during this period. But some are not who they say they are or will employ high pressure tactics to try to sell you coverage you don't need. Be aware.

Many offers of “free” medical supplies or checkups via postal mail are excuses to extract personal information from you. Check them out carefully before agreeing to them.

HELPFUL WEBSITES
Medicare website.
Medicare telephone: 1-800-Medicare

Medicare and You
By now, Medicare enrollees will have received your annual Medicare and You booklet. If you have not received it, or misplaced it, there is an electronic version [pdf]. Note that only the print version has a list in the back of plans available in your state.

Medicare Find a Plan

Here is a direct link to the Medicare Find a Plan main page.

My Medicare Matters
The National Council on Aging (NCOA) maintains a good educational website with lots of trustworthy information about Medicare and how it works.

SHIP Help
The State Health Insurance Assistance Program (SHIP) is a national program that offers free, one-on-one counseling and assistance to people with Medicare, their families and caregivers. Find your state's SHIP here.

65 and Signing Up For the First Time
If you are new to Medicare, Kaiser Health News has a succinct one-pager to get you started with a lot of links to additional online information.

Don't Forget
Open enrollment ends on 7 December 2016.


Exercise, Even In Small Doses, Offers Tremendous Benefits For Elders By Judith Graham

RONNI HERE: Remember last month when I told you that my friend Judith Graham, a trustworthy and respected reporter on the “age beat,” had begun a new column at one of the most trustworthy and respected health websites we have, Kaiser Health News?

Yesterday, as I was pulling together links to include in blog post today to harangue you yet again with the latest information about how important even small amounts of exercise are for elder health, Judith's newest column materialized.

She had already written a great deal of what I intended that I don't see any reason to repeat all her good work.

So below is Judith's column in full as Kaiser encourages republishing. Also, Judith is always looking for older adults with aging and health stories to tell. If you’ve got one, send it to her at judithegraham@gmail.com.

One more thing. I realize that I probably write post stories about exercise way too often - that you've got the point by now - and asked myself why it keeps coming up for me. Here's what I think:

I am so astonished that repeated, independent studies from respected researchers all around world keep reaching the same conclusion, that it doesn't take much exercise at all to make an enormous difference in our health.

Most of my life I was told and believed that to have any benefit, exercise needed to be long and hard and lots of it. And that just wasn't in me. But the new studies - the number and continuing flow of them - must be believed and even I can do as much (and even more) than they recommend.

But it's one of those things that amaze me - real, measurable, observable health benefits without having to be a gym rat or marathon runner. I haven't gotten over my astonishment yet. In future, I'll try to keep my enthusiasm under more control
.

* * *

(Republished with permission from Kaiser Health News.)

Retaining the ability to get up and about easily — to walk across a parking lot, climb a set of stairs, rise from a chair and maintain balance — is an under-appreciated component of good health in later life.

When mobility is compromised, older adults are more likely to lose their independence, become isolated, feel depressed, live in nursing homes and die earlier than people who don’t have difficulty moving around.

Problems with mobility are distressingly common: About 17 percent of seniors age 65 or older can’t walk even one-quarter of a mile, and another 28 percent have difficulty doing so.

But trouble getting around after a fall or a hip replacement isn’t a sign that your life is headed irreversibly downhill. If you start getting physical activity on a regular basis, you’ll be more likely to recover strength and flexibility and less likely to develop long-term disability, new research published in the Annals of Internal Medicine shows.

This encouraging finding comes from a study of people at high risk of mobility problems: men and women between the ages of 70 and 89 who were sedentary and had some difficulties with daily activities but were still able to walk a quarter mile without assistance.

Half of the group attended 26 weekly health education classes followed by monthly seminars. The other half spent about an hour getting physical activity — primarily walking — at a clinic twice a week, followed by at-home exercises.

The goal was to have participants meet the government’s recommended standard of 150 minutes of weekly moderate physical activity and sustain that level over time.

Results confirmed the extraordinary benefits of physical activity, which has been shown in previous research to lower an individual’s risk of heart disease, cognitive impairment, diabetes, depression and some cancers.

The group that focused on walking and strength and balance exercises was 25 percent less likely to experience significant problems with mobility than the group that focused on education over a period of almost three years. Specifically, they recovered faster from episodes of being unable to walk and were less likely to have problems getting around after that recovery period.

The program “was a godsend,” said John Carp, 87, who didn’t make it a point to walk regularly before he joined the study. “There was an improvement in physical feeling and also my mental attitude.”

“If there was a pill that offered comparable benefits, it would be a billion-dollar product and people would be all over it,” said Dr. Thomas Gill, lead author of the new paper and a professor of geriatrics at the Yale School of Medicine, as well as director of Yale Program on Aging.

Gill hopes to convince Medicare and other insurers to adopt the intervention he helped create. But older adults don’t need to wait for that to happen. There are plenty of places — YMCAs and senior centers, for instance — where seniors can take classes. Experts’ practical advice:

It’s never too late. “Older adults may think ‘it’s too late for me — I’m too old or too sick for this,’” said Patricia Katz, a professor of medicine and health policy at the University of California, San Francisco. “The message from this study is it’s never too late.”

“Prescribing exercise may be just as important as prescribing medications,” Katz wrote in an editorial accompanying Gill’s report.

Focus on activity, not exercise. “Older adults, if you talk to them about exercise, will say that’s not for me, that’s for my grandchildren,” Gill said. “But if you talk to them about become more physically active, they’ll say ‘okay, I can do that.’”

“Basically, I walk in the park or around the neighborhood and move my arms and legs around at night in different positions, and try to flex my muscles,” Carp said, describing his daily routine. “It’s not hard, and it makes a big difference.”

Start slow. Some participants could barely make it around a track at the beginning of the study so “we started low and increased slowly,” offering remedial help along the way, Gill said.

“I recommend focusing on smaller and achievable goals, initially, and not trying to do everything at once because we know that tends to make people give up,” said Dr. Anne Newman, chair of the department of epidemiology at the University of Pittsburgh and co-author of a new study showing that people who eat healthily, maintain a normal weight and are physically active live longer and spend less time being disabled at the end of their lives.

Even small amounts make a difference. Newman’s study tracked more than 5,000 older adults over the course of 25 years. One conclusion: “There’s no threshold for benefit from physical activity,” she said. “Every little bit helps.”

“You don’t need to get on a treadmill, go to the gym, or wear Spandex,” Newman said. All you need to do is start walking for a few minutes every day and gradually build up your strength and endurance.”

Beware of becoming sedentary. The worst thing seniors can do is “sit down and take it easy,” said Susan Hughes, co-director of the Center for Research on Health and Aging at the University of Illinois at Chicago.

Make a plan. Hughes helped develop Fit & Strong, an evidence-based physical activity program for seniors with osteoarthritis that incorporates health education.

Before participants go off on their own, coaches craft an individualized plan that covers three questions: What are you going to do and how often, where are you going to do it and who are you going to do it with? You can make a plan yourself, but make sure it’s enjoyable, Hughes said. Otherwise, it’s very unlikely you’ll follow it for any length of time.

* * *

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.


Elder Orphans – Part 1: Definition

About 18 months ago, I started a conversation here about elder orphans. It is a distinct characteristic of old age for tens of millions of old people but recognized as such only recently.

Somehow I dropped the ball on this and am only now getting back to it. The intention this time (and you are allowed to call me out if I don't follow through) is to cover the issues in installments that will appear here on a regular basis – about once a month or so.

Let's start today with the definition – who/what is an elder orphan? This is more important and more complicated than I anticipated because as I began catching up on the newest information, I was shocked at the universally negative description of life in old age itself and worse for elder orphans. Some samples.

Even Dr. Maria Torroella Carney, chief of geriatric and palliative medicine at the North Shore-LIJ Health System in New York City (who may or may not have coined the phrase, elder orphans, paints a terrible picture.

”According to Carney,” writes Carol Marak in Huffington Post, “older adults have a higher risk of having trouble with daily tasks, experience cognitive decline, develop coronary heart disease and even die.

“The risks increase for people living alone and socially isolated. They have higher incidences of medical complications, mental illness, mobility issues and health care access problems. This is not good news for us, the single without children.”

Well, geez, just shoot me now.

Ms. Marak, who keeps a Facebook page called Elder Orphans, also writes, at Next Avenue in a piece titled, Elder Orphans Have a Harder Time Aging in Place:

”...once 65 hits, the changes bring reminders that we’re no longer the same. We don’t move as quickly, we don’t multitask as well, nor do we easily adapt.

“Those are the simple cues. As we age, the physical and mental challenges delivered through loss, immobility and dependence are the ones that put us at higher risks.

“However, the effects of aging land harder on an 'elder orphan,' because the worry and concern of 'what will become of me if I can’t care for myself?' triples when no one is around.”

There is no way to know where that “triples” reference comes from nor do I buy it. Not for a minute do I think elder orphans worry three times as much as non-orphans about the effects of aging.

However, even without that hysterical tone, some academics sound as dire in their definitions of elder orphans: “both childless and friendless;” “people over 65 who are single or widowed, have no children at least in the area, and no support system;” “have low social capital.”

Some of you who have been here at TGB for a number of years perhaps recall what I discovered about the literature of growing old after I had been studying aging for half a dozen years. As I wrote in the About page for this blog:

”...I spent the greater part of my time away from the workplace researching what it is like to grow old. I wanted to know what I was in for and it wasn't a pretty picture.

“Whether popular books, magazines and newspapers, scholarly and academic research, psychology and medical texts, movies, TV shows, advertising and comedy too, the conclusions were universal: old age was all about the three Ds – disease, decline and decay leading to a fourth D, death.”

And that was the best anyone had to say about growing old which is why I adopted the subtitle for this blog, "what it's really like to get old." It's nowhere near that bad.

In the decade since then, as the boomers have reached the beginning of their elder years, old age has become “cool” to write about as both popular and academic reporting has taken a more realistic and positive attitude toward it.

Except, apparently, among the people who have at least acknowledged the existence of elder orphans. I'm going to assume that these people mean well but I reject their descriptions of old age just as I did a dozen years ago.

Yes, some old people will become sick, lonely and dependent on family or others but nowhere near a majority of old people and I'll back that up with research and statistics in a future post.

Today, let's get to a definition of an elder orphan. At the risk of stringing out what would have been a one-page blog post until I started reading, here is a definition in list form from Ms. Marak's Huffington Post story linked above:

”Who are elder orphans?” she writes.
We are the socially and physically isolated aged living in local communities

We live without a family member or a designated surrogate

We have a higher vulnerability to losing the decision-making capacity

We use only a few community resources and are lonely

We have a high risk of losing independence and safety

We aren’t acknowledged (as a group) that will need more attention and care”

No. NO. NO. There is no evidence for a word of that.

Lack of family or close friend, in itself, does not make anyone more vulnerable, lonelier, less safe or liable to loss of cognitive abilities than old people with children or close friends.

I suspect Ms. Marak has confused research on loneliness in old age with being an elder orphan. Some elder orphans are lonely. Some old people with families are lonely. The two characteristics are not synonymous and alone is not the definition of lonely.

Here is a better definition of an elder orphan from 18 months ago:

An elder orphan is an old person who is single, lives alone, has no children or family member or friend who can act on his or her behalf in handling health, legal and financial issues.

An elder orphan has no one, or is uncertain of who, to list on that “next of kin” line in forms, no one designated to carry out end-of-life wishes, and see to the funeral and burial.”

That was a decent definition a year and a half ago but it needs expanding at least this much: Some old people who have children or other family members are elder orphans because they are estranged from their family or children and/or don't want them involved in decision making.

It's amazing how many people I've run into who feel this way. Having relatives doesn't mean you trust them – or even like them.

As my friend Wendl Kornfeld – who knows a whole lot about elder orphans and who you will be hearing more from during this series of blog posts – says:

”We urge people without family to be their own strongest advocate and to support that by creating a community as their family.”

And that is what we will do in this series: break down the issue into easily doable chunks. And we will do it without making anyone feel that being an elder orphan is a calamity that makes our lives worse than that of other old people. It is not.