522 posts categorized "Health"

Medicare Enrollment Period for 2019: Important Information

Okay, enough for now of this dying stuff of the past few days. Let's get on with the particulars of living – in today's case, Medicare.

On Monday this week, the annual Medicare open enrollment period began. It runs until 7 December which isn't very long if, like me, you procrastinate over such tedious work. But it's important so pay attention. I'll make this a easy and clear as possible.

Let's start with this (deceptively) simple overview of the process:

Here are the things you can do during this fall enrollment period:

If you now have traditional Medicare (Part A for hospital coverage; Part B for outpatient coverage), you can switch to an Advantage plan (Part C) if you wish

If you now have an Advantage plan, you can switch to traditional Medicare

If you dislike your current Advantage plan, you can switch to a different Advantage plan

If you have a Part D prescription drug plan, you can choose another or you can purchase one if you did not do so when you were first eligible

BACKGROUND INFORMATION
Remember, traditional Medicare (Parts A and B) is offered by the federal government. Advantage plans and Part D (prescription drug coverage) are commercial products although they must meet certain requirements of the government.

Here are the 2019 premium and deductible changes for traditional Medicare :

Ninety-nine percent of traditional Medicare beneficiaries pay no Part A (hospital) premium. The deductible, when you are admitted to a hospital, will be $1,364 for 2019, up from $1,340 this year.

The new Part B (outpatient) premium, deducted from your Social Security benefit each month, will be $135.50 in 2019, up from $134 this year. The deductible will increase to $185 from 2018's $183.

There is more detailed information on Part A and Part B premiums and deductibles here.

The grandmother of all Medicare information sources during fall enrollment is the Medicare and You 2019 book.

In the past, it was snail-mailed to every Medicare beneficiary in the U.S. Some people still get it that way. If you receive yours electronically or if you have misplaced it, you can download a copy online here. [pdf]

For Advantage plans (combined Parts A and B in one package with, most of the time, Part D), and for stand-alone Part D plans to go with traditional Medicare, there are differences from state to state. You can find information for each individual state here [pdf].

A NOTE ON SOME DIFFERENCES BETWEEN TRADITIONAL MEDICARE AND ADVANTAGE PLANS
Advantage plans sometimes have no monthly premiums and usually offer additional services such as coverage for vision, hearing and dental along with reduced gym membership fees and such which make them attractive.

However, each one also requires that you use their roster of physicians, hospitals and other service providers. Also, just this week, The New York Times reported on some Advantage plans that have been improperly denying claims.

Traditional Medicare leaves some gaps in coverage which beneficiaries fill in by purchasing supplemental (“Medigap”) and (Part D) policies but there are no plans with vision or dental or hearing coverage.

Generally, between the two Medicare possibilities, traditional Medicare delivers the widest choice of hospitals and doctors and with supplemental and prescription drug plans added in can result in much lower out-of-pocket costs particularly for people with serious health conditions.

That certainly is true for me over the past 16 months of heavy use and I'm now quite grateful I stayed with traditional Medicare. But needs, obviously, differ from person to person.

CHOOSING YOUR 2019 PLAN
Year after year, Medicare has been improving their Plan Finder pages - there can be more than two dozen plans depending on the state. You will find the beginning page here where you can follow it through the steps either for Plan D or Advantage plans or both.

I could take you through every step here, but as it turns out, Portland, Oregon's local newspaper, The Oregonian, has just published an easy-to-follow instruction video. Here it is.

(Note that the online pages may look somewhat different from those in the video, but the information is the same.)

Because this was produced in Oregon, the telephone help line number at the end of the video is for Oregon residents only. You can search for help where you live by Googling something similar to “choosing a part D plan in [state]”.

Or, you can telephone Medicare (1.800.MEDICARE) where a representative will help you through the entire process however long it takes.

Or, you can find personal help in your state through the nationwide State Health Insurance Assistance Program (SHIP) at this website. I've known several SHIP helpers and they are smart, well-trained and extremely knowledgeable people.

JUST DO IT
Okay. You have six weeks to get this done. With Part D, it is important to work your way through the minutiae of formularies, tiers, deductibles, etc. to find the best plan for you.

It's tedious, but doing it last year over two days in short bursts, I saved a lot of money on the Part D premium, deductible and copays. My drugs still cost me a small fortune and dumped me into the infamous donut hole for awhile this past year. But if I'd kept my previous policy the drugs would have cost a lot more.

THE DONUT HOLE

There are good changes to the Part D donut hole in 2019. It is complicated to explain and I've already carried on too long. There is a explanation at Kaiser Family Foundation.




Prescription Drug Prices Off the Charts

It's almost that time of year again, the annual open enrollment period for Medicare Part D (prescription drug coverage) that will take place from 15 October to 7 December 2018. We'll have a more detailed discussion of that here in a couple of weeks.

For now, you should know about the most recent annual report from the AARP Public Policy Institute titled (exhaustively), AARP Public Policy Institute Trends in Retail Prices of Brand Name Prescription Drugs Widely Used by Older Americans: 2017 Year-End Update.

It was released last week and it is not good news. According to the report, summarized at AARP,

The retail prices of some of the most popular prescription drugs older Americans take to treat everything from diabetes to high blood pressure to asthma increased by an average of 8.4 percent in 2017, far exceeding the 2.1 percent inflation rate for other consumer goods and services...

“The report shows that the annual average retail cost for just one popular brand-name drug among the 267 that AARP studied would have been nearly $6,800 in 2017.

“But had pharmaceutical price increases been limited to the country’s general inflation rate between 2006 and 2017, that cost would have been more than $4,600 lower. Retail prices increased in 2017 for 87 percent of the brand-name drugs studied.”

The report notes that the retail price of one widely used brand-name drug to treat fibromyalgia, Lyrica,

”...increased by 19.3 percent; the price of diabetes drug Januvia increased by 8.2 percent; and the price of Benicar, a widely used medicine for high blood pressure, increased by 17.8 percent.”

Here is a chart from page 12 of the report showing what the average price of the prescription drugs would be if increases had matched overall inflation:

PriceIncreasevInflation

The researchers have sliced and diced their price findings about a dozen different ways but the numbers come out all the same: jaw-dropping increases. Among the highlights (well, I suppose we ought to call them lowlights):

“Brand name drug prices increased four times faster than the 2017 general inflation rate”

“Retail prices in 2017 increased for 87 percent of the 267 brand name drugs studied”

“Retail prices for 113 chronic-use brand name drugs on the market since at least 2006 increased cumulatively over 12 years by an average of 214 percent compared with the cumulative general inflation rate of 25 percent between 2006 to 2017”

After a lifetime of good health requiring no more prescription drugs than an occasional antibiotic, I found out first hand this past year about the cost of drugs. It's frightening.

One of the giant problems with Medicare prescription drug plans is that none of us has any way to predict what drugs we may need in the coming year and the varying providers have different formularies.

Since I am not a fortune teller, until my cancer diagnosis in 2017, I had always chosen the cheapest coverage.

Then, during the Part D enrollment period for 2018 last year, I knew what drugs I would need to continue taking I made an informed choice of which policy would be best for me.

That worked well enough until, in May, I was prescribed an expensive drug not covered by my provider. Oof. That was tough.

Many Medicare beneficiaries who take more than one or two prescription drugs has his/her own story about that kind of sticker shock but we'll discuss that another day.

Among the study's concluding observations are these two strong charges:

”Current market forces do not adequately protect against excessive brand name drug prices and price increases, and the resulting growth in pharmaceutical expenditures is not sustainable.”
“Current pricing practices for brand name pharmaceuticals are a threat to the health and financial security of individual consumers and to taxpayer-funded programs like Medicare and Medicaid.

“Brand name prescription drugs can provide substantial health benefits including improved health outcomes; however, these benefits are only available to those who can afford to use them.”

You can read the full AARP report here. [pdf]




Annual National Falls Prevention Checkup

Saturday was the first day of fall and it was lovely, sunny and warm, here. How about where you live?

Also, in the United States, it was the tenth annual National Falls Prevention Day, sponsored by the National Council on Aging (NCOA) – always a good time to review one's habits and home for falling safety.

I write about fall prevention so frequently that you must know the U.S. statistics related to people 65 and older by now. The two most important are:

  • An elder is treated for a fall in an emergency room every 13 seconds
  • In 2016, 29,668 people in that age group died as the result of a fall

If that doesn't get your attention, in May, the Los Angeles Times, working with data from the Centers for Disease Control, reported an alarming increase in death from falls among elders:

”...falls ended the lives of 61.6 out of every 100,000 senior citizens [in 2016]. Back in 2007, there were 47 fall-related deaths for every 100,000 senior citizens. That means the mortality rate due to falls increased by 31% over the course of a decade...”

The Times attributes the increase to growing numbers of people living longer, and Kaiser Health News reports that one's 80th birthday is a warning sign of increased susceptibility to falling:

”Fear of falling — and the emotional and physical blowback from a fall — are part of turning 80.

“If you are in your 80s and living at home, the chance that you might fall in a given year grows more likely, said Kritchevsky...The study notes that the risk increases with age, making people in their 80s even more vulnerable.”

So this is a good time to do a home and personal inventory to reduce the possibility of falling. The biggest change I made this year is to give up ladders. I'm just not as sure-footed getting up and down on them, so time to stop.

This video, even with its brevity, covers almost everything you need to know about preventing falls.

This infographic from the NCOA covers similar ground:

Ncoa-falls-free-infographic-680pixels-2

And this 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 Falls in the Elderly

Mayo Clinic

WebMD

National Institute on Aging

Just this week, Apple announced the release of its Series 4 Apple Watch that includes a fall detection algorithm. (It is also a blood pressure and heart rate monitor). Here is a photo:

Apple-Watch-ECG-heart-handout-712

Reports MobiHealth News,

”Apple's addition of fall detection is likely to be overshadowed by the ECG news, but it's also an impressive achievement...

"When the Watch detects the fall, it will give the user an opportunity to call an emergency contact. But if it detects that the user is immobile for one minute after the fall, it will automatically reach out to authorities using Apple's emergency alert system. It also sends a message to emergency contacts in that situation.”

Of course I have no idea how well this works – just letting you know it exists, among many other kinds of wearable falls detection devices. You will find one comparison list here.

On the other hand, if you're thinking this is too much ado about only one kind of elder danger (it isn't, but go with me on this for a moment), there is always this solution to taking a fall:

Cantgetup

My apologies to the TGB reader who sent this cartoon – I forgot to make note of your name.




What About Medicare For All

As soon as someone says “Medicare for All” or “single-payer healthcare” or “universal coverage”, someone else will argue about definitions. And there are important differences.

But today, we are going with what most of us mean when we use one of those phrases: a system of health care under which everyone is covered, however it is paid for.

Most western democracies use some form of this system. As VeryWellHealth explains:

”...several countries have achieved universal coverage, with 100 percent of their population covered. This includes Australia, Canada, Finland, France, Germany, Hungary, Iceland, Ireland, Israel, the Netherlands, New Zealand, Norway, Portugal, the Slovak Republic, Slovenia, Sweden, Switzerland, and the United Kingdom.”

No one in these countries worries that a major illness will bankrupt them as happens in the United States.

Currently, in 2018, about 88 percent of Americans, according to Gallup, are covered to one degree or another depending on what they can afford from private insurers.

Among that number, however, there is one group of people in the U.S. who do enjoy universal, single-player health coverage. It's us old folks, 65 and older. It is of course, called Medicare and as it happens, over the past 15 months I've had a crash course in how it works in real life when something deadly serious comes along.

First, back up to 1965 when Medicare went into effect. I paid into the program from that time forward until I stopped working in 2004. Currently, the Medicare tax is divided between employer and employee, 1.45 percent each.

Many people believe that the Medicare tax covers it and that Medicare, once you are old enough to join, is free. Not so. Use me as an example (this is about traditional Medicare, not Medicare Advantage Plans which I'm not discussing today):

Part A - hospital insurance: free.

Part B – medical insurance: a premium, calculated on income, is deducted from the Social Security (or railroad, etc.) benefit each month. There is a deductible, $183 in 2018. Part B covers about 80 percent of Medicare-approved expenses.

Part D – prescription drugs: provided by Medicare-approved private insurance companies. Premiums vary dramatically.

Supplemental (Medigap) coverage: helps pay the 20 percent of medical costs Part B does not. Premiums currently range from about $74 to more than $400 per month.

In addition to all the personal fears and concerns I had when first diagnosed with pancreatic cancer last year, I was terrified at what the surgery and accompanying care would cost me, and if I could even afford it. I decided to deal with after I recovered from the surgery.

What I learned is amazing: Medicare is a whole lot like universal coverage in those other countries: So far, I have paid not a dime for medical treatment.

My biggest expense has been Part D, prescription drugs. Just this month, I finally climbed out of the so-called “donut hole” having paid $5,000 out-of-pocket for drugs this year. I am now in what the program calls “catastrophic coverage” where I pay a small fee for each prescription until next year when the process begins again.

Until I was thinking about this blog post, I had never added up what I pay per year for Medicare coverage. I was surprised to find that the premiums for Part B, Part D and supplemental come to just over $4500 per year.

That sounds like a lot until you know that my treatment costs are, so far, close to $1 million.

Most of the objections to Medicare for All are about cost. I have seen estimates of between $2.4 trillion to $2.8 trillion per year. Who knows if that is anywhere near what the reality would be.

For decades, in certain quarters of the population, a few politicians talked about Medicare for All. Recently, during the 2016 presidential campaign, it was presidential candidate, Bernie Sanders, calling for Medicare for All. The idea began to spread and catch on.

In April this year, Paul Waldman wrote in the Washington Post:

”Right now Democrats are coalescing around a new model for health-care reform. This November’s election could validate it in a way that practically settles the issue among Democrats. That will then determine the discussion in 2020, and in 2021 it could become the basis for a hugely ambitious overhaul of the system.

“Right now we could be witnessing the genesis of one of the most important domestic policy changes in our history.”

Also in April, Democratic Senators Jeff Merkley of Oregon and Senator Christopher Murphy of Connecticut introduced S.2708, the Choose Medicare Act, that would open up Medicare to anyone who wants it and isn’t already eligible for Medicare or Medicaid.

It is such a good idea to just expand Medicare to everyone rather than start of scratch on a new program. The main infrastructure is already in place, it works well, and could be built upon for the entire population.

Of course, the Choose Medicare Act has gone nowhere due to the Republican control of Congress but if there turns out to be a blue wave in the November mid-term election, that bill – or some others with similar intentions - could come to the floor of Congress.

It won't happen that easily or that quickly, but it would be a fine start to the conversation and eventual reality.

Those countries that have had universal coverage for decades pay a lot more in taxes than we Americans do but I sure wouldn't care if everyone could be as free of economic worry as I have been granted, thanks to Medicare, during the wildly expensive treatment I've received.

Most of all, it is the right thing to do. Health care is a human right and the United States, that so glibly repeats that all men are created equal, that the rights of all persons are diminished when the rights of one are threatened, etc. etc., cannot possibly claim those principles if some cannot afford health care.

The United States desperately need this policy change. If you put more than a minute's thought to it, how can we do differently. Are people without coverage or inadequate coverage just allowed to die in the U.S.? I can't find the answer to that question – or maybe it would be too painful to know.

You might want to think about all this as you consider who to vote for in November.




Is This the Beginning of Dementia? Plus The Alex and Ronni Show

Most old people I know ask themselves that headline question from time to time. It usually follows such instances as these:

In the middle of a sentence, you forget the name of the movie or book or author you're talking about.

Sometimes it's the name of an everyday item you forget. Not long ago, I perfectly well knew I wanted the word, “scissors,” but it wouldn't come to mind. I resorted to “that thing you cut paper with.”

Now and then I forget what I did yesterday. It happens often enough that I've begun joking that as far as I can tell nowadays, I go to bed on Sunday night and wake up Saturday morning.

These common incidents of forgetfulness are unlikely to be signs of serious disease. According to the U.S. National Institute on Aging (NIA),

”Forgetfulness can be a normal part of aging. As people get older, changes occur in all parts of the body, including the brain. As a result, some people may notice that it takes longer to learn new things, they don't remember information as well as they did, or they lose things like their glasses. These usually are signs of mild forgetfulness, not serious memory problems, like Alzheimer's disease.”

Here's a handy chart from the NIA on the differences between normal forgetfulness and Alzheimer's disease:

ForgetfulnessVAlzheimers

According to the NIA, there are both biological and psychological causes of non-dementia and non-Alzheimer's forgetfulness:

Tumors, blood clots, or infections in the brain
Some thyroid, kidney, or liver disorders
Drinking too much alcohol
Head injury, such as a concussion from a fall or accident
Medication side effects
Not eating enough healthy foods, or too few vitamins and minerals

”Emotional problems, such as stress, anxiety, or depression, can make a person more forgetful and can be mistaken for dementia. For instance, someone who has recently retired or who is coping with the death of a spouse, relative, or friend may feel sad, lonely, worried, or bored. Trying to deal with these life changes leaves some people feeling confused or forgetful.

“The confusion and forgetfulness caused by emotions usually are temporary and go away when the feelings fade.

The Mayo Clinic website has an easy-to-use report about dementia-or-not-dementia on a page titled, Memory Loss: When to Seek Help. Here is an encouraging list of possible causes of memory loss that are reversible:

Medications
Minor head trauma or injury
Emotional disorders. Stress, anxiety or depression
Alcoholism. Chronic alcoholism can seriously impair mental abilities
Vitamin B-12 deficiency
Hypothyroidism
Brain diseases. A tumor or infection in the brain

Not to mention plain-old old age which, if not reversible, does not disrupt one's life much. The Mayo Clinic discusses a condition known as mild cognitive impairment thusly:

”This involves a notable decline in at least one area of thinking skills, such as memory, that's greater than the changes of aging and less than those of dementia. Having mild cognitive impairment doesn't prevent you from performing everyday tasks and being socially engaged.

“Researchers and physicians are still learning about mild cognitive impairment. For many people, the condition eventually progresses to dementia due to Alzheimer's disease or another disorder causing dementia.

“Other people's memory loss doesn't progress much, and they don't develop the spectrum of symptoms associated with dementia.

As the Mayo piece notes, professionals “are still learning” not only about cognitive impairment but how the brain works in general so what is thought to be true today may not be tomorrow.

And what else I found out in researching this post is that just about everyone from health and medical reporters to doctors and researchers have a bias. They interpret the same information on a scale that runs from “don't worry about, it's normal” to “oh my god, see your doctor immediately.”

Okay, I'm overstating for effect, but as far as I can find it works that way a lot of the time.

That notwithstanding, personally I am relying on the conclusion of the bevy of physicians from five disciplines (!) who worked together on the solution to my internal bleed problem last spring.

When all of them showed up together in my hospital room late one afternoon, each trailed by two or three of his or her medical students, I asked for a clarification of a point because, I told them (and it's true), I get really stupid every day after about 3PM.

Each immediately replied with some version of “Oh, please, Ronni, you're sharp as a tack, you've got nothing to worry about.” I have decided to believe that until something untoward happens.

I've carefully monitored my mind for decades. I know the kinds of mistakes I make regularly and I know the ones – mostly memory – that have increased as the years pile up. Knowing these things helps keep them at bay or allows me to compensate for them to a degree I couldn't do otherwise.

For example, I can't recall even a list of just three items I want at the grocery store so I never rely on memory. I always make a list and these days I can do it on my phone via Alexa, adding items between shopping trips as they occur to me or I notice I'm out of olive oil.

I must have been in my 20s when I started making daily to-do lists at the end of the day. I never shut my computer without having made my tomorrow list.

Obligations to others such as in-person appointments but also via internet or telephone are always in red pen. I use yellow highlighter for things that have a close deadline or that I could but should not let go to another day. Most of the rest are reminders.

If there is something I absolutely must take with me when I leave the house, I put in front of the door where I will trip over it if I don't pick it up. I've learned that a sticky note on the door doesn't work, especially if it's been there for more than a day when it becomes just part of the woodwork.

A great help is that I have come to see my memory lapses as funny – at least when they are not annoying. I wrote this to give you a little information on the dementia/not dementia question but I also wonder how this stuff affects you and what you do about it.


* * *

Here is the latest episode of The Alex and Ronni Show recorded yesterday. If you would like to see Alex's entire two-hour show with other guests following our chat, you can do that at Facebook or Gabnet on Facebook or on YouTube.




Living in the Medicare Part D Donut Hole

Now and again I am reminded of how many TGB readers live in countries other than the United States so let me first supply a short definition of the evil donut hole.

Part D is a supplement to standard Medicare health coverage which itself does not provide prescription drug coverage. Part D is a voluntary purchase for which consumers pay an extra premium but the cost doesn't stop there.

Without going into arcane details, in general, when the consumer's total out-of-pocket payments for drugs reach $3,750 in a calendar year, the “donut hole” kicks in during which the consumer pays a higher percentage for the drugs until his/her out-of-pocket cost hits $5,000.

After that milestone, the insurer pays all but five percent of the drug costs until the accounting starts over again from scratch in January of the following year.

Until I was diagnosed with cancer last year, the only prescription drugs I had taken were antibiotics now and then, the price of which was paid for by my health insurance so I had no idea how expensive many drugs can be.

I sure do now, having entered the donut hole about two months ago and from which I will emerge, if my calculations hold up, fairly soon.

Quick story: At the beginning of my chemotherapy treatment last fall, I was handed my first month's supply of the oral drug along with a piece of paper with a figure of $5,000.

At first I felt the blood drain from my head and then I laughed. “You're kidding?” I said to the pharmacist. “I'll have to skip this treatment and hope for the best.”

As often happened during my year-long cancer ordeal, I got lucky. “Oh, I'm sorry,” the pharmacist said. “I didn't mean to scare you. That's the actual price the computer spit out but you don't pay anything.” (Long story, not worth the effort here today.)

The chemotherapy finished in January but the price of the four prescription drugs I take now are, if nothing like that oral chemo treatment, scary enough while I've been in the donut hole - they've busted my small budget all to hell.

That's the thing about money, it's relative. If you've got enough, all good. If not, you could die.

Here's the story I really came here to tell you today.

Three or four weeks ago, I was next in line at the pharmacy to pick up a prescription and although I was behind the separator that gives customers privacy while talking with the pharmacist, I could clearly hear most of the conversation at the window.

The customer, older than I by a decade I guessed, did not have enough money to pay for her prescriptions. I overheard the phrase, “donut hole.”

There are some programs that can help certain low-income patients with payment but apparently none were available in this case and the two women – one a young-ish professional, the other knocking on frailty's door – were at an impasse, neither knowing what to do or say next.

Something came over me and without thinking it through, I marched up to the window, gave the pharmacist my credit card and said, “Use this.”

There were some “oh no, I couldn'ts” and “please don't mention its” between the older woman and me but we sorted it out and I was relieved to see – having realized by then what I might have gotten myself into - that at a couple of hundred dollars and change, it was nowhere near that oral chemo price.

This story is not to tell you how wonderful I am. There are plenty of people in the world who will tell you otherwise and they are not wrong. Not to mention the voice in my head that day yelling, “What are you doing, screwing up your budget that's already a mess from the price of your own drugs?”

But nowhere near as much a mess as that old woman's. Here's the real problem:

No one should go without health care of any kind – treatment or drugs – because they don't have enough money. No one.

Some small help for prescriptions drugs is due soon thanks to former President Obama's Affordable Care Act which included a provision, when it was enacted in 2010, to gradually close the donut hole by year 2020, now changed to 2019, although some healthcare experts suggest the insurance companies will increase premiums and/or deductibles when it happens.

That prediction is of a mindset with the many politicians who want to cut Medicare, Medicaid, and Social Security too. President Trump campaigned on a promise not to do that but if we didn't know before, we surely do now that you can't count on anything Trump says.

It would be a good thing for all Americans, as we make decisions about which candidates to vote for in the midterm election in November, to think about increasing moves toward universal healthcare or Medicare-for-all that are stirring in some enlightened political circles.

Would it be difficult to do? Yes. Would it take a long time to happen? Yes. Would it be expensive? Yes. Would our taxes go up? Yes. But the time has come, it is the right thing to do and we have a lot of examples to study and learn from: just about every western democracy already has such a system.

Excuse me now while I go worry about what will happen with that old woman next time she needs to fill her prescriptions and is still in the donut hole.




Live Alone? What's Your Help Plan?

EDITORIAL NOTE: Well, that was a landslide on Wednesday. Just about everyone voted yes for adding a storytelling component to Time Goes By and so it shall be.

Give me some time to sort out the logistics and get the back end arranged and then I will formally announce it. What a whole lot of enthusiasm you have for this. I'm looking forward to it..

* * *

Not too long ago, TimeGoesBy reader, PiedType, whose blog title is the same as her signature, suggested a story topic:

”How 'bout a post asking those who live alone how they plan to call for help if necessary?” she asked. “Smart watch, home assistant device like Alexa, pendant monitored by paid third party, cell phone or regular phone, regular calls or visits from someone, security cameras, etc. So many options, none of them perfect. I'm curious what others are doing.”

It's a good idea for us to discuss this but let me say up front that if Alexa is indicative of how well such types of assistant devices work in general, don't rely on them for help in an emergency. Too often, my Alexa answers a request with, “I'm sorry, I don't have that information.” Plus, I don't believe Alexa and its competitors are intended – at least, not yet – for such use and although most can be programmed to dial a landline or mobile phone, they cannot yet dial 911.

PiedType also mentions monitoring cameras, often called granny cams. That is a fraught topic all by itself. Too many articles and providers pay only lip service to privacy questions. One such report assures the adult child that

”...with the right technology, you can check on her every few minutes or see where she is moving or if she stops moving.”

Let's save granny cams for another day. PiedType's question is what are we who live alone each doing to call for help should it be necessary.

A review of the online literature about help services mostly turns up dire warnings about how risky it is for old people to live alone. They don't state that explicitly, they just list all the awful things that will happen: medication overdoses, depression, anxiety, malnutrition, falls, social isolation, forgetting to pay bills and more.

The suggested remedy is to move into assisted living or with family. (I don't want to get wound up on a side-topic today, but it infuriates me when the first assumption about old people is that we are dysfunctional or incompetent.)

ELECTRONIC ALERT DEVICES
Most commonly, people use medical alert systems, wearable devices that with one touch can call, via a base unit in the home, the dispatcher who then summons emergency services or a designated friend or family member.

Not so long ago, they worked only via landline but nowadays you can choose home-based service and/or cell-based with GPS technology for when you are away from home. There are more features for additional fees and an important one might be an automatic detector that can sense falls and call the service without you pressing the call button.

The companies that provide this service are many. The best overview I found is from Consumer Reports. In an article from April this year, they tested nine systems and report, including photographs, on available features, price, types of systems, languages, battery life and contact information.

It's trustworthy information but it is always important to do your own due diligence too, check thoroughly and talk with people who use the devices.

MY SAFETY SYSTEM
For the past few years I've had a daily email check-in system with a friend. We each email the other every morning and evening, and we have one another's personal contact names, telephone numbers, etc.

Our deadline is 10AM and if there is no email by then, we contact the designated persons. It's not a perfect system. Undoubtedly you already have worked out that if something happens at – oh, say 8PM, after the evening email is sent, and you can't reach the phone, you're stuck until 10AM the next morning when your buddy hasn't heard from you.

Nevertheless, it works for the two of us for now but I suppose it depends on one's physical capabilities and, importantly, one's tolerance for taking chances. In my case, I know I can't cover every contingency in an imperfect world and I'm going with this until I change my mind.

In addition, I am working at remembering to take my cellphone into the bedroom at night. I can't tell you why that is so difficult for me but it is.

So that's one safety aid – setting up a system with a friend.

A COUPLE OF OTHER THOUGHTS
Not all by any means, but some senior centers have a daily check-in system members can sign up for. It is often free and works a lot like my personal system – they call whomever you have designated if you don't check in by whatever deadline is mutually agreed upon.

I have heard of one Village (see Village to Village Network for more information on Villages in general) that provides such a service and others may also. There are more than 200 active Villages in the United States (others around the world).

According to the U.S. Census there were in 2015, about 48 million people age 65 and older in the 50 states. Of those, the Administration on Aging tells us, about one-third (15 million or so) live alone in the community but I think that certain elders who do not live alone – especially caregivers whose spouse or other family member is incapacitated - could use these ideas too.

Now it's your turn. Do you use any commercial or personal alert systems? Do you have other ideas to share with us? Let us know in the comments below.




Affordable Help for Some Kinds of Hearing Loss

Remember last week when I wrote a blog post about how so much non-life-threatening health or medical stuff that can go wrong in old age is located above the neck?

Even so, in the United States, Medicare excludes coverage of almost everything above the neck.

We personally foot the bill for medical needs related to our eyes, ears and teeth except, in many cases, when they involve surgery. Correction for cataracts is one example as are cochlear implants.

But in general, we are on the hook for what is, usually, thousands of dollars and even tens of thousands of dollars as was the case with my teeth several years ago.

Another pricey, above-the-neck treatment is hearing aids. One-third of Americans age 65-75 have some degree of hearing loss. That goes up to nearly 50 percent in people older than 75.

In addition, only about 20 percent of people who could benefit use hearing aids. Some may reject them because of the social stigma attached but undoubtedly, for many, it is due to the price which can easily top $4,000 for both ears and experts estimate their life span is from only three to seven years.

Now, there is an affordable alternative ($10 to $500 or so) for some with certain kinds of hearing loss.

Last year, in a full-on, bipartisan voice vote in the Senate and 94-to-1 vote in the House, the U.S. Congress passed H.R. 2430: FDA Reauthorization Act of 2017. The president signed it into law on 18 August 2017.

The bill is an amalgam of several other stand-alone health care bills including the notable provision we are concerned with today. H.R. 2430, as govTrack reports, “Allows certain types of hearing aids to be sold over the counter.”

Leading up to the vote, there was strong opposition from organizations representing hearing aid professionals, and even gun rights groups which, according to GovTrack, “claimed the provision could allow the FDA to regulate sound amplification devices often used by hunters.” (Not true, says GovTrack.)

Let me be clear: whatever Govtrack says, the devices at issue are not hearing aids or, at least, are not called that. They are called Personal Sound Amplification Products, or PSAPs for short. They are what the name says, sound amplification devices that are one-size-fits-all, cannot be adjusted to individual hearing loss and should not be considered a replacement for hearing aids.

It saves me a lot of effort when I can piggyback on other people's work and in hunting around the web, I found that the most useful, basic information on PSAP devices came from Consumer Reports.

Earlier this year, they reported on a small study of PSAPs published the Journal of the American Medical Association in which:

”...researchers pitted five different PSAPs against a traditional hearing aid. They found that among 42 older adults with mild to moderate hearing loss, three of the five PSAPs performed nearly as well as the hearing aid.

“Some PSAPS may help with mild to moderate hearing challenges (such as difficulty hearing the TV or a conversation in a noisy bar), experts say, but won’t work for more severe hearing loss.”

As noted above, there are cheap PSAPs and more expensive ones. Consumer Reports breaks down what to expect from differently priced PSAPS they tested in their labs:

”The two cheaper models we tested, the Bell & Howell Silver Sonic XL, $20, and the MSA 30X, $30, offer basic functions, such as on/off switches and volume control.

“Pricier models, such as the SoundWorld Solutions CS50+, $350, allow you to customize settings to amplify sounds in the frequencies where you need the most help or stream music or take phone calls through your smartphone via Bluetooth.

“These pricier PSAPs might also have such features as a directional microphone, which can pick up sounds in front of you and not those behind or to the side of you. This makes it easier to hear conversations in a crowded restaurant or other noisy places.

In their report on PSAPs, Consumer Reports is careful to issue this warning:

"Additionally, our hearing expert says these low-end devices might overamplify loud noises, such as a fire engine wail, which could potentially damage hearing further.”

The magazine also says that PSAPs are generally simple and straightforward to use but as with Ikea, there is some work getting started:

”You have to learn how to insert and remove the device from the ear, adjust the settings to maximize its performance, change the battery, and clean and maintain it...

“Certain parts could also be small and hard to manipulate, and some higher-end PSAPs may require you to download an app for making adjustments.”

In the end, Consumer Reports suggests you consider what is most important to you in using a PSAP:

”If you simply want a little amplification while watching TV, for example, you may do well with a moderately priced device. But if you’re looking for help in a range of situations - dining out with friends, taking phone calls, listening to music - you might consider a pricier, full-featured version.

“For now, however, CR advises that you avoid very inexpensive models, such as those under $50.”

Unless one's hearing loss is complex enough to need an audiologist, I think this is a great idea. There was a time, not so long ago, when reading glasses required a prescription from an optometrist or ophthalmologist and were quite pricey. Now we can pick them up with the toothpaste and vitamins.

As several readers noted in last week's post, untreated hearing loss can be a serious health hazard. It can lead to social isolation, loneliness, reduced personal safety, impaired memory and more.

PSAPs are not an ideal solution (yet; they will undoubtedly get better over time) and they are not for every kind of hearing loss. But for many it can improve lives at an affordable price.

Be sure to do your homework before purchasing a PSAP and, perhaps, consult an audiologist, too.

Below are a few additional links for more information. Do keep in mind as you check into PSAPs that the professional hearing loss community quite understandably does not usually recommend them. I'm pretty sure the professional eyecare community wasn't too hot about drugstore readers either when they first appeared. But do consider the source when you read recommendations.

If you have used or are using a PSAP, please let us know in the comments how they are working for you.

Over-the_Counter Hearing Aids

Best PSAP Hearing Devices

Under new law, over-the-counter hearing aids could be cheaper and more widely used




Anorexia of Ageing: How Growing Old Affects Appetite

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What's your experience with anexoria of ageing?




Reducing Elder Pedestrian Fatalities And the Alex and Ronni Show

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

* * *

Here is latest episode of The Alex and Ronni Show.

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




The Danger of Extreme Heat on Elders

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

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

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

Death toll at 3 from Vermont heat wave

Southern California heat wave breaks records

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

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

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

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

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

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

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

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

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

Wear light-colored, loose clothing.

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

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

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

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

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

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

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

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

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

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

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

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

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

Don't fool around with heat stroke.

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




Caregiver Friends

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Talk about ironies...




How Brains Change in Old Age

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

Among the symptoms are

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

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

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

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

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

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

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

Learn new things
Create new memories
Improve vocabulary and language skills

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




Insomnia in Elders

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Keep a regular sleep schedule

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

Avoid naps during the day

Keep your sleep surroundings as dark as possible

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

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

A few experts suggest no reading in bed either

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

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

SECOND SLEEP

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

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

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

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

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

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

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

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

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

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

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




Are You Ageing "Normally"?

Depending on how you define the phrase, probably not.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

From another page at Alger's blog:

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

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

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

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

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

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

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

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

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




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

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

* * *

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

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

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

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

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

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

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

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

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

TrumpAzarScreenGrab

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And you wonder why your drugs cost so much.

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

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

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

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




Brain News for Elders, Ageist Headline and Net Neutrality

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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




The Losses of Age

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

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

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

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

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

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

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

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

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

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

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

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

And from David Newman:

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

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

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

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

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

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

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

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

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

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

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

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

But we'll save that for another day.

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




Missing Here on Wednesday

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

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

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

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




Four Days in the Hospital

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

Here is what happened.

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

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

Oh goody.

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

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

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

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

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

But not for me. Too bad.

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

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

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

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

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

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

I cannot get enough of hearing words like these.

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

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

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

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

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

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