495 posts categorized "Health"

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?

* * *

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.

Living and Dying: A Love Story

At the bottom of this page is the latest edition of The Alex and Ronni Show – a conversation between me and my former husband, Alex Bennett, that we recorded on Tuesday.

Early in the recording, Alex (who lives in New York City) asked about Oregon's Death With Dignity Act – that is, physician-assisted suicide – and as serendipity sometimes has it, later that day as I was looking around the web, a documentary about an Oregon married couple's choice to die together in this way turned up.

Living and Dying: A Love Story is powerful and poignant, sad and uplifting and by the end, you know this couple, Charlie and Francie Emerick, made the right choice for them.

The couple's daughter, Sher Safran and her husband, Rob, asked permission to record her parents' final days and hours, and also gained their approval to share the video publicly.

Both Charlie and Francie had been diagnosed with less than six months to live and they are thought to be the only couple to take the drugs together. Kaiser Health News (KNH) reports,

”The pair, early members of the 1980s-era Hemlock Society, had supported the choice for years, and, when their illnesses worsened, they were grateful to have the option for themselves, family members said.

“'This had always been their intention,'” said [another] daughter Jerilyn Marler, 66, who was the couple’s primary caretaker in recent years. 'If there was a way they could manage their own deaths, they would do it.'”

And so they did, taking the state-prescribed medication together on 20 April 2017. Kaiser Health News again:

Francie, 88, went first, within 15 minutes, a testament to the state of her badly weakened heart. Charlie, 87, a respected ear, nose and throat physician, died an hour later, ending a long struggle that included prostate cancer and Parkinson’s disease diagnosed in 2012.

“'They had no regrets, no unfinished business,' said Sher Safran, 62, one of the pair’s three grown daughters. 'It felt like their time, and it meant so much to know they were together.'”

But that is only the bare bones of the story. Sher and Rob, using mostly cell phone video, have produced a remarkable record not only of her parents' long (66 years) and loving marriage, but of the procedure involved with using the Death With Dignity Law in Oregon that so many of us are curious about.

Here is a trailer from the Safrans' 45-minute documentary, Living and Dying: A Love Story.

You can see a short, 20-minute version of the documentary at the Safran's website, Share Wisdom Network, where the longer, full version is also available to view online. (Scroll down to get to them.)

It is astonishingly brave to make this choice of controlling one's death – choosing time and day and making preparations. I've always said that I want to die in my sleep although I'm told most people say this and that it doesn't happen often.

Physician-assisted suicide is, to me, a good alternative when you know there is no chance of recovery and that your life will become considerably more difficult and/or painful toward the end. I would hope, in that circumstance, I would make the decision Charlie and Francie Emerick did.

Here are a couple of links that may interest you:

Wikipedia overview of U.S. states that allow assisted suicide.
Oregon Health Authority's section on the Death With Dignity Act with answers to your questions.

* * *

The Alex and Ronni Show
Recorded Tuesday 6 April 2018.

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 or Vimeo.

An Extraordinary Personal Health Essay

When, last year, the shock of being diagnosed with pancreatic cancer had subsided to a small degree, I set about deciding whether to write about it in these pages.

A whole bunch of thoughts filled my head: This is blog about ageing, not illness. This blog is not a personal diary, it is an exploration of growing old in general. Writing about my experience with cancer in real time is overly self-indulgent.

On the other hand, since I am unlikely to be able to concentrate on much else for awhile, I may as well let readers in on what's happening so they will understand if I post on a reduced schedule.

And Sunday's TGB music columnist Peter Tibbles, when I consulted him, said that “it's best to tell readers what's going on. They're a smart bunch.”

All this came flooding back when I read New York Times Op-Ed columnist Frank Bruni's remarkable column yesterday. If I retained any doubts about my decision to be as open and honest as possible about the cancer, Bruni crushed them yesterday with his riveting account of life with a condition known as nonarteritic anterior ischemic optic neuropathy (N.A.I.O.N.).

It could, in time, leave him blind in both eyes. The manifestation for Bruni happened about four months ago in his right eye,

“...a thick, dappled fog across the right half of my field of vision, which was sometimes tilted and off-kilter. I felt drunk without being drunk, dizzy but not exactly dizzy.”

Bruni, who is 53, was told this usually occurs after age 50.

”It typically strikes during sleep, when blood pressure drops, and is sometimes associated with sleep apnea, diabetes, hypertension or the use of pills for erectile dysfunction — none of which applied to me. I was a mystery.”

The doctor said that in time the brain would adjust letting Bruni's left eye help give him useful vision. He might even get some clearer vision back in his right eye.

“But there was a much better possibility that I wouldn’t. There was nothing I could do — no diet, no exercise, zilch — to influence the outcome. Worse, the 'stroke' revealed anatomical vulnerabilities that meant that my left eye was potentially in jeopardy, too, and there was no proven script for protecting it.”

Bruni gives us a lot more detail about N.A.I.O.N. and his treatment but what grabbed me are his continuing thoughts and fears about the possibility of permanent blindness.

”What if I’d had another 'stroke'? It was the same every morning: a stab of suspense, then a gale-force sigh of relief. I could still see.

“And I can still see. The oddity of my situation — the emotional riddle — is the distance between the manageability of my current circumstances and what tomorrow could bring.”


”I’ve learned that the best response to weakness is strength: Prove to yourself what you can still accomplish. I had a column due three days after I woke up to my newly blurred vision. I wrote it on time — and kept to my usual pace from then on.”

Bruni met a 75-year-old judge, David Tatel, who has been blind since his late 30s:

”He adapted to his disability; his workplace adapted to him,” writes Bruni. “Various digital advances — in particular, text-to-speech technology — helped hugely. 'I’m really looking forward to self-driving cars,' [Tatel] laughed...”

Bruni also met Peter Wallsten, 45, the senior politics editor at the Washington Post who lost his vision in his thirties:

”He works on an enormous screen that shows letters in a gigantic font,” explains Bruni, “and he listens to writers’ stories and does some of his editing by dictation.

“'This is the important thing to remember: It’s not your brain that’s affected,' he told me. 'It’s your eyesight. He added, 'There are things much harder than this.'”

No kidding. There are things much harder than a pancreatic cancer diagnosis too. Bruni also quotes Joe Lovett, 72, a filmmaker who documented his slowly developing glaucoma in the film, Going Blind. Lovett counseled,

“'...you cannot spend your life preparing for future losses.' It disrespects the blessings of the here and now. Besides, everyone lives in a state of uncertainty.”

I recognized some of Bruni's and the other people's thoughts and conclusions; I had arrived at similar ideas for myself over the months since last June.

But what I most appreciated were the feelings he describes that I hadn't been able to find words for yet. And I get now why my personal celebration a couple of weeks ago at being told I am cancer-free has been more subdued that I would have expected.

Now too, I understand why so many of you, dear readers, have responded so positively to my chronicle of cancer treatment.

Frank Bruni's full essay is a stunningly good and important read that you will find here at The Times. If you do not have access, let me know (use the “Contact” link at the top of this page) and we'll work something out.

Cancer and an Altered Self-Image

We don't much think about – or, perhaps, it is I who has not done so – who we are. What descriptions we have of ourselves accumulate, I think, over our lifetimes and we hardly notice it happening: doctor, lawyer, Indian chief, mother, father, brother, sister, fat, skinny, young, old, married, single and so on.

For example, since in the United States we mostly identify ourselves with what we are paid money to do, I am a former radio producer, TV producer, internet news managing editor, New Yorker morphed now into a retiree who blogs about what it's like to be old and who, way near the top of the list, thinks of herself as healthy.

No more. Last June, “cancer patient” was added to my list of personal descriptors, something I see in retrospect was an easier change to make than I would have thought.

All it takes is a massive surgery and lengthy recovery period accompanied by pain, pills and doctor visits to self-identify as a sick person Or, at minimum, no longer healthy.

I didn't see it coming, didn't even notice, consciously, that the switch had happened until this week. One way I suspect that happens is the medical checklist.

When you have a serious ongoing disease, you are asked to fill out a lot of forms. They are mostly identical and involve checking yes or no on long, long lists of diseases, conditions and symptoms. I've checked off no in all of them all my life. And then eight months ago, I had to check yes on cancer.

I was not healthy anymore. As I may have related to you in the past, a more light-hearted take on the issue was spoken by my primary care physician: “Ronni,” he said, “except for the cancer, you're very healthy.”

Riiiiight – and other than that, Mrs. Lincoln, how did you enjoy the play. That doctor and I have had several good laughs about his bon mot gone awry.

Who we are in our minds, in our bones, affects how we understand ourselves, present ourselves to the world and informs many of the choices we make. Cancer patient is not what I want to be part of my self-image but it happened.

Then, this week, another change took place. On Monday, I had a CT scan, a more definitive test for cancer cells than the test I told you about a couple of weeks ago. Like that first test, this one came back with the best news any cancer patient can hope for:

“CT looks good,” wrote my medical oncologist in her test results analysis. “There is no sign of the cancer at this time.”

That's two tests two weeks apart with the same great, good news. Only a tiny minority of pancreatic cancer patients get this far so I should be ecstatic.

How come I'm not, then?

Intellectually, I'm over the moon but the the thought lacks the emotional joy I expected, the urge to dance around the house, for example, to Joe Cocker's Cry Me a River at full volume.

Instead, even if I am not shrugging off the news, my mind slipped straight into anticipation of the apprehension I felt this time as I waited for the test results that will be repeated every four months or so when they continue to check for cancer. What is the matter with me?

Here's what I think happened:

That added definition of sickly person crept up on me so quietly I hardly noticed it these past months. Even as I have felt increasingly better physically, the daily pills, the chemo treatments, the blood tests, the transfusions along with the many doctors, nurses and other healthcare providers all became silent markers of my new status which I internalized without any thought, made part of my self-image.

While I wasn't paying attention, I became a different person than I have known for my 76 years, someone identified by a terrible disease, and I suspect I am not alone in this phenomenon.

Major life events, good and bad, are stressors that can alter our self-image. There is even a scale for it called the Holmes-Rahe Life Stress Inventory on which my recent life event, “Major personal injury or illness,” is listed at number six out of 43 items.

Since Monday when I received the good test news and recognized that I wasn't feeling like a kid on Christmas morning, I realized I need another change in self-image – from sickly to healthy again or, perhaps, in the more familiar vernacular of the cancer world, survivor.

It may take awhile to make the switch back, but at least I am doing it consciously this time instead of it sneaking up on me while I wasn't paying attention.

Does this resonate with you? Have major life events changed your sense of yourself? For better or worse?

The Question of a Loneliness Epidemic

Just last week, British Prime Minister Theresa May created a new government position: Minister for Loneliness.

According to a 2017 report, more than 9 million people in Britain often or always feel lonely. May, quoted in The New York Times, said in announcing the new ministry,

“For far too many people, loneliness is the sad reality of modern life.”

“I want to confront this challenge for our society and for all of us to take action to address the loneliness endured by the elderly, by carers, by those who have lost loved ones — people who have no one to talk to or share their thoughts and experiences with.”

(More about how the Ministry will tackle the problem is reported at gov.uk.)

It's not just a British problem. According to a U.S. study of 218 studies, loneliness is not only a social problem, it is harmful to our health:

"They discovered that lonely people had a 50 per cent increased risk of early death, compared to those with good social connections. In contrast, obesity raises the chance of dying before the age of 70 by around 30 per cent,” as reported in The Telegraph.

As the American Psychological Association [APA] reported on the same study:

”Approximately 42.6 million adults over age 45 in the United States are estimated to be suffering from chronic loneliness, according to AARP’s Loneliness Study...

“'These trends suggest that Americans are becoming less socially connected and experiencing more loneliness,' said [researcher Julianne] Holt-Lunstad.”

I do not doubt for a moment that there are millions of old people who are lonely but I think there is something else at work on this topic that the researchers won't understand until they are old: that many old people voluntarily withdraw from social life to greater or smaller degrees as the years pile up.

I can't prove that and I haven't seen a single study that addresses it, let alone agrees. But a growing body of anecdotal evidence, just in my own small circle, seem to indicate something the loneliness researchers don't know.

A reader named Albert Williams left this note on a TGB post about making friends in old age. It's a bit lengthy but worth it:

”Whew! I'm glad I found this site,” wrote Williams. “I was beginning to think that I was the only person with such problems, and that, perhaps, there was something wrong with me.

“However, after a bit of introspection, I realize that this is not completely true. (Completely? Try old, ugly, curmudgeonly, short-tempered, cynical, and a few more applicable adjectives...)

“Time has, indeed, taken its toll. I am now an old man. Most of my life-long friends are gone. I've never had any kids; I've outlived two wives; and almost all of my family on both sides have already died.

“I find it very easy to make new acquaintances, but these seem to never develop into the deep, trusting, abiding friendships I had when I was young. Loneliness, apparently, has become a permanent part of my remaining days, and my best friends nowadays are my dogs and my computer.”

In addition, a long-time internet/blog friend, Cowtown Patty, recently wrote in an email:

”Found that as I age, while I enjoy people to a degree, I am happier when I am at our 'farm' out puttering in the 'garden' or in the house somewhere alone. Even Kent, who is the easiest person in the world to get along with, can be an irritating intruder sometimes.

“Do you think we 'cocoon' as we age? Protection? Preparing? Insulating ourselves from a world grown too noisy?”

That may be true for me. Although I have always seemed to need a lot more alone time that many people I know, in recent years I've purposely chosen fewer social engagements in exhange for time alone (reduced energy may be a contibutor too).

It's not that I don't like people or don't enjoy time with them. I do. But as I follow my innate nature these days, I am eager for less of that than during most of my adult life and as far as I can tell, the biggest change that would bear upon the desire for fewer social engagements is that I've grown older.

Which doesn't sound too far off from Patty's “cocooning” idea – perhaps even subconsciously, we begin separating ourselves from a world we know we will be leaving much sooner than people who are younger than we are.

There is an interesting entry at the Wikipedia Old Age page on this subject (emphasis added):

”Johnson and Barer did a pioneering study of Life Beyond 85 Years by interviews over a six-year period. In talking with 85+ year olds, they found some popular conceptions about old age to be erroneous.

“Such erroneous conceptions include (1) people in old age have at least one family member for support, (2) old age well-being requires social activity, and (3) 'successful adaptation' to age-related changes demands a continuity of self-concept.

“In their interviews, Johnson and Barer found that 24% of the 85+ had no face-to-face family relationships; many have outlived their families. Second, that contrary to popular notions, the interviews revealed that the reduced activity and socializing of the over 85s does not harm their well-being; they 'welcome increased detachment.

The researchers spoke only with people 85 and older. I strongly suspect that if they talked with 60- and 70-somethings, the trend would be there already.

Certainly there are millions of old people yearning to make connections with others who are having trouble doing that.

But as with all things related to elders, I don't believe you can bundle all of us into one handy explanation for any issue and it could be that what looks like loneliness to younger researchers is a personal choice some elders make.

What do you think?

A Funny Little Health Remedy that Actually Works – For Me

ATTENTION PLEASE: As I first noted at the bottom of this post, commenters may not recommend any medications including over the counter meds. I have just removed all references to magnesium - in a couple of cases, the entire comment regarding how magnesium works on cramps. It very well may work, but there are side effects depending on dosages and it can interact negatively with other meds. So the rule for this blog stands: you may not recommend in any way, any medication. It will be deleted.

Surely you have been hit with a charley horse more than once – that sudden muscle spasm in a leg, arm, foot, hand, fingers or toes that can cause excruciating pain.

According to the Mayo Clinic, age increases risk of muscle cramps because as old people lose muscle mass, remaining muscle can more easily become overstressed.

From time to time throughout life I've been afflicted with horrible muscle cramps. If in my legs and/or feet, I've found that walking heavily, putting a lot of extra pressure on my feet as I walk will help to a degree.

Most of all, however, the best remedy has been a hot bath – really irritating when a cramp has wakened me in the middle of the night and I just want to sleep.

Last Friday, I spent an entire day fighting cramps in my hands and fingers, toes and feet, arms and lower legs – all at once. It was the biggest, longest bout of muscle cramps I can recall enduring. The two hot baths I took helped for about ten minutes each.

The pain was terrible – it was towel-biting time to avoid screaming and it sent to me to the internet to look for information.

At the Mayo Clinic, Harvard Medical School, Medical News Today and some other reputable healthcare websites I learned that no one in the medical community takes muscle cramps seriously (“most muscle cramps are harmless”) nor do they know much about them.

Cramps can be related to rheumatoid arthritis, muscle overuse, dehydration and might be associated with such diseases as diabetes and nerve, liver and thyroid disorders, they say.

Assuming no underlying medical cause, the suggested remedies were nothing I didn't already know – stretch the muscles, drink more water, low-impact exercise and use correct hand tools.

Oh, please. By the time you have a cramp it's too late for any of those. I was screeching in pain so I expanded my internet search beyond the reputables. Here's one I found:

Pickle juice? Although I have a couple of jars of pickles in the refrigerator, I took a pass. Then I discovered the website of Dr. David Williams who is, according to the About page:

”A medical researcher, biochemist, and chiropractor [who has a reputation] as one of the world’s leading authorities on natural healing.”

Mainly, however, the website exists to sell his supplements and like the guy in the video, he touts pickle juice to stop muscle cramps within 60 seconds. I still wasn't convinced. (The link to Dr. Williams's website is for information only and does not endorse his products.)

He also says he believes a calcium deficiency causes cramps so recommends trying a different brand of calcium, and he also suggests DMSO. But I was in extreme pain as I read his webpage and I needed help right away so this caught my eye:

”A doctor by the name of Donald Cooper discovered a technique you can use to put a stop to a sudden cramp or spasm,” writes Dr. Williams. “He says it works 90 percent of the time. Dr. Cooper describes the technique:

"'At the first sign of muscle cramping, take a good, firm hold on the upper lip between the thumb and index finger, maintaining constant pressure. The cramping will stop or fade away, usually within 20 to 30 seconds, although sometimes it may take longer. I often pinch for a total of two or three minutes. Don't knock it until you've tried it.'”

“Oh pshaw,” she said to herself. But even though the cramps had been going on for several hours, I firmly grabbed my upper lip with thumb and forefinger.

And folks, to my utter shock and dismay, it worked. In less than a minute the cramping had stopped. When, ten or 15 minutes later, it started up again the lip grab did the job once more. And there was no more cramping that night.

To give you an idea of how severe the cramps were, my bicep and calf muscles still ache four days later although they're steadily improving.

I know this remedy sounds crazy. I don't want to believe it and part of me still thinks it is a coincidence or some kind of self-suggestion born of horrendous pain. But as weird as it appears to be, the cramping did stop, essentially immediately.

So strange.

IMPORTANT NOTE: I suspect some of you will have some odd home remedies for minor health issues that have worked for you. That's good, include them below.

But you may not claim cures for diseases or conditions, nor recommend any medication, prescription or otherwise, nor link to any websites.

Crabby Old Lady and the Things They Don't Tell You About Getting Old

Crabby Old Lady will be here in a moment but for a few sentences this is me, Ronni. After I wrote today's post, members of the U.S. Federal Communications Commission (FCC) voted on Friday to kill Net Neutrality. A couple of weeks ago, I wrote about what that then impending vote, if passed, would mean for you and me.

Answer: more expensive internet services for all of us and in the case of small blogs like this one or startup businesses counting their pennies, having your website "throttled" (slowed down) if you don't pay big fee. It's now law of the land.

This vote was taken, by the way, even though more than a million FAKE comments were found at the FCC website supporting repeal.

We'll talk about this more next week. Meanwhile, there are rumblings of at least one state attorney general and a number of public interest political organizations that oppose repeal will be suing to repeal the repeal. Some hope. Maybe.

* * *

There are all kinds of things they don't tell people about growing old. Throughout the midyears, most people sort of know it's mostly old people who are afflicted with cancer, heart disease and diabetes, for example. In fact, they are even called “diseases of age”.

But most convince themselves that such events are too far in the future to cause concern and anyway, it won't be me, says everyone.

Today, however, Crabby Old Lady is talking about the relatively benign afflictions that accompany old age – they won't kill you but they are massively annoying, and they never go away.

Let's start with hair: ear hair, nose hair, thin hair, no hair. Ear hair shows up mostly on men and Crabby had assumed that was true for nose hair too. Wrong. If she is not vigilant, it could grow long enough to braid.

More men appear to be bald than women but Crabby is catching up. The hair on the back of her head was becoming so thin that a couple of years ago she took to collecting hats and mostly does not leave home without wearing one. Lately, however, the loss is worsening.

Undoubtedly Crabby Old Lady should be grateful that chemotherapy hasn't made her bald (yet), but that place on the back of her head and now her front hairline are becoming thinner by the day – a lot more skin showing that hair.

This hair misery gets its own paragraph. It's amazing how fast these isolated – three or four at a time – hairs appear dotted across Crabby's chin and pulling them out with a tweezer causes big-time pain.

This wasn't a problem for most of her life and even though she finally found a specialized razor that works quite well, Crabby resents the need to keep up with those stray hairs.

When she was a kid, Crabby longed for smooth unblemished skin but I was stuck with freckles, little brown spots that she believed then were unattractive at best, ugly at worst.

Life goes on and sometimes you find a way to accommodate disappointments. In this case, when Crabby learned of age spots that commonly turn up on the backs of the hands of old people, she thought, “Oh, goodie. When I get old, age spots will hide the freckles."

The flaw in that thinking is obvious and anyway, no one would confuse age spots with freckles. Crabby doesn't like either one but she honestly doesn't care nowadays. It is one of the great benefits of old age - not caring about all sorts of things anymore.

For most of Crabby's adult life, she believed it was men who couldn't get through the night without two or three or more trips to the bathroom.

It's been about ten years since she was disabused of that error. Unless Crabby is the only one, it's women too.

This wasn't as important before cell phones started using fingerprint ID technology. Did you know that old people can lose their fingerprints? As reported here four or five years ago,

”...the elasticity of skin decreases with age, so a lot of senior citizens have prints that are difficult to capture,” reported Scientific American.

“The ridges get thicker; the height between the top of the ridge and the bottom of the furrow gets narrow, so there's less prominence. So if there's any pressure at all [on the scanner], the print just tends to smear.”

This also happens to people like bricklayers and tilers whose fingers have been worn flat.

It seems as soon as a new security technology comes along, there is a glitch its creator didn't take into consideration. Already with cell phone facial recognition, the wrong people's faces are being identified as correct.

Undoubtedly you can come up with more irritating afflictions that Crabby Old Lady has overlooked: eye floaters and tinnitus come to mind. And there there is this: when some new malady manifests itself, it can be hard to know if it requires a doctor visit or is just some new aggravation about which there's nothing to be done.

It's not as if the late actor Bette Davis didn't warn us: “Old age ain't for sissies,” she said.

AG Sessions Aiming For Marijuana Prosecutions

Today's story is an update of one from 23 October 2017 titled Cannabis and Chemo about my first visit to a marijuana dispensary to see if I could find relief for my insomnia.

Over-the-counter sleep aids don't work for me and my doctors are reluctant to give me prescription sleep drugs but one of them suggested weed (I live in Oregon where both medical and recreation marijuana are legal).

I'm expanding on this story because in the past two weeks, Attorney General Jeff Sessions has made it clear he intends to find a way to agressively prosecute marijuana growers, distributors, sellers and users. He believes marijuana use is "only slightly less awful" than heroin addiction.

Oh, please.

”Sessions argued that the DOJ's hands need to be untied when it comes to prosecuting marijuana dispensaries, 'particularly in the midst of an historic drug epidemic and potentially long-term uptick in violent crime.' reports Amanda Marcotte in Salon.

“There is, of course, no evidence,” she continues, “that marijuana use is contributing to the opioid crisis and, in fact, there's a significant link between legalized medical marijuana and a decrease in opioid overdoses.”

First of all, opioids are about 50 times more addictive than heroin and they are the cause of the current epidemic. Rolling Stone magazine reports that early in 2017,

”...the National Academies of Science, Medicine and Engineering released a landmark report determining that there is conclusive evidence that cannabis is effective in treating chronic pain.

“What's even more promising is that early research indicates that the plant not only could play a role in treating pain, but additionally could be effective in treating addiction itself – meaning marijuana could actually be used as a so-called 'exit drug' to help wean people off of pills or heroin.”

The reason this is of great interest to elders is that they are the fastest growing group to adopt cannabis for medical reasons.

Motley Fool reports that a recent Gallup poll shows

”...a record 64% of Americans now want to see pot legalized nationally. That's up from 60% in 2016...Support for medical weed is even higher, with a separate survey from Quinnipiac University in April 2017 finding 94% support for legalization.”

But even as old people are fast adopting marijuana especially for medical use, even growing their own in some cases to cut down costs, their acceptance of legal weed lags significantly behind young people's. Motley Foolagain:

“In the combined 2003 and 2005 analysis, Gallup found that only 29% of seniors supported the idea of legalizing weed. By 2016, as noted, this was up to 45%.

The magazine notes that it's hard to tell if elders are increasingly embracing the use of pot or if younger adults are growing into the elder age category.

However - different polls, different results. In October of 2016, The Pew Research Center survey demonstrated widespread support for sensible cannabis laws in nearly every demographic.

”The poll, conducted in August, shows 37 percent against legalization. A decade ago, opinion on legalizing marijuana was nearly the reverse – just 32% favored legalization, while 60% were opposed, Pew reported.

Millennials – those ages 18 to 35 – are more than twice as likely to support legalization of marijuana as they were in 2006 (71 percent today, up from 34% in 2006), and are significantly more likely to support legalization than other generations.

Among Gen Xers — ages 36 to 51 — a majority (57 percent) support legalization, a considerable jump from just 21 percent in 1990.

But even Baby Boomers— ages 52 to 70 — are seeing the light: 56% percent support legalization, up from just 17 percent in 1990.”

Obviously, legalization is a trend that can't be denied.

As I noted in my previous pot post, marijuana is useful for helping to treat and/or alleviate many of the symptoms of the “diseases of age” - cancer, chronic pain, epilepsy, arthritis, depression and glaucoma among many others.

I use it for sleep, having switched from cannabis candies to tincture. I have noticed – as I did in all the decades I smoked pot for fun – that there is, for me, a mild hangover the next day. I feel slightly sluggish physically and mentally so I use it only every second or, sometimes, third night.

Eight states have legalized marijuana for recreational use while 29 states and the District of Columbia have done so for medical use. In 2014, Congress passed The Rohrabacher-Blumenauer amendment which bars the U.S. Department of Justice from using federal funds to prosecute people buying or selling medical marijuana in states that have legalized it.

Last Friday, that amendment would have expired leaving AG Sessions free to prosecute except that Congress renewed it even over objections from Sessions. However,

”Ames Grawert of the Brennan Center for Justice told Salon, 'Every time, there’s sort of a dance around whether it will actually get cut this time or not."

“It’s reasonable to be at least 'a little concerned,' Grawert said, that Sessions' pressure will eventually convince congressional Republicans to dump the amendment.

In response to that, Rep. Dana Rohrabacher, a California Republican, and a bipartisan group of 24 other lawmakers earlier this year introduced a new piece of legislation, the Respect State Marijuana Laws Act of 2017, which would prevent the federal government from prosecuting any marijuana users, growers or distributors who are in compliance with state laws.

With all the real troubles in our country you would think the attorney general would have better things to do than chase down people whose health benefits from cannabis along with a business that brings in billions of dollars in taxes to states where the drug has been legalized. I sure don't want to lose my sleep remedy now that I've found it and I'm pretty sure millions of other elders feel the same way about the reasons they use marijuana.

You might want to let your representatives in Washington, D.C. know where you stand on this issue – even if you don't use marijuana. You can find their contact information here.

How the Tax Bill Harms Elders


I'll get back to that tweet from the California Congress member in a bit. First:

In case you slept through the weekend, in the early hours of Saturday morning, the Senate voted along party lines 51 to 49 to pass their version of H.R. 1: Tax Cuts and Jobs Act, the sweeping tax reform bill that pretty much steals money from everyone else and gives it to corporations and the very rich.

Many different senators were adding and subtracting and changing items in the bill – often hand-written in the margins - until about two minutes before the vote took place. Here is Montana's Democratic Senator Jon Tester:

No one, not a single person in that legislative body had read the entire bill, let alone had any time to understand it or weigh the consequences before voting.

And don't apply any “what-about-ism”. Do not let the fact that Democrats have done this same thing in the past deter you from heaping contempt for those 51 yea-voting Republican senators, nearly every one of whom lied to the public about who will benefit and who will lose from the bill.

There are only three reasons, all of them corrupt, to vote for a bill that will affect every American and crush tens of millions of them:

To appease the Trump base who scare the crap out of Republicans who are up for re-election in 2018

To deliver on legislative promises to their rich and powerful campaign donors

To have this one and only thing to show the public that they did something this year besides sit on their thumbs

The Tax Cuts and Jobs Act now goes to the conference committee to iron out the differences between the Senate version that passed on Saturday and the House version that passed on 16 November.

When that work is done and the bill is reconciled, it will be voted on in both chambers of Congress. Over the weekend, some pundits predicted that could be as soon as this week.

There are painful shockers in H.R. 1 for just about everyone who is not in the top one percent of wealth holders but we are concentrating on elders here not because I think they are more important than the poor, working and middle classes but because that's who we are at this blog.

With the caveat that especially with all the late-night, last-minute alterations, no one yet knows or understands the entire bill, here are some of the reported changes that will affect old people if the bill becomes law.

Sarah Kliff, writing at Vox, notes that H.R. 1 is really a health care bill that affects more than 100 million Americans who rely on the federal government for their health insurance. The bill, she writes,

”...includes tax cuts so large that they would trigger across-the-board spending cuts — including billions for Medicare. The last time Medicare was hit with cuts like this, patients lost access to critical services like chemotherapy treatment.”

(Can you tell how terrified I am right now about that?)

The National Committee to Preserve Social Security and Medicare (NCPSSM) explains in more detail why this would happen:

”...the Congressional Budget Office (CBO) says that the tax bill would trigger an automatic $25 billion cut to Medicare, as required by the Statutory Pay-As-You-Go Act of 2010 (PAYGO).

“In response, the President’s Office of Management and Budget would be required to cut Medicare payments to health care providers...”

Both the Senate and House versions of the bill would replace the standard cost-of-living index currently in use (CPI-U) to calculate COLA adjustments to Social Security, military and federal civilian retirement benefits with the more slow-growing chained CPI. As the NCPSSM notes:

”According to the Chief Actuary of the Social Security Administration, three years after becoming law, calculating the COLA based on the chained CPI would decrease Social Security benefits by about $130 per year (0.9 percent) for a typical 65-year-old.

“By the time that senior reaches 95, the annual benefit cut would be almost $1,400, a 9.2 percent reduction from currently scheduled benefits.”

Among the reasons AARP opposes this tax bill concerns people who are not quite old enough for Medicare, those between age 50 and 65:

” Eliminating the mandate would leave 13 million additional Americans without health coverage over the next decade, according to Congressional Budget Office estimates.

“Repealing the mandate would also drive up premiums by roughly 10 percent in the health insurance marketplace; 64-year-olds could see their tabs jump by an average of $1,490 a year.”

The most insidious cut in the tax bill is the stealth move (by design?) to eventually eliminate Social Security, Medicare and other social programs that stupidly uninformed legislators and partisans refer to as “entitlements” instead of earned benefits. It goes like this:

Because the Congressional Budget Office (CBO) estimates that the tax bill will balloon the federal deficit by an unfathomable $1.4 trillion, the bill will become the Republicans' reason to enact their long-term, dearest wish – to kill these programs altogether.

Newsweek explains how Republicans intend to play out this goal:

”[Senator Marco Rubio (R-Fl.) and] Other key Republicans have hinted that after the tax bill passes they’ll take on welfare and entitlement programs.

House Speaker Paul Ryan (R-Wis.) said that he wants Republicans to reduce spending on government programs in 2018, and last month President Donald Trump said that welfare reform will, 'take place right after taxes, very soon, very shortly after taxes.'

“Senate Finance Committee Chair Orrin Hatch (R-Utah) said Thursday that 'liberal programs' for the poor were wasting Americans’ money.

"'What's coming next is all too predictable: The deficit hawks will come flying back after this bill becomes law,' said Senator Ron Wyden, (D-Ore.) 'Republicans are already saying “entitlement reform” and “welfare reform” are next up on the docket.

“'But nobody should be fooled—that's just code for attacks on Medicaid, on Medicare, on Social Security, on anti-hunger programs.'”

Again, as California Representative Barbara Lee tweeted on Friday,


President Donald Trump wants this bill on his desk before Christmas. All the “in-the-know” people are saying it will sail through Congress and into law without a hitch.

That doesn't mean we shouldn't complain, shouldn't tell our senators and representatives to vote with the American people and not against them.

Do it. Find their contact information here. Polls show that only about 25 percent of Americans want this bill, so make a nuisance of yourself with your Congress people, and do it today.

The Justice Ginsburg Workout

Thanks to her fiery dissents from the bench and that she is without question her own woman, Associate Supreme Court Justice Ruth Bader Ginsburg is a cultural icon, “the notorious RBG”, who has become an inspiration to young and old, especially women. But I suspect more that a few men admire her too.


Among her fans it is well known that the 84-year-old successfully beat back colon cancer in 1999. My recently-found sense of connection with Justice Ginsburg is that in 2009, she was diagnosed with pancreatic cancer and although her tumor did not require the extensive Whipple procedure I underwent, part of her pancreas, like mine, was removed.

And she's still here nearly eight years later.

To regain her “strength and well-being” following the 1999 surgery, Ginsburg began regular workouts in the Supreme Court gym with a personal trainer, Bryant Johnson. As soon as she could following the pancreatic cancer surgery in 2009, she resumed her exercise routine with Johnson.

”At a pace I could manage [after the first cancer surgery], Bryant restored my energy as I worked my way back to good health," says Ginsburg.

“Ten years later, in 2009, another challenge confronted me. The diagnosis pancreatic cancer. Surgery once again and follow-up treatment, leaving me in a frail condition.

“As soon as I could, I resumed workouts with Bryant. Step by step, Bryant restored my energy, adding planks as well and push-ups to my regimen.”

RBGworkout-cover-150That quotation is from Justice Ginsburg's foreward to Bryant Johnson's just-published exercise book, The RBG Workout: How She Stays Strong and You Can Too!. As soon as I saw a preview a couple of months ago, I pre-ordered it and it arrived on Tuesday.

It's a how-to book of RBG's regular hour-long routine with Johnson including drawings and explanations so you can do it too - at a gym or the same exercises adapted for home. Here are a few of the drawings from the book as posted by ABC News:




What surprises and pleases me is how many of the individual RBG exercises are already in my own routine which I just returned to doing two weeks ago after my surgery recovery.

One difference is that RBG does real pushups while I do “girlie” ones on my knees instead of toes. The book convinced me that over time I can do that too and I started yesterday – not wildly successfully. I couldn't even lift myself up from the first pushup so I'll stick with my girlie version while I keep trying to do the real ones – one at a time if that's what it takes.

As Bryant Johnson explains in his introduction to the book, when Justice Ginsburg began working with him in 1999,

”...she couldn't have done the workout that is now her regular routine, but she was determined as all get-out, and we started building her regimen from scratch.

“Justice Ginsburg receives bone density scans every other year,” he continues. “After some years of twice-weekly workouts, her bone density began to increase. The result of this test became my report card for whether the exercises we did were effective or not.

“My efforts were confirmed by a majority decision when her doctor delivered this verdict: 'I'm not sure what you're doing, but keep doing it. It's working.'”

Here's a video from USAToday of Johnson showing some of RBG's workout at the gym.

Not every old person can do Justice Ginsburg's workout routine or even mine. We age at different rates, we get gobsmacked by unexpected diseases and conditions or, as was true for me five years ago when I began a home routine, we are just terribly out of shape.

Bryant Johnson's book is arranged to make it easy to choose the exercises you can do to begin with and then move on to harder ones as you build up your strength.

This routine was devised by a professional trainer especially for a certain old women but as he points out, it's good for any of us - men too. If you want to try it on your own, do talk with your physician first.

Medicare Open Enrollment Begins Sunday

EDITORIAL NOTE: Everyone not living in the U.S. can take the day off from TGB – unless you in developed countries want to find out how lucky you are to have the healthcare systems you have.

The annual Medicare Open Enrollment period begins this Sunday 15 October and lasts through Thursday 7 December – 54 days to make Medicare choices for 2018.

For elders, the enrollment end date has become the equivalent of tax day in April – a dreaded deadline that involves complex decisions that you never feel you have done well or well enough.

Nevertheless, it is important and doing the homework can save you money, sometimes thousands of dollars. So this post is longer than usual, but the basic information is here. Depending on what you need, you can skip around, pick and choose the information you want.

If your needs are more complicated than what I've explained, you may already have an insurance agent who can help or I have included a section on free places to get reliable, informed, personal help.

UPDATE AT 8:50AM PACIFIC TIME: The 2018 Social Security cost-of-living adjustment (COLA) has just been announced. It is 2.0 percent. Over the past eight years, the annual COLA has averaged just above 1 percent. In the previous decade, it averaged 3 percent.

As Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare just emailed:

“The just-announced 2.0% cost-of-living increase (COLA) for Social Security beneficiaries is woefully inadequate. The 2018 COLA translates into a paltry $27 a month for the average recipient, barely enough for a prescription co-pay, a tank of gas, or a bag of groceries. Because COLAs are cumulative from year to year (2016’s was 0% and 2017’s 0.3%), beneficiaries will continue to fall further behind."

More about this in these pages next week.

* * *

⚫ If you are covered by traditional Medicare, you can switch to a Medicare Advantage Plan.

⚫ If you have a Medicare Advantage Plan, you can switch to traditional Medicare.

⚫ If you have a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan.

⚫ If you have (or choose a new) Advantage Plan without drug coverage, you can choose a stand-alone Part D prescription drug plan.

⚫ If you have traditional Medicare, you can change to a different Part D prescription drug plan.

These are the main choices available during Open Enrollment to the majority of Medicare beneficiaries, and what is being covered in today's post.

MedicareAndYou2018_100 There is a lot of mostly clearly written information in the 2018 Medicare and You Handbook which you have already received in the mail or is available for free download in several formats here.

Medicare: 1.800.633.4227
Open 24/7 with recorded answers to almost any question. Say “agent” at any time for a live person. You can sign up and/or change plans via telephone, all for free.

State Health Insurance Assistance Program (SHIP)
Free one-on-one consultations for Medicare beneficiaries, their families and caregivers. (I've known two certified helpers in this program and they are amazingly knowledgeable.)

Medicare Rights Center
A national nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives. The toll-free helpline for Medicare assistance is 800-333-4114.

Local Organizations
Local organizations such as senior centers, clubs, social groups and even churches sometimes often hold free seminars on navigating Medicare during this open enrollment period. Contact them for information or ask what Medicare help services in your area they know of.

It all starts with this traditional Medicare coverage. Part A is generally free, no premium payment, and covers hospital stays. It's got its own complexities but they don't much apply to what we're discussing today.

Part B covers most medically necessary doctors' services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. We all pay a premium for this coverage which is why I bring it up today.

Medicare has not yet announced the new Part B standard premium for 2018 but expect to pay more than the $109 per month that 70 percent of beneficiaries are paying in 2017, which is usually deducted from Social Security payments. People who fall under other regulations have been paying $134 per month.

How much more Part B will cost in 2018, for most people, depends on the increase in the cost-of-living adjustment (COLA) for Social Security which also has not yet been announced although it is widely believed it will be about just over 2 percent.

There is a “hold harmless” provision which requires that the net Social Security check cannot decrease year-to-year so if the Part B premium increase were to be larger than the COLA, the premium increase - or part of it - would not apply to those 70 percent who are hold-harmless beneficiaries.

Sometimes called Part C, these are a kind of Medicare version of an HMO that are required to include all that traditional Medicare Parts A and B cover. Many offer such extras as dental, vision and hearing coverage, free gym membership and such.

There are many plans, each with different coverage options and premiums which vary widely in general and in different regions of the country.

And, the options change frequently, so it is important to closely check your coverage for 2018. There are probably other Advantage plans available to you if you see the need.

Traditional Medicare does not provide drug coverage and neither do some Advantage plans so if you do not have Part D prescription drug coverage, it behooves you to think seriously about buying a plan.

Because I took no prescription drugs, until now, for all the 12 years I have been a Medicare beneficiary, I always chose the plan with the cheapest premium and hoped for the best if I needed it. (Yes, this is how it works in the United States: just hope.)

Now, one of the drugs I will need to take for the rest of my life costs about $750 per month retail. That is out of the question for me if I had to pay that full price. I'm lucky now that the cheap plan I chose last year covers all but about $250 after the deductible is satisfied.

But that doesn't mean I'm not going to check all the Part D plans that are available to me and you should do so too. Obviously, I know that my current plan covers my drugs but they have advised me that the premium, the deductible and the percentage co-pays for my drugs will increase in 2018.

Some insurance companies decide not to offer the plan you have now and in that case you will be forced to select a new one. But everyone should investigate whether they can save money with a different plan.

Daniel McFadden and Joachim Winter explain in U.S. News that only 10 percent of Part D enrollees switch plans each year resulting in an average overspending of $373 per person per year and $1.2 billion in excess subsidies by the government. Further, they write,

”In 2015, the average savings for an individual who switched plans was $1,104. Last year the savings was $1,006. One retiree who had a key medication dropped by insurer in 2016 saved $45,768 by switching plans.

“Another retiree, Jerome Walker, 74, and his wife Lora take 14 prescription medicines combined. One year, they saved over $4,000 by switching plans. 'We find that we need to change plans virtually every year,' said Jerome. 'Those who don't choose, lose,'”

The infamous doughnut hole has been closing but it won't be gone until 2020.

For the first time in five years, the average monthly premium for Part D coverage will decrease for 2018, from $34.70 to $33.50. That is a $1.20 reduction. Don't spend it all in one place.

In this section, we are discussing PDPs – stand-alone prescription drug plans for traditional Medicare or Advantage plans that do not provide drug coverage. Follow these steps to select a drug plan:

⚫ Make a list of your prescription drugs including name, dosage, dosage frequency and the current costs to you.

⚫ If you already have Part D coverage, consult the Annual Notice of Change which you have received already from your insurer. Make note of any premium increase, increases in co-pays for any of the “tiers” of drugs you take, and check the formulary (drug list) to see if any of your drugs have been dropped.

⚫ Go to medicare.gov and click on “Find Health & Drug Plans” near the top of the page, white text on green background.

⚫ Enter your Zip Code and other requested information. I suggest that you use the second entry box rather than the “general search” above it so you will get a more personalized list. Click “Find Plans.”

⚫ On this page, you can enter the drugs you use. If you have done this in the past and have saved the list, you can retrieve it here and make any necessary changes. If you do not enter your drugs, you will see a drug plans list but it will not have the correct estimates matching your drugs.

⚫ On the next page, there will be three lists: for people with Original (Traditional) Medicare; for Medicare Health Plans (Advantage plans) with drug coverage; for Medicare Health Plans (Advantage plans) without drug plans. Choose one and click “Plan Results.”

The results shown are ordered by the estimated annual cost including monthly premium, deductibles, co-pays and coinsurance - and star rating. You can sort the results by any of these choices.

When you click the name of a plan, you will get to a page with links to the company's drug formulary and how to enroll, along with other information to help you decide.

One important thing: too many people use only the monthly premium to choose a plan but the other criteria such as deductibles, co-pays, coinsurance and other costs make a difference too and insurers often increase these year to year. So it's important to compare the premium with the overall estimated annual cost.

Sometimes it can make a different which pharmacy you use. If you already have Part D coverage, check your new Annual Notice of Change for the list of the insurance company approved pharmacies which are usually a bit less expensive. Some of them may have additional cost-saving plans, and there is usually at least one mail-order pharmacy that can save money too.

The pharmacy list is also included on the individual web pages of each plan that is available to you.

This is a tedious, boring process fraught with stumbling blocks along the way. If we had real single-payer coverage, it wouldn't be necessary, but we don't so we're stuck with this annual ritual. My only suggestions are to start early, move through the process slowly and carefully, and take advantage of the free help listed above if you need it.

The 21st Meal Weight Loss Plan

On Friday, in a couple of comments and even more emails, readers asked how I lost 40-odd pounds, what my weight loss plan was.

It's been more than five years since I wrote about that so maybe it's time for an update and/or additional information.

* * *

EDITORIAL NOTE: But before I go one word farther, this must be said: what I will tell you today is one woman's successful effort to lose 25 percent of her body weight. Although it is based on well-known, widely-accepted fact within the nutrition, diet and medical professions, it is not a prescription for everyone.

How our individual bodies function differs. In addition, at our ages in particular, conditions, diseases and medications can have an effect along with food allergies and other considerations. So read this only as something that worked for one person; maybe there is a tip or two that might help you and always consult your physician before embarking on a major change in diet.

* * *

The only way to lose weight is to eat fewer calories than your body uses. Period.

The best short(-ish) overview I've ever read about research into calorie restriction versus exercise for weight loss was published last June at Vox. The conclusion:

”...people who have had success losing weight share a few things in common: They weigh themselves at least once a week. They restrict their calorie intake, stay away from high-fat foods, and watch their portion sizes. They also exercise regularly.

“But note: These folks use physical activity in addition to calorie counting and other behavioral changes. Every reliable expert I've ever spoken to on weight loss says the most important thing a person can do is to limit calories in a way they like and can sustain, and focus on eating healthfully.”

I developed a 45-minute home exercise routine that I followed during the year of weight loss and have continued since then. I don't think it helped in taking off the pounds but it did, and does, help my overall health and strength.

FYI: There are about 3500 calories in a pound of fat so you need to burn 3500 calories to lose one pound.

An average woman needs to eat about 2000 calories per day to maintain, and 1500 calories to lose one pound of weight per week. An average man needs 2500 calories to maintain, and 2000 to lose one pound of weight per week.

Obviously this formula varies from person to person but it is equally obvious that you cannot, as some TV commercials promise, lose 10 or more pounds a week. Well, not without starving yourself.

There is no way to know how many times I lost the same, recurring 10 pounds over my adult life. This time I wanted to end that cycle so I spent a great deal of time planning a weight loss campaign that I could easily continue as a maintenance program. I came up with these four simple rules for myself:

⚫ It doesn't matter how long it takes to lose the 40-odd pounds just so long as the weight is declining week to week.

⚫ Weigh yourself every morning at the same time and keep a chart. Inevitably, weight will fluctuate up and down. That's normal as long as the overall trend is downward.

⚫ Keep a close watch on portion control; don't let it creep up.

⚫ Make sure every meal is wholesome, healthy, and never snack. (I found that if I was feeling hungry between meals, a short walk – as little as 15 minutes – could take care of that.)

At first I used the Harvard Healthy Eating Pyramid to balance the foods I ate:


But that graphic is way too complicated and apparently Harvard thought so too because they soon issued their Healthy Eating Plate. This is simple and easy to use:


BREAKFAST: I tried smoothies for awhile but I don't really like them. I do like oatmeal and that became my go-to morning meal: Stone-ground oatmeal with several fruits (bananas, peaches, berries, etc.) and home-made apple sauce (apples, water, lemon rind – nothing else) stirred into the oatmeal.

LUNCH AND DINNER: Three or four times a week, one of these meals was steamed or broiled fish with a pile of veggies over brown rice or whole wheat noodles, for example. Other times I substituted part of a chicken breast for the fish which I had poached in broth, garlic, white wine and honey.

Because a serving of commercial soups contains almost a day's supply of sodium, I kept a freezer full of home made pea soup, vegetable soup, chowder, etc. for filling meals especially on chilly days.

And then there is Gorilla Salad, named (and as far as I know invented) by my friend Joyce Wadler (who writes a terrific humor column at The New York Times).

It is huge - 10 or 15 different cut-up veggies, pre-cooked - usually roasted - when necessary, maybe some fruit like grapes or melon or some left over chicken breast all held together with homemade dressing.

Always homemade dressing. Commercial salad dressings can be gigantic calorie hogs and the low- and no-fat varieties have an awful, chemical taste. But if you make your own, you can control that. Use good oil, olive or canola, and you can vary the acid – balsamic vinegar, lemon juice, even Japanese mirin work plus any flavorings you prefer.

Keep the dressing portion small. A tablespoon of dressing is about 100 calories. You can use small amounts of dressing if you toss a salad for a long time.

I came up with only one trick that was useful to keep me on target. I happen to like vegetables as lot, and fruit and fish so this was a reasonable diet for me but I still wanted to stave off cravings that could derail my weight loss.

So I invented The 21st Meal Diet.

It goes like this: there are 21 meals in a week. It cannot possibly hurt the weight loss program if one meal is devoted to something you like but isn't on the agenda – in my case, usually ice cream or cheeses. So for one meal a week, I gave myself a favorite but disallowed food.

Sometimes it was two or three or even four reasonably-sized wedges of excellent cheeses I had bought especially for the meal. Other times it was ice cream. You do know, I assume, that whatever anyone tells you otherwise, a serving of ice cream is a pint. Right?

Even so, for the 20 other meals, portion size is an important issue. The experts tend to describe one portion as the size of a tennis ball, a small fist, a deck of cards, a bar of soap. All those are about right for one serving. Here's a page that might help further.

Weight loss is a giant topic online; type that phrase into Google and you'll get a quarter of a billion (with a B) returns. A lot of it is junk. Some of it is not.

Here are two website I think are useful: The USDA Food Tracker and the Harvard Healthy Eating Plate. Both are packed with honest, straightforward, proven eating and weight loss information.

Looking back now after keeping off the weight I lost for five years, I think the two most useful pieces of advice to myself were these:

Don't rush it. It doesn't matter how long it takes to lose the weight as long as it is regular and steady.

The 21st meal. That became the big treat I looked forward to each week and helped keep me going.

(NOTE: We're all eager to hear your experience along with any tips that have kept you on pace to reach your weight loss goals in a healthy manner. Just remember, no medical advice and no recommendations of herbs, oils and magic potions "guaranteed" to take off excess weight.)

Cancer Linked to Obesity

During a medical checkup while I was recovering from the Whipple surgery for pancreatic cancer, one of the physicians told me that even though I was among the 10 percent who are eligible for that procedure, they probably would not have done it due to my age, 76, if I had not been as healthy and in as good physical condition as I was.

Based on that information, four years earlier – when I was 72 - they would have rejected me.

Back then I weighed more than 160 pounds (I am 5' 2” tall), couldn't walk up one flight of stairs carrying the groceries without stopping halfway to rest and got no more exercise than trying to climb those stairs or running the vacuum cleaner once a week.

When I realized, after being laid off from work in 2004 that it was unlikely I would be hired again, I sold my home in New York City and moved to Maine. What I also did was allow myself to eat all the things I'd kept to a minimum all my life to help maintain a reasonable weight – wonderful things like ice cream and cheese.

My weight crept up and up and up.

By late 2012, it was sometimes difficult to breathe even when walking on flat ground and I always avoided hills, even small ones. That's when I realized I had to get healthy or become incapacitated in some manner.

I devised an eating regimen that would keep me healthy while losing weight at a reasonable rate – about four to five pounds a month - and a daily exercise routine that combined old-fashioned calisthenics, some ballet exercises, resistance and weight training, flexibility work and tai chi.

A year later I was down to a consistent 120-125 pounds. I could walk for miles, up hill and dale and stairs and my exercise routine kept me strong.

There is a just-released study titled “Vital Signs” from the Centers for Disease Control (CDC) in collaboration with the National Cancer Institute showing an association between obesity and 13 kinds of cancer:

”As many as 40 percent of all cancers are related to obesity, according to the new research, which suggests that these cancers would be preventable if weight was kept under control...” reports Medical News Today.

“The findings are particularly important given the alarming statistics on obesity in the United States. Between 2013 and 2014, the CDC note, as many as 2 in 3 adults were deemed overweight or obese.”

Here are the 13 cancers:


According to The Guardian, deputy director of the CDC, Anne Schuchat, said their research

“'...found an increase in a number of types of cancers associated with obesity and overweight, at a period when the prevalence of obesity and overweight has increased substantially in the middle ages...The prevalence of obesity and overweight is starting to show up in our cancer statistics.'

“...In 2014,” continues The Guardian, “roughly 630,000 people in the US were diagnosed with overweight- or obesity-linked cancer. Two-thirds of those cases were in Boomer-generation adults, between 50 and 74.”

Having lost weight four years earlier didn't seem to affect my getting pancreatic cancer but all cancers are mysterious things. Some researchers I've read have talked about cancer cells living benignly in our bodies for many years, if not all our lives, and then something triggers them to go wild. Maybe, sometimes, obesity? No one knows. Yet.

This seems to be a particularly timely study for old people because so many of us put on excess weight as we grow older.

There are many more details of the study at those two links above, at the Centers of Disease Control and elsewhere around the web.

A Matter of Life and Death Or...

The cruel Graham-Cassidy repeal-and-replace the ACA healthcare bill.

Yes, life and death. Because if this bill passes thousands of Americans will die. Let me walk you through it.

If passed, Graham-Cassidy will end up killing sick Americans because it does away with the Obamacare (ACA) requirement to cover pre-existing conditions.

Republicans, including Senators Graham and Cassidy and President Trump keep saying the bill covers pre-existing conditions. That is a lie.

The reasons are a bit complicated involving state exchanges and other esoteric effluvia in the bill but, as the Washington Post boiled it down for us [emphasis is mine],

”...the Cassidy-Graham proposal simply would allow states to waive the ACA’s prohibition against varying premiums based on an individual’s health status.

“Insurance companies would then be free to charge higher premiums to people with preexisting medical conditions.”

In addition, Graham-Cassidy removes premium subsidies and the Medicaid expansion which would leave many who bought health insurance for the first time under Obamacare unable to afford it under the new rules.

There is strong evidence that uninsured people, lots of them, die for want of coverage. As The Guardian recently explained:

”Various studies have looked at whether uninsured people have a higher risk of death. The most cited was published [pdf] by the American Journal of Public Health in 2009 and found that nearly 45,000 Americans die each year as a direct result of being uninsured.”

No one knows the actual cost of Graham-Cassidy - to insureds or the government - because the Congressional Budget Office has informed Congress that it does not have enough time to score the bill before the vote this week.

What we do have, from the USC-Brookings Schaeffer Initiative for Health Policy project, is an analysis that seeks to approximate the Congressional Budget Office’s methods. As reported in Vox, Graham-Cassidy will cause

15 million fewer people to have insurance in 2018 and 2019, versus current law

21 million fewer be insured by 2026

32 million fewer Americans with coverage after 2026 if the funding provided in the Obamacare repeal bill [Graham-Cassidy] is not reauthorized by Congress

As I mentioned on Saturday's Interesting Stuff post, late night host Jimmy Kimmel waged a week-long war of words against Senator Bill Cassidy who, four months ago on Kimmel's show, said that he would not vote for a bill that did not include coverage for pre-existing conditions.

Then he went right back to Washington and co-authored this bill that does the opposite. Can you spell hypocrite?

Last Thursday a new survey from Public Policy Polling showed that only 24 percent of Americans approve of Graham-Cassidy. There is more detail about the poll at Vox.

Most of the news media and pundits are saying that the bill is hanging by a thread and has almost no chance of passing.

Three Republican senators have indicated they probably will not vote for the bill: Rand Paul, of Kentucky, Susan Collins of Maine and Lisa Murkowski of Alaska. On Friday, in a move that Vox called a “death blow,” to the bill, Senator John McCain of Arizona announced that he opposes Graham-Cassidy.

[UPDATE 5:45 AM PDT: Overnight, Republican senators altered Graham-Cassidy to throw more money via block grants to Alaska and Maine as a bribe to Senators Murkowski and Collins to vote for the bill. It will be interesting to see what they do.]

But are you going to count on that to quash the bill? Fifty-one votes are needed and we know at least one senator who went back on his public word.

Among the things I am grateful for even with my frightening diagnosis of pancreatic cancer is that I am old enough for Medicare. Without it, I would not have had anywhere near enough money to pay for my treatment and I would have had to just go home and die.

As will happen to too many people if Graham-Cassidy becomes law. Private insurance is not as comprehensive as Medicare but the Obamacare changes have gone a long way to help more people afford coverage. Graham-Cassity guts that.

They say that the Senate will vote on this bill on Wednesday. Unless Republicans withdraw it, they must vote by next weekend when Senate rules change and more than 51 votes are needed to pass a bill.

So please call your senators now to let them know where you stand. Even if you believe your senators will vote against it, call anyway. The number of calls matters.

Let's keep it simple – you don't need direct numbers to senators' offices. This number - 202.224.3121 - will get you to the Congressional switchboard. Just ask for your senator's office. Then, when you've left your message there, call back and ask for your other senator.


Do it now.

Too Old to Fall

Are you age 65 or older and live at home? If so, in any given year, you have almost a one in three chance of falling. If you live in a care home, you have a 50 percent chance.

This is not to be taken lightly. Little kids fall all the time and bounce right up - their bones are still pliable. Old people's? Not so much and a broken bone, even a bad bruise, can lead to disability. Here are some statistics about elders and falls (emphasis is mine):

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

Today, the first day of autumn, is the annual Falls Prevention Awareness Day and as we do here every year at this time, we remind ourselves to take stock of how to protect ourselves from this particular danger.

For elders who live independently, most falls happen at home.

Before I get rolling on this topic, here is a short video from the National Council on Aging about preventing falls. It's a little too cutesy for me, but it has the basic information you need to keep in mind to help you stay safe from falls:

For such a short piece, that video covers the preventable causes of falls quite well and the beginning of this new season is a good reminder to correct the problems in your home that might trip you up.

Two unexpected things changed after my Whipple procedure surgery in June: I lost my taste for sweet things (not that I don't eat them but they are no longer something I crave) and my balance, which had always been good, has become shakier.

For the first time, I now have a mat in the tub so not to slip while showering and I have taught myself, especially when I get up from a chair or bed, to hang on to something for a few moments until I feel steady on my feet.

You might like to take a mental inventory to see if such things may have changed for you.

Here is a list of websites about most of the hazards and preventions we should check for and correct once a year:

National Institute on Aging

AARP – Preventing Fall in the Elderly

Mayo Clinic


National Institute on Aging

Few of these and other well-meaning instructions mention an important hazard we discussed in August – running children.

”Suddenly, two boys – maybe seven, eight or nine – ran full tilt down the hallway, brushing the old man's cane arm as they scooted by and then, making a course correction, nearly bumped into my wheelchair.

“I don't recall any previous time when I was frightened in just that way. I immediately pictured myself and the wheelchair tipped over on the floor of the hallway, my incision ripped open with blood pouring forth.”

This post drew a lot of comment and several of you mentioned the additional problem of adults looking at cell phones while walking and bumping into people. Here's my free advice about that:

If you use a cane, a walker or a quarterstaff, take it with you every time you leave the house. One reader commented in August that they also work well as defensive devices when out and about.

Another useful device is a medical alert system that will notify a response team if you have fallen and can't get up. (Yes, I agree, those TV commercials are awful.) There are many different systems to choose from and some may not be as reliable as anyone would want or need.

One place you can check is the reviews.com page about these devices. They say they have carefully checked and tested many systems and give reasons for their recommendations so you might want to consult them. Just so you know, their About page notes:

"If you buy our picks, we'll often make money on that purchase. That is how we can stay in business...We pledge that we'll never name a top pick that's not truly great even it'd mean a bigger payout for us."

As always, be careful where you shop online.

Most of us at this blog are too old to risk falling so let's all be safe out there, just as Sergeant Phil Esterhaus (Michael Conrad) used to say every week on Hill Street Blues.

A Question of Organ Recitals


A few days ago in a comment, a reader made an approving reference to a friend who refused to take part in groups of old people who indulge in “organ recitals” - that supposedly clever but disparaging phrase for discussion of medical problems.

(It is always applied to elders. Young people who talk about their health are never accused of being boring but we'll save discussion of that kind of ageism for another day.)

Certainly we have all known people who carry on at mind-numbing length or go through the details of their surgery at inappropriate moments – Thanksgiving dinner comes to mind. But there is another side to this issue.

A couple of weeks ago, on a post here in which Crabby Old Lady was writing about her cancer, reader Rina Rosselson who blogs at age, ageing and feature films, left this note in the comments:

”Thanks for your crabby post. At 82 I still have not heard what my friends had been going through when struck by a serious illness. There is such reluctance and fear to communicate and share these feelings. Your posts make it easier to talk about these changes.”

Rina is right. As much as some organ recitals can be excessive, plenty of other people go too far in their silence about serious medical issues. It helped me a lot, eased my mind to a degree, especially when I was first diagnosed, that people I know – in “real life” and on this blog – passed on what they had experienced during cancer treatment.


Even if it would not closely match my experience, it helped me understand how difficult or easy my treatment might be and, most important, that those people had got through it - a real question when facing so much that is frightening and new.

Here is another thing that happened – to me, anyway – after the surgery and during recovery from it; even as I desperately wanted to not become a “professional patient” and wanted to hang on to my pre-diagnosis life, cancer is insidious in at least one additional way beyond the physical attack on the body:

Over time, and not all that long a period, it creeps into every cell of your brain. Trying to read a newspaper or a book? The mind strays to cancer. Watching a movie on TV? Next thing you know you're wondering if the chemo will actually work, and you've lost the thread of the film story.

Even washing dishes or making the bed, you suddenly worry that you forgot to take your pre-meal pill at lunch.

But perhaps the worst? Those ubiquitous commercials for various cancer treatment centers scattered in cities around the U.S. that always imply that they can cure cancer.

They enrage me. As much as I suspect a generally positive attitude is helpful in treating cancer, I resent being lied to as though I'm incompetent. And although, if you listen carefully to every word, they don't promise a cure, few of us pay that kind of close attention and it sounds like that's what they are saying.

Either way, there you go down the cancer rabbit hole again.

One thing I've noticed is that too often when I've told people about my diagnosis, they don't know what to say – they are stunned - understandable - and I think part of that is our general reluctance to discuss such things at all.

So I'm with Rina. I think discussing details of our serious diseases and conditions (appropriately, for sure) is a big help in reducing fear in everyone involved – friends and family as well as patients. Talking about these dramatic changes, when they hit us, with loved ones goes a long way to finding a way to live with them.

I am reminded of the large number of doctors and nurses I have been dealing with through these months. They answer every question with the truth, even the hard truths, with compassion, understanding and a good deal of humor. The rest of us should be doing that too.

Friends Having Lunch

What Medigap Changes Mean For Elders

[EDITORIAL NOTE: Today's post is a bit wonkier than I usually publish but it is important for U.S. readers who will become eligible for Medicare in the next two years, and for current beneficiaries too. It shouldn't be hard to follow.]

Since my pancreatic cancer diagnosis three months ago, I have blessed President Lyndon B. Johnson every day for his part in creating Medicare. With the price tag for my surgery and ongoing care already into high six figures, without Medicare I would be doomed – as many old people were before Medicare.

Now, there are some changes coming to Medicare that will make it more expensive for elders while also reducing coverage. This involves changes that Congress passed in 2015 to the supplementary (or “Medigap”) coverage.

(We are talking about traditional Medicare today, not Medicare Advantage plans.)

Medicap policies pay most of the 20 percent or so of doctor and hospital costs that Parts A and B of Medicare do not cover. The choices of Medigap insurance plans are labeled by letters: A, B, C, D, F, G, K, L, M, N. As the Chicago Tribune explained the coming changes recently,

”In 2020, people who are on Medicare and don't already have what's known as Plan F or Plan C Medigap insurance won't be able to buy it because the federal government will close those plans to new participants.

“That means that when people go onto Medicare at 65, or if they switch Medicare-related insurance during the next couple of years, they are going to have to be diligent about scrutinizing insurance possibilities before some of those doors start to close.”

Plans C and F are, according to The Trib, the most popular Medigap choices for good reason. Plan F, which I chose when I signed up for Medicare in 2006,

”...is the most comprehensive. It doesn't cover dental, vision, or medicine [no Medigap plans do], but if retirees pay their monthly premiums they shouldn't have to pay anything else for doctors, tests or hospitals. Even medical care overseas is partially covered.

“In other words, at a time in life when medical issues can pop up suddenly and cost a fortune, Plan F is predictable. Plan C is popular for the same reason, although it isn't as comprehensive as Plan F.”

When Congress enacted this coming change, the goal was to save money on Medicare. So as of 2020, the Part B deductible will no longer be covered by existing Medicap policies and Plans C and F will no longer be available to new enrollees.

People currently on Plan C or F, like me, will still

”...be able to shop your coverage. If another insurance company offers it at a better price down the road, you can apply to change to that insurance company’s Plan F policy...” reports Forbes.

“However, over time we can probably expect Plan F premiums to slowly rise, since the total number of people enrolled will be shrinking annually.”

Meanwhile, it is not clear that this change will reduce Medicare costs. As Reuters reported when the legislation was passed in 2015,

”Numerous studies show that exposure to higher out-of-pocket costs results in people using fewer services, [Tricia Neuman, senior vice president and director of the Program on Medicare Policy at the Kaiser Family Foundation] says.

“If seniors forego care because of the deductible, Medicare would achieve some savings. 'The hope is people will be more sensitive to costs and go without unnecessary care,' she says.

“'But if instead, some forego medical care that they need, they may require expensive care down the road, potentially raising costs for Medicare over time.'”

There is more detailed information at all the links I've provided above.

You can be forgiven if, thanks to the Experian Equifax data breach affecting 143 million Americans, you think this is too little too late. Also, the theft is so large, just assume you are affected.

Next year, all Medicare beneficiaries will receive new Medicare cards with a new kind of numbering system – no more Social Security numbers. Last week, Medicare released a first look at the new card:


There are all kinds of things to know about this change you can find at cms.gov.

And if you haven't done anything to secure your stolen data from being used nefariously, here is a good instruction piece from The New York Times. It will cost you $20 or $30 to set up credit freezes and fraud alerts. And here is a later report from The Times answering reader questions about the data breach.

Finding New Friends in Old Age

EDITORIAL REMINDER: One of the reasons Time Goes By is such a friendly place to have a conversation is that from day one, no commenter has been allowed to personally attack me or anyone who posts a comment.

Disagree about ideas? Fine. Assail others? Never.

On Monday's post, one reader attacked my research abilities and my thinking skills. That person's comment has been removed and he or she is now permanently banned from commenting here. No recourse.

That's how it's done at TGB. Fortunately, it doesn't happen often.

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A quick search around this blog reveals that about once a year we discuss loneliness among elders including all the terrible statistics related to people who feel lonely.

For example, Medical News Today recently reported that

”Two new meta-analyses from Brigham Young University (BYU) in Provo, UT, reveal that loneliness and social isolation may increase the risk of premature death by up to 50 percent.”

We could discuss that again (and probably will in the future), but last week a new reader, Albert Williams, left a comment on a 2014 post about friends in old age that interests me:

”Whew! I'm glad I found this site,” wrote Williams. “I was beginning to think that I was the only person with such problems, and that, perhaps, there was something wrong with me.

“However, after a bit of introspection, I realize that this is not completely true. (Completely? Try old, ugly, curmudgeonly, short-tempered, cynical, and a few more applicable adjectives...)

“Time has, indeed, taken its toll. I am now an old man. Most of my life-long friends are gone. I've never had any kids; I've outlived two wives; and almost all of my family on both sides have already died.

“I find it very easy to make new acquaintances, but these seem to never develop into the deep, trusting, abiding friendships I had when I was young. Loneliness, apparently, has become a permanent part of my remaining days, and my best friends nowadays are my dogs and my computer.”

That is a familiar thought for me. Most of my “deep, trusting, abiding friendships” of many years have died or live far away and the people I enjoy spending time with where I live now haven't crossed to that special status yet although two or three are heading in that direction.

It's close enough to true to say that all websites aimed at elders repeat the same, facile solutions on this subject: join a senior center, make use of online groups, figure out local transportation options if you don't drive anymore.

But none of that gets to the more ephemeral problem that Albert Williams is talking about and they don't discuss the reasons this happens to so many old people.

Here are a couple of my disjointed thoughts about how this happens:

Disability, health conditions and just plain being more tired than when we were young keep many of us at home. I know that it has been years since I have booked social engagements two days in a row and I sometimes need more days in between.

We no longer have careers and children in common as a starting place for new friendships. In fact, the only thing we can be certain of sharing in old age is our health which, as a reader noted recently, many are reluctant to talk about and too many others are guilty of oversharing.

Social media – texting, Facebook, etc. - have taken a toll on friendly telephone conversations. Remember when the phone would ring at random times and a friend was on the other end seeking to make a dinner appointment or just chat for awhile?

Few people I know do that much anymore. We make appointments – actual appointments – via text or email to chat on the phone. I appreciate that with my far-away old friends but I miss the serendipity of telephone visits with people nearby even as I have become accustomed to making these appointments.

No one can decide to make someone a friend. The thing about friends who fit like an old shoe is that it takes time - and the effort to keep in touch between in-person visits.

Always, a new friendship has surprised me even back in the days when it seemed easier than now. After some period of time, usually several months, I think, I realized one day, “Hmmm. When did Tom, Dick or Mary become a friend? I didn't see it coming but here it is and I am glad for it.”

It happened while we were going to movies together, sharing stories about ourselves, recommending books to one another and becoming comfortable enough together that we came to relax together in ways we can't until we have come to trust.

Those opportunities seem to diminish as we grow older. Albert Williams is not alone and the problem of elder loneliness, according to researchers, is increasing. I'm pretty sure some of you have plenty to say about this.

(There is a new-ish category of friends, online friends we have never met in person or only once or twice that I believe are important to our well-being and expand our lives in important, lovely ways. But that conversation is for another day.)

You and Me and Flu Season

EDITORIAL NOTE: Several readers suggested I replace the far right photo in the banner with a screen grab from the video interview I posted on Saturday. I thought that was a pretty good idea, so I did it. See above.

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Flu vaccine

God knows my memory could be off but I'm guessing I began getting an annual flu shot sometime in the late 1970s or early 1980s. Before then, a week home in bed with the flu was a winter ritual.

Only once in the 30 to 40 years I've taken the vaccine, did I forget to do it – but I will never forget the flu I suffered that year, and I do mean suffered.

It happened about 15 years ago, so let's say I was age 60 or so and I was in bed for two full weeks with all the awful symptoms – fever, muscle aches, headache, chills, sweating, fuzzyheadedness, etc. and it took a month after that before I was at full capacity again.

During those two weeks, I had little sense of time passing, just horrible discomfort and then, finally, the pain and fog lifted. I was well and functional again. But it has puzzled me ever since that in the kitchen that day I found two empty gallon jugs of water.

I had never bought water. There is no need in New York City which regularly wins awards for the best tap water in the United States. Yet there they were, those two empty jugs.

Had I gone to the corner bodega to buy them? If so, why? I didn't remember then, I don't remember now and I don't recall anyone visiting me who might have brought them although there is nothing to say those things didn't happen. It's not a big deal; just one of the small mysteries of life but forever attached to the word “flu” for me.

So here we are at the beginning of the 2017/18 flu season and even though people 65 and older are at high risk for the flu itself and at greater risk for preventable complications than younger adults, nearly one-third of those between the ages of 65 and 74 skipped the flu shot last year.

A couple of other worthwhile statistics: 90 percent of flu-related deaths occur in people 65 and older as do 60 percent of flu-related hospitalizations.

Almost all elders should get a flu shot each year and there is a special, high dose vaccine for old people called Fluad. According to the Centers for Disease Control (CDC),

”The 'high dose vaccine' is designed specifically for people 65 and older and contains 4 times the amount of antigen as the regular flu shot. It is associated with a stronger immune response following vaccination (higher antibody production).

“Results from a clinical trial of more than 30,000 participants showed that adults 65 years and older who received the high dose vaccine had 24% fewer influenza infections as compared to those who received the standard dose flu vaccine.”

The vaccine is a good health investment and in fact, for most us requires no monetary investment. For those with original Medicare, Part B covers the shot with no copay - that is, free. If you have Medicare Advantage, check with your insurer.

If you have an allergy to eggs, you should consult with your physician about the flu vaccine and here's something new I learned recently: if you are receiving chemotherapy, you should talk with your physician before getting the shot. With approval from my doctor, I got mine, Fluad, two weeks ago, about three weeks before my chemo begins.

In my old age, a bad cold feels too much like the flu so I don't want to even imagine what a flu would feel like to me nowadays.

Oh, and here is one more reason to get the flu shot. It is estimated that people 65 and older who skip the flu immunization increase U.S. health care costs by $4.8 billion a year.

So you can contribute to Medicare's solvency too when you get a flu shot.

Here is the CDC's extensive website section on the flu.

Myths About Our Ageing Brains

EDITORIAL NOTE: Today is a holiday in the U.S. and I'm giving myself a little extra time off – mostly by republishing a post from AARP. If, like me, you're one of the people who have issues with AARP, calm down. This is informative work from one of their research organizations.


There is a lot of nonsense promulgated about ageing brains. Yes, we find oursevles forgetting names or losing too much time looking for our reading glasses but most beliefs about cognitive decline in old age are myths.

A few weeks ago, the Global Council on Brain Health (GCBH) which is an independent collaborative of scientists, health professionals, scholars and policy experts that was convened by AARP and recently issued their 2017 report on cognitive ability and brain health.

Here are seven of the myths identified in the GCBH survey as reported by AARP:

“1. Older people can’t learn new things. Not so. Trying new activities can actually stimulate cognitive skills. Seeking out new social connections that involve learning names and information about the people you meet, going back to school and taking up a new musical instrument are just a few examples of activities that can boost your brain health.

2. You’re stuck with the brain you were born with. Also not true. Brains are made up of cells called neurons. While it’s true that most of the neurons are created before birth, studies have shown that new neurons can be created in the area of the brain that deals with learning and memory. Researchers hope that by better understanding how new neurons are created, they can help individuals with brain injuries and neurodegenerative diseases.

3. Experts don’t have a clue about how the brain works. Actually, scientists are learning more about the brain every day. Granted, it is a complicated organ. But new treatments for neurological conditions are coming to light, and researchers expect exciting breakthroughs down the road.

4. It’s inevitable that older people will get dementia as they age. Not true. Dementia can be caused by Alzheimer’s disease or age-related events, such as a stroke. But getting older doesn’t automatically mean you will get dementia. And it doesn’t mean you are developing dementia if you can’t remember the name of an old acquaintance you run into at the grocery store.

5. Learning a new language is for the young. It is usually easier for children to pick up a new language, as sentence structure tends to be less complex for them — and they tend to be less self-conscious when trying something new. But adults also can learn a new language. In some countries, such as Sweden, it’s common for retired people to take classes for a third language.

6. Older people are doomed to forget things. Being forgetful about details such as names and facts happens to everyone, no matter his or her age. Poor memory can often be attributed to lack of attention. Some helpful tips on remembering include writing things down (such as shopping lists) and taking note of visual details associated with your surroundings.

7. Just take memory training, and you’ll be fine. Not exactly. While it’s a good idea to look for ways to fine-tune your memory, if you don’t practice those skills and keep challenging your brain, all that hard work will be wasted. It’s the ultimate 'use it or lose it' advice.”

There are a lot of things we can do to maintain our cognitive abilities as the years pile up. (By the way, widely advertised “brain games” are not one of them. Repeated research over several years has shown that their value is iffy at best.)

But cognitively stimulating activities are. Here's a GCBH infographic about with an overview of how to keep challenging your brain:


And here is a GCBH library page with links to many other sources of brain health information.