514 posts categorized "Health"

Anorexia of Ageing: How Growing Old Affects Appetite

Some medical professionals call the loss of appetite in old people the “anorexia of ageing.”

Up until a year ago, if anyone had told me I would one day need to work at maintaining or gaining weight, I would have collapsed laughing. The opposite had always been my problem and I've always loved to eat - just about anything.

Then, even after recovering from the extensive Whipple surgery 13 months ago, I wasn't hungry much of the time.

As happened to with me, serious diseases and conditions can reduce appetite in elders but it is not uncommon for a remarkably long list of other reasons too. Here are some of both kinds:

Any acute illness such as:
Cardiac disease
COPD
Renal failure
Liver disease
Parkinson's disease
Cancer
Alzheimer's disease

Other difficulties such as:
Dental conditions or denture problems
Reduced saliva production
Swallowing problems
Constipation
Impaired senses of smell and taste
Medication side effects
Depression
Loneliness
Lack of energy to cook

And that's just a partial list from which, I suppose, it can be extrapolated that pretty much every old person has an appetite problem at one time or another.

The BBC website tell us that changes to appetite happen throughout our lives but become more common in old age:

“After the age of 50, we begin to suffer a gradual loss of muscle mass, at between 0.5-1% per year. This is called sarcopenia, and lessened physical activity, consuming too little protein, and menopause in women will accelerate the decline in muscle mass.”
At age 60 and beyond, the BBC continues, old age and lack of hunger can lead “to unintentional weight loss and greater frailty,” and frailty is nothing to fool around with. The opening paragraph of Wikipedia's entry about it is worth quoting if just for the literary reference that amuses me:

”Frailty is a condition associated with ageing, and it has been recognized for centuries. As described by Shakespeare in As You Like It, 'the sixth age shifts into the lean and slipper’d pantaloon, with spectacles on nose and pouch on side, his youthful hose well sav’d, a world too wide, for his shrunk shank…'

“The shrunk shank is a result of loss of muscle with aging. It is also a marker of a more widespread syndrome of frailty, with associated weakness, slowing, decreased energy, lower activity, and, when severe, unintended weight loss.”

Unintended weight loss is serious business that is difficult to reverse in elders. A good-sized 2017 study about appetite in elders discovered that

”...older adults with poor appetites ate much less protein and dietary fiber. They also ate fewer solid foods, protein-rich foods, whole grains, fruits, and vegetables.

“However, people with poor appetite did eat/drink more dairy foods, fats, oils, sweets, and sodas compared to older adults who reported having very good appetites...

“The team concluded that identifying the specific food preferences of older adults with poor appetites could be helpful for learning how to help improve their appetite and the quality of their diets.”

Directly following my surgery, I was told to eat six small meals a day. I was lucky to be able to get down four before anything more that day threatened to cause me to vomit. But the nurses were terrific in helping me figure out how to increase the high daily calorie count I needed to prevent more weight loss.

Little things, they said, like adding grated cheese to scrambled eggs, switching to whole milk for cereal, eating as much of my two favorite foods – ice cream and cheese – as I wanted, also peanut butter, lots of high protein foods including red meat.

They also recommended that old folks' staple, protein drinks. I won't mention brand names because I dislike all the supermarket brands – it's like trying to drink glue to get them down.

(I go out of my way to not mention product names here and I tell you this one for information purposes: I finally discovered a brand of protein drink that actually tastes good: Odwalla. They make other kinds of drinks so if more protein is your goal, be sure to use the bottles labeled “Protein.” on the front. Of course, everyone's tastes differ.)

For the first three or four months, I wasn't allowed most vegetables and no fresh fruit with small seeds. When I said I was concerned about my health with such a high fat, high protein diet, one nurse said, “Ronni, cancer will kill you long before this diet will,” so I stopped complaining and followed instructions.

As much as the point was to keep up my weight, it was also to accommodate the radical surgery that removed quite a few pieces of my digestive system – something that would not apply to the diet of those who haven't had this kind of surgery.

Nowadays, just over a year since the surgery, I eat a normal three meals a day, am back on lots of salads, fish and fruit but I've hung on to red meat once or twice a week and I drink Odwalla (average 300 calories per 15 ounce container) several times a week.

Plus, I weigh myself every morning and keep a chart. Mostly my weight is stable but if it drops more two pounds within a week, I up the calorie intake for awhile.

And now, after nearly a year off, I am back to my workout four times a week. I've lost a lot of muscle mass and doubt I'll get much of it back, but I can work at strengthning the muscles I've got.

The point is to fight back against loss of appetite – it will go a long way to keeping us healthy and active. WebMD has a good list of strategies to help overcome lack of hunger.

What's your experience with anexoria of ageing?



Reducing Elder Pedestrian Fatalities And the Alex and Ronni Show

It's no secret that people often walk more slowly as they grow old. Some use canes or walkers, and wheel chairs too that can further impede their speed, and this happens at a time in life when, in some cases, driving is no longer a choice.

The result is serious injury and, too often, death in crosswalks where walk/wait signs don't take older, slower pedestrians into account. Cyclists of all ages are also at high risk.

Recently, my friend and elderlaw/consumer attorney, John Gear of Salem, Oregon, forwarded a story about all this from The Guardian:

”...the tragic rise of cycling and pedestrian deaths in a city such as Toronto, the biggest city in one of the world’s most progressive countries, demonstrates that we are caught in the transition.

“We are adding density and pedestrians and cyclists without transforming the design of our streets, and in many cases refusing even to lower speeds limits, which tends to reduce deaths dramatically.”

The Toronto Police department maintains a “Killed or seriously injured” data page online. Numbers for the year 2017 show that 52 percent of pedestrian fatalities involving vehicles were people 55 and older (23 deaths in 44 collisions).

Counting all traffic fatalities in 2017, involving pedestrians of all ages, those 55 and older made up 23% of the total (36 deaths in 151).

The number of fatalties in 2017 in Toronto was down from 2016, when a five-year project, Vision Zero, was created to decrease traffic fatalities to zero. But recent numbers are not encouraging:

”...the rate of deaths on city streets is not declining,” The Star reported in May this year. “Including Wednesday’s fatal accident 18 pedestrians or cyclists have been killed in Toronto so far this year, according to data compiled by Toronto Police and the Star.

“That pace exceeds the number killed by May 16 in both 2013 and 2016, the two worst years in the data, which goes back to 2007.”

The demographics of cities everywhere are changing and, writes Jennifer Keesmaat in The Guardian story, that means streets, originally planned to be auto-friendly, must become more pedestrian- and bicycle-friendly:

”In the old model, if driving is the key to freedom, then cyclists and pedestrians need to get out of the way. They are audacious, misplaced and – even worse – entitled. Who and what are streets for, anyway? They are places to get through, and fast. Lowering speed limits to ensure pedestrians are safe makes no sense...

“In the new model, however, streets aren’t just for getting through – they are places in their own right, designed for people, commerce, lingering and life. It’s the people, the human activity, that should come first.

“Cycling isn’t just for radicals and recreation, and lower speed limits make sense: they protect and enhance quality of city life. In Oslo, for example, where cars move slowly, an easy sharing of space takes place.”

New York City began a Vision Zero project four years ago to positive results:

”Traffic fatalities in New York, which launched its Vision Zero program in 2014, fell for three successive years through 2016,” reports The Star. “Traffic deaths in that period declined 23 per cent (this includes all traffic deaths, not just pedestrians.)

“That decrease came with a considerably larger investment than in Toronto.”

It is clear that slower speed limits, bike lanes, extending pedestrian crossing times, safety zones and, I would add, enforcing statutes against distracted driving (read smart phone use while driving) would go a long way toward reducing the number of traffic deaths.

Some years ago, my block association in Manhattan petitioned the city to extend the crosswalk time at one of the corners in our area because there were a lot of old people in the neighborhood who could not make it across the busy avenue in the time allotted.

It took us more than a year of petitions, meeting with city council representatives, phone calls, followups and more but we kept at it and eventually the city increased the crosswalk time.

You can do this too. We have an election coming up in November that beyond votes for federal senators and representatives, local offices are on ballots.

Between now and then, you could contact local officials and candidates with your suggestions for making the streets safer for old people in your community. Start a petition. Get neighbors involved. Make phone calls. Attend town halls. Make a calendar of activities to campaign for safer streets and stick to it.

And remember, one of the strongest arguments you have is that anything good for old people in a community is always good for everyone else too.

* * *

Here is latest episode of The Alex and Ronni Show.

If you would like to see Alex's entire two-hour show with other guests after me, you can do that at Facebook or Gabnet on Facebook or on YouTube.



The Danger of Extreme Heat on Elders

Given the rat-a-tat-tat of outrageous and even depraved behavior that pours forth daily from upper levels of the U.S. federal government, it is hard for other news to break through.

But we need to seek out important information and at this time of year, the weather headlines from around North America are a reminder that we must be careful to take precautions in our over-heated climate. Last week's weather was a killer:

Death Toll in Canada (Quebec) Heat Wave Jumps to 34

Death toll at 3 from Vermont heat wave

Southern California heat wave breaks records

Here are some of the temperatures (Fahrenheit) for the Los Angeles area last Friday:

Hollywood Burbank Airport - 114 degrees
Van Nuys Airport - 117 degrees
Ramona - 117 degrees
Santa Ana - 114 degrees
Riverside - 118 degrees

Once upon a time in my life, numbers like that showed up in the U.S. only in Death Valley.

With temperatures hitting three figures all too often – it's only 9 July and there is a lot more summer to get through – it is time for the annual TGB reminder that although everyone suffers, extreme heat is more often deadly for elders than younger people.

In France in August of 2003, during an extreme heat wave, 14,802 heat-related deaths occurred, most of them elders. In the U.S., it is estimated that about 370 deaths a year are attributable to heat, half of them elders. Do not take extreme heat lightly.

HOW TO STAY COOL AND SAFE IN HOT WEATHER
Here are the best suggestions for staying cool and safe during extreme hot weather. Yes, I've published these before – pretty much every year - but it's good to review them again.

Even if, like me, you dislike air conditioned air, when temperatures hit 80F, it's time to pump up the volume of that appliance. Fans, say experts, don't protect against heat-related illness when temperatures are above 90 degrees; they just push hot air around.

If you don't have an air conditioner, plan for the hottest part of the day by going to a mall or a movie or the library or visit a friend who has air conditioning.

If you have air conditioning and have elder friends or neighbors who don't, invite them for a visit in the afternoon. Some other important hot weather tips:

Wear light-colored, loose clothing.

Drink plenty of liquids and make reminders to yourself to do so. Elders sometimes don't feel thirst (another thing that stops working well with age). One way to know if you are drinking enough water is to check the color of your urine. Light-colored is good; dark indicates dehydration.

Do not drink caffeinated and alcoholic beverages; they are dehydrating.

Plan trips out of the house and exercise for the early morning hours.

Eat light meals that don't need to be cooked. High-water-content foods are good: cantaloupe, watermelon, apples, for example.

Keep a spray bottle of cold water to help you cool down. Or use a damp, cool towel around your neck.

Close doors to rooms you are not using to keep cool air from dissipating.

Medications for high blood pressure, diabetes and other conditions can inhibit the body's ability to cool itself, so it might be a good idea to ask your physician if you can cut back during hot weather.

Pull down the shades or close curtains during the hottest times of day.

In that regard, I have been quite successful in keeping my home cool during hot weather without the air conditioner. In the morning, when the temperature here in Portland, Oregon is typically in the mid- or high 50s, I open all the windows.

I keep my eye on thermometer and when the outside temperature reaches 65F or 70F – usually by late morning - I close the windows and the shades. After several years of practice with this method, I only rarely need the air conditioner even on 90-plus degree days. It saves a lot of money, too, not using the air conditioner. But to repeat: turn it on when it is necessary.

SERIOUS HEAT-RELATED CONDITIONS
Heat exhaustion occurs when the body gets too hot. Symptoms are thirst, weakness, dizziness, profuse sweating, cold and clammy skin, normal or slightly elevated body temperature.

Move yourself or someone experiencing this to a cool place, drink cool liquids, take a cool bath or shower and rest.

Heat stroke is a medical emergency. It can cause brain damage so get thee or the affected person to a hospital. It occurs when body temperature reaches 104 or 105 in a matter of minutes. Other symptoms include confusion; faintness; strong, rapid pulse; lack of sweating and bizarre behavior.

Don't fool around with heat stroke.

There now. That's pretty much the best of health experts' recommendations about protecting ourselves and others during extreme hot weather. If you have additional suggestions, please add them in the comments.



Caregiver Friends

As I write this on Thursday, it is late morning. I have just returned from the Oregon Health & Sciences University (OHSU) campus on the banks of the Willamette River in Portland, Oregon.

While there, I was given the last of five, weekly, liquid-iron infusions meant to knock out the anemia that has slowed me down for several months.

It will be a month before there are blood tests to assess the outcome but meanwhile, I have felt a big change in my energy level.

When the anemia was diagnosed, I was lucky to vacuum one room without breathing heavily and needing to sit down for half an hour. About three days ago, I vacuumed the entire house in one go, hardly noticing any exertion.

These infusions took place at the same clinic where, for three months last year, I was treated weekly with chemotherapy for pancreatic cancer. That, combined with the internal bleed that took several months to fix, are what led to the anemia.

One more recent item: Last Monday, at the Marquam Hill campus of OHSU, I underwent an FNA - medical jargon for Fine Needle Aspiration: that is, a biopsy of a lump on my neck.

The lump has been there for a long time – more than a decade. It was small and didn't bother me so I ignored it all that time. Then, in the past few weeks it has changed, enlarging a great deal during the day but returning to its small size overnight.

Whatever the diagnosis from the aspiration, there will undoubtedly be a visit with the physician who ordered the FNA along with a few already-booked appointments over the rest of the year with other doctors who track this and that resulting from the cancer and surgeries.

Overall, since the pancreatic cancer was diagnosed in June 2017, I've met with about two dozen doctors along with many more nurses and other health care aides during uncounted office appointments and 25 days – give or take - in hospital over the past year.

If you have read this far (who can blame anyone who hasn't), let me tell you the reason I have recounted all this. In so much time together, some of these medical people have become friends in a certain kind of way with which I have no experience. They make a big difference in my life; the reason for an appointment aside, I always look forward to our visits, to chatting with them, to getting to know them a bit better each time.

Now, unless or until something goes terribly wrong with my health again, I will be seeing them far less frequently and it struck me hard this morning how much I will miss them.

“Good morning, Ronni,” said the woman who checks me into that infusion lab every time I'm there. “Full name and birthdate?” (She have their rules.)

“Hey, Ronni, it's been awhile,” said the CNA who checked my vitals. “Did you have a good holiday?”

“Yes,” said I, “and how did that cute daughter of yours like the fireworks?” I asked. He had shown me photos of her in the past.

“What's all this bruising on your neck, Ronni?” asked the RN who was hooking the infusion line to the port embedded in my upper chest. I explained about the FNA and she said such lumps are often not important.

Another CNA and a couple of other RNs waved and said “Hi, Ronni,” as they passed by my chair on their way to their patients.

These professionals who have helped and attended me this past year have become as familiar and important to me as the employees I know at the supermarket, the pharmacy, several restaurants I patronize regularly and even the FedEx delivery guy. Part of the rhythm of my days.

It seems to me there are concentric circles of important people in our immediate lives. Most broadly, they start with family and closest confidants; continue to good friends far and near; some neighbors; followed by the merchants and service people we see in our regular rounds who are part of our communities.

(Somewhere in the mix are co-workers but that diminishes a good deal when we retire.)

Because I had the great, good fortune to be so remarkably healthy for 76 years, I hardly ever saw medical professionals and then, not frequently enough to know about their families, children, books and movies, other interests, etc.

So this is a whole new set of people I know and like and with whom I have more personal conversations than I ever will with my closest friends.

I mean, I don't get naked with friends. I don't have detailed conversations with them about the nature of my bowel movements which my OHSU helpers have taught me to do as easily as I discuss the weather with anyone else.

And with a couple of important exceptions whom I cherish, I don't laugh as loudly or as long with friends about the ironies of my newly intimate association with my own death as I do with OHSU companions.

In a manner similar to friends and neighbors but different too, I look forward to seeing them each time. I had no idea this would happen and as my visits to OHSU become fewer (god willing), I will miss them.

Talk about ironies...



How Brains Change in Old Age

Following my 12-hour surgery last year, I was plagued with what I learned is popularly called “anesthesia brain,” a relative of “chemo brain.”

Among the symptoms are

Confusion
Difficulty concentrating
Difficulty finding the right word
Difficulty multitasking
Being disorganized
Feeling of mental fogginess
Short attention span

Inability to concentrate, mental fogginess and shortened attention span were my biggest difficulties. For a few weeks, it affected my ability to carry on conversations, to read and even to follow a movie or TV plot.

I had no trouble knowing the meaning of each word, but there was a lag time of a second or two in putting together the meaning of an entire sentence – just enough for me to notice (and be irritated by) the slowdown of my brain. I learned to take notes when doctors were speaking with me so not to lose important information.

Nurses in the hospital assured me this was a temporary consequence of long anesthesia and that it would dissipate over time.

Fortunately it did, but the experience of the temporary diminished cognition got me wondering how anesthesia brain compares to the brain changes that can accompany old age. The U.S. National Institute on Aging (NIA) tell us that among common changes to thinking in old age are

Increased difficulty finding words and recalling names
More problems with multi-tasking
Mild decreases in the ability to pay attention

Sounds a lot like anesthesia brain to me. In fact, however, I couldn't multi-task well when I was 20 or 30, and recalling words and names? Don't even ask. But the NIA also tells us that elders have more knowledge and inisight due to a lifetime of experience and contrary to all-too-common myth, can still

Learn new things
Create new memories
Improve vocabulary and language skills

A frustrating thing about looking into brain and cognition science is that researchers, as hard at work as they are, don't know much. Almost every statement includes such weasel words as: it may be, the results suggest, could be associated with, is far from clear, etc.

In a story from last year, Medical News Today (MNT) tells us that

”As we age, all our body systems gradually decline - including the brain. 'Slips of the mind' are associated with getting older. People often experienced those same slight memory lapses in their 20s and yet did not give it a second thought.

“Older individuals often become anxious about memory slips due to the link between impaired memory and Alzheimer's disease. However, Alzheimer's and other dementias are not a part of the normal aging process.”

Here is some of what is known about normal physical changes to the brain as we grow old – again from MNT:

Brain mass: Shrinkage in the frontal lobe and hippocampus - areas involved in higher cognitive function and encoding new memories - starting around the age of 60 or 70 years.

Cortical density: Thinning of the outer-ridged surface of the brain due to declining synaptic connections. Fewer connections may contribute to slower cognitive processing.

White matter: White matter consists of myelinated nerve fibers that are bundled into tracts and carry nerve signals between brains cells. Myelin is thought to shrink with age, and as a result, slow processing and reduce cognitive function.

Neurotransmitter systems: Researchers suggest that the brain generates less (sic) chemical messengers with aging, and it is this decrease in dopamine, acetylcholine, serotonin, and norepinephrine activity that may play a role in declining cognition and memory and increased depression.

(Did you notice all the weasel words: may, is thought to, suggests, etc.? It can't be helped with science's current level of understanding.)

Nevertheless, eventual results from such studies will help researchers discover what therapies and strategies can help slow or prevent brain decline. Meanwhile, you probably know the current prescription to help preserve cognitive ability:

Regular physical activity
Be socially active
Manage stress
Eat healthy foods
Get enough sleep
Pursue intellectually stimulating activities

In regard to the last item, sales of so-called brain games bring in millions if not billions of dollars a year to their purveyors who promise their products will improve or, at least maintain memory and brain function. Studies are showing otherwise.

A year ago, Psychology Today reported on a study from The Journal of Neuroscience:

”The results were disappointing. There was no effect on brain activity, no effect on cognitive performance, and no effect on decision-making.

“The participants who trained with Lumosity did improve on the cognitive assessment, but so did the control group and so did a group who played no games whatsoever.

“In other words, it wasn’t the game that was having an effect. Kable attributes the gains to the fact that everyone had taken the test once before.

Research into ageing brains is not far enough along for us to have much understanding of who may be afflicted with declining function and who not.

Meanwhile, I'm sticking with those suggestions for maintaining a healthy brain because it is well known that they also contribute to good health overall.



Insomnia in Elders

A month or so ago, TGB reader Salinda left this comment:

”Over the past year, sleep has become very elusive, and despite good advice from herbalists and docs, meditation, lots of exercise, no screens before bed, ETC, the situation persists.

“For now a coping strategy is to take a nap each day, whenever possible. Not only is my capability to function impaired by the tiredness, it's also more difficult to keep a positive attitude. Would love to hear how others deal with this.”

Remember what sleep was like when we were teenagers? In 1957 when I was 16 years old, I woke one morning with my bed two feet from the wall and no memory of how that could have happened without my noticing, even while asleep. Soon, radio news informed me that there had been an earthquake during the night.

There is no way I could sleep through that nowadays and for more than a decade nothing the so-called “experts” recommend to treat insomnia had helped me.

People don't take insomnia seriously enough. Even though masters-of-the-universe types and tech workers have for many years made it a point of pride to brag that they work 16, 18 and more hours a day, regular lack of sleep can have important consequences and it affects more people than I thought.

According to the National Institutes of Health, it is common problem affecting nearly 50 percent of people 60 and older and about 30 percent of younger adults resulting in significant impairment.

Lack of sleep causes difficulty with concentration, memory, reasoning, problem solving, not to mention attention lapses and slowed reacton time.

”The National Highway Traffic Safety Administration (NHTSA),” reports Medscape, “estimates that at least 100,000 crashes and 1500 deaths annually are attributable to sleepiness/fatigue.”

With so many people affected, you would think there are remedies, but there are not many that actually work well.

Insomnia is defined as difficulty falling asleep and/or staying asleep. How many jokes have you heard over the years about old men getting up half a dozen times a night to use the bathroom? I'm living proof that it's a problem not only for men and until recently, I could never get back to sleep afterwards.

Treatments fall mainly into categories of “natural,” of over-the-counter and prescription drugs, and of alternative or life-style changes. Before you try anything, be sure to find out if your insomnia is a result of an underlying disease or condition, or a side effect of medications. If not, here is a short overview.

NATURAL
Acupuncture, guided imagery, yoga, hypnosis, biofeedback, aromatherapy, relaxation, meditation and massage fall into this category. There are herbs like melatonin and valerian that work for some people.

Exercise too, including tai chi, are useful although it needs to be no later than three or four hours before bedtime.

OVER-THE-COUNTER SLEEP REMEDIES
The names of these are probably familiar to you: Nytol, Sominex, Tylenol PM, etc. They contain antihistamines which induce drowsiness and they lose effectiveness over fairly short periods of time.

PRESCRIPTION SLEEP REMEDIES
Ativan, Xanax, Valium, Restoril and others are benzodiazepines which are habit-forming, contribute to falling and can be difficult to stop using. Old people's bodies metabolize drugs of all kinds differently from younger adults and because drugs are almost never tested on people older than 65, it is hard to know what is safe.

There is a comprehensive list of safety and efficacy of sleep medications in older adults at this website.

LIFESTYLE CHANGES
These suggestions for a good night's sleep may seem obvious but many studies have shown that they work as well of and, often, better than drugs.

Keep a regular sleep schedule

Avoid heavy meals, smoking, alcohol, or caffeine near bedtime

Avoid naps during the day

Keep your sleep surroundings as dark as possible

Don't watch TV in bed (I record late-night shows for later viewing)

Don't use other tech toys in bed – no phone, tablet, etc.

A few experts suggest no reading in bed either

Make sure you have a comfortable bed in a room not too hot and not too cold

If, in the end you can't get to sleep asleep, specialists suggest you get out of bed, leave the room and return when you feel sleepy again

SECOND SLEEP

That last suggestion brings me to a historic practice that was similar: First Sleep/Second Sleep which I wrote about here in 2012. I first heard about it in a fascinating book, At Day's Close – Night in Times Past by A. Roger Ekirch who posits that from about 1500 to 1850, before the advent of artificial light, people may have commonly slept in two shifts – so commonly that hardly anyone thought to mention it.

”...fragments in several languages...,” writes Ekirch, “give clues to the essential features of this puzzling pattern of repose.

“Both phases of sleep lasted roughly the same length of time, with individuals waking sometime after midnight before returning to rest...Men and women referred to both intervals as if the prospect of awakening in the middle of the night was common knowledge that required no elaboration...”

“After midnight, pre-industrial households usually began to stir. Many of those who left their beds merely needed to urinate...

“Some persons, however, after arising, took the opportunity to smoke tobacco, check the time, or tend a fire. Thomas Jubb, an impoverished Leeds clothier, rising around midnight, 'went into Cow Lane & hearing ye clock strike twelve' returned 'home & went to bed again.'”

I've tried this in the past and it worked for me to a degree except that too often, I stayed up several hours then slept in too late in the morning than I felt comfortable with.

CANNABIS
For the past several months, I've been using a tincture of cannabis to help me sleep and now, after at least a decade of not sleeping more than three or four hours a night, it feels like a miracle to me.

I use a tincture of THC (the non-high-producing CBD works for some people) and I'm easily getting seven or eight hours of sleep a night. Plus, when I get up to use the bathroom, I can go right back to sleep when I return to bed.

I could give you a long list of online websites to consult but it's just as easy for you to search “insomnia remedies” or “insomnia treatment”. There is an enormous amount of information and with minor discrepancies, most agree with one another.

Meanwhile, let's help out Salinda. What is your experience with insomnia? What have you tried that did not work and what have you used that does?

(Remember: no medical advice, no recommendations of medications, no links to other websites.)



Are You Ageing "Normally"?

Depending on how you define the phrase, probably not.

As we have always reported at Time Goes By, people age at remarkably different rates and any gerontologist or geriatrician worth his/her salt, will tell you that people, as they grow older, become more individual from one another than when they were younger.

Because those two, four-day hospital visits in April interrupted my blog life, there are several topics that got lost in the shuffle that I want us to catch up on. One is a story from the highly respected Kaiser Health News (KHN) titled, Is There Such a Thing as Normal Aging?

They don't really answer their question. Instead, the KHN reporter consulted with Dr. Thomas Gill, a geriatric professor at Yale University, and three other geriatric experts to identify

”...examples of what are often — but not always – considered to be signposts of normal aging for folks who practice good health habits and get recommended preventive care.

In doing so, they break down ageing into decades containing these typical changes. My short version – the subheads in the story:

• The 50s: Stamina Declines
• The 60s: Susceptibility Increases
• The 70s: Chronic Conditions Fester
• The 80s: Fear Of Falling Grows
• The 90s & Up: Relying On Others

Those are the generalities of “normal ageing.” (There are fuller explanations at the links to Kaiser above.) Except for noting that the oldest old feel happier than young people, KHN defines normal ageing from only one point of view: negative health issues. I wondered how others approach the idea of normal ageing and checked out the usual suspects:

The Mayo Clinic website provides a long list of what physical things can go wrong in late years and supplies suggestions on how to prevent them.

WebMD has a similar list that's not quite as thorough as the Mayo Clinic.

Area Agency on Aging (in St. Petersburg, Florida) has a long but succinct list of physical changes and the reasons for them.

The Merck Manual Consumer Version online has the most usable, useful and informative version of health issues that can be expected in old age. And I like their pullquotes of these little nuggets of information:

“Disorders, not aging, usually account for most loss of function.”

“To make up for the muscle mass lost during each day of strict bed rest, older people may need to exercise for up to 2 weeks.”

“Most 60-year-olds need 3 times more light to read than 20-year-olds.”

However, all four web pages, each from a reputable health organization, deal only with those negative health developments of growing old, reinforcing the widespread but erroneous belief that to be old is to be sick.

It's a tricky thing to balance curiosity about what “normal” physical changes might turn up in old age without feeling you are being defined as sickly. While surfing around the web on these topics, I came across a blogger named Brian Alger who has some different thoughts on “normal aging”:

Aging doesn’t just place a limit our our lifespan, it also constantly alters the physical, emotional, spiritual, and social context of being alive. In this sense, aging is a medium, a total surround, of our experiences in life.”

That resonates with me for putting into words some feelings I've been having about growing old but haven't been able to articulate even to myself. Further, writes Alger,

”We can confidently expect that every aspect of our life will be touched by the direct felt experience of aging. Normal aging makes time increasingly precious. As a form of communication, aging inspires a conversation with time, impermanence, and the great flow of life that we are immersed in.”

From another page at Alger's blog:

”Aging is our most intimate connection [to] the natural world; it is a source of unity and essential belonging with all life everywhere at once. The very essence of elderhood originates entirely in nature.”

Regular TGB readers would be disappointed, I'm sure, if I didn't bring up how the language of old age reinforces negative beliefs about it in both elders and younger people.

In response to sickliness being the most common definition of growing old, in 2014, Science Daily reported on a study from the University of Alberta. One of the researchers says such terms as “normal” or “healthy” aging themselves fall short how elders actually live:

”"The implication is that if you have a chronic illness as an older adult, you've somehow failed in this goal of aging without chronic disease, which is perhaps not that realistic a goal."

"When aging is just defined as 'healthy' and 'devoid of disease,' it doesn't leave a place for what to do with all of these older adults who are still aging with chronic illnesses..."

I have long contended that issues relating to aging should always include input from someone who is old, as this quotation from a subject of the Alberta study makes clear:

"'I don't know what would be considered normal aging,' said [80-year-old Diana] McIntyre, past president of the Seniors Association of Greater Edmonton. 'What's normal for a 45-year-old? What's normal for an 80-year-old? Those are really irrelevant terms as far as I'm concerned.

“'My own philosophy is I would like to do as much as I can, for as long as I can, as well as I can.'”

That last sentence from McIntyre works for me. How about you? Do you think you're ageing “normally”?



What Trump's Proposed Drug Plan Does for Elders (and Others)

EDITORIAL NOTE: This is long-ish and gets a bit wonky in places but it is important to know this stuff.

* * *

We have all known or have read about elders who don't fill medication prescriptions or cut them in half because the cost forces them to make the choice between life-saving drugs and food.

Just recently, I had a personal encounter with such an issue. A newly prescribed drug I inject twice a day costs me hundreds of out-of-pocket dollars a month which is way beyond my means and at first I told the doctors it was out of the question; find something else to help me that I can afford.

Then someone in the meeting realized they had neglected to note that I need the drug for only three months. I don't like dipping into my emergency fund for that much money, but I suppose that's why I call it an emergency fund. And I can handle three months.

I'm lucky to have that fund. Millions of American adults who can't afford their prescriptions with or without insurance converage just don't fill them, endangering their health and their lives.

Why, do you suppose, are prescription drugs so expensive in the United States, higher than in other countries. Here is an explanation from CNN:

What reporter Christine Romans overlooks in this video is that pharmaceutical companies do not bear the entire of burden of new drug development. A great deal of money and help comes from the U.S. National Institutes of Health (NIH).

In the White House Rose Garden on Friday, President Donald Trump unveiled a proposal he says will lower the prices of prescription drugs for consumers. It tells us something that minutes later, the stock market price of pharmaceutical companies soared:

”The stock prices of Pfizer, Merck, Gilead Sciences, and Amgen all spiked after Trump’s speech,” reported STATnews. “Wall Street analysts said the speech posed few threats to the drug industry on the whole.”

Do you think that outcome could that have anything to do with input from the man accompanying Trump at the podium Friday, the one who will be in charge of implementing Trump's proposed drug plan, Health and Human Services (HHS) secretary Alex Azar?

TrumpAzarScreenGrab

Until last year, Azar spent a decade employed at pharmaceutical giant, Eli Lilly and Company first as the firm's top lobbyist and later as president of Lilly USA LLC.

So what does Trump's proposal, disingenuously titled American Patients First, include? NBC News reports:

”The plan, presented as a thinly described set of executive actions...focuses on four elements, according to the Health and Human Services Department:

Increasing competition
Better negotiation
Creating incentives to lower list prices
Reducing patient out-of-pocket spending."

That is a far cry from Trump's campaign promise to

”...allow Medicare to negotiate directly with drug manufacturers... The industry is now having the last laugh,” reports The Atlantic. “In a speech Friday on drug pricing, President Trump completed his 180-degree turn on Candidate Trump’s promises.

“The White House’s new plan, as outlined, does seek to address high prescription-drug costs. 'We will not rest until this job of unfair pricing is a total victory,' Trump said. But it doesn’t directly challenge the pharmaceutical industry and the direct role it plays in setting prices.

“Indeed, the new policy largely meets the goals of big pharma, signaling an ever-tightening bond between Trump and drug manufacturers.”

Trump didn't say much about how his proposals will lower prices and what is conspicuously missing, despite the second item on that list, is any plan to allow Medicare to directly negotiate drug prices with pharmaceutical companies.

Big Pharma won that one when Medicare's prescription drug plan, Part D, was introduced in 2003; the legislation specifically disallows price negotiations between Medicare and the pharmaceutical companies. Trump's proposal does not change that.

During the Rose Garden speech, Trump attacked what he called “global freeloading” by countries where citizens often pay much less than Americans for the same brand-name drugs:

“He directed his trade representative to make fixing this injustice a top priority in negotiations with every trading partner,” reports Robert Pear in The New York Times...

“It is not clear,” continues Pear, “why higher profits in other countries would be passed on to American consumers in the form of lower prices, and officials in those countries pushed back hard.”

The Times also reported on another of the proposal's items:

”Alex M. Azar II, the secretary of health and human services, said the Food and Drug Administration would explore requiring drug companies to disclose list prices in their television advertisements.”

It is equally unclear how that would reduce the cost of advertised drugs. It is worth quoting Robert Reich, Professor of Public Policy at UC Berkeley who served as President Bill Clinton's secretary of labor, at some length on this:

While it’s true that Americans spend far more on medications per person than do citizens in any other rich country – even though Americans are no healthier – that’s not because other nations freeload on American drug companies’ research,” writes Reich in Eurasia Review.

“Big Pharma in America spends more on advertising and marketing than it does on research – often tens of millions to promote a single drug.

“The U.S. government supplies much of the research Big Pharma relies on through the National Institutes of Health. This is a form of corporate welfare. No other industry gets this sort of help.

“Besides flogging their drugs, American drug companies also spend hundreds of millions lobbying the government. Last year alone, their lobbying tab came to $171.5 million, according to the Center for Responsive Politics.

“That’s more than oil and gas, insurance, or any other American industry. It’s more than the formidable lobbying expenditures of America’s military contractors. Big Pharma spends tens of millions more on campaign expenditures.”

And you wonder why your drugs cost so much.

"'This [proposal] is not doing anything to fundamentally change the drug supply chain or the drug pricing system,' said Gerard Anderson, a health policy professor at Johns Hopkins University,” quoted at CNN.

The so-called American Patients First proposal is not a bill and while a small number of the proposals would require Congressional legislation, most can be put into effect with regulations or guidance documents.

So much for lowering the price of prescription pharmaceuticals. Like most everything else in the Trump administration, this proposal is gift to big business.

You can read the full, 44-page proposal here [pdf].



Brain News for Elders, Ageist Headline and Net Neutrality

Often I run across stories of interest to elders that are too long for an item in Saturday's Interesting Stuff and too short for a full blog post. Here today are a three of those.

CAFFEINE CAUSES BRAIN ENTROPY...
and although counter-intuitive, that's a good thing, according to a new study, especially for elders.

”There's not much debate on the subject,” reports Curiosity, “a more chaotic brain is a more effective brain. They call the quality 'brain entropy,' and it measures the complexity and irregularity of brain activity from one moment to the next...

“We generally associate entropy with chaos or decay, but in this case, it's a sign of a brain working correctly...An effective brain is one that doesn't always rely on the same patterns of thinking, and one that can solve problems in unexpected ways.

“By contrast, a brain with lower entropy is characterized by order and repetition. The most orderly brains of all? They belong to comatose people and people in the deepest sleep.”

More than 90 percent of American adults regularly consume caffeine, reports Big Think:

“Despite decreasing blood flow to the brain, caffeine leaves individual regions more stimulated. The stimulating effects are uneven, however, creating a chaotic balance of energy when the stimulant is in full force. The greater unevenness in stimulation throughout the brain, the higher the entropy.”

In addition to drinking coffee, Curiosity notes that there is one sure way to increase entropy in your brain:

”All you need to do is age. Yes, entropy naturally increases with age — we suppose that's just the wisdom of the years accumulating. After all, the longer you've been alive, the more types of thinking you'll have encountered or come up with on your own.

“And with that kind of broad experience, your brain will have a million different possible ways to think.

For the scientifically-minded among you, there is more detailed information about the study at PLOS and at nature.com

MAGAZINE'S AGEIST HEADLINE
Earlier this week we discussed one type of ageism, age discrimination in the workplace. But ageism manifests itself in many other obvious and/or devious ways which hardly anyone recognizes as demeaning to elders.

The latest I came across was published at New York magazine this week.

Before I show it to you, let me say I am far from being a Rudy Giuliani fan, never have been going back to his mayoral stint in New York City. That, however, does not make this headline acceptable:

”Trump Worried Aging, Loudmouth New Yorker Can’t Stay on Message”

“Aging loudmouth.” “Can't stay on message.” The slur is repeated in the story's lede: “Donald Trump is starting to wonder if it was a mistake to trust an elderly, New York celebrity...”

These are among the most common insults – nay, beliefs – regularly used against elders: that we are forgetful and untrustworthy. Further, that "loudmouth" crack is just another version of "get off my lawn" gibes. Even the word "elderly" is used disparagingly in this instance.

The byline on the story is Eric Levitz, a young reporter at the magazine but youth does not absolve him. I'm pretty sure that were he writing about a black person or a woman, Levitz would not have used the N word or "chick' as a description.

It's not that I mean to pick only on Mr. Levitz – hundreds of writers and reporters of all ages use these slurs (and worse) against old people every day with nary a consequence. And that is wrong.

NET NEUTRALITY
It's ba-a-a-a-a-ck, net neutrality. It can seem to be a complicated idea but it isn't, really. Here is a succinct explanation from a February post here quoting Engadget:

”'Net neutrality forced ISPs [internet service providers] to treat all content equally; without these rules in place, providers can charge more for certain types of content and can throttle access to specific websites as they see fit.'

"So, for example, big rich companies could afford hefty fees to providers so their web pages arrive faster in your browser than – oh, let's say political groups that depend on donations or blogs like yours and mine that are throttled because they can't bear the increased cost."

After a vote by the Republican-dominated Federal Communications Commission (FCC), regulations to trash net neutrality, the 2015 rules will cease on 11 June.

Now, the Los Angeles Times reports that the fight for net neutrality is back.

"The effort formally begins [last] Wednesday as backers file a petition in the Senate that will force a vote next week to undo the FCC's action. Amazon, Netflix, Facebook, Google and other online giants support the move...

"Although they're poised for a narrow win in the Senate, net neutrality supporters acknowledge the attempt to restore the Obama-era regulations is a long shot. The hurdles include strong opposition from House Republicans and telecommunications companies, such as AT&T Inc. and Comcast Corp., as well as a likely veto from President Trump.

"Regardless of the outcome, the debate over net neutrality — and by extension, the future of the internet — appears headed for a key role in November's congressional midterm elections.

"'There's a political day of reckoning coming against those who vote against net neutrality,' warned Sen. Ed Markey (D-Mass.), who is leading the Senate effort to restore the rules."

It is said that despite the FCC and its chair, Agit Pai, 86 percent of Americans support net neutrality. You could do your part to move the initiative to restore the 2015 rules by contacting your representatives in both houses of Congress. You can do that here.



The Losses of Age

This is Part 2 of the new series, The Wit and Wisdom of TGB Readers - today with a musical surprise at the end.

There is a motherlode of wisdom, inspiration, wit and humor in the comments section of a post last week. Among a variety of other, one theme was loss – the many kinds we encounter at this time of life which are closely related to limitations that we discussed on Monday.

Fatigue and Physical Decline
Before I get any further, let us remind ourselves that individuals age at dramatically different rates.

Some are in physical (and, sometimes, mental) decline by their fifties or sixties. Others (I am repeatedly surprised to find out how large the number is) are highly functional into their nineties and beyond. (Hello, Darlene Costner and Millie Garfield.)

I've learned a lot about overall tiredness and fatigue these past weeks with two in-hospital procedures. I'm still napping twice a day. Even without medical difficulties, youthful energy just isn't available anymore as the years pile up.

”I've reached the point at 81 where the ability (and/or money) to do many of the activities I once enjoyed are in dwindling supply,” writes Elizabeth Rogers.

“I used to enjoy my job, also gardening, decorating and shopping, among other things. I was able to donate to causes I support, political and otherwise. Now? Not so much.”

TGB reader Henry, who will be 91 in a couple of months, says he knows a lot about having to slow down:

”...it takes a lot of energy to get down the stairs to the laundry in the basement and back up again so I sit down to rest for a moment and then it’s time for a lunch and a short nap and I try to plant something in the garden and it’s time for Jeopardy.

“It’s so damn frustrating. Everywhere around me there are so many things shrieking at me 'Doo me!' If only I had more stamina.”

Giving Up Favorite Activities
It is not just slowing down. Sometimes it is chronic pain and/or conditions that force us to accept that we just can't keep up anymore. From Norma:

”Have recently been trying to come to grips with pain issues, old and new. After today's appointment I have agreed to try some new meds. I need to do something, but mostly I am angry that I may be having to settle with limitations I am just not ready to accept.”

And from David Newman:

”A harsh reality for me was knowing when to quit [blogging]. I stopped the last of my own life-long journalistic activities when I realized I could no longer meet deadline, thanks to health issues.”

Losing the Touchstones of Our Lives
It is not just that our worlds shrink as friends and relatives die. It is that they are gone forever, the people who made our lives warm and wonderful and whole.

(By the way, I've never understood how people say, “I loved him” or “I loved her” - past tense - sometimes a few minutes after the person dies. I still love all the people who are gone from my life, even decades later.)

”I could do without the 4-5 doc appointments a month,”Lyn Burstine tells us, “but maybe that's why I'm still here, having outlived all but one of my ancestors, and, sadly, many of my friends. And of those left, many now have dementia.”

Celia, who is 76, makes an important point about the loss of our culture along with that of loved ones:

”Aside from the deaths there is also a loss of some of what made me myself and where I came from. I have one younger sister who remembers me as child and our family life at that time, and one aunt and uncle who have made it together into their 90's. No one else.

“It's like we came from a culture that disappeared. Ancient history. I guess I am my own artifact.

The Ultimate Loss
During this past year of pancreatic cancer, survival and a couple of subsequent health risks, I've often said that I'm not done yet, that I have a few more things I want to do before I go.

My friend Jim Fisher talked about that too in regard to his volunteer work with our local City Natural Areas:

”I have a new worry related to my aging,” he writes. “...I worry that I may not live long enough to achieve everything I care about. It’s a new, nagging feeling, and one I try to dismiss.”

The ultimate loss, of course, is ourselves, fraught in many different ways depending on personal beliefs. Even with worry such as Jim's, I still believe deep inside that you and you and you will die but not me. I am the one immortal, (she cackled).

Which, of course, is stupid and what I really believe is that the most important job for each of us in old age is to come to an acceptance of our own mortality.

But we'll save that for another day.

Now, for reading through all this doom and gloom today, here is a treat for you. A new song from Willie Nelson who turned 85 last Sunday. It is titled, Last Man Standing and I know just how he feels. So, I think, will you. (You may need to go to YouTube to watch this. Just click the link in the image and it will open.)



Missing Here on Wednesday

Mage Bailey of Postcards blog left a note on Monday's post about where I might have been when no story appeared here as is usually routine on Wednesday.

Gilda Radner's Roseanne Roseannadanna character used to say in the early days of Saturday Night Live, "It's always something" and maybe Ms. Radner didn't live long enough (she died in 1989 at age 42) to learn that that is especially true of old people. I was in the hospital again. Another internal bleed. Lots of excellent care and a new skill: I now know how to give myself an injection.

I arrived home last night too late to pull together a proper post but I'm typing this early Friday morning so not to alarm anyone with another extended absence. I am fine, no worries please and maybe let's use today's comments section below as an open forum - we've never done that before. So, anything you'd like to say about anything related - even vaguely so - to growing old.

And I'll be back here on Monday with a further explanation, some of what I learned over my four-day hospital stay that also relates to what it's really like to get old.



Four Days in the Hospital

Thank you for the kind concern many of you showed in the comments on last Wednesday's post and in emails, wondering where I was on Friday and Saturday when the usual posts did not show up. I sure do appreciate your concern. On the other hand, if you emailed and I have not/do not respond, I came home to more than 900 emails on top of all the medical record-keeping, medications and follow-up that need attention not to mention the blog work. I hope you understand.

Here is what happened.

In my little red PT Cruiser, I made my usual way to the lab early Wednesday morning for my weekly blood letting to check various levels including hemoglobin which tells us if and how much the anemia is improving. Or not.

Having done my part to help keep the clinic vampires nourished, I got a haircut and went to lunch with my terrific stylist. When I returned home, there were about six messages from the medical center each with a similar message: Get to the emergency room, your hemoglobin numbers are dangerously low, we need to transfuse you now.”

Oh goody.

But I've done this frequently enough now that it is almost routine. Usually, they pump the blood into me and I go home. This time, nooooo. After three or four months of this, it was time, they told me, to address and correct the underlying cause: repair the location of the bleed that is causing my numbers to tank.

That turned into four days. Because I had not intended to stay over night let alone three nights, I had not brought my laptop so was without an internet connection. Hence, no blog updates.

An endoscopy was performed during which, they say, I suddenly vomited blood that also gushed from my nose. (Amazingly, doctors and nurses and technicians, etc. pay big bucks to study medicine only to regularly encounter such messiness. Me? I was asleep. If they hadn't told me, I would have no idea it had happened.)

As I mentioned once in a past post, the internal bleed is the result of the Whipple procedure surgery for pancreatic cancer. Sometimes it manifests as a loose connection where a hose is attached in a new place. In this case, they believe, a vein has narrowed so blood cannot flow properly causing it, the blood, to go to the wrong places. Hence, my low hemoglobin counts and anemia.

They had left it alone until now, I was told, because sometimes they repair themselves.

But not for me. Too bad.

After two or three days of consults among more doctors than I could count – I met at least 25 new medical people – it has been determined that an interventional radiologist (have you ever heard of that medical speciality? I hadn't) and his team will go into my Whipple-rearranged torso, find the damaged vein and insert a stent – not dissimilar to a heart stent – to keep the vein open and working.

This will happen very soon, within a couple of weeks. Unlike the Whipple, from which I have a scar running from just below my heart to my nether regions, this will involve two small holes through my skin each of which will be covered afterwards with a Bandaid, and I will be able to go home the same day.

As with any kind of surgery, there are risks. Infection, in this case, or a clot later at the location of the stent but the the incidence of those is low, they say.

That's the bad news which is not really so bad under the circumstances; they also considered cutting me open down the middle again.

The good news – actually two pieces of good news - is that a CT scan following the endoscopy showed, as another had six or seven weeks ago, no evidence of cancer.

In addition, the interventional radiologist told me that he and the team are taking on this procedure with the same kind of consideration and attention as if I were a patient who had never had cancer.

I cannot get enough of hearing words like these.

Most of the time I was in the hospital was a waiting game – to find out what they would decide to do. Except for two small meals, I wasn't allowed to eat in case they decided on surgery right away and I learned exactly what the relatively new portmanteau word, “hangry” means.

This may sound odd, but this all is a great relief because it is not cancer. It is the result of the surgery meant to rid me of cancer, a mechanical issue, not a disease problem. That is a good thing.

And here's a lovely sad/sweet story the nurses told me about another patient on my ward. A woman who is terminally ill got married while I was there. Earlier in the day, I had seen piles of paper chains (remember those from our childhoods?) that the nurses were making to decorate the patient's room.

Someone brought flowers. A friend of one of the doctors, a professional photographer, donated his services and the woman was married to her fiance in her room among relatives and friends along with the doctors and nurses caring for her.

You're supposed to cry at weddings and I did, bittersweet tears even though I was in my room and didn't hear about it until it was over.

So that's the story of why I was missing for a few days. I'm back now to my regular schedule.



Elders and Cannabis – Part 2

EDITORIAL NOTE: Although today's is a lengthy post, I hope at least some of the information will be useful to you. If it isn't, you could scroll to the bottom for the latest edition of The Alex and Ronni Show. In fact, you could watch it even if you do read the entire post.

* * *

Elders and Cannabis – Part 1 can be found here.)

To pick up from where we left off on Monday discussing legal issues of cannabis, here is a map from Governing showing which states permit medical and/or recreational marijuana – or not. Visit governing.com for other variations from state to state.

MarijuanaMap2018FINAL

MEDICAL USES OF MARIJUANA
Cannabis has been used as a medical treatment for thousands of years. Nowadays we know that the two main chemicals in marijuana used for medical purposes are tetrahydrocannabinol (THC) and cannabidiol (CBD).

THC gets you high, CBD does not, no matter how much you imbibe, and both are useful in treating medical conditions. At legal dispensaries, in addition to buds of marijuana themselves, you can buy edibles that contain entirely CBD, entirely THC or a combination of both in various proportions.

For my sleep problem, my first try was an edible containing CBD. For me, I might as well have had a glass a water – it did nothing for my sleep. I switched to a THC tincture and it puts me to sleep within about 45 minutes – not enough time to get high or, more likely, to notice that I'm high.

The number of conditions that cannabis helps is long and includes cancer. There are two U.S. Federal Drug Administration (FDA)-approved pills containing cannabis, Marisol and Cesamet, that are often prescribed to help control nausea and vomiting during chemotherapy.

I don't know if it is still so, but back in the 1990s, my step brother was prescribed Marinol to control some of the effects of AIDS.

The top two reasons elders use cannabis is for arthritis pain and difficulty sleeping. Dr. Igor Grant is a distinguished professor and chair of the Department of Psychiatry at the University of California, San Diego and the recipient of one of the rare federal grants allowing him to research the potential benefits of pot. From CBS News:

"'First of all, there is increasing evidence that cannabis is helpful in the management of certain kinds of pain,' Grant said. And it's the kind of discomfort experienced by seniors, like sharp pains felt by nerve damage, caused by things like chemotherapy or diabetes...

“Kerry Stiles, 78, wears a pacemaker. And he discovered pot at the Rossmoor retirement community in Walnut Creek, across the bay from San Francisco. 'I drop it under my tongue, about five or six drops, and that helps me sleep,' Stiles said.”

Moving on from pain and sleep, a January 2018 study from Ben-Gurion University of the Negev (BGU) and the Cannabis Clinical Research Institute at Soroka University Medical Center reported in Science News found that

”...cannabis therapy is safe and efficacious for elderly patients who are seeking to address cancer symptoms, Parkinson's disease, post-traumatic stress disorder, ulcerative colitis, Crohn's disease, multiple sclerosis, and other medical issues.”

There is conclusive or substantial evidence that cannabis or cannabinoids are effective:
For the treatment for chronic pain in adults
Antiemetics in the treatment of chemotherapy-induced nausea and vomiting
For improving patient-reported multiple sclerosis spasticity symptoms (oral cannabinoids)

There is moderate evidence that cannabis or cannabinoids are effective for:
Improving short-term sleep outcomes in individuals with sleep disturbance associated with obstructive sleep apnea syndrome, fibromyalgia, chronic pain, and multiple sclerosis

There is limited evidence that cannabis or cannabinoids are effective for:
Increasing appetite and decreasing weight loss associated with HIV/AIDS
Improving clinician-measured multiple sclerosis spasticity symptoms
Improving symptoms of Tourette syndrome (THC capsules)
Improving anxiety symptoms, as assessed by a public speaking test, in individuals with social anxiety disorders
Improving symptoms of post-traumatic stress disorder

There is limited evidence of a statistical association between cannabinoids and:
Better outcomes (i.e., mortality, disability) after a traumatic brain injury or intracranial hemorrhage

There is limited evidence that cannabis or cannabinoids are ineffective for:
Improving symptoms associated with dementia
Improving intraocular pressure associated with glaucoma
Reducing depressive symptoms in individuals with chronic pain or multiple sclerosis

Hardly any of this information is definitive – at least in the U.S. - because, as NORML reported in 2010:

”Lawmakers and health regulators demand clinical studies on the safety and efficacy of medical cannabis, but the federal agency in charge of such research bars these investigations from ever taking place...

“Under federal law, the National Institute of Drug Abuse – NIDA - (along with the U.S. Drug Enforcement Administration) must approve all clinical and preclinical research involving marijuana.

“NIDA strictly controls which investigators are allowed access to the federal government’s lone research supply of pot – which is authorized via a NIDA contract and cultivated and stored at the University of Mississippi.”

Nothing has changed with the federal government's position toward cannabis research since this report.

POTENTIAL SIDE EFFECTS OF USING CANNABIS
If you can stand one more list, here is a one about possible side effects of from the same study [pdf] done by the U.S. National Academies of Science and published in January 2017:

Substantial evidence:
Statistical association between cannabis smoking and worse respiratory symptoms in respiratory disease with long-term cannabis smoking
Increased risk of motor vehicle crashes
Development of schizophrenia or other psychoses, with the highest risk among the most frequent users
Statistical association between increases in cannabis use frequency and progression to developing problem cannabis use

Moderate evidence:
No statistical association between smoking cannabis and incidence of lung cancer
Impairment in cognitive domains of learning, memory and attention (acute cannabis use)
Small increased risk for development of depressive disorders

Increased risk of suicide ideation and suicide attempts with a higher incidence among heavier users
Increased incidence of social anxiety disorder with regular cannabis use
Being male and smoking cigarettes are risk factors for the progression of cannabis use to developing problem cannabis use
Major depressive disorder is a risk factor for the development of problem cannabis use

Limited or no evidence:
Increased risk of acute myocardial infarction
Statistical association between cannabis smoking and developing chronic obstructive pulmonary disease
Statistical association between cannabis use and death due to cannabis overdose

Due to the lack of research, I don't buy a lot of this list – especially those in the moderate, limited and no evidence categories which is why, with so much anecdotal evidence of the therapeutic value of cannabis, the federal government needs to catch up with the 30 states and approve the research.

Whether the FDA, Attorney General Jeff Sessions or anyone else in the federal government likes it or not, it is only a matter of time now until cannabis is accepted as both a medical treatment and for recreational use, as alcohol is accepted.

In fact, Bloomberg News recently reported that the alcohol industry is concerned as is the soft drink industry. Here is their short video report:

It is true that as we get older, we get sicker: cancer, diabetes, Parkinson's disease, heart conditions, etc. are called “diseases of age” for a reason. If cannabis can help control symptoms, it should be legally available to everyone.

Of course, it's important to consult a physician first. In my case, it was a doctor who first suggested cannabis for my sleep difficulty.

Now, whenever I see my doctors – cancer and primary care – I am handed a printout of my current drugs from their records so I can confirm them. We recently added cannabis to the list so that when prescriptions are being added, subtracted or changed, interactions can be taken into consideration.

HOW TO IMBIBE CANNABIS
For years of illegal marijuana, almost everyone smoked it or, occasionally, made brownies and other edibles with it. I still have a 1996 paperbook titled Brownie Mary's Marijuana Cookbook that includes recipes for pot macaroni and cheese, shrimp casserole and spagetti sauce.

These days, cannabis is much MUCH stronger than in the past. If you are smoking it, what once took a joint or two to get high, requires only a couple of tokes. These days, in addition to hand-rolled joints, there are various kinds of pipes and vaporizers.

In states where cannabis is legal, you can also buy tinctures to take by mouth, creams to rub into your skin, candies along with ingestible oils that come in capsules. Visit this page at Leafly for more information about how to use cannabis.

Most of the links through this story have additional good information about cannabis in general and as related to elders.

* * *

Here's the latest episode of The Alex and Ronni Show.



Elders and Cannabis – Part 1

PERSONAL NOTE: Thank you for your Happy Birthday comments and emails on Saturday. I spent some quality time with a friend visiting from out of town and otherwise had a quiet day. It was number 77 - a nice one, don't you think?

Although I shied away from acknowledging the thought during my surgical recovery and chemotherapy last year, I don't think I really believed I would be here for this birthday. It's a wonderful surprise and I also frequently think about the support and encouragement you have given me during this ordeal. It has undoubtedly been a big contribution to my now cancer-free status.

Again, thank you so much for your birthday greetings Saturday.

* * *

Did I say cannabis in that headline? That seems to be the latest “approved” name for what the rest of us call pot, weed, maryjane, ganja, dope, hemp, reefer, doobie and tea among probably hundreds of others including, of course, marijuana.

So you know where I'm coming from on this post, I started smoking weed when I was in high school, about age 15 or 16. I still believe it helped get me through the early months of emotional difficulty after my husband and I broke up 15 years later. Most evenings, after work, I'd light up a joint and it kept my mind off my troubles.

But most of my life I've smoked weed because being high is fun. It enhances music, promotes creativity (if you remember to write down your ideas – heh) and is good for all sorts of other activities including sex. Plus, there's no hangover and within three hours or so of imbibing, it wears off.

About ten years ago, I stopped smoking weed altogether because it made me cough so hard. Ageing lungs, I guess. Although I never made the possible connection until this moment, a decade or so ago is also when I started having trouble sleeping. Most nights I woke after three or four hours never able to get to sleep again.

During chemotherapy toward the end of last year I became concerned that it couldn't be good for my cancer treatment that I slept only about half as much as experts tell us we should. I mentioned this to my doctors but they mostly ignored me.

When a new doctor was filling in for one of the regulars, I mentioned it to him. He said, “Oh, just go to one the dispensaries and buy some cannabis. You'll sleep fine.”

And so I have done ever since. It is remarkable how much more alert and sharp I am nowadays with seven or eight hours of sleep a night.

One of the helpers (aka “bud-tenders”) at the dispensary I use told me that the majority of their customers are old people and I've been wondering since then what is known about elders' use of weed. Hence, today's and Wednesday's posts.

LEGAL ISSUES
Cannabis has been illegal under federal law in the U.S. since 1937 when the Marijuana Tax Act went into effect over the objections from the American Medical Association related to medical usage.

The federal Drug Enforcement Administration lists cannabis as a Schedule 1 drug, the most serious category "with no currently accepted medical use and a high potential for abuse."

Schedule II drugs, which are considered less dangerous in this tightly controlled hierarchy, include cocaine, meth and oxycodone,” reports Mic.

Really? They list meth and oxycodone as less dangerous than marijuana? Doesn't anyone at that agency have a lick of common sense? Or they could just read the research.

More than half the states in the U.S. now disagree with the federal government. As of late last year, 29 states plus the District of Columbia have legalized medical marijuana. Here is the list with bolded names for states that also allow recreational use:

Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Hawaii
Illinois
Maine
Maryland
Massachusetts
Michigan
Minnesota
Montana
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Dakota
Ohio
Oregon
Pennsylvania
Rhode Island
Vermont
Washington
West Virginia

Oregon did not legalize weed for recreational use until about two years after I moved here. Before then, late night television commercials for medical marijuana cards were a joke.

Ostensibly meant to advertise medical practices that issued the cards, the ads made clear that even without a health reason, you wouldn't have any trouble getting a card from that physician.

According to a recent story at Alternet, even states that have legalized cannabis retain restrictions that can get a user in serious trouble.

Employers in some of those states can refuse to hire you if marijuana turns up in a pre-hiring drug test.

You will be prevented from legally purchasing fire arms in every state if you are a pot smoker. The federal Bureau of Alcohol, Tobacco & Firearms (ATF) asks potential gun buyers if they use or are addicted to controlled substances and warns on the form:

"The use or possession of marijuana remains unlawful under Federal law regardless of whether it has been legalized or decriminalized for medicinal or recreational purposes in the state where you reside."

Even in legal pot states, parents can lose custody of their children for marijuana use and it gets worse, according to Alternet:

”Medical marijuana support groups report hundreds of cases of parents losing custody of their kids, some merely for having registered as medical marijuana patients.

“But there are small signs of positive change on the horizon: California's Prop 64, for instance, includes a provision saying courts can no longer rescind or restrict a parent's custodial rights solely because they have a medical marijuana recommendation.”

If you are poor and live in federally subsidized housing, you can be kicked out of your home for possessing marijuana.

”Under a 1999 HUD Memorandum Regarding Medical Marijuana in Public Housing still in effect, any activity relating to controlled substances, including even medical marijuana, can get you evicted.

“And it doesn't have to be just you. If you live in federally subsidized housing and your grandson gets caught smoking a joint in the parking lot, you can find yourself tossed out on the street.”

When he isn't being publicly berated by President Trump, U.S. Attorney General Jeff Sessions regularly makes noises about beefing up enforcement of federal marijuana law in those 29 states where pot is legal.

Apparently, he is can't see that none of those states is going to give up millions of dollars in tax revenue from legal weed and it won't be long now until the federal government is forced to go along with the states on cannabis. The Feds will happy then, too, to see their portion of pot taxes.

Coming on Wednesday in Part 2: medical uses of marijuana, side effects and information about use by elders. Here is a sneak peak from a STAT report:

"Two papers published [2 April 2018] in JAMA Internal Medicine analyzing more than five years of Medicare Part D and Medicaid prescription data found that after states legalized weed, the number of opioid prescriptions and the daily dose of opioids went way down...

“Previous research has pointed to a similar correlation. A 2014 paper found that states with medical marijuana laws had nearly 25 percent fewer deaths from opioid overdoses.”


Elders and Alcohol

Most of us at this blog are old enough to remember when everyone smoked cigarettes. Betty Davis, Joan Crawford, Ava Gardner, Rita Hayworth, Humphrey Bogart, William Powell, Cary Grant, James Stewart, Spencer Tracy – all the cool kids back in those days smoked and they also drank. A lot. At least they did so in their movies.

A lot of us, as we came of age, followed the lead of our favorite screen actors - the social media of the day where we could find out what was chic, fashionable and, as far as it was a concept then, cutting edge.

Even so, it was a surprise to me recently when I watched Revolutionary Road, a movie set in 1950s suburbia starring Kate Winslet and Leonardo DiCaprio, how much drinking was going on.

It reminded me of my parents as I was growing up in that decade. So much was alcohol a part of their lives that by age 10 or eleven I was expert, thanks to my dad's tutelage, at making a proper cocktail. Martini, manhattan, old fashioned, whiskey sour, gibson, gimlet, gin and tonic – I knew how to mix all the popular alcoholic concoctions of the era.

When I was older, I realized my mother was an alcoholic. She worked full time all her adult life, never drank during the day but made up for it evenings and weekends. She often said she wasn't an alcoholic because unlike real ones, she remembered to eat.

Yeah. Right, mom.

For a long time I thought my father was alcoholic too but over time I came to believe that he drank to keep up with mom. My point is that I was primed for alcohol to be as big a part of my life as it was for my parents and a couple of other relatives who may have regularly abused it.

Apparently, however, I didn't inherit the gene - if that's what it is - or the habit. Certainly I drink, always have, but appropriately if you don't count a few young-and-stupid benders. And it has always been about being social for me; it never occurs to me to drink when I'm alone.

Nowadays, it's even less and that's just as well. In old age, we cannot drink as much or as frequently as we could when we were younger. A couple of years ago, U.S. News and World Report made a list of how alcohol affects older bodies. A sampling, paraphrased:

Tolerance for alcohol declines over time so your blood alchohol content can be higher even if you drink the same amount as before.

Even moderate drinking can affect liver function leading to cirrhosis of the liver and liver cancer.

Chronic conditions are complicated by alcohol. According to the American Diabetes Association, alcohol can cause dangerously low blood sugar up to 24 hours after drinking.

Alcohol can interfere with prescription and over-the-counter medications.

Alcohol dehydrates the body and can disrupt sleep.

In addition, drinking can impair judgment, coordination and reaction time increasing the risk of falls, household accidents and car crashes. According to the U.S. National Institutes of Health:

”In older adults, too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries...Studies show that the rate of hip fractures in older adults increases with alcohol use.”

All that is not to say there isn't an upside to drinking. A few years ago, CNN reported on a study published in the American Journal of Epidemiology which

”...found that healthy seniors who consume light to moderate amounts of alcohol reduce their odds of developing physical disabilities or dying in the next five years by 23 percent, compared with either heavy drinkers or those who abstain.

Medical News Today (MNT) explained that when studies “report harm associated with consuming alcohol, they nearly always refer to binge drinking, alcohol abuse, or alcoholism.” Earlier this year, MNT listed benefits of moderate drinking on elders culled from a variety of studies:

”A study published in the journal Strokefound that light-to-moderate alcohol consumption may lower the risk of stroke in women. The study included self-reported data about the drinking habits of 83,578 female participants of the Nurses' Health Study.

“In a study of 2,683 men and 2,822 women aged between 55 and 80 years, Spanish researchers found that regular, moderate wine drinking might reduce the risk of developing depression, while heavy drinking increases the risk. The participants mostly followed a Mediterranean diet and drank wine in a social context, with family and friends.

“An Italian review of studies published in the European Journal of Epidemiology found that moderate wine and beer consumption reduced the risk of cardiovascular events, but spirits did not.

“Investigators at University College in London reported in the Journal of Epidemiology & Community Health that moderate drinkers who followed a healthful lifestyle were more likely to see a protective effect on the heart, compared with moderate drinkers who smoked or had a poor diet.

With or without all these studies, I don't have any plans to cut alcohol out of my life. It seems to me that barring negative interactions with disease, conditions and/or medications, moderate drinking is just fine for us old folks if we are so inclined.

Experts have differing definitions of moderate drinking but this one, from the National Institutes of Health (NIH) defines it for people 65 and older as “no more than three drinks in a given day and seven drinks in a week.”

The next question, of course, is how is a standard drink measured. Here's a chart from the NIH:

Standard-drink-sidebar

Next week: elders and cannabis.



How to Prevent Falling

On last week's post about loneliness versus solitude, long-time TGB reader Darlene Costner left a comment about how quickly a fall can occur and one way for old people living alone (unrelated to loneliness) to be prepared for them.

It is a powerful statement and I am repeating it here almost in its entirety. Emphasis is my own:

"I do want to tell those people who say they are going to die anyhow so why have a panic button that unless they are much braver than I am,” writes Darlene. “I would have given all I possessed to have had one when I fell the first time and broke my hip.

"Before I realized I had to get to a phone I sat there wondering how long it takes to die without water. I was in shock at first and must have passed out because when I realized my predicament I was sitting with my back against a cabinet wondering how in the bloody hell I got there.

"I have had worse pain, but it still wasn't fun when I had to move my body so I could roll over on my stomach and crawl to the other side of the room to get a telephone. From the time I fell until help arrived it had taken me 10 hours to get help...

"Another time I fell and to break my fall I instinctively reached for a heavy coffee table made of Belgian glass and it fell on my arm trapping me. I would not have been able to crawl to a phone that time and was soooo glad I could press the panic button around my neck (with the other hand) and help would arrive.

"I do not understand why others have had trouble with them. I have had Alert 1 for years and the only problem I have had was when I accidentally pressed the button and the firemen came and I was surprised to see them. That would not happen with someone who is not hearing impaired because they try to reach you on the phone when you don't answer them asking if you are all right."
The first day of autumn each year is the official Falls Prevention Day of the U.S. National Council on Aging (NCOA). For many years on that day, I have posted information about how to keep ourselves as safe as possible from falling, and here are three good reasons to do that:

Every 11 seconds, an older adult is treated in the emergency room for a fall; every 19 minutes, an older adult dies from a fall

Falls result in more than 2.8 million injuries treated in emergency departments annually, including over 800,000 hospitalizations and more than 27,000 deaths

Falls are the leading cause of fatal injury and the most common cause of nonfatal trauma-related hospital admissions among older adults

Since my Whipple surgery last June and for the first time in my life I have a dizziness, or vertigo, problem. It occurs most commonly when I get out of bed so I now sit on the edge of the mattress until the room stops spinning.

Sometimes the vertigo turns up for no good reason when I'm walking around the house and I've taught myself to touch a nearby wall, door or piece of furniture until the sensation subsides. It usually takes only a few seconds until I feel steady again.

With one or two exceptions, it is we ourselves who can prevent our own falling. The NCOA has produced a video that, for all its brevity, covers almost everything you need to know about keeping yourself safe at home from falls:

The video makes a visual point of warning against ladders. About 10 days ago, two sets of fluorescent tubes above my kitchen cupboards burnt out. I dragged the ladder from the storage room, climbed up and retrieved the dead bulbs to know what replacements to buy.

Then, THEN it occurred to me that I might be in big-time falling trouble if the vertigo hit me when I was on the ladder. So I saved the new tubes for a 40-something friend who, a few days later, arrived for a visit and installed the tubes for me. It is undoubtedly time, at nearly 77 years, that I turn over ladder climbing to younger people.

Usually on Falls Prevention Day in September, I publish either a long checklist of how to falls-proof your home and/or link to other good information to keep us safe from falling. Here is one of those posts.

Since last autumn I have found another important prevention item I have never seen listed and I have discovered is important.

In addition to and separate from vertigo since the surgery, I am less certain of being steady on my feet. The difficulty in this case is getting my pants on. All my life, I've just stood there wherever I was in the room and pulled them on - one leg at a time, as they say.

You might call it free-styling with nothing to support myself when I'm on one leg. I considered it a daily exercise to improve my balance, but no more. The mild unsteadiness I feel sometimes in general, multiplies when I'm on one leg.

So now, I sit down to pull on my pants or, at the very least, lean against a wall or counter. This, I believe is an important addition that has been overlooked in the lists of falls prevention items.

Darlene's powerful testament reminded me that given the statistics, twice a year is not too frequent to remind ourselves about falls prevention. The life you save may be your own.



Crabby Old Lady and Home Monitors for Elders

These days, you can install indoor and outdoor cameras on your home to catch a burglar. You can reset your heating, air conditioning and turn on the lights as you're driving home so the house is comfortable when you get there.

If you've got the right digital kitchen equipment, you can remotely turn on the grill, oven or slow cooker with an app for your iPhone or Android so dinner is ready when you arrive.

Of course, there are dozens if not hundreds of wearable trackers to count your steps, measure your heart rate, fat, BMI, muscle mass and even pregnancy.

Just about every day a bunch of new gadgets come on the market and those above are only a handful of the most obvious in the new-ish category of “smart home” living.

The closest Crabby Old Lady has gotten to it in both personal interest and use is the Alexa – she owns three and you probably would not be wasting your money if you bet that sometime soon she will throw at least one of them against a wall.

They regularly misunderstand words, behave as if they are deaf unless Crabby shouts, don't have an answer for commonplace questions and – a new one Crabby hasn't been able to fix yet – play random music when she hasn't asked. If that grill controller is as iffy as Alexa, Crabby hopes it comes with an automatic fire extinguisher.

Her skepticism notwithstanding...

The biggest demographic market for smart devices may be elders. There are the ubiquitous home alert necklaces that can and do save lives – just ask TGB reader Darlene Costner. And Crabby has come to believe that electronic pill monitors could be useful especially for those, like her, who need a chart to track when a dose is due.

For Crabby, however, it gets trickier when talk turns to sensors that monitor an elder's activity and send the information to distant caregivers or family members.

Marketed as a way to help elders live independently at home for as long as possible, hardly anyone has spent much effort yet to find out how the spied-upon old people feel about inanimate objects acting as nannies and tattling to their human controllers.

When you look into these gadgets, one of the first things notice is that elders themselves are left out of the conversation as though they are already too senile to evaluate the service themselves which, obviously, begs the question about why, in that case, anyone would leave them home alone - sensors or no sensors.

Here are a couple of examples of how marketing language is typically aimed toward the children or caregivers and not elders themselves:

'Looking after an elderly relative who lives alone can be a huge source of worry. But what if your smartphone could automatically alert you if your mother has stayed in bed all morning or suffered a fall?

“If a senior does not get up in the morning and turn on the coffee machine as usual, the system detects the lack of activity and the person's carer is warned by text message.”

Oh yeah? What if Crabby just wants to sleep in this morning? Are you really going to wake her for breaking YOUR rule about her morning routine so you can congratulate yourself about your caregiving chops?

There's more. A newly-developed sensor uses radio waves to map where people are in a room. Another company is working on a sensor that warns when a senior is at risk of falling by detecting sudden changes in their walking speed or gait.

Does that second one make any sense at all? Maybe she's just dancing a little jig because it's a beautiful day. And if she's about to fall, Crabby doubts anyone will get there in time to save her from it. Plus, does anyone think the police or EMTs have time to show up at someone's home on a maybe?

Are these helpful things or intrusions, do you think? Lifesavers or invasions of privacy? And why don't sellers target elders themselves about this stuff? Here is one point of view in a short, humorous film about an 70-year-old widow, Thomas, whose adult children have loaded his home with smart gadgets to organize his day.

The film, Uninvited Guests, was developed about three years ago by an organization called Superflux. It stars actor James Leahy:

(Thank Chuck Nyren, proprietor of the blog Advertising to Baby Boomers, for sending this video which prompted today's post. You can find his thoughts on wearable tech gadgets here and you can read more about the film and its genesis at the Superflux website.)

Do any of you, dear readers, live with such monitors and reminders? If not, would you consider it – for yourselves or, perhaps, for you own ageing parents? Here is what Superflux says about the issues raised in their film:

”The brightly coloured 'smart objects' in the film are...symbolic ‘ghosts of the future’, where with time, their physical presence fades into the fabric of our environment, and all that is left is their invisible halo constantly monitoring, logging, tracking and processing ambient feedback.

“Ultimately it is our intention that this, at times comedic story, plays on and gives form to some of the growing tensions between human and machine agency. And in doing so, provoke questions about how we want to live and grow old in an increasingly technologically mediated word.”

Crabby Old Lady sees value in some of these new electronic helpers and in particular, she is looking forward to virtual doctor visits via her computer one day.

But she is skeptical about the privacy issues and about the control of elders' daily lives and schedules by people – loved ones or otherwise - who believe they know better. Like it or not, however, it is only going to become more widespread and commonplace.

What do you think?



Maybe Being a Loner is Good for Your Health

Over the past couple of years, there has been a growing number of academic reports and news features about the dangers – to adults of all ages but especially elders – of loneliness. The problem is repeatedly called an “epidemic.”

Loneliness can cut seven-and-a-half years off your life, they say. It has the same risk to life as diabetes or obesity, say others. Social connections are necessary, they tell us, for cognitive function and a well-regulated immune system.

Last time we discussed loneliness here, in early February, comments revealed that TGB readers almost universally make the important distinction between being lonely and spending time alone, understanding that they are not the same thing.

Nevertheless, this is rarely addressed in the media coverage of the so-called “loneliness epidemic.” Pretty much all fail to acknowledge that alone time is as important to well-being as social time, and the amount of solitude that a given person needs or desires varies widely among us.

Finally, last month, a well-done story at BBC.com took on a discussion of the benefits associated with reclusiveness:

”One key benefit is improved creativity. Gregory Feist, who focuses on the psychology of creativity at California’s San Jose State University, has defined creativity as thinking or activity with two key elements: originality and usefulness...

“Feist’s research on both artists and scientists shows that one of the most prominent features of creative folks is their lesser interest in socialising.”

Susan Cain, founder of Quiet Revolution, a company that promotes quiet and introvert-friendly workplaces tells us that

”...humans are such porous, social beings that when we surround ourselves with others, we automatically take in their opinions and aesthetics. To truly chart our own path or vision, we have to be willing to sequester ourselves, at least for some period of time.”

And unlike those dire predictions of early death to people who are lonely, another study finds that both our mental and physical health may partially depend on spending time without the distractions of having other people around:

”Daydreaming in the absence of such distractions activates the brain’s default-mode network. Among other functions, this network helps to consolidate memory and understand others’ emotions.

“Giving free rein to a wandering mind not only helps with focus in the long term but strengthens your sense of both yourself and others.”

“Strengthens your sense of yourself...”

More than many people I have known, I have always needed extended periods of unstructured time alone. One of the results of my solitude is that I know intimately how my body functions. I am acutely aware of when something is not right and I generally know when it needs attention or can be ignored.

I am convinced that the accumulation of that bodily knowledge over many decades is what gave me the impetus to badger my physician about my too many symptoms that, although mostly minor individually, added up to something more serious.

It took the medical people four months or so to find the pancreatic cancer, but I might not have pushed them as hard if I didn't have such a thorough knowledge of how my body works and I wouldn't have that knowledge without my quiet time.

So maybe, without my solitude, the cancer would not have been found in time for the surgery to be possible. I can't prove that but I pretty much believe it.

Still, I doubt Feist was thinking of cancer diagnoses when he said,

”'...there’s a real danger with people who are never alone.' It’s hard to be introspective, self-aware, and fully relaxed unless you have occasional solitude.”

The BBC.com story, written by Christine Ro, is a good antidote to the media scare-mongering that passes for settled social science on the subject of loneliness.

Of course, there are lonely people who may need help combating it but that should not be confused with the human need for quiet too, and that there is no "right" amount of solitude. Balance and an allowance for individuality is what is called for.



Urinary Incontinence is No Joke

Incontinencecartoon

There is an amazing number of icky things our bodies can do to us and they seem to increase as we get older.

In general, we don't talk about this stuff but since my pancreatic cancer diagnosis and Whipple procedure nine months ago, any embarrassment I felt about discussing pee and poop is gone.

It was the post-surgery nurses and doctors who taught me all about that acceptance and, in time, ease with the topic. On the first morning I was lucid following the surgery, a nurse popped into my room and with a big smile on her face asked, “Have you pooped yet today?”

A little later, another asked, “Have you farted yet?” And another minced no words at all: “Have you shit this morning?”

Healthcare professionals talk about pee and poop the way you and I discuss the weather. Over my 11 days on that post-op floor, I got used to their most frequent talking point and a good thing that is because since then they have never stopped.

As one nurse answered my question about all the poop and pee talk, when someone has had abdominal surgery, it is important afterward for them to know how well – or not – food is being processed as it moves through the patient's body.

So they don't just ask “if” but also want to know size, shape, color, density, etc. And these queries have continued long after my recovery from the surgery so that, like those nurses and doctors in the hospital and clinic, I'm as comfortable with it now as they are.

But that wasn't always so.

I first wrote about urinary incontinence in these pages back in 2009 because it had been plaguing me and I know that if it's my problem, so it is for many other people.

When I'd finished, it seemed to be a useful blog post but I couldn't bring myself to hit the “publish” button. It just wasn't something I was comfortable talking about in public and thought that was probably true for you too.

It took three days for me to work up the nerve to post the story and surprise, surprise – the response was quite large with a lot of readers recounting their leaky pipe problems, many of them with a great deal of humor. You can read that post here where you will also find some useful links to good information about dealing with urinary incontinence.

My own leaky pipe problem disappeared when I lost more than 40 pounds five or six years ago but that is not always a cure and now I have the problem all over again.

Since the surgery, I no longer have any warning when I need to pee. The urge comes on suddenly and it means NOW (as I had to learn the hard way). No waiting until I finish typing this sentence or being polite to wait until you finish telling me a story. If I don't go immediately, there will be a puddle.

A few days ago, I ran across a useful story at AARP with “10 things you didn't know about urinary incontinence”:

”For something so shrouded in secrecy, urinary incontinence affects a staggering number of people — a quarter to a third of men and women in the U.S., according to the Maryland-based Urology Care Foundation,” reports AARP.

“That’s not a third of seniors or a third of pregnant women. A third of all people, regardless of age or sex.”

Here are a few samples of the information compiled in the AARP piece. Go to the website for the full explanation of these and the other six items.

One Cause? Blame Winter
“Cold weather affects the bladder muscle by making it contract harder and sooner than it ordinarily would, even if the bladder is not full...”

Reducing Liquid Intake Won't Help
“Cutting down on your water can result in dehydration, constipation and even kidney stones — urine flushes out the bacteria in there — which will only worsen the symptoms.”

Botox for Incontinence is a Real Thing
“Botox has become an increasingly popular fix for incontinence — and if you’re like us, that news probably made you wince and ask, 'Wait, they want to put a needle where?'”

(Ronni here: Botox for this also has some serious side effects so if you are interested, do your research. Here is a start.)

Peeing in the Shower Might Help
“It sounds nuts (and more than a little disgusting), but there are health benefits to using a shower as your personal toilet, at least for women with incontinence.”

If medical fixes are not for you or behavior adjustments don't work, there are the growing numbers and types of incontinence products which I'll write about soon.

Meanwhile, feel free to discuss this in the comments below or anywhere else. After all, actors like Samuel L. Jackson and Kate Winslet have done so on television as has writer Stephen King, among others. Even I've learned to be at ease with it.



Do Dreams Change in Old Age?

PERSONAL NOTE: Apparently it is interview season at TimeGoesBy. There are the ongoing Skype chats with my former husband, Alex; the recent print interview with Debbie Reslock at Next Avenue; and today, an audio interview with Jana Panarites of Agewyz. Scroll to the bottom of this post for our interview.

* * *

It has been many years since I last remembered a dream. Sometimes there are fragments when I wake but they float away before I can grab hold of them.

That's probably just as well because in a lifetime, the single pleasant dream I recall is flying around my bedroom having a marvelous time swooping and dipping, rising again and seeing the room from a whole new angle. It was a load of fun and that happened in about 1960 when I was 19 or 20.

All the other dreams I remember are anxiety- or fear-ridden, like the one that began when I was about six years old. A huge bear was chasing me. I ran into a room, slammed the door shut believing I had avoided him but turned around to see that the bear was still there.

I ran out of the room, found an elevator, punched a button and when I turned around again, there was the bear. And so on.

That dream, which repeated now and then for several years, finally stopped but I have never forgotten it or the fear it induced. Apparently being chased by a bear is a common dream and at least one dream interpreter says this:

”To dream that a bear is chasing you and you are running away in fear, this means you are avoiding a big issue in your life, and it is time to deal with it.”

I don't have any truck with dream interpretation to begin with an it feels like a stretch to apply an adult psychological concept to a first-grader.

This and a few other dreams impressive enough to not forget came to mind while reading an Aeon essay about how dreams change throughout our lifetimes. I hoped part of it would be a good discussion of how elders' dreams are similar or different from younger people's but there was only this:

”Older adults tend to dream more about creative works, legacies and enduring concerns, while the dreams of dying people are filled with numbers of supernatural agents, other-worldly settings and images of reunions with a loved one who has died.”

Nevertheless, the rest of the piece, written by Patrick McNamara, an associate professor of neurology and psychiatry at the Boston University School of Medicine and a professor at Northcentral University, dropped some fascinating information on me:

”...amputees very often dream themselves intact,” he writes. “They might not experience the loss of their limb in dreams even years after the amputation, and even if the physical handicap was congenital.

“Similarly, dreams of the congenitally deaf-mute or those of the congenitally paraplegic cannot be distinguished from those of non-handicapped subjects. It is as if the dream has access to the whole dreamer who is a different person from the individual anchored in waking consciousness.

“Dream reports from deaf-mute individuals involve them talking and hearing normally. Patients with varying degrees of paraplegia report themselves flying, running, walking and swimming. The dream is accessing somebody different from the waking individual who is having the dream.”

And on a historical note, this:

”Dreams differ...dramatically across historical epochs. The dreams of the ancient Greeks and Romans, and indeed the dreams of most peoples of the ancient world, were viewed as direct portals into the spirit world and the realm of the ancestors and gods.

“Ancient peoples (and traditional peoples even today) often experienced dreams as the place to conduct a transaction with a spirit being who could significantly help or hinder you in your daily affairs.”

I probably could have used a good spirit guide for this dream that, even after 25 years or so, I remember in detail:

I was a contestant on a television game show. The host and I were on one side of a stage facing the live audience and cameras. A wall divided the stage in half and on the other side of it stood two men, I was told, with hand guns poised and if I got the next question wrong, they would come around the wall and shoot me.

It was a yes-or-no question and although I don't remember what it was, I do recall pondering that I had a 50/50 chance of dying in the next minute or so and no way to change the odds.

The only chance I had, I told myself, was that this was a dream. It didn't feel like a dream, I didn't believe it was a dream, but I had nothing to lose if I tried to awaken myself.

And I did, breathing heavily, scared to death – so to speak – and I sat in bed that night with the light on for a good, long time.

Professor McNamara concludes in part:

”The huge variety of dream states suggests that dreaming is just as important as waking life for biologic fitness, and very likely has multiple generative mechanisms and functions. For example, dreaming about scary threats likely helps us to avoid those threats during the daytime...”

You can be sure I will never appear on a TV game show.

There may not be much in McNamara's story about dreams in old age but there is a lot more information about the purposes of dreams which you can read here. Plus, there are several more pieces on the topic of dreams at his website.

Have your dreams changed as you have grown older?

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A couple of weeks ago, I spent about an hour on the phone with Jana Panarites. She is the founder of Agewyz Media Group, created in 2014 to raise awareness in the media about the plight of caregivers in the US and to promote healthy aging across the generations.

The Agewyz Podcast, Agewyz Media’s main property, explains Jana, is an online radio program distributed weekly on multiple platforms including iTunes, Stitcher and Google Play Music, in addition to the nationally syndicated Speak Up Talk Radio Network.

I had a fine ol' time with Jana that day. Here is the interview or, you can listen to it on her website which, in any case, is worth a visit.