561 posts categorized "Health"

Falls Prevention – March 2020

Long-time readers of TGB probably yawn when they see this headline about falls prevention. I do it twice a year because falls are so serious for elders but at the same time, relatively easy to prevent. It's that time of year again so here goes. Please take a moment or two to refresh your knowledge.

The U.S. Centers for Disease Control and Prevention (CDC) tells us, via caring.com,

”...falls among older adults are extremely common with an estimated 2.5 million older adults treated for fall injuries in the U.S. every year.

“An estimated 25,000 of those fall injuries result in death. Justifiably so, our research showed that 8 out of 10 caregivers are worried about fall prevention for their loved ones.”

Now that many of us are stuck at home due to COVID-19, we can make good use of some of that time be sure our homes are, as much as possible, fall-proof.

I'll repeat some of my usual suggestions and ideas below but first, here is a new item - a reliable, well-researched, up-to-date guide to the best medical alert systems for 2020 from caring.com. As explained on the website,

”Medical alert systems allow seniors to retain their independence at home and in their communities, while minimizing the risk of further injury or death from falling [and] being unable to receive immediate help.

“While there are many quality, above-board companies in the home medical alert industry, there are also those that are overpriced, misleading or profiting from hidden fees.

“We’ve created this review to shed light on the top home medical alert options so that seniors and their loved ones can easily choose a reputable and affordable home medical alert company that works for them.”

Here are caring.com's top eight choices with reasons for their recommendation:

Medical Guardian – Best for Premium Features
MobileHelp – Best for Those Without a Landline
LifeFone – Best Standalone Mobile App
Life Alert – Best for Industry Experience and At Saving Lives
Bay Alarm Medical – Best for Low Monitoring Costs
Medical Care Alert – Best for EMT/EMD Certified Monitoring
QMedic – Best for Compliance and Activity Monitoring
BoomerAlert – Best For Advanced Fall Detection

It's not just a list at caring.com. They provide initial prices for each service and monthly cost for monitoring, how and why they chose each service, pros and cons of each service and more.

So if you or someone you know is considering a falls monitoring service (or should), certainly check out caring.com.

In last September's falls prevention story, several people mentioned the risk of falling that pets and small children can cause. I don't know a solution for people who have pets, but I have had a personal run-in with a kid running at top speed at the entrance to a hospital.

He nearly knocked over a man in wheelchair and almost crashed into me. But his mother did nothing to slow him down or stop him.

It's been about two years since that happened but when I'm in public, I am still warily watching for and nervous about free-range children especially since parents seem to take no heed of their kids' behavior in crowds. (I am well aware that I sound like a “get-off-my-lawn” old man, but I'm only reporting what is, in my experience.)

So, here is a general overview of the things you can do to help fall-proof your home.

There is an excellent website about fall prevention that I had not seen before last fall: Health in Aging.org. It is extraordinarily clear, concise and useful. Here are links to the main sections:

Basic Facts

Causes

Diagnosis and Tests

Care and Treatment

Lifestyle and Management

Unique to Older Adults

That is not the only good site on this subject - there is an abundance of information online about falls prevention. We should make good use of it because unlike cancer, dementia, COPD, heart disease and other conditions that affect so many elders, we can each have a direct effect on preventing falls.


ON MY MIND: An Anniversary and the Virus

The anniversary in the headline is that of this blog. It was born on this date 16 years ago. In that first post, I answered a reader's question about the difference between being 40 and 62.

If you check it out, fotolog mentioned in the story was an early social media website although I don't think the phrase, “social media” had yet been coined. Way back when, I posted photographs there. As the captions got longer and I had read about a then-new platform called a weblog, I started Time Goes By.

If anyone had asked back then, I would never have believed it would still be going 16 years later.

VIRUS
It was Friday morning last week that the full impact of the Corona virus finally hit me. Before then, I thought I could wash my hands a lot, leave home as infrequently as possible and when I must go out, wear nitrile gloves while keeping a distance from others. Inconvenient, but not difficult.

Then an email arrived suspending my twice-monthly current affairs discussion group until further notice. Shortly after that, a friend canceled our upcoming lunch date and I read a news story online that grocery shelves are being emptied and not always restocked.

My freezer suddenly looked chillingly empty.

So I got serious about thinking through how the virus will affect me and by extension, those I come into contact with.

PRESCRIPTION DRUGS
Here is an additional measure I have added to the list in Friday's post to help me try to avoid becoming infected.

On Saturday, I ordered a supply of four prescription drugs that are essential to my well-being. An unknown percentage of U.S. drugs and/or their ingredients are manufactured in China (and some other countries), much of which has been shut down for many weeks so I am concerned about a shortage.

Vox reported a week ago that due to the spread of the virus, manufacturing in China has been disrupted,

”...taking factories offline that are only now slowly ramping back up. That’s all increased fears of potential drug shortages in the United States.

“But how worried should we be? Experts say the answer largely depends on how long these disruptions continue in China and whether the outbreak becomes widespread in other countries critical to the drug supply chain, including India.

On the other hand, reports Vox, many drug companies have backups in place and the U.S. keeps a Strategic National Stockpile of some critical drugs and medical supplies.

I am not deeply worried (yet) but have ordered my drugs in an abundance of caution. Read the Vox story, which is excellently reported, to see what you think.

GROCERY SHOPPING AND CREDIT CARDS
I made Saturday grocery day and, suited up in my nitrile gloves, went early hoping to avoid crowds. The first issue was missing carts – none in the usual storage area so I tracked down one in the parking lot. What was that about? Did someone tweet that the carts cure the virus?

Traffic inside the store was light. Still, it was hard to keep six feet of distance between me and other people. Repeatedly, other shoppers sidled up near me – within a foot or two – perusing the shelves. I moved on and if the item was important to me, I checked back when the aisle was empty.

Frozen vegetables were entirely sold out, freezer cases empty except for the veggies everybody hates like lima beans. I grabbed the last bag of broccoli and cauliflower and another of green beans.

The meat counter was empty. Nothing. There were no cooked chickens either. Fresh produce was hit and miss. Three cucumbers remained on the shelf but no blackberries and only four containers of raspberries. I checked four cartons of eggs before I found one without broken eggs.

Checking out, I used my new rule for payment: credit card only. I like to pay cash for most daily purchases because a quick glance at my wallet lets me know whether I'm on budget for the week. But now it's a card so I don't need to touch money which, even without a virus floating free, is one of the dirtiest things we handle.

HAND SANITIZER
There has been a lot of confusion about whether hand sanitizer is helpful against the virus with many false claims that it is not. The Centers for Disease Control says that if the sanitizer is at least 60 percent alcohol, it can be useful against contracting or spreading the virus.

You can read more about hand sanitizers at FactCheck.org.

DEPENDING ON ONE ANOTHER

Few of us have any experience at this and in the U.S., confusion and negligence within the federal government make it clear that we do not have a trustworthy leader.

The governors of individual states and mayors of cities seem to be stepping up well, however. Even so, to a large degree we are each on our own.

Oddly, at a time when we must separate ourselves from one another to help ensure the health of everyone as much as possible, we need one another more than ever. To protect ourselves is to help protect everyone and for the foreseeable future, we each have a moral duty to live by the recommended precautions while holding one another in our hearts.

Let us know in the comments how your community is coping and what you are thinking about this unnerving cataclysm.


The COVID-19 Pandemic

This is a longer post than I would usually do but I also think that we should not stop talking about COVID-19 and keep reminding one another what we must do to stay healthy.

So, here are some of those reminders from me, a poem about our predicament and the latest episode of The Alex and Ronni Show which is also about the virus this time. I know, it's a lot. Choose what you want and leave the rest.

But let's do talk about this below in the comments.

It's a pandemic now, says the World Health Organization (WHO). That doesn't change anything - it just means that the virus has been formally declared to be a worldwide problem.

Whatever the president says, this Corona virus is not a small thing. It will not, as he told us on television, fade away next week. It is here for the long haul. No one knows when it ends.

Dr. Anthony Fauci, director of the U.S. National Institute for Allergy and Infectious Diseases, testified in Congress on Wednesday in stark terms: “Bottom line,” he said, “it’s going to get worse.”

GO WASH YOUR HANDS

Every person must do their part to try to keep the virus at bay. But particularly if you are old or your immune system is suppressed or you have an underlying condition such as heart disease, lung disease, kidney disease, cancer, diabetes or high blood pressure, you are at greater risk of dying from the virus than children and younger adults.

Because the U.S. government has so badly botched testing for the virus, all statistics are dubious but according to Fauci on Wednesday,

“The [seasonal] flu has a mortality rate of 0.1 percent. This [COVID-19] has a mortality rate of 10 times that. That’s the reason I want to emphasize we have to stay ahead of the game in preventing this.”

GO WASH YOUR HANDS

Here's another important thing Dr. Fauci has said: “Every infected person will, on average, infect two-to-three more people who each will infect two-to-three more people and so on.”

So you see how this goes and how quickly the number of infections multiplies.

Because I am 78 years old and have two serious conditions – cancer and lung disease – that make COVID-19 more dangerous to me than if I didn't have those conditions, I've gone full-tilt boogie on prevention.

Washing my hands constantly.
Close to succeeding at not touching my face.
Using hand sanitizer whenever, wherever it's available.
Not going to crowded places.
Not shaking hands.
Not hugging.
Keeping six feet away from other people, if possible.
Mostly staying home.

GO WASH YOUR HANDS

Doing all this is tricky. I am down to one travel-size bottle of hand sanitizer and can't find any (I trust) to buy online or off.

At the market one day this week, the sanitizer dispenser was empty so now I keep nitrile gloves in my car so I will have something between my hands and whatever I'm buying that an unknown number of people may have touched.

GO WASH YOUR HANDS

In his Oval Office speech Wednesday evening, Trump's big announcement was a ban on travel from a bunch of European countries. However, the U.K., where Trump owns three golf resorts, is exempt. There are other loopholes too.

But, really, what is the point of the travel ban even without loopholes and exceptions? The virus is already in the United States and most other countries with the number of infections growing daily from community transmission.

The most important thing the U.S. needs to do is test, test thousands of people as other countries do to give us an informed look at what we are up against. But Trump did not mention testing in his speech on Wednesday and the next morning, Vice President Mike Pence could not say how many tests have been done or what any results are.

I don't know about you, but I am now officially terrified.

GO WASH YOUR HANDS

Yesterday, both remaining Democratic presidential candidates, former Vice President Joe Biden and Senator Bernie Sanders, delivered addresses to the nation covering the policy proposals they would institute if they were president. Both behaved as a steady, normal leader would do facing such a pandemic.

My god I wish one of them were president.

It's hard to live without hugging or touching the people we love but we are stuck with that for the foreseeable future during which we will not be congregating at ball parks, theaters, museums and all the other places in the public square we like to go.

Daily life is dramatically changed now and, probably, for a long time to come.

What to me is obvious as we live through this virus is to help one another with all the care and love for one another we have within us.

TGB reader, Ann Burack-Weiss, who contributes to Reader Stories now and then, sent this yesterday from poet, Lynn Unger. It is titled, Pandemic.

What if you thought of it
as the Jews consider the Sabbath—
the most sacred of times?
Cease from travel.
Cease from buying and selling.
Give up, just for now,
on trying to make the world
different than it is.
Sing. Pray. Touch only those
to whom you commit your life.
Center down.

And when your body has become still,
reach out with your heart.
Know that we are connected
in ways that are terrifying and beautiful.
(You could hardly deny it now.)
Know that our lives
are in one another’s hands.
(Surely, that has come clear.)
Do not reach out your hands.
Reach out your heart.
Reach out your words.
Reach out all the tendrils
of compassion that move, invisibly,
where we cannot touch.

Promise this world your love-
for better or for worse,
in sickness and in health,
so long as we all shall live.

As Ann said to me in her email, I find this comforting.

Now, here is the latest installment of The Alex and Ronni Show – also about the Corona virus. (I keep asking if he can't find a better still shot for the static image; he says he can't. Oh well.)

GO WASH YOUR HANDS


Study: Single Dose of Psilocybin Eased Anxiety Four Years Later

In a follow up to their 2016 study, researchers at New York University Langone Health (NYU Langone) announced in January that

”...cancer patients who were given psilocybin reported reductions in anxiety, depression, hopelessness, demoralization, and death anxiety more than four years after receiving the [single] dose in combination with psychotherapy,” reports CNN.

"'Our findings strongly suggest that psilocybin therapy is a promising means of improving the emotional, psychological, and spiritual well-being of patients with life-threatening cancer,' said Dr. Stephen Ross, associate professor of psychiatry in the Department of Psychiatry at NYU Langone Health.”

Wow. It was considered a landmark finding when those participants reported continued relief from symptoms at just six months after their psilocybin sessions.

As many of you know, in December 2018, I spent a day on a psylocybin “trip” with a guide. The purpose was directly related to my terminal diagnosis of pancreatic cancer. You can read about that session here and here.

In recent years, multiple studies have found benefits of psilocybin (“magic mushrooms”) in treating not only people with terminal cancer but depression,

anxiety, PTSD and other psychological disturbances.

This follow-up study is the first to show long-term positive results.

”Fifteen of the original participants were then followed up 3.2 and 4.5 years later and showed sustained long-term improvements,” reports CNN, “with more than 70% of them further attributing 'positive life changes to the therapy experience, rating it among 'the most personally meaningful and spiritually significant experiences of their lives,' according to the study published Tuesday in the Journal of Psychopharmacology.”

To be clear, this is was a small study with 29 original participants in 2016, and 15 of them in the recent follow up.

No one knows how psilocybin works in the brain yet but evidence that it does work is growing.

"'These results may shed light on how the positive effects of a single dose of psilocybin persist for so long,' said Gabby Agin-Liebes, lead investigator and lead author of the long-term follow-up study, and co-author of the 2016 parent study.

"'The drug seems to facilitate a deep, meaningful experience that stays with a person and can fundamentally change his or her mindset and outlook.'"

It has been only 14 months since my psilocybin experience but so far it has worked that way for me. The black, paralyzing fear of dying is no longer with me although I have recently been feeling a profound sadness when I think about leaving our world. But I've had a good life so I think that's appropriate and it's not debilitating.

Psylocybin is illegal, a Schedule 1 controlled substance and researchers must get permission for their studies with it. But a growing number of top institutions are doing so including the University of California, Johns Hopkins and the home of this study, NYU Langone.

People in several states in the U.S. are working to get local measures for decriminalization of psilocybin or its use in medical settings on the ballot in November. My state, Oregon, is among them. The Oregon Psylocybin Society has worked to develop the 2020 Psilocybin Service Initiative:

“The intent of the 2020 Psilocybin Service Initiative of Oregon is to advance a breakthrough therapeutic model currently being perfected in research settings at top universities around the world,” states the Initiative.

“The service model involves a sequence of facilitated sessions, including assessment and preparation, psilocybin administration, and integration afterwards. We envision a community-based framework, where licensed providers, along with licensed producers of psilocybin mushrooms, blaze trails in Oregon in accordance with evolving practice standards.”

You will find more information at the PSI-2020 website.

Here is a video from PSI-2020 of testimonials from people who have undergone psilocybin therapy.


A Simple, Surprising Foot Pain Treatment

UPDATE: This blog post is not an endorsement. I'm just explaining a surprising result in my case. I have no idea or any way to know if it would be helpful for anyone else.

Do you know what this is? Or what it is for?

Therabrush2

Stick with me here and I'll tell you.

Until 2017, I spent 76 years being so healthy that I hardly noticed my body. The occasional cold, the even fewer influenzas over decades repeatedly confirmed my long-settled expectation that good health was just how I rolled in life.

I didn't even think my health was particularly remarkable. It just was. Until it wasn't anymore.

Until cancer and, subsequently, COPD too, I thought of medical treatment in terms of big, serious stuff – hospital, surgery, prescription drugs. It turns out (and maybe you already know this) that much more mundane, ordinary remedies do a lot of good.

In January, I told you about my first big surprise in this regard – pulmonary rehab. With simple exercises and breathing techniques, the nurses moved me within a few weeks from being incapable of walking between the bedroom and kitchen without stopping once and sometimes twice to catch my breath, to sailing along the hallway.

Okay, not sailing. But it's been a long time now since I even thought about my breathing in and around the house.

A second problem has been neuropathy pain in my feet – tingling on my soles but worse, huge pain in my heels, particularly when I wake in the morning or get up from a chair after sitting for more than 15 or 20 minutes.

I mean really bad pain. I'd been gritting my teeth while I walked around like a crab for a couple of minutes until the pain subsided a bit and I could almost function.

Two weeks ago I found myself with another rehab therapist who specializes in feet, only feet. In addition to some exercises, she handed me a therabrush, also called a therapressure brush. (See image above)

My new therapist showed me how to use the brush in a circular motion on my heels - while I tried not to laugh out loud. How could what looked like a small, oval shoe brush keep pain at bay, I wondered.

I was just as skeptical at home when I placed the therabrush on the table next to my bed, and tried it for the first time the next morning sitting on the side of my bed.

After a few rounds of pressure on one heel and the other as I moved the brush round and round, I put my feet on the floor and stood up. I took a tentative step. And then another. And another.

And there was no pain. Or, rather, so little that it didn't matter.

Once again, one of those physical therapy folks showed me who's boss. If I had only read about this and not been directed by a therapist, I would never have tried it. Now I use it every day.

Mostly, in the news and on medical television shows, we hear only about the heroic means of healthcare and saving lives. They don't show us what a new way to breathe or 30 minutes of morning exercises or a cute little brush can improve our lives. A whole lot.

It's a good thing for me that these wonderful professionals don't withhold their expertise from non-believers like me, and I am most grateful for that.

A short and shallow trip around the internet shows me that there are other uses for these brushes but you're on your own to track down those. (Just search “therapy brush”.)


Where Do You Want to Die?

Surely you remember movies from childhood and maybe a bit later showing the patriarch of the story dying in his bed as family members hover around?

I sure do. It was such a common scene back then that images of several different ones are stored in my head still, although I can't name the films.

For eons, dying at home was the norm. And then, beginning in the early 1900s, it wasn't anymore.

Now, for the first time since then, more people in the U.S. are dying at home than in hospitals and nursing homes. As CNN reported in December:

”The researchers looked at the number of natural deaths in the United States based on data collected by the US Centers for Disease Control and Prevention and the National Center for Health Statistics.

“They define natural deaths as when a medical condition leads directly to death, meaning people died from heart problems or cancer, among other diseases, rather than dying in a car accident, for example. The authors looked at data from 2003 to 2017.

“They found that hospital deaths are still common, but that number is declining. There were 905,874 hospital deaths in 2003, 39.7% of deaths. And by 2017 there were 764,424 hospital deaths, 29.8% of deaths.”

As veteran science and medicine journalist, Gina Kolata, reported in The New York Times,

”In Boston in 1912, about two-thirds of residents died at home, [Dr. Haider J. Warraich, a cardiologist at the Veterans Affairs Boston Healthcare System and a co-author of the new research] said. By the 1950s, the majority of Americans died in hospitals, and by the 1970s, at least two-thirds did.

“Americans have long said that they prefer to die at home, not in an institutional setting. Many are horrified by the prospect of expiring under fluorescent lights, hooked to ventilators, feeding tubes and other devices that only prolong the inevitable.”

But it is not always easy to die at home. Dr. Warraich, writing recently in the Washington Post, notes how difficult it can be for both family caregivers and the dying person.

”...as more people die at home, it also means that much more responsibility falls on the shoulders of patients and their caregivers. Caregiver burden is a growing problem in America. As a doctor tending patients with heart failure, I am keenly aware of how hard managing care can be for both patients and family members.”

He says, too, that many people feel strongly about where at home they want to die, and there are other practical and personal considerations:

“Nearness to a bathroom is key. Sometimes, light remodeling, such as installing handrails in bathrooms or ramps, is helpful.

“A person at the end of life will probably have feelings about who they want to spend time with — or who they don’t want — so it is important to discuss in advance who will provide caregiving, along with who might provide occasional backup for regular caregivers.”

According to the study, there has also been an increase in the number of people who die in hospice facilities.

”In hospice,” explains CNN, “an interdisciplinary team of professionals that specialize in end-of life-care address the whole person. They work to help manage pain and the person's physical needs, as well as their mental and spiritual distress. Hospice also helps the family and coordinates care.”

Medicare (and other insurance) covers hospice care which often takes place at home. Last year, an internet friend had been under home hospice care but was grateful in the last few days of her life to move to a hospice house where she could receive additional care allowing her the time to let go.

A home hospice worker can't do everything the patient and family need and there are other options. Kelly Sanders, who is an RN and end-of-life doula in Michigan, told Healthline,

“'Hospice does a great job taking care of the medical aspect of dying, but due to the changing nature of healthcare compensation, little time was left for the other aspects of dying that are just as important for a peaceful passing,' she said. 'End-of-life doula services fit that need.'

“She said there is a big misconception that hospice provides the same services as a death doula.

“...a death doula can fill a gap in care. People can work with a death doula before they reach a point where they qualify for hospice. And an end-of-life doula is able to devote themselves to a single person, going in without an agenda to fulfill that person’s needs.”

When I started pulling this story together, I intended to give you these new statistics about where people die, and let you know how people – medical professionals, families, those who are dying – deal with the choices. But there's a lot more to it than I had considered for one short blog post.

So. Let's stop here for now and over the next while I will post additional information about such issues as advance directives, hospice at home and at a facility, doulas, etc. that we can discuss individually.

Today, I'm curious about how much thought you have given to where and how you want to die. Do you think it is morbid to talk about? (Most old people don't.) Have you talked with your family about end-of-life issues? And so on.

(I urge you to follow the links within the story above. They have a great deal more good information.)


Concentration and Focus in Old Age

It usually goes something like this:

There is a whole bunch of stuff piled on a chair in the living room. It's been there too long and it is high time I sort it out to make the chair available again.

There are three or four cloth bags that should be in the car for shopping. That book I've been searching for over the previous week too. A bottle of hand sanitizer. A Theraband that belongs in a box across the room. A teeshirt that has no reason to be in the chair. A whole lot of loose pieces of paper with notes on them...

There's more, but you get the idea. I decide to walk the teeshirt to the laundry room (I can't remember if it was clean when I dropped it in the chair – hell, I don't even recall leaving it in the chair).

The washer is half full but, I figure, if I add what's in the laundry basket, I could get a good-sized wash done and be ahead of the game. I head for the bedroom.

The closet door, behind which is the laundry basket, squeaks – as it always does – so I check the cupboard to see if there is a can of WD40. Nope. Maybe it's in the storage room – I head in that direction.

On the way, as I pass the desk, it pops into my mind to check email – it will take only a couple of minutes - which is where I find myself a hour later at lunch time. That chair is still piled with stuff.

All too often these days, that is how it goes for me.

Relatedly, just a week ago we were talking about how greedy old age is, stealing our time in so many little ways – concentration among them - that I've been checking out what science knows about concentration in old age.

We are not imagining this phenomenon. From Harvard Health:

”...scientists now see the brain as continuously changing and developing across the entire life span. There is no period in life when the brain and its functions just hold steady. Some cognitive functions become weaker with age, while others actually improve.

“Some brain areas, including the hippocampus, shrink in size. The myelin sheath that surrounds and protects nerve fibers wears down, which can slow the speed of communication between neurons.

“Some of the receptors on the surface of neurons that enable them to communicate with one another may not function as well as they once did. These changes can affect your ability to encode new information into your memory and retrieve information that's already in storage.

There have been a few studies targeting distraction itself rather than the brain in general. Psychology Today reported on a study showing that compared to young adults, old people have decreased brain activity in areas that enable concentration.

Other studies reveal that old people tend to have difficulty ignoring distractions and irrelevant stimuli that younger people easily tune out.

There are easy ways to improve concentration most of which we could figure out for ourselves (if we could just focus):

Do not multitask
Try meditating
Exercise regularly
Try caffeine (don't overdo)
Take breaks
Turn off distracting sounds
Get a good night's sleep

One report tells us that about half of the older adults do not have this problem, and Harvard Health reports that as we age,

”...the branching of dendrites increases, and connections between distant brain areas strengthen. These changes enable the aging brain to become better at detecting relationships between diverse sources of information, capturing the big picture, and understanding the global implications of specific issues.

“Perhaps this is the foundation of wisdom. It is as if, with age, your brain becomes better at seeing the entire forest and worse at seeing the leaves.”

Now I'm going to go tackle the mess on that chair again.


Old People Most at Risk for COVID-19 (Corona Virus)

After a serious nuts-and-bolts post on Wednesday about surviving possible Census fraud, I had intended a lighter, more fun post today but world events have intervened.

As happens with many infectious diseases, the hardest hit, those who suffer the largest number of fatalities, are old people. In the research attending the Corona virus, that is abundantly clear again.

Ian M Mackay is an Australian virologist who keeps a website called Virology Down Under which has the best information I've seen about the Corona virus including general interest and advice.

(Thank you to Jan Adams who blogs at Where is the Way Forward?)

On Tuesday, Mackay published an extensive (and easily understandable) story on this not-yet-pandemic.

Here is the chart – numbers as of 11 February 2020:

CoronaChartElders

People with underlying serious conditions such as heart disease or diabetes (often old people) are more susceptible to the virus than younger people.

According to one health expert, a vaccine is not possible for a year to a year-and-a-half and, some say, it is currently questionable if it would be affordable.

On Thursday, the White House announced that all U.S. government health officials and scientists are required to clear all public appearances and statements with Vice President Mike Pence's office, according to The New York Times which also reported,

”Officials insist the goal is not to control the content of what subject-matter experts and other officials are saying, but to make sure their efforts are being coordinated, after days of confusion with various administration officials showing up on television.”

Uh-huh.

Given the questionable data from China along with the contradictory statements about the spread of the virus from the president, as contrasted with the health experts at Wednesday's press conference, it's obvious we the people are on our own for needed information.

In a situation as fluid and unknown as the future of COVID-19, we each need to take precautions to help keep ourselves healthy along with those we come into contact with.

So I'm going to summarize the crucial behavior we need to practice to stay as safe as possible.

But first, this from the Australian virologist, Ian Mackay:

”REMEMBER: As long as the virus circulates, and as long as you have never been infected, you are susceptible to infection resulting in COVID-19. This will be the case for the rest of your life until you have been infected which should protect you from severe disease.

“COVID-19 is mostly a mild illness but can cause severe pneumonia in approximately 20% of cases, leading to hospitalization for weeks and in a portion of these cases, to death.”

TO REDUCE RISK OF INFECTION:

  • Stay at least three feet (one meter) from obviously sick people
  • Avoid shaking hands
  • Wash hands frequently with soap and water for 20 seconds
  • Or, wash hands with an alcohol-based hand rub and air dry
  • Avoid touching your face

At the grocery store yesterday, I realized that it is a good idea to use the disinfectant wipes some stores supply to clean the shopping cart handle, or bring your own. You might also consider nitrile gloves – you can't know where someone has recently sneezed.

SHOULD YOU WEAR A MASK?
There are mixed messages on the usefulness of face masks. Here is what Mackay says:

”While a mask seems like a good idea, and when used by professionals it does protect from infection, it can actually give inexperienced users a false sense of security.

“There isn’t a lot of good evidence (still!) that shows a mask to reliably prevent infection when worn by the public at large. They are useful to put on a sick person to reduce their spreading of the virus.”

PRESCRIPTION DRUG SUPPLY DISRUPTIONS
A large percentage of U.S. pharmaceuticals are produced in China as are some critical ingredients needed for drugs produced in the U.S. If COVID-19 continues to accelerate, it's not impossible that shortages may appear. However, on Wednesday, the Washington Post reported:

”The FDA [Federal Drug Administration] said that no companies are reporting drug shortages linked to the coronavirus. But in a sign of its efforts to get ahead of any problems, an FDA spokeswoman said the agency has contacted 180 China-based prescription-drug manufacturers asking them to evaluate their supply chains and remind them they’re required to notify FDA of any coming disruptions.”

In anticipation of possible widespread, ongoing transmission of the virus, you might want to contact your physician about an additional supply of critical drugs.

There is more advice which I'll link to for you below, but it is important to know that no one knows what is going to happen. Will COVID-19 become a pandemic? Or will it hit a lower peak and subside? Stock markets worldwide are dropping dramatically day-by-day. For how long? And so on.

We also do not know how other countries' governments are controlling (or not) information as the U.S. government is now doing so it is hard to know what reports about the virus to trust. Read carefully. Use your bullshit detector.

Here are three good links and a Google search will bring up thousands more. Again, choose carefully.

Virology Down Under

How to Prepare for Corona Virus - New York Times

A Guide to Prepare Your Home for the Corona Virus - NPR


Precautions to Help Old People Avoid the Coronavirus

As with seasonal flu, the most vulnerable to the coronavirus are old people and others with compromised immune systems which applies directly to most of us who hang out at this blog.

According to the U.S. Centers for Disease Control (CDC) this week, so far the good old fashioned seasonal flu is more dangerous to Americans than the new caronavirus from China. That will be true until it's not anymore but the precautions work for both illnesses.

There is so much to say about the coronavirus let's get to the most important information first - how to protect ourselves – and then I will pass on some of the peripheral information.

WHAT IS THE CORONAVIRUS?
There are other coronaviruses. This one has never been seen before and it has jumped species from animals to humans – most likely from seafood. The first to be infected were workers and customers at the Wuhan wholesale seafood market.

Human-to-human transmission of the virus has been confirmed in China, in the United States and in Germany. Tests elsewhere are ongoing.

WHAT ARE THE SYMPTOMS OF THE CORONAVIRUS?
The Guardian online newspaper has been doing excellent “explainers” of the illness. Here is their information on symptoms:

”The virus causes pneumonia. Those who have fallen ill are reported to suffer coughs, fever and breathing difficulties. In severe cases there can be organ failure.

“As this is viral pneumonia, antibiotics are of no use. The antiviral drugs we have against flu will not work. If people are admitted to hospital, they may get support for their lungs and other organs as well as fluids. Recovery will depend on the strength of their immune system. Many of those who have died were already in poor health.”

To state the obvious, this year's seasonal flu vaccine is not effective for the c0ronavirus.

PREVENTION
As of Tuesday when I am writing this, there are only 11 confirmed cases of coronavirus in the U.S. That doesn't mean it won't change. Here are the recommended prevention measures. We all know them but we don't always follow them.

• Avoid close contact with people who are infected

• If you're sick, avoid interacting with other people - stay home

• Do not go to work if you're sick

• When you sneeze, cover your nose and mouth

• Do not touch your eyes, nose, and mouth

• Regularly clean and disinfect surfaces and objects that could be contaminated with germs (like your phone)

• Regularly wash your hands with soap and water for 20 seconds or more, or use an alcohol-based sanitizer with 60% alcohol or higher if you can't get to a sink.

WHAT ABOUT FACE MASKS?
China is reporting that face masks are sold out all around China, as they are in other countries as well. However, face masks are not as effective protection as the list above, according to the CDC, and health experts mostly advise against using them.

Last week, David Heymann, who led WHO's [World Health Organization] infectious disease unit at the time of the SARS epidemic in 2002-2003, told CNBC that wearing masks can be useful if you’re sick in order to prevent you from sneezing or coughing into somebody’s face.

“But, 'a mask that is used to stop getting an infection is sometimes not very effective because people take it off to eat, many times they are worn improperly (and) if they get wet and somebody sneezes on that mask it could pass through. So, there is really not a lot of evidence (to support wearing masks).'”

Except that masks are recommended for health care workers treating coronavirus patients.

IS THE U.S. PREPARED FOR A WIDESPREAD OUTBREAK?
Not according to a variety of news outlets. Reuters reported on Sunday that President Donald Trump seemed to downplay the impact on the United States,

”...telling Fox television in an interview, 'We’re gonna see what happens, but we did shut it down, yes.'”

We shut it down?

In an announcement on the Health and Human Services (HHS) website last Friday, Secretary Alex M. Azar II declared the coronavirus a public health emergency which allows states, tribal and local health departments to temporarily reassign some personnel under certain circumstances.

QUARANTINE
Americans in China have been scrambling to return to the U.S. before a two-week quarantine goes into effect. According to The New York Times,

”The Trump administration ordered that as of Sunday afternoon, any American citizen who in the last two weeks had visited the Hubei province, whose capital city is Wuhan, was subject to a quarantine of up to 14 days after arriving in the United States.”

As is too often the case with this administration, facts and details about the extent of the quarantine and who it applies to vary. One person returning from China tried to avoid quarantine by leaving the military base where his private plane landed. (What is the matter with people.)

There may be other impediments to a swift government response. According to Laurie Garrett writing in Foreign Policy magazine last Friday,

”For the United States, the answers are especially worrying because the government has intentionally rendered itself incapable. In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure.

“In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion.

“If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is.”

INSTANT HOSPITAL
Meanwhile, back in Wuhan, China, where the coronavirus first appeared, a 1,000-bed hospital was build in 10 days and is open for business. Here is a time lapse of the construction which involved 7,000 workers:

A second instant hospital for coronavirus patients is currently under construction.

The important thing here today is that list above of how to help prevent infection. Let's all follow it carefully and diligently.


Marijuana and Old Folks

We've discussed this several times before but I think it is worth coming back to because use of cannabis among elders continues to increase but I keep meeting people (in a state where it is legal) who are interested but hesitant to try it.

The little wicker basket next to my bed holds several brands and types of edible cannabis I use for sleep. It's quite a collection now. Currently, there are two kinds of chocolate, four of fruit-flavored gummies, one of lemon hard candies and a bottle of tincture.

Even when they contain the same dosage of THC, the effectiveness of each differs with me depending on how frequently I use it. One of my physicians and several marijuana dispensary employees have confirmed my experience, that the same product used every night will eventually stop working – which happened to me.

So now I keep that nice little variety around to mix it up from night to night.

Currently, 33 U.S. states and the District of Columbia have legalized cannabis to a greater or lesser degree. Some restrict usage to what is called “medical marijuana” that for purchase usually requires a card from a physician. Many other states now allow recreational marijuana.

Here is a map of current legal availability as of 25 June 2019. Follow this link for more information by individual state.

LegalCannabisMap

Oregon was the first state to decriminalize marijuana use and later legalized it for people 21 and older – first for medical use and then expanded to recreational use.

In the past month or two, I've noticed that my local Safeway supermarket is now selling CBD products. CBD is the non-psychoactive chemical in cannabis. It's counterpart, THC, gets you high.

When I first started experimenting with cannabis for sleep, I tried CBD. It worked about as well as a glass of water so I switched to THC which not only puts me to sleep, it keeps me there for seven to eight hours which I hadn't slept in a decade or more.

Other people say CBD works well for them.

When the subject of marijuana use comes up in conversation, it is predicable that someone will say, “Oh, but I wouldn't want to get high.” To which I can only say, “Why not?”

Mostly I'm asleep before the high kicks in because that takes about two hours with edibles as opposed to smoking pot which is almost immediate. (No smoking for me with COPD.)

I patronize several cannabis dispensaries in Oregon all of whom have told me that the majority of their customers are old people. WebMD reported on a 2018 survey of elders who use marijuana for chronic pain.

”...it reduced pain and decreased the need for opioid painkillers.

“Nine out of 10 liked it so much they said they'd recommend medical pot to others.

"'I was on Percocet and replaced it with medical marijuana. Thank you, thank you, thank you,' said one senior.”

Many say that marijuana doesn't eliminate pain but it does make it manageable.

Dr. Mark Wallace, a board member of the American Pain Society, told WebMD,

"'The geriatric population is my fastest-growing patient population. With medical marijuana, I'm taking more patients off opioids,' he said.

"'There's never been a reported death from medical marijuana, yet there are 19,000 deaths a year from prescription opioids. Medical cannabis is probably safer than a lot of drugs we give,' Wallace said.”

I've made sure my cannabis use is included on my list of medications so that doctors can consider drug interactions when/if they prescribe something new.

The body of scientific research suggests that cannabis is useful in treating a variety of conditions and diseases such as

• Amyotrophic lateral sclerosis (ALS)
• Anorexia due to HIV/AIDS
• Chronic pain
• Crohn's disease
• Epilepsy or seizures
• Glaucoma
• Multiple sclerosis or severe muscle spasms
• Nausea, vomiting or severe wasting associated with cancer treatment
• Terminal illness
• Tourette syndrome

Note that they don't list sleep but I can't be the only old person who has discovered that use.

The National Organization to Reform Marijuana Laws (NORML) which has been lobbying for legalization since 1970 reports that

”According to national polling data compiled by Gallup in October 2019, 66 percent of the public - including majorities of self-identified Democrats, Republicans, and Independents - favor adult-use legalization.

"Bipartisan support among the public for medical marijuana legalization is even stronger.”

MarijuanaLegalization

I was in high school when I smoked my first joint. I enjoyed it then and, presumably, I still would if I could stay awake long enough to feel the high.

But what I can't figure out is how, through the decades, I had so much time to fool around - it's not like you get much done when you're stoned. Who knew, back then, that weed would be my key to getting a good night's sleep.

Certainly some TGB readers use cannabis. Let's hear from you, and if you want, feel free to use an alias in place of your name.


Ageotypes – The Key to Personalized Medicine?

For many years, regular readers of this blog have heard me bang away at the boring-sounding but important fact that people age at dramatically different rates.

Unlike infants, whose normal walking, talking, feeding themselves, etc. development can be tracked within a month or so, people grow old at different ages. Some are creaky in their fifties while others may retain the stamina common to a young person well into their eighties or even nineties.

It is important to know that, to understand that in ageing, one size does not fit all. Now it appears that it may not be true of only of ageing in generalized.

If research published last week in Nature Medicine [pdf] holds up under further testing, discovery that our individual organs may age differently from one another shows promise for future development of personalized medicine.

As journalist Sharon Begley reports in STAT, the Stanford University School of Medicine researchers

”...conclude that just as people have an individual genotype, so too do they have an 'ageotype,' a combination of molecular and other changes that are specific to one physiological system.

“These changes can be measured when the individual is healthy and relatively young, the researchers report, perhaps helping physicians to pinpoint the most important thing to target to extend healthy life.”

Biologist Michael Snyder, who led the Stanford study, explains that within an individual, some systems age faster or slower than others:

“'One person is a cardio-ager, another is a metabolic ager, another is an immune ager,' as shown by changes over time in nearly 100 key molecules that play a role in those systems. 'There is quite a bit of difference in how individuals experience aging on a molecular level.'

“Crucially, the molecular markers of aging do not necessarily cause clinical symptoms. The study’s 'immune' agers had no immune dysfunction; 'liver agers' did not have liver disease. Everyone was basically healthy.

“If aging is truly personal, understanding an individual’s ageotype could lead to individualized, targeted intervention. 'We think [ageotypes] can show what’s going off track the most so you can focus on that if you want to affect your aging,' Snyder said.”

So far, the research team has identified four ageotypes: immune, kidney, liver and metabolic but there are really more, they say, because some people may meet the criteria for more than one ageotype.

Obviously, there is a lot more work to be done before ageotypes can be used to create personalized medical treatment for patients. As LiveScience reports

”Snyder and his co-authors plan to follow the study participants to see how their aging profiles morph over time.

“They also aim to develop a simple ageotype test that could be used in the doctor's office to quickly assess a patient's health status, and potentially point them toward the best possible treatment options.”

The study was small, just 43 participants. So why am I telling you about this when it is unlikely to be developed enough to help most of the people who read this blog?

The first reason is that in the days after I read about it early last week, I kept going back to reread the news stories. Then a long-time blog friend, Chuck Nyren, sent me one of the stories.

And most of all, I'm posting this because I read a lot of health news about old people and it's not often I feel researchers are on to something as important as this could be.

Science breakthroughs almost never happen full-blown. If you recall the story from school, it is said that Thomas Edison tried 1,000 times before he came up with a viable light bulb.

When a reporter confronted him with all those failures, Edison said, "I didn’t fail 1,000 times. The light bulb was an invention with 1,000 steps."

I figure the Stanford scientists have a lot of steps to go and I wish them well. What a great difference this would make for health care.


THINKING OUT LOUD: Memory Lapses and Unsuccessful Aging

Three times in an hour-long conversation with a friend this morning, I had reason to say, “Never mind, I lost the thought.” In my case when that happens, the thought is gone forever.

Most TGB readers are old enough to know the problem of forgetting the name of a place, person or thing (these lapses are almost always nouns). It has an infamous twin - walking into the bedroom and forgetting why you're there.

This is an old-age phenomenon, short-term memory being too short to be useful. But Daniel J. Levitin, a 62-year-old neuroscientist says we are wrong.

”This is widely understood to be a classic problem of aging,” he wrote in an opinion piece in The New York Times. “But as a neuroscientist, I know that the problem is not necessarily age-related.”

(Or maybe it is; note how he hedges his statement with “necessarily.”)

He goes on to explain that “short-term memory is easily disturbed or disrupted.”

”It depends on your actively paying attention to the items that are in the 'next thing to do' file in your mind. You do this by thinking about them, perhaps repeating them over and over again...

“But any distraction — a new thought, someone asking you a question, the telephone ringing — can disrupt short-term memory. Our ability to automatically restore the contents of the short-term memory declines slightly with every decade after 30.”

Dr. Levitin tells us that his 20-year-old students make “loads” of short-term memory mistakes.

”They walk into the wrong classroom; they show up to exams without the requisite No. 2 pencil; they forget something I just said two minutes before. These are similar to the kinds of things 70-year-olds do.”

The difference between to the two age groups, he says, is how they each describe the events:

”Twenty-year-olds don’t think, 'Oh dear, this must be early-onset Alzheimer’s.' They think, 'I’ve got a lot on my plate right now' or 'I really need to get more than four hours of sleep.'”

Cognition does slow down with age, says Dr. Levitin, but given a little more time, elders' memory works fine. As others before him have explained, part of the slowing down problem is old people have so much more information stored in their brains that it takes longer to sort through it all.

But there's good news too.

”Some aspects of memory actually get better as we age. For instance, our ability to extract patterns, regularities and to make accurate predictions improves over time because we’ve had more experience.

“(This is why computers need to be shown tens of thousands of pictures of traffic lights or cats in order to be able to recognize them). If you’re going to get an X-ray, you want a 70-year-old radiologist reading it, not a 30-year-old one.”

Dr. Levitin says elders more easily recall events from long ago because they were new when they happened and make strong impressions.

Although little of Dr. Levitin's memory discussion is new to me, I was enjoying reading his piece until I came upon the last paragraph:

”...experiencing new things is the best way to keep the mind young, pliable and growing — into our 80s, 90s and beyond.”

What a bunch of - oh, never mind. I have new experiences every day. Everyone does even if it's as simple as reading something new. That's not going to make anyone's mind young. Instead, it just reinforces the ageist belief that age is inferior to youth.

And anyway, new experiences don't help me remember why I walked into the bedroom.

The Times' article notes that Dr. Levitin's article is adapted it from his book, Successful Aging: A Neuroscientist Explores the Power and Potential of Our Lives.

I was just about to type out a snarky response to that title, but I think most TGB readers will think what I do when see that sorry phrase: please do tell us, then, what is UNsuccessful aging.


House Vote on Medicare Drug Prices This Week

What with “All Impeachment All The Time" news on television, in newspapers and the internet, it's hard to know there are other things going on in Washington, D.C. But I did come across one last week that is important to most of the people who read this blog.

According to a press release at the House website of Speaker Nancy Pelosi, the U.S. House of Representatives this week will vote on H.R. 3, the Elijah E. Cummings Lower Drug Costs Now Act. The legislation will give Medicare

”...the power to negotiate lower drug prices and make those prices available to people with private insurance [Part D]. No longer will Americans have to pay more for their prescriptions than what Big Pharma charges in other countries for the same medicines.

“We are reinvesting the more than half a trillion dollars the federal government alone saves from lower drug prices to expand Medicare to cover vision, dental and hearing for the first time. We add billions to the search for breakthrough cures and treatments, confronting the opioid epidemic, strengthening our community health centers, and more.”

There are 106 co-sponsors of the bill, all Democrats. Text of the bill is here.

The White House opposes the bill primarily on grounds that it will prevent drug companies from creating new life-saving drugs. You can read the White House response here.

On the other hand, The Journal of Clinical Pathways reports

”Republicans in Congress have expressed concerns with the legislation citing, like the White House, that it would discourage innovation in new pharmaceutical product development, but the President has nevertheless praised Pelosi’s plan.”

Neither the publication nor I have a source for the president's praise.

Meanwhile, under current regulations, Part D costs to enrollees will increase next year. According to a Kaiser Family Foundation (KFF) analysis of changes for the year 2020:

”...Medicare Part D enrollees are facing a relatively large increase in out-of-pocket drug costs before they qualify for catastrophic coverage.

“This is due to the expiration of the ACA provision that constrained the growth in out-of-pocket costs for Part D enrollees by slowing the growth rate in the catastrophic threshold between 2014 and 2019; in 2020 and beyond, the threshold will revert to the level that it would have been using the pre-ACA growth rate calculation.

“For 2020, the out-of-pocket spending threshold will increase by $1,250, from $5,100 to $6,350.”

Here's the chart:

KFFPartD

Further increases for Part D enrollees, according to KFF, include

”...higher out-of-pocket costs in 2020 for the deductible and in the initial coverage phase, as they have in prior years.

“The standard deductible is increasing from $415 in 2019 to $435 in 2020, while the initial coverage limit is increasing from $3,820 in 2019 to $4,020 in 2020.

“For costs in the coverage gap phase, beneficiaries will pay 25% for both brand-name and generic drugs, with plans paying the remaining 75% of generic drug costs—which means that, effective in 2020, the Part D coverage gap will be fully phased out.”

There are additional changes (what else is new) that you can read here.

H.R. 3 is not the only proposal in Washington to modify Part D costs. There is a bill from the Senate Finance Committee (SFC) and another from the Trump administration's fiscal 2020 budget (TAdmin). They would cap enrollees' out-of-pocket spending as follows:

H.R. 3 – at $2,000 out-of-pocket
SFC – at $3,200 out-of-pocket
TAdmin - Unknown

Here's the chart:

CatastrophicPartD

Whew. I'm nearly cross-eyed from sorting out all this information and trying to translate it from the government-ese. With that, I've left out a lot but you now have the general idea. You can get more detail from the links above.

Even given that no House Republicans signed on as co-sponsors, H.R. 3 is likely to pass in the House this week.

Over the past three years we have learned what happens to Democratic sponsored bills when they get to the Senate. But if you think this is a good proposal, you should urge your representative to vote for the bill – even if you already know he or she will do so. At least their offices will have tallies of constituents' leanings.

The Congress telephone number is (202) 224-3121, then ask for your representative's office by his/her name. Or, go to the House of Representatives website and enter your Zip Code to reach your representatives page.



My $45,000 Per Month Inhaler

It shouldn't be this way, but every year between 15 October and 7 December, Americans who use Medicare for their health coverage, most of whom are 65 and older, can change their coverage for the coming year during the “open enrollment” period.

That sounds accommodating but the real reason is not for insureds' benefit; it is for insurers and big pharma. Not to mention that it has always been a teeth-grinding, boring task each year to compare current coverage to what is available for the next year, but at least it was close to accurate.

Not so this year.

It has never been a good idea to just go with the coverage you've got because insurers are allowed to and may have:

• Raised premiums
• Raised deductibles
• Raised co-pays
• Changed the prices of drugs you use
• Removed some of those drugs from the formulary
• Limited the size of prescriptions

To make it even more adventurous, they might also move drugs around among the four “tiers” which can change the price too.

(There is no law against reducing the prices of drugs. Someone tell me why it is that I doubt that would happen.)

When the new Medicare materials arrived in the mail from the federal government this year, I was appalled to see that there are 28 Part D (prescription drug) plans available in my area for 2020. Count them: 28.

(Am I the only person who knows that too many choices is no choice at all?)

There are also just as many Medicare Advantage programs in case I want to switch from traditional Medicare. No thank you.

What this means is that I needed to look at each of the 28 drug plans on Medicare's website, figure out the cost of each and compare them to my current plan.

The process of finding a reasonably priced plan is so tedious it could make you cry. But this year is worse than previous ones. Truly awful, I would call it, because it turns out the Medicare website is broken this year. ProPublica reports:

”The federal government recently redesigned a digital tool that helps seniors navigate complicated Medicare choices, but consumer advocates say it’s malfunctioning with alarming frequency, offering inaccurate cost estimates and creating chaos in some states during the open enrollment period.”

Inaccurate? You want inaccurate? How about $45,000 per month for an inhaler? Yes, I really meant to put all those zeroes on the price.

(I spoke about this recentlyi on The Alex and Ronni Show. If you really care about additional details, you can view the show here.)

No matter which plans I tested, the same price came up for the inhaler. $45,000.

Well, that's just a joke, isn't it. Even if it were correct. But I didn't believe all 28 providers would just happen to assign an identical price. Okay, I only checked six or eight plans before I sought outside help. But still.

It took several days of calling around to Medicare, insurers and others – all useless - until I found a savior, an extremely well-informed woman who told me to change the number of doses per month on the Medicare website chart from 60 to 1, and explained what Medicare had got wrong:

The Medicare website assumed that each dose, two-a-day in my case, was a separate inhaler so that according to them, I needed 60 inhalers a month instead of one inhaler containing 60 doses.

Whew! But why didn't the customer service representatives know this when I telephoned?

ProPubica goes on to report that Nebraska shut down a Medicare network of 350 volunteer telephone helpers because the website is so problematic. One insurer sent a warning email to insurance brokers nationwide because Medicare's online tool was producing too many errors, reports ProPublica, and

”Minnesota’s Association of Area Agencies on Aging said in a news release on Nov. 14 that the Medicare Plan Finder 'continues to produce flawed results,' including inaccurate premium estimates, incorrect prescription drug costs and inaccurate costs with extra help subsidies.”

Medicare told ProPublica that they tested the redesigned site before its launch. Really?!?

AARP has also written about the mistakes on the Medicare website. Their advice is to call the insurer to double-check the website prices, drug availability and

”For people who have already picked a plan and thought they were finished with open enrollment, advocates say they too should go back, call the plan they have selected and make sure the prices and other information on the website were correct.”

Been there, done that and all I got was, “If that's the price on the website, that's the price.”

I'm sorry that I have no other suggestions for you.

Being old is hard enough. Reading pages and pages of fine print online, mostly numbers, while trying to sort out what one's healthcare will cost in the coming year and then having to wonder if it is accurate is really unkind – even nasty.

The holiday got in my way last week and I'm late posting this story. Open enrollment is in effect only through next Saturday, but that still leaves time to double-check your plan selection for 2020.

I'm going to give the insurer I selected for next year another call and then hold my breath until January to see if I am charged $90-something for that inhaler instead of $45,000.

You should probably do that too – the phone call, I mean, not hold your breath. Good luck.



When Health Professionals Disagree

No sooner had I written here about my diagnosis of pancreatic cancer in 2017 than people began telling me about cures, usually in other countries but some that involved eating large portions of “good” foods while eliminating “bad” foods.

Even before pancreatic cancer raised its head in my life, I was a firm believer in the view that if there were a miracle cure for any given disease we would all know about it.

And so, within a day or two of the diagnosis, I determined that I would follow the instructions the doctors and nurses gave me. After all, they've been treating cancer patients for a whole lot longer than I had even thought much about it and although there cannot be promises, they know what has worked – and not – over time.

When I was recovered enough from the Whipple surgery two or three weeks later, the chief oncology nurse sat me down for a lesson in how I would need to eat from that point forward. It was my first test in believing what the medical experts tell me.

Until then, I had maintained a simple, healthy diet for a couple of decades: lots of fruit, vegetables, legumes, etc., a hefty portion of fish three or four times a week with a sweet treat (ice cream, a chocolate croissant) now and then.

The nurse explained my new diet that would include four-to-six small meals a day with the kinds of proteins and fats I had not eaten in many years. I objected. She insisted. I tried to explain some more and she cut in: “The cancer will kill you long before the diet will. So do as I say.”

Yes, ma'am. Of course she was right and her instructions, modified to expand my food choices as time passed, have served me well.

Then, this year, along comes COPD. Recently, there was a nutrition lecture in connection with the pulmonary rehab I attend twice a week and guess what? The nutrition advice doesn't match. How to eat to help make living with COPD easier is a lot closer to how I ate before pancreatic cancer than how I eat now.

What to do? What to do?

Well, all right – it's not that difficult. I'm adjusting the conflicts between the two diets and so far it is working well.

But it does reinforce the idea that we – you and I, patients in other words – need to be responsible for our own health practices. It was easy before the COPD was diagnosed and I had just one condition to be aware of. Now I need to balance the two.

Old people are much more likely to have several diseases or conditions that must be managed and one kind of doctor – an oncologist, for example - doesn't know a whole lot about COPD and vice versa.

So it is our job to bring up the questions and conflicts when they occur, and that reminds me:

We old folks are the number one experts on our own bodies. We each know how ours operates, how it feels when it is working well and when something is not right.

We know what kinds of pain or other discomforts occur and we have learned how to treat them with the help of our physicians. And we know when something is wrong enough to require a visit to the doctor.

Some of you undoubtedly think this is all elementary and obvious, that you have always lived this way in regard to your health. But it hasn't been so to me. Let me confess here and now that before the cancer diagnosis, I hardly ever saw a doctor. I often went four or five years, maybe more, between visits.

I was just lucky that hardly anything happened beyond a bad flu now and then.

It is only now, living with two serious diseases, that I have come to see that it is up to me in a much larger sense than I had thought about before, to manage my health, tapping the knowledge and expertise of the appropriate physicians when necessary.

Remember a week or two ago when I wrote about my mother's saying, “Too young we're old, too old we're wise?” This is a perfect example of it and instances of my ignorance are piling up fast recently.



Conserving Energy in Old Age

As you know, earlier this year I was diagnosed with COPD in addition to the cancer I have been living with for more than two years. For now, the cancer seems to just sit there slowly growing and doesn't get in my way day to day.

COPD, however, affects all my life when I'm not sitting or lying down. To not lose my breath, I walk slowly now - indoors and out - and when I forget, I pay for it, heaving to get my breath back as I grab for the rescue inhaler.

In old age, being short of breath might happen to anyone even if you're not a former cigarette smoker. A long time ago I read somewhere that after age 20 or so, people lose about one percent of their lung capacity each year, and when I asked one of my physicians about that, he told me that's basically correct.

So an occupational therapist has been added to my list of medical providers. It's her job to help me make the most of my life by showing me how to do everyday things that have become more difficult with impaired breathing.

At my first visit, she gave me a two-page list of instructions on how to conserve the limited supply of energy I now have, and I was surprised at how much of this I already do, have always done.

Things like avoiding unnecessary steps, mixing up heavy with light physical tasks, sliding objects instead of lifting them. Even the obvious things on the list are useful as reminders and I do them now because I must rather than, as before, because I can be monumentally lazy.

The section of the instructions that was mostly new to me and therefore most valuable was on stress management. I had noticed that when I'm running late or trying to control my anger (nay, rage) at the difficulties in sorting out my Medicare Part D options, I lose my breath even while I'm sitting still.

Stress, it turns out, causes shortness of breath. You may know that but I didn't.

Here are the instructions for stress management that appear to be simple, even obvious, but things I need to relearn in this new context. Maybe they are helpful to you too.

⏺ Set realistic goals
⏺ Live in the present, not the past or future
⏺ Think about what you can do, instead of what you cannot do
⏺ Accept what cannot be changed
⏺ Practice good posture and breathing techniques
⏺ Eat nutritious food
⏺ Learn from your successes AND your mistakes
⏺ Listen to your body
⏺ Save time and energy for fun
⏺ Ask questions; take control of your illness; don't let it control you

The instructions also cover Scheduling, Pacing, Simplifying, Organizing in addition to Stress Management. They are from the Physical and Occupational Therapy department at Oregon Health and Science University. Click below to download it.

Download the Energy Conservation instruction page



Sleeping – or Not – While Old

Until about 18 months ago, most nights I slept for about four hours; five hours when I was lucky. There was a time, more than a decade ago, that an evening dose of melatonin kept me asleep for the more traditional seven or eight hours and I felt so much better then.

But after a couple of years it stopped working.

I got by as I always had, toughing it out during the day when there were things that must be done. I was slow to twig to the fact that I now live in a state where cannabis (that's what we're supposed to call it now – I still think of it as weed or pot) is legal.

About a year-and-a-half ago, I began using a tincture of cannabis which kept me asleep all night, seven or eight hours, until it didn't anymore. Both a dispensary “budtender” and one of my physicians said that often, sleep aids of all kinds can stop working and suggested I try alternating types of cannabis. So now I use a gummy in between the tincture.

It's been working for me. Some friends have had less success. (I always use THC cannabis; CBD does nothing for me in regard to sleep.)

Insomnia is serious but common problem for old people. Even when sleep disorders such as restless leg syndrome, sleep apnea, pain or certain medications are discounted, about one-third of people 65 and older don't get enough sleep according to a 2017 University of Michigan poll.

Today's post is not about medical conditions that cause sleep disorders but I want to pass on what the National Sleep Foundation says about sleep apnea:

”...untreated sleep apnea puts a person at risk for cardiovascular disease, headaches, memory loss and depression. It is a serious disorder that is easily treated.

“If you experience snoring on a regular basis and it can be heard from another room or you have been told you stop breathing or make loud or gasping noises during your sleep, these are signs that you might have sleep apnea and it should be discussed with your doctor.”

Note that phrase, “serious disorder that is easily treated.” How often does anyone tell us that? So if you suspect sleep apnea or any other medical cause of insomnia, get thee to your physician.

When there is not an underlying medical reason for sleeplessness, there are other reasons it happens. WebMD tells us, there is

”...a big difference between younger and older sleepers: the timing of rest. As adults age, advanced sleep phase syndrome sets in, causing the body's internal clock to adjust to earlier bed and wakeup times. But some seniors continue to stay up late, as they did in their younger years. Sleep deprivation is often the result.”

Every source I read tells us that it is a misconception that people need less sleep as they age. Research shows that sleep need remains constant throughout adulthood – seven or eight hours.

Assuming there is no underlying medical reason you can't sleep or can't sleep enough, what's an insomniac elder to do?

There are always the prescription sleep potions, right? Ambien, Lunesta, etc. In an excellent article about elder sleeplessness, Consumer Reports warns against them noting that one analysis found that people using these drugs

”...fell asleep only 8 to 20 minutes faster than people taking a placebo.

“Taking sleep meds may also cause dependency and increase your risk of car accidents, and more than double your risk of falls and fractures, common causes of hospitalizations and death in older adults, according to Consumer Reports’ Choosing Wisely campaign.

“Because of these dangers, the American Geriatric Society includes the more potent prescription sleep drugs—eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien)—on its list of medications that adults age 65 and older should avoid.”

This can be true of some over-the-counter sleep aids too. And if you would be inclined to try cannabis, what if you don't live in a place where it is legal? There is no dearth of advice around the web. This is one of the better lists of useful techniques. From WebMD:

⏺ Get set. Wake up at the same hour every day and exercise and eat meals at set times to help get sleep back on track.

⏺ Get Exercise. Check with your doctor to see what type of activity is best for you, and then get out and do it. You might want to do it early in the day, though, so it doesn’t keep you up at night. A little sunlight each day can make a big difference too!

⏺ Get Cool. Keep your bedroom on the cool side. And turn off all those lights and electronics. Keep the TV out of the bedroom.

⏺ Get a Routine. Anything that relaxes you—a warm shower, a few moments of meditation, a good book.

⏺ Get Out of Bed. That’s right! If you are tossing and turning after about 10 or 15 minutes, get out of bed and do something relaxing. Just don’t turn on that TV or computer.

⏺ Get checked. Some medication or certain medical problems can interrupt sleep. If a medication is to blame, your doctor can recommend adjusting the timing or dose, or possibly switching to an alternative prescription. And if it’s a medical problem that’s stealing away your shut eye, she can address that, too.

There is another list from helpguide.org – a much longer list than above – that may be helpful.

The reason you're reading this today is that the cannabis, even with two delivery systems, has stopped working for me. Well, it's been only since Monday and maybe it is just a short-term anomaly, so I'm going to give it some more time before figuring out something new.

But in case I need it, I tracked down all this information so I'm passing it along to you.

I'm sure we would all like to hear about your own adventures in sleep – or not - too. Just remember that you may recommend NO PRESCRIPTION DRUGS nor any other treatment except in the context of what has worked or not worked for you. And no links.



Old Age and Loneliness

It has been known for years now that loneliness can be devastating to the health and well-being of old people. According to a report from the National Poll on Healthy Aging at the University of Michigan published earlier this year,

”Research shows that chronic loneliness can impact older adults’ memory, physical well-being, mental health, and life expectancy. In fact, some research suggests that chronic loneliness may shorten life expectancy even more than being overweight or sedentary, and just as much as smoking.”

Other reports have found that one-third of American elders are lonely. More women say they are lonely than men and living alone has a high correlation with loneliness.

The people who hand out advice online tell us that loneliness can be relieved by what has become a fairly standard list of prescriptions that includes volunteering, joining a tai chi class or a choir, practicing gratitude or adopting a pet. One list of this type includes buying an Amazon Echo to talk with.

Uh-huh.

Undoubtedly, much younger people are the ones making these lists. They don't often take into account such things as physical limitations or transportation difficulties, for example. Further, all the studies I've looked at assume that any person who says he or she is lonely, even those who choose the “sometimes” answer, are miserable about it.

News flash: I feel lonely sometimes. I have felt lonely sometimes throughout my life. Usually I can move on after a good night's sleep.

What has become clear in my case over the years is that I need a lot more time alone than many people I have known. No one who studies loneliness seems to have considered the fact that some of us enjoy our own company a great deal of the time.

None of that is to say that loneliness is not painful, hard to live with and often associated with depression. And old people have the added difficulty that if you live long enough, a lot of the people who mean the most to you, who you may have known for decades, die.

Sometimes I wonder if one of the reasons I enjoy keeping in touch with my former husband is that he is the last human on earth who knew me when was 17. There is comfort in that.

For a story about elder loneliness last March, Time magazine interviewed Dr. Carla Perissinotto, associate chief of clinical programs in geriatrics at the University of California San Francisco:

“She says loneliness refers to 'the discrepancy between actual and desired relationships' — so it’s possible that someone who lives alone doesn’t meet that definition, while someone in a house full of busy people does. 'It gets to the quality of the relationship,; she says.

“Perissinotto says it’s important to address each person’s underlying cause of loneliness, whether it’s the death of a spouse, medical problems that make it difficult to socialize or leave the home or unmet social expectations.

“Doing so takes 'understanding and being honest with yourself about whether you could be experiencing loneliness,; Perissinotto says.”

There is at least one place in the world that has done more about elder loneliness than any of those lists could. I was alerted to it by TGB reader John Gear.

This short video explains clearly what has been happening in Frome, England, after a doctor there created a system in which loneliness is treated as a medical condition. Take a look:

I'm not sure that the same approach would work everywhere but a good start would be to make loneliness an integral part of healthcare, something physicians, nurses and other healthcare professionals ask patients about. Of course, the hard part comes next - finding ways to help. I suspect what works in a small town would be difficult in larger cities.

What do you think?



Annual Medicare Enrollment Period has Arrived

EDITORIAL NOTE: This is so far from comprehensive as to be a joke but I hope it will give you an overview of the basics of Medicare and how they apply in the annual enrollment period.

Because this post is longer than usual, I've used bolding and lists to make it easier to navigate and get to the sections that interest you most.

* * *

It's that time again – Medicare Annual Open Enrollment begins tomorrow, 15 October, and lasts through 7 December. During this period of 54 days you can:

⏺ Switch from traditional Medicare to Medicare Advantage (MA)

⏺ Switch from Medicare Advantage to original Medicare

⏺ Select a different Medicare Advantage plan if you have one now

⏺ Enroll in a Part D prescription drug plan

⏺ Change to a different Part D plan if you already have one

If you are new or newish to Medicare, it can be daunting. Medicare is a massive program and I'm pretty sure that even people who are certified to help the rest of us figure it out don't know all of it.

In that regard, there is a short list of links at the bottom of this post for more detailed or personalized information.

Here are the various Medicare parts:

Part A: Part of traditional Medicare, it covers hospital and hospice care along with some skilled nursing services after a hospital stay. There is no premium for Part A.

Part B: Part of traditional Medicare, it covers doctor visits and certain outpatient services. The Part B premium is deducted from your monthly Social Security payment and will be about $144.30 in 2020, up from $135.50 in 2019. The exact amount has not been announced yet.

Parts A and B constitute traditional Medicare. You may choose any doctors who accept Medicare.

Part C: Medicare Advantage (MA), issued by private insurance companies, is required to include traditional Medicare Parts A and B (at the same premium as traditional Medicare) and often includes Part D along with limited coverage for vision and dental care, for example.

MA takes the place of traditional Medicare. (Some companies charge no premium.) You are restricted to their network doctors.

Part D: Helps pay for prescription drugs. Part D is private coverage for which you pay a separate monthly premium if you have traditional Medicare.

Medigap: Also called Medicare Supplemental, is private coverage that helps pay for what Medicare does not, such as co-payments, co-insurance and deductibles. Restrictions apply as to who can buy Medigap coverage and when.

MEDICARE AND YOU HANDBOOK
The Medicare and You Handbook has many explanations and answers. You can download an electronic copy online. There is a wide choice of editions: PDF, large-print PDF, ebook for your Kindle, iPad, etc. You can also telephone to have a CD audio version, a Braille version or the paper edition mailed to you.

The telephone number is 800.633.4227 or visit the webpage.

This booklet is well organized, clearly written and as easy to use as anything related to Medicare can be.

MY MEDICARE
The official Medicare website is at medicare.gov. Check the dropdown menus at the top of the page for many specific questions.

If you have not signed up for My Medicare which personalizes the Medicare website for you, you can do that on this page. It can help a lot.

When I signed in to My Medicare to check my Part D coverage a couple of days ago, all my current prescriptions were already listed for me – names, dosages, quantities for each refill, and frequency of refills. All of it was correct.

If any of my prescriptions had changed, this is were I could edit them or add and subtract drugs as needed.

In my state, there are 28 Part D plans available, most with a deductible. With just a mouse click, I could see details of each plan and select up to three-at-a-time to compare with one another and check that my drugs are still covered.

That's important. It can change from year to year and, of course, each company's formulary is unique to it.

A recent mailing from that plan advised me that if I wish to continue for 2020, I don't need to do anything. My plan will roll over to next year.

You can also check drug prices of plans at several pharmacies near you and at mail-order pharmacies.

It took me about two hours to work through all the information and make my choice. I use seven prescription drugs. If you have more, it will take longer but the interface makes it relatively easy with one caveat: the plan finder is newly updated and may contain some glitches.

The above applies only to Part D in connection with traditional Medicare. If you have Medicare Advantage or are switching to it, you're on your own. MA is a mystery to me but Medicare's MA Plan Finder works similarly to the Part D Plan Finder.

PERSONAL SUGGESTION NO. 1: If you do not use any prescription drugs, choose the least expensive plan. Since there is no way to predict what might go wrong and therefore what drugs you would need, nothing else makes sense.

When I was diagnosed with cancer and began using prescription drugs, there was one not covered by my plan. Fortunately, it was not too expensive but in the next enrollment period, I chose a Part D plan that covered all my drugs.

(Yes, it is a stupid idea to make people choose a plan when they don't know what they will need it for. Complain to your representatives in Congress.)

PERSONAL SUGGESTION NO. 2: I was prescribed a new inhaler this year. When I was told my part of the price, I nearly passed out – about $500 per month. I told the pharmacist that was out of the question and prepared to see what else the doctor could recommend.

But the pharmacist told me that drug companies will reduce the price considerably in many circumstances, that I would need a declaration signed by my physician and that they, the pharmacy, would take care of all the paperwork.

In less than a week, the drug company approved me and the price dropped to just over $100. So if the price is high, ask what can be done. Pharmacists are well informed and helpful.

WHAT'S NEW IN MEDICARE FOR 2020
Medicare Advantage may now cover such items grab bars, rides to and from medical appointments, acupuncture, massage therapy and more. They are offered at the plan's discretion and only for certain health conditions. This applies only to Medicare Advantage and not to traditional Medicare.

At last, the Medicare Part D doughnut hole (coverage gap) goes away completely in 2020. However, the new limit for out-of-pocket expenses increases from $5100 in 2019 to $6,350 in 2020. Part D plan members will now pay 25 percent of the cost of generic and brand name drugs.

Once you have reached that $6,350 threshold, you pay five percent of a drug's cost.

WHERE TO FIND PERSONALIZED MEDICARE HELP
You can get personalized help as you ponder your open enrollment decisions.

MEDICARE
Medicare.gov has an online chat feature available during open enrollment, and the Medicare hotline, 800-MEDICARE (800-633-4227), is open 24 hours a day, seven days a week during the annual enrollment period.

SHIP (State Healthcare Insurance Assistance Program)
These state-based organizations offer help with Medicare questions, including your benefits, coverage, premiums, deductibles, and coinsurance along with help for joining or leaving a Medicare Advantage Plan, any other Medicare health plan, or Medicare Prescription Drug Plan (Part D).

Locate a SHIP representative in your state here.

Another SHIP list by state from Seniors Resource Guide. This list is up to date as of October 2019.



Today: Falls Prevention Awareness Day

Right now, you who have been reading TGB for awhile, are likely groaning: Is she really going to go through the falls prevention thing again? Really?

Well, yes. Twice a year I post a reminder and time-proven advice to help us all avoid falling. I do it because it can save our lives.

Today is the first day of fall, the day the U.S. National Council on Aging chose for its annual reminders about preventing falls. This year there is some updated research that is not encouraging:

Mortality From Falls Among US Adults Aged 75 Years or Older, 2000-2016 is a study published in June 2019 in the medical journal JAMA.

The researchers discovered that the number of deaths from falls among people 75 and older more than doubled between 2000 and 2016. As The New York Times noted in its report of the study:

”In 2016, the rate of death from falls for people 75 and older was 111 per 100,000 people, they found. In 2000, that rate was 52 per 100,000 people.”

That's a huge jump in fatal falls. The study states that the researchers do not understand the increase.

Earlier statistics from the U.S. Centers for Disease Control and Prevention state them differently:

Every 11 seconds, an older adult is treated in the emergency room for a fall

Every 19 minutes, an older adult dies from a fall

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

Obviously, those numbers will increase if the new statistics from JAMA are applied.

So what can you do to help keep yourself safe from falls. Here is a short, well-done video I've posted before – from the U.S. National Council on Aging:

This year I've discovered an excellent website about fall prevention that I had not seen before: Health in Aging.org. It is extraordinarily clear, concise and useful. Here are links to the main sections:

Basic Facts

Causes

Diagnosis and Tests

Care and Treatment

Lifestyle and Management

Unique to Older Adults

That is not the only good site on this subject - there is an abundance of information online about falls prevention. We should make good use of it because unlike cancer, dementia, COPD, heart disease and other conditions that affect so many elders, we can each have a direct effect on preventing falls.