485 posts categorized "Health"

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.

* * *

WHAT YOU CAN DO DURING OPEN ENROLLMENT
⚫ 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.


WHERE TO GET HELP
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.


MEDICARE PART A AND PART B
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.


MEDICARE ADVANTAGE PLANS
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.


PART D PRESCRIPTION DRUG PLANS
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.


HOW TO CHOOSE A PART D PRESCRIPTION DRUG PLAN
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.

CHOOSING A PHARMACY
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.

* * *

A COUPLE OF IRREFUTABLE FACTS
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.

MY RULES
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:

HarvardHealthyEatingPyramid1024x950

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:

HarvardHealthyEatingPlate

MY MEALS
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.

THE 21ST MEAL
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.

A NEW STUDY RELATING CANCER AND OBESITY
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:

13Cancers

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.

2122243121

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

WebMD

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

Friends

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.

Conversation

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.

FIRST LOOK AT NEW MEDICARE CARDS
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:

Medicare_Cards_Identity_Theft680

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.

* * *

Senior-loneliness

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.

* * *

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.

Bvrain3

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:

BrainHealthInfo

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


Amazing Medical Advances (?)

A whole bunch of you, TGB readers, sent me a medical story published this week about the development of a deceptively simple test for pancreatic cancer – nothing more than a smartphone app called BiliScreen that uses the whites of a person's eyes to diagnose the disease.

PANCREATIC CANCER TEST
The reason the five-year survival rate for pancreatic cancer is only nine percent is that there are few symptoms and no tests to catch it before it has spread.

”One of the earliest symptoms of pancreatic cancer, as well as other diseases, is jaundice, a yellow discoloration of the skin and eyes caused by a buildup of bilirubin in the blood,” reports Science Daily.

“The ability to detect signs of jaundice when bilirubin levels are minimally elevated - but before they're visible to the naked eye – could enable an entirely new screening program for at-risk individuals...

“In an initial clinical study of 70 people, the BiliScreen app...correctly identified cases of concern 89.7 percent of the time, compared to the [bilirubin] blood test currently used.”

Bilirubinapp

Of course, much more testing is needed but it sounds good, right? Well, pardon my skepticism.

For the 20-odd years I've been studying ageing, I've been subscribing to a variety of reports on health and medical developments and have been disappointed again and again.

They generally sound as amazing as this one and the medical media excitedly report them as breakthroughs that are “closer than you think.” And then they disappear never to be heard of again. And in this case, I wonder what who is "at risk" for pancreatic cancer. Until my diagnosis, no one ever mentioned that it was a potential problem for me.

Nevertheless, how I hope this is not one of the advances that disappears. I was lucky my diagnosis was early enough to treat. I would hope that everyone who is told they have pancreatic cancer could, like me, be eligible for the surgery. Early diagnosis is not a cure, but it does give a patient a better shot at it.

BLOOD TESTS TO DETECT CANCER
Also announced this month are several reports of the development of blood tests for cancer. In one, from the American Council on Science and Health, a test for a certain type of DNA would allow cancers to be detected at earlier, and therefore more treatable, stages:

”It was tested in people who were in an early stage of four different types of cancer: colorectal, breast, lung and ovarian. Using this approach, they examined 58 cancer-related genes.

“Out of the patients studied that were in the earliest stage of cancer (stage I), the ctDNA was detected in 50% with colorectal, 67% with breast, 45% with lung, and 67% with ovarian cancer.

“An even higher percentage of people were able to be detected from the pool of people with more advanced cancer."

A lot of researchers, including my surgeon, have been working to develop a blood test for cancer for a long time and they are increasingly encouraged. This, of course, would be wonderful for the same reason the Biliscreen app would be: earlier detection.

Here's my question about this one: All the test subjects had already been diagnosed with a certain cancer. If people not known to have cancer are tested, how would doctors know what kind of cancer the patient has?

Yes, I'm a skeptic. I've been disappointed too many times with “breakthrough” announcements and it seems to me that most advances in health care are rarely of the quantum leap variety and more of the small incremental steps variety.

But that doesn't mean I'm not hopeful.


Cutting Cancer Down to Size

At a Wednesday follow-up appointment, my surgeon lifted most of my diet restrictions, “as long as you don't go hog wild,” he said.

If I took that as a sign that this pancreatic cancer won't always be at the forefront of my mind – and I did - a phone conversation later the same day not only confirmed that idea but gave me the determination to make it so.

My friend, Joyce Wadler, had called to check on how I'm doing (fine, thank you). She is a long-term survivor of two separate breast cancers and of ovarian cancer and her advice before my surgery was crucial to making my recovery easier and smoother than it otherwise would have been.

Joyce is the person who told me to make a list of everything I do every day, note which ones would become difficult or impossible after surgery and figure out what I would do about them.

I would never have thought to do that on my own and I silently thanked her every day when I got home. The only important thing I missed was the cat food and water bowls which, as I showed you here, a clever neighbor figured out for me.

Joyce's first bout with cancer took place in about 1990, the others following some years later. On Wednesday when we spoke, I was curious to know, especially after three times, how much cancer still plays a part in her life.

I asked because, as you can undoubtedly tell from the number of blog posts I've written about it over the past two months, my cancer is the central circumstance of my life nowadays. But even with a long road of chemotherapy and god knows what else ahead of me, I'm already tiring of this concentrated, all-day focus every day.

I'm tired of reminding myself to take certain medications before, during or after meals. I'm tired of the work involved in keeping prescriptions up to date. I'm tired of forcing food when I'm not hungry because it is important to gain back the lost weight.

I'm also tired of arranging my schedule for at least one appointment – and sometimes more - with a doctor each week. And all that in addition to physical therapy exercises twice a day, a tai chi routine once a day and at least one half-hour walk per day.

Whew. They do keep you busy, these medical folks. But I am starting to become resentful that it takes so much time that used to be my own to do with as I pleased - and chemotherapy has yet to be plugged into the schedule.

So it was heartening that Joyce's answer to my question about how much her cancers play a part in her life today is “not much.” That's what I want too and I want it sooner rather than later.

Joyce's “not much” has spurred me on to work out how I can cut cancer down to size so it's not my entire life.

In my case, for as long as I live there will be cancer doctors - for chemo, for regularly-scheduled scans to check on the cancer's development up or down, for other checkups. But in between I would like to just live in every other way that doesn't involve personal cancer awareness.

Maybe I can think of the medical appointments as visits with old friends. I like the physicians and their nurses and other assistants a lot and I already look forward to seeing them – just the not the topic of conversation.

Or maybe I can fit those visits in like I schedule a hair cut – a chance for some interesting conversation with a friendly professional I trust that doesn't impinge on my life in between.

And, too, further recovery should improve my appetite and I'll gain more expertise in tracking those pesky medications, so all that should help loosen cancer's hold on my mind.

I clearly recall, with Joyce's first cancer diagnosis so many years ago, that she either started or increased her sessions at the gym. She had to be strong, she said then, to get through the coming treatment. She worked hard at it and my memory of her determination then along with her advice on prepping my home for post-surgery and now her “not much” are my inspiration to keep cancer from defining me.

Joyce has written two books about her cancer, My Breast and Cured, My Ovarian Cancer Story (Plucky Cancer Girl Strikes Back) which are available at the usual book sources around the web.

You can also read Joyce's newspaper column, “I Was Misinformed”, which appears regularly in The New York Times. Hint: Like me, she often writes about the joys - and not - of growing old but she is much funnier than I am.


Crabby Old Lady, Prescription Drugs and Insurance Companies

Rx

Having complained in these pages about my fuzzy brain with its lack of focus and concentration, it's only fair to let you know that over last weekend, it improved dramatically.

Or, maybe it has been improving a little at a time but was finally far enough along for me to notice only a few days ago. Either way, I'm glad to finally be more cognitively functional again.

I just read a book in three days, can now get through news articles I care to read and, as you might have noticed on Monday, can actually write something that involves a little research and more organization than I've been able to handle for the past few weeks.

Best of all, Crabby Old Lady has reappeared and she would like me to shut up now so she can get on with what she came here to say.

Crabby's attention and energy level have improved enough that she could probably drive her car again – at least for short distances - but she's not willing to try it quite yet. Over the past weeks of her recovery from surgery, she has relied on neighbors and friends to get her around but does not like to burden them any more than necessary.

With that in mind, Crabby arranged with Cathi Lutz to drive her to a doctor appointment this morning and on Monday, intending to combine what would otherwise be two trips, she telephoned her pharmacy to arrange to pick up a couple of medication refills – just a small detour on the way home – while Cathi would be driving.

Sorry, said the pharmacist. You cannot refill prescriptions until one day before you run out.

Listen, folks, this is not a controlled substance like, oh say, oxycodone. It's a drug that replaces enzymes Crabby's pancreas no longer produces. She will need to take it a minimum of three times a day for the rest of her life and without it, the pain resulting from eating is agony.

Secondly, people with life-threatening diseases, people recovering from surgery and people who rely on others to get them out and about cannot easily pop over to a pharmacy at the pharmacy's convenience.

The difficulty might be the availability of a friend to drive. Or, maybe it's being too sick or too fatigued or in too much pain on that particular day to be able to leave the house. Crabby knows all about those problems these days.

Crabby knew she was well on her way to being her old mental self when she told the pharmacist all this, making it abundantly clear at the same time that she was – well, miffed would be putting it mildly.

There was a long silence on the other end of the telephone connection and then: “There is nothing I can do about it.”

Unable to control her indignation – or, perhaps, relishing it – Crabby asked the pharmacist how it is not cruel to inflict this stupid rule on people many of whom may be at their most vulnerable. Or, what if Crabby were going out of town for a week or two and needed the medication to have while she was away?

Long silence at the other end of the phone again. Then: I can't help you. It's not a pharmacy rule; it's the insurance company.

Is that the dumbest rule you've ever heard – that the insurance company decides how soon a customer can refill the prescription? The company that may be hundreds or thousands of miles away?

Then it got weirder. The pharmacist told Crabby that the earliest she could refill the script was on Tuesday, the next day, but Crabby would need to phone again then to make the request. One day's difference.

To make matters worse, this pharmacy does not deliver. So, apparently, they are willing to let a customer go without what, in some cases, could be a life-saving drug because they allow an insurance company to dictate when they can dispense it.

As has been discussed in these pages before, being old is hard. Being old and sick is even harder and it is harder still when a person can't easily hop in the car or on a bus to get somewhere.

It may seem to be a small thing but Crabby Old Lady believes such a refill rule as this is of a piece with the kind of awful healthcare the Congressional Republicans and President Trump are trying to foist on Americans too young for Medicare.

The operating principal of the lawmakers and the insurance companies appears to be to make it as hard as possible for people of all ages to get the care they need - even simple things like prescription refills.


The Specialness of Caregivers

Pretty much everyone works for a living. Some enjoy their jobs, others don't and a few lucky people consider their work a calling, even a mission to which they are fully dedicated.

Undoubtedly the Oregon Health & Sciences University Hospital, where I stayed for a total of 12 days, isn't alone in the excellence of its patient care but it has been four decades since I last needed the services of a hospital so what do I know.

I'll tell you what I know now about OHSU: without exception, every person who helped me in all their various ways – and there were about two dozen of them – were smart, knowledgeable, experienced, friendly, compassionate and always made me feel that caring for me was the most important thing they were doing that day.

At a time when I was the most vulnerable I've ever been as an adult, every one of them made me feel safe. Safer than I have ever felt.

I'm not going to mention names because I will leave out too many and there is not one who doesn't deserve my thanks, respect and gratitude:

The surgeon and his team who told me the truth about my disease with kindness, understanding, hope and who held my hand when I wept.

Meal delivery man who told me not to order coffee from the menu but allow him to bring me the better-tasting coffee that was brewed on my floor. He did that every day.

Nurses and CNAs who somehow inspired me to walk more frequently and farther than I would have done on my own, and without my ever feeling coerced. They made it fun.

Those same RNs and CNAs who wiped my bottom when I couldn't do it myself and made me feel as okay about it as when they helped me in and out of bed.

The night nurses who somehow woke me for a pill without entirely waking me so I could sleep through the night.

My primary care physician who just dropped by one day for a personal visit.

Now that I'm home, there are my go-to nurse from the surgeon's team, the dietition and the medications nurse who are friendly, caring and patient with my phone calls, questions and worries.

I believe the people who choose these careers and professions are different from me and probably most other people. They are special in ways I do not know about.

It is one thing to care for a loved one, as I did with my mother during the last months of her life, and quite another to not only show, but feel the same commitment to the strangers who arrive sick and frightened every day at the hospital or other medical facility where you work.

All these helpers never once faltered in their kindness and concern. They were not pretending. It is as though they have a goodness gene I certainly don't have. This is who they are and I cannot think of them without becoming weepy with gratitude.

* * *

Remember about four weeks ago when Autumn was writing blog posts in the first days following my surgery? She titled one of them “A Room with a View” and this is why: my room overlooked a small portion of the huge OHSU campus on a hill.

OHSU


How Elders and Their Physicians Might Collaborate

patient-doctors-office

The U.S. geriatrician population has been hovering around 7,000 for several years without much change. At the same time, the elder population grows by about 10,000 a day. You see the problem.

One reason is that geriatrics is at the bottom of the pay scale for doctors and one reason for that is the time-consuming nature of the field wherein patients' needs are more complex than younger adults. As U.S. News reported in 2015:

”Unlike other physicians who might specialize in one organ system or disease, geriatricians must be adept at treating patients who sometimes are managing five to eight chronic conditions...

“Geriatricians also 'pay special attention' to a person’s cognitive and functional abilities, including walking, eating, dressing and other activities of daily living, McCormick says. 'Geriatricians take a holistic approach. We look at how we can help patients to be as functional as possible and exist in the community in the best way possible,' he says.

“For example, older adults may have a hearing or visual deficit that impacts their physical health and quality of life. Something as simple as eye glasses or hearing aids can make a world of difference.

“'We look for little things that can improve quality of life and surprisingly enough you can often make things quite a bit better,' McCormick says.”

Because there are far too few geriatricians to go around, most elders, like me, wind up with a family physician or internist for their primary care. These men and women do their best to help but they are hindered by time constraints and by the less than adequate education they receive in medical school about old people's health issues:

”Despite the diverse range of knowledge and skills required to appropriately care for older adults, the median time devoted to geriatric education in medicine in 2005 was still only 9.5 hours,” according to a 2012 report published in The Gerontologist.

“A survey of medical schools in the United States revealed that less than half (41%) of responding schools have a structured geriatrics curriculum and less than a quarter (23%) require a geriatric clerkship.”

(As you can see in the quotation, these statistics are dated which is due, according to the report, to “an absence of more contemporary information” - common in healthcare related to elders – we are too often not included in studies or, as in this case, the studies are not conducted frequently enough.)

Eighteen years ago, Dr. Edward Ratner, a geriatrician and associate professor in the University of Minnesota’s Department of Medicine in Minneapolis started a senior mentoring program that had medical students spend a series of afternoons with older people as their mentors.

That worked well enough but students were reporting a lot of loneliness and isolation among the elders. So, according to an article at Next Avenue, he changed the program:

”Students moved into the Augustana Apartments in downtown Minneapolis, where their mentors lived — some of them very independently, some with a few support services. Augustana residents got new neighbors and companionship.

“The building, run by the senior housing and services nonprofit Augustana Care, filled several apartments that were standing empty. Augustana’s social services director got volunteer help from students with recreational activities and other needs that residents had.

“And the students gained more learning time with elders, a place to live near the university and a discount on rent in exchange for their volunteer work.”

Dr. Ratner goes on to explain the problem with the limited amount of geriatric study in medical schools – which is so bleeding obvious once someone says it:

”The trouble with traditional medical education isn’t just that it gives students only episodic glimpses of older adults or that it leaves out all the context of seeing them in their homes and communities. It’s also that every older adult the students see is sick, Ratner says.

“'That’s a terribly negative stereotype because most elderly aren’t sick most of the time,' he explains. 'If students think that elderly are always sick and disheveled and confused — because that’s how they look when they see them — they won’t appreciate that [older adults] can be a lot better after treatment and they’ll discount the value of even trying.'”

I've been thinking about elder medical care all week as an appointment with my primary care physician, not a geriatrician, was scheduled for this morning.

We are to check up on the “mystery malady” that is still with me, though less so than a few months ago, and I want to discuss with him why I am not taking his recommendation for a certain, well-known drug to treat osteoporosis or, in my case, osteopenia.

My physician is young – there are reasons this is good. But he also has little experience with the medical issues of old people yet so since I first met him late last year, I have made myself a mentor to him.

I haven't told him this and I probably won't. But I speak with him differently than physicians I had when I was younger and in the past decade of my elderhood because I believe we share responsibility for my wellbeing.

I know a lot more about my body than all the tests he schedules can reveal and because of what I do (this blog), I read a great deal more about the health and medical needs of old people than he has time for.

So gently, carefully and as it pertains to what is on our schedule on any given visit or phone call, I share my knowledge, my life experience as an old person and sometimes what I have learned from you, TGB readers, over the years.

It's not a lecture or a lesson; I make sure it is a conversation – short, to the point and not to get in the way of the expertise he has that I need to know.

This doctor is a good guy, I like him. But given the medical school deficiencies in geriatrics and, as we have discussed here many times over many years, no one really knows what it's like to be old until they get here.

So maybe my little project will help my physician not just with me but with future elder patients.

Stethoscope


Modern-Day Phossy Jaw and Osteoporosis Drugs

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

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

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

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

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

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

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

Then, a century later, this:

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

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

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

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

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

Brand name bisphosphonates

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

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

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

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

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

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

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

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

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

Osteoporosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Osteoporosissymptoms

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

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

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

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

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

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

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

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

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

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

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

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


A Creepy Vampire Story About Anti-Ageing

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

* * *

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

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

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

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

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

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

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

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

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

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

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

The Washington Post also reported that Oracle founder Larry Ellison

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

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

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

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

Mice

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

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

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

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

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

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

Mouse rejuvenation

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

Ambrosia owner, Jesse Karmazin says that

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

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

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

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

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

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

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


Travel While Old (and Resistance Notes)

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

Greece2

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

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

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

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

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

Full-aircraft-xlarge

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

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

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

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

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

Bora-Bora

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

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

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

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

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

Crowded-terminal_Editorial

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

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

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

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

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

What do you think?

* * *

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

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

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

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

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

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


Hot Flashes and a Resistance Note

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

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

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

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

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

Hot-flashes1

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

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

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

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

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

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

Real_women_dont_have_hot_flashes_they_have_power_surges_sign

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

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

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

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

Maxinehot-flushes-sat

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

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

What's your experience?

* * *

RESISTANCE NOTES – OLIVER ON TRUMPCARE

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

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

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

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

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


Elders and the Republican Healthcare Plan

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

* * *

Healthcare introduction

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

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

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

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

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

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

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

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

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

  • annual wellness visits without a copay

  • free annual flu shot

  • the extension of Medicare solvency to the year 2029.

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

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

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

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

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

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

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

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

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

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

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

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

Let's give Nancy Altman that last word today:

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

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

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