530 posts categorized "Health"

Making a Misery of Old Age?

In response to Wednesday's post about MIT's AGNES suit, I was startled to find this email in my inbox:

”I think people make too much misery out of old age. My eyes are dimming and so are my ears, my steps are slow. My breath is short and my nights long. My husband of 62 years died in Jan.

“Nevertheless I see friends daily, go to weekly workshops, write a newspaper column, just went to NYC with friends and visited family in NJ. I see lots of movies and read the NYTimes and a cascade of books. At 86 I don't expect miracles, but for now I'm having a fine time.”

How lucky that you apparently do not have any major impediments to being as active as you want. That is not true for all old people nor do they bring it on themselves, as you appear to imply. According to the U.S. National Council on Aging,

”...about 80 percent of older adults have at least one chronic disease and 68 percent have at least two. In our survey, nearly one in two seniors reported living with two or more chronic conditions...

”From making it difficult to perform daily tasks such as walking up steps or bathing, to causing significant physical, emotional, and financial strain, these diseases can take an extensive toll, particularly among seniors. What’s more, without proper care, chronic illness can reduce quality of life, and keep seniors from maintaining the level of independence they desire.”

God knows I've said it often enough here over 15 years but one more time seems necessary: we age at entirely different rates. Sometimes a 50-year-old needs full-time care and other times, a 90-year-old is functioning as well as we expect a healthy 50-year-old to do.

My surprise at reading this email wasn't done. Checking the comments on the blog, I saw that about half a dozen dismissed the AGNES suit out of hand:

”I have a strong negative reaction to these types of suits,” wrote James Cotter. “They suggest that ALL older persons experience all of these decrements at one time. They do not reflect the experience of growing older, especially for those who have maintained decent health and mobility.”

Let's stop right there with “...those who have maintained decent health and mobility.” What about the people who haven't? Does anyone here think it is the patient's fault she was diagnosed with MS at age 31? And no, AGNES does not suggest that all old people suffer exactly the same experiences.

”I think these toys have some utility,” wrote Harold, “but they will not provide insight into what it's like to wake up with these limitations permanently installed and likely to become more pronounced and an awareness that this is the best it's ever going to be.”

First, AGNES is not a toy. For well more than a decade, MIT has used the suit to help people design products and services that help elders engage with the world more easily.

As to understanding that limitations are often permanent, we can't ask people to wear the suit for a week or a month or more. But a day will do it quite well in increasing understanding of elders.

Jeanette wrote, ”...what is missing is their learning that there is an interior life - where we can explore as many different worlds as they do - where we can laugh, make love, watch Mick Jagger on a rope bridge - we can read, listen to music and through the magic of technology.”
”...for real understanding of coping with some of the simulated conditions,” wrote Emma J., “I suspect the value may be minimal. The emotional and psychological aspects of coping with chronic pain, limited mobility, vision and hearing deficiencies, dental problems, poverty without realistic hope of eventual relief can be insidious.”

Oh, I'm not so sure about that, Jeanette and Emma J. No one needs any kind of suit to imagine other worlds, to laugh, make love, etc. Young people do those things every day. And I would bet good money that after even an hour or so in the suit, participants begin to see the difficulties you mention, Emma J. We all come to realize that growing old won't always be easy.

No suit can exactly emulate a human being physically, emotionally or any other way. But for many years, AGNES has been educating people who need or want to know what daily life is like for old people. Let's not throw out that baby with the bath water – the AGNES suit is a good tool that has proved its importance and usefulness in hundreds of ways.

As it happens, just a week ago, The New Yorker published a long, online profile of the director of the MIT AgeLab, Joseph Coughlin, written by the estimable Adam Gopnik who tried out the AGNES suit. I will quote his experience with it:

Slowly pulling on the aging suit and then standing up—it looks a bit like one of the spacesuits that the Russian cosmonauts wore—you’re at first conscious merely of a little extra weight, a little loss of feeling, a small encumbrance or two at the extremities.

“Soon, though, it’s actively infuriating. The suit bends you. It slows you. You come to realize what makes it a powerful instrument of emotional empathy: every small task becomes effortful. 'Reach up to the top shelf and pick up that mug,' Coughlin orders, and doing so requires more attention than you expected.

“You reach for the mug instead of just getting it. Your emotional cast, as focused task piles on focused task, becomes one of annoyance; you acquire the same set-mouthed, unhappy, watchful look you see on certain elderly people on the subway.

“The concentration that each act disrupts the flow of life, which you suddenly become aware is the happiness of life, the ceaseless flow of simple action and responses, choices all made simultaneously and mostly without effort. Happiness is absorption, and absorption is the opposite of willful attention.

“The annoyance, after a half hour or so in the suit, tips over into anger: Damn, what’s wrong with the world? (Never: What’s wrong with me?)

“The suit makes us aware not so much of the physical difficulties of old age, which can be manageable, but of the mental state disconcertingly associated with it—the price of age being perpetual aggravation.

“The theme and action and motive of King Lear suddenly become perfectly clear. You become enraged at your youngest daughter’s reticence because you have had to struggle to unroll the map of your kingdom.”

MIT AgeLab has worked with thousands of volunteers of all ages – including old adults even past age 85 - to participate in research and interactive workshops. And the AGNES suit has helped other thousands create new technologies that help people design products, delivery services and policies that improve the lives of elders.

And here's something else that is useful – recounting the “misery of old age.”

When I began this blog 15 years ago, I was appalled by all the negative writing about old people. Whether academic research, news and magazine stories, movies, TV, novels and more, the prevailing attitude was that getting old is the worst thing that can happen to anyone.

I didn't believe that and then made the rookie mistake of ignoring too much of the downsides of ageing. Looking back at those years, I found a lot of overstatement on my part about how good life is after 60 or 70 or 80 and more.

Geez. Of COURSE, our bodies slow down. Some body parts stop working properly. Others give out. Mysterious aches and pains show up. It's what bodies do. The key in old age is to adapt but that's for another day.

What I've changed here at TGB now since I realized my early mistake in being a bit too rosy about the effects of growing old, is make room on a fairly regular basis to complain and moan and groan and bitch about the irritations of life in the old person lane.

I believe this kind of time is valuable particularly now when we in the oldest generation have lived most of our adult lives in an atmosphere where old age could barely be acknowledged let alone discussed.

But it helps - a lot sometimes - to learn that other people are struggling through the same things you are. It doesn't mean we don't also laugh, read books, go to the movies and whatever else engages us that is still possible. But letting off steam together kind of clears the air.

But no one here is “making a misery of old age.”




What It's Like to Be Old

That headline is not about me nor is it about most of you who are reading this. We're already old and we know quite well what being old is like.

Instead, I'm talking about much younger people, the ones who invent, design and/or market products and services for and to old people. You know, the ones who haven't a clue about what old age is like but who don't let that get in the way of telling old people what's good for them.

Like I once was and was Ceridwen Dovey, a 30-ish novelist and short story writer who tried to create a late-80s-year-old-man (among other elders) from her imagination. As she said later in the New Yorker about her attempt:

”I modeled my characters on the two dominant cultural constructions of old age: the doddering, depressed pensioner and the ageless-in-spirit, quirky oddball.

“After reading the first draft, an editor I respect said to me, 'But what else are they, other than old?'”

This next quotation, longer than the first, is from psychologist Tamara McClintock Greenberg writing in Psychology Today about learning what many elders live with every day.

After being outfitted with earplugs, popcorn kernels for her shoes, gloves to simulate neuropathy and eyeglasses to limit peripheral vision, she tried the “simple” activity of walking no more than a few feet down a hall.

”I thought to myself,” said Dr. Greenberg, “'I can do this.'”

“Then, given a cane, I was asked to walk down the hall. It was maybe 100 feet. I was pretending to be an elder with impaired hearing and vision, bad mobility and numbness in my hands and pain in my feet. I realized that I was not sure that I could actually complete the walk down the hall.

“Suddenly, my class exercise did not feel like a game. I started to panic. From the loss of peripheral vision, I could not see who was standing next to me, and I started to feel suspicious. As I walked, I had a lovely young woman at my side (I was lucky, she is a physical therapist in real life), who could help me if I needed it.

“I did not want help however; I wanted out of my body, which felt trapped, alone, and isolated. Weirdly, even though we were pretending, I felt mad at my companion, who had a body that worked so much better than mine.

“It was at this moment I understood something in a way that I never have before. I thought, I might kill myself if I had to live this way.”

She's not alone in that thought and some elders carry it through to its logical conclusion. Most, however, do not.

As it turns out, those changes that were made to limit Dr. Greenberg's mobility already exist in what the Age Lab at MIT calls its AGNES suit (invented at the Age Lab) that simulates the physical difficulties that come with old age. Here is a short video about what AGNES does:

There is a further explanation on the YouTube page:

”Put on this suit and you feel increased fatigue, reduced flexibility in joints and muscles, spinal compression, and difficulty with vision and balance.

“Altogether, AGNES is more than just a suit. It is a calibrated method developed and constructed by exercise physiologists, engineers, and designers. As demographics shift, we need to fully understand the needs of an aging population to design a future that is accessible and engaging for people of every age.”

The Try Guys are a group of four comedians, actors and filmmakers who, since 2014, have been making videos about – well, anything they are curious about – what it's like to be a mother, changing diapers, making cupcakes, pottery and in today's case, testing the AGNES suit.

Last month, the Age Lab posted several videos about ageing – two of them about the AGNES suit. Here is the first one with the four members of The Try Guys along with the director of the Age Lab, Joseph Coughlin. (Pay attention to him. He knows a lot about what it's like to be old.)

These are long-ish videos. If you are up for more, here is the video of The Try Guys wearing the suits for a full day. The video makes an important point about being old that is rarely mentioned – how hard it is to get through a day of what we called normal activity when we were younger, but no more. It's not easy when you're old.

MIT AgeLab and the AGNES suit have helped many companies design products and services that better and more realistically serve old people's needs.

As I've said many times and Joseph Coughlin says at least once in these videos, anything that improves life for old people does so, too, for people of every age. As just one example, curb cuts work as well for mothers with kids in strollers as they do for adults in wheel chairs and scooters.

We need a lot more of such seemingly “ordinary” innovations; the U.S. Census Bureau tells us that “by 2035, there will be 78.0 million people 65 years and older compared to 76.7 million under the age of 18.”

Feel free to add anything in the comments that would help not-yet-old people understand what being old is like.

(Even though they've been around online since 2014, I had never heard of The Try Guys before researching this story. They're funny while trying all sorts of things they've never done before and in addition to laughs they leave you, by the end of each episode, with some interesting thoughts, ideas, facts and information you probably didn't know before.)

Here is their YouTube channel.




Skin Hunger and Elders

”Touch is the most primitive of all the senses,” explains a physician writing in Psychology Today two years ago. ”It is the first sense to develop, and is already present from just eight weeks of gestation...

“Compared to children, adults are less dependent on touch, but older adults, who tend to be more alone, more vulnerable, and more self-aware, are likely to need considerably more skin contact than their younger counterparts.

“Therapy animals have become common in care homes, and, despite a lifetime of reservations, residents can be encouraged to hold hands or rub each other’s shoulders.”

Even with all the joy and solace pets can provide, I have my personal doubts about therapy animals - not to be confused with robot animals – but both seem to work for some people.

And a good thing that is because the older we get, the fewer friends we have. Last time I wrote about skin hunger here six years ago, one quotation made that poignantly clear (the source website no longer exists):

“One elderly woman put it this way, 'Sometimes I hunger to be held. But he is the one who would have held me. He is the one who would have stroked my head. Now there is no one. No comfort.'”

I know something about that feeling and I have no doubt some of you do too. You can't get as old as some of us are without our social circles shrinking.

Studies have shown, according to Newsday, that people who are significantly devoid of human contact or who resist or avoid touch, could be at a higher risk for experiencing depression and stress. They are likely to be less happy, more lonely, and in general have worse health...”

Further, according to Newsday,

”Satisfying your skin hunger requires you to have meaningful physical contact with another person. Although many people satisfy their skin hunger through sex, or in fact, confuse the need for touch with the need for sex, skin hunger isn't really a sexual need...

“Neuro-chemically, human touch releases the hormone oxytocin, which is shown to be integral to human bonding and in intimacy. Showing affection physically to those closest to us, from something as simple as a pat on the shoulder or back rub, or a hug establishes trust and communicates a commitment to them, and their well being, as well as to bonding with them.”

There are studies, too, showing that as little as 15 minutes a day of touching usually bring benefits. Further, according to The Atlantic,

Studies that involved as little as 15 daily minutes found that touch alone, even devoid of the other supportive qualities it usually signifies, seems to have myriad benefits...

And from The New Yorker:

“In her New York Times Modern Love essay, writer Michelle Fiordaliso makes the case for unexpected moments of intimacy between strangers. 'Touch solidifies something – an introduction, a salutation, a feeling, empathy,' she writes.”

Evidence has been piling up for years that from cradle to grave, the human touch is a necessity to our wellbeing. Newborns who are not held and cuddled do not thrive. And neither do old people. In one series of studies,

”...one group of elderly participants received regular, conversation-filled social visits while another received social visits that also included massage; the second group saw emotional and cognitive benefits over and above those of the first.”

We are living, in these current times, in a touch-free environment, where touching one another is seen as dangerous.

Maria Konnokova reported in her New Yorker story:

”Recently, the Toronto District School Board warned its employees that 'there is no safe touch when you work with children.' Many of our kids spend most of the day in a touch-free zone.

“We don’t mind getting a massage, but we fear embracing touch wholeheartedly, either because we think it’s dangerous, in the case of young children, or 'touchy-feely,' in the case of adults. We await what Tiffany Field, in 1998, called 'a shift in the social-political attitude toward touch.'”

Why wait? The evidence is strong that touching appears to help keep us healthy. Why not start changing this now?




High Rates of Suicide Among Elders

In the past couple of months or so there has been an uptick in the number of media stories about old people taking their lives and, according to those articles, there is an alarming increase in the suicide rate among the U.S. older population.

”In a nation where suicide continues to climb, claiming more than 47,000 lives in 2017, such deaths among older adults...are often overlooked.”

A six-month investigation by Kaiser Health News and PBS NewsHour finds that older Americans are quietly killing themselves, frequently in nursing homes, assisted living centers and adult care homes.

”Poor documentation makes it difficult to tell exactly how often such deaths occur,” reports the KNH/PBS study. “But a KHN analysis of new data from the University of Michigan suggests that hundreds of suicides by older adults each year — nearly one per day — are related to long-term care.

“Thousands more people may be at risk in those settings, where up to a third of residents report suicidal thoughts, research shows.”

According to federal statistics, 16,500 suicides were reported among people 55 and older in 2017 – 364 of them among people living in or moving to long-term care settings – or among caregivers.

Dr. Yeates Conwell is director of the Office for Aging Research and Health Services at the University of Rochester. He says the main risk factors for senior suicide are what are called “the four D’s”: depression, debility, access to deadly means and disconnectedness.

“'Pretty much all of the factors that we associate with completed suicide risk are going to be concentrated in long-term care,'” said Conwell.

Veterans are among the highest risk for suicide in recent years:

”The VA National Suicide Data Report for 2005 to 2016, which came out in September 2018, highlights an alarming rise in suicides among veterans age 18 to 34 — 45 per 100,000 veterans.

“Younger veterans have the highest rate of suicide among veterans, but those 55 and older still represent the largest number of suicides.”

Most seniors who choose to end their lives don’t talk about it in advance, and they often die on the first attempt, he said.

(The suicides referred to in the KHN/PBS article - and others I consulted - are not about people like me who have chosen, when the time comes, medically-assisted suicide. That's a different kind of end-of-life choice with different issues.)

The KNH/PBS research relates the story of Paul Andrews whose father died by his own hand. Andrews says he was “shocked, devastated and even angry about his dad’s death. Now, he just misses him.”

”'I always feel like he was gone too soon, even though I don’t think he felt like that at all,' he said.

“Andrews has come to believe that elderly people should be able to decide when they’re ready to die.

“'I think it’s a human right,' he said. 'If you go out when you’re still functioning and still have the ability to choose, that may be the best way to do it and not leave it to other people to decide.'”

Conwell see it differently. He finds the idea of

”...rational suicide by older Americans 'really troublesome.' 'We have this ageist society, and it’s awfully easy to hand over the message that they’re all doing us a favor,' he said.”

Here is a 10-minute video of this research from PBS NewsHour including some additional information.




Getting Doctors to Listen

Reader comments on Wednesday's blog post, Cancer, Chemo or Old Age?, turned it into a much more important story that it could otherwise be. There are at least half a dozen topics those comment suggest but let's go with ageism in healthcare today.

Ageism among health care providers is a well-known phenomenon. As reported at the website of the American Society of Aging,

”The geriatrician and writer Dr. Louise Aronson (2015) describes a disturbing example of explicit ageism in which a surgeon asks the medical student observing his case what specialty she is thinking of pursuing.

“When she answers, 'Geriatrics,' the surgeon immediately begins mimicking an older adult complaining about constipation in a high-pitched whine.”

You know, if you do things like that often enough, they become commonplace and people soon believe them. But of the many ways some physicians and other healthcare workers can and do demean elders, ignoring them is near the top.

Another Dee had this to say on Wednesday's post:

”I may not be correct, and I don't think I am paranoid, but I really think that they see my age on the chart, the white hair on my head, and not the human being seated in front of them.”

She's not wrong. I know. I've been there.

Six months or so before my pancreatic cancer diagnosis, I went to my then primary care physician about a bunch of seemingly unrelated symptoms including neon-orange urine. It practically glowed in the dark, so you'd think that alone would alert a doctor.

But noooo. He kept typing at his computer as I answered his questions and after seven minutes of this, he got up to leave saying something close to, “I'm sure it's a simple virus. You'll be fine soon.” And he left the room.

Huh? I fired him that day and began my search for a more attentive doctor.

Several TGB readers didn't use the word “ageism” in their comments but it is certainly what they are talking about. Seventy-two-year-old Judith Darin, an RN who has worked as a hospice nurse and now works at a skilled nursing facility that is, she says, the best place of its kind she has seen.

”What Dee describes about her treatment,” continues Judith, “and how medical people view her, is a reality. And I have been guilty of thinking about patients (and elderly folks in general) in the way that Dee describes.

“But that has changed. As I get to know each of my patients as individuals, and consider all they have been through, and learn to LISTEN, my perceptions have changed.

“When I am in my own doctor's office, if I don't feel like I am being heard and respected, I ask the staff to stop what they are doing, and to listen to me. I am an RN and try to care for my patients in a holistic way, but now I am also a woman in my 70s with white hair.”

Nancy Hutto left this story:

”My sister, who is 84, recently went to the emergency room with heartburn and back and chest pain, after I made the call to 911. The excellent doctors there found an artery 95 percent blocked and inserted a stent.

“This was after a visit 2 weeks earlier to her cardiologist and several months of increasingly debilitating loss of energy, shortness of breath, and risk factors such as diabetes and an autoimmune disease requiring daily prednisone.

“We have excellent health care in the Seattle area but we still need to be squeaky wheels in advocating for ourselves. It is also helpful to have an advocate who will listen and make the decision that an emergency is in progress, even at the risk of a false alarm.”

I'm not up these days for starting a medical ageism protest organization but we can stand up for ourselves. I deliberately decided to do that two years ago when I found my new doctor(s) at Oregon Health & Science University (OHSU).

Since then, I've made it a point to find out about the doctors, nurses, medical assistants, schedulers, etc. who are part of my treatment team. We exchange some personal information – whether we have kids, where we live, what we like to do when we're not working and more.

Maybe in the beginning it was a tactic to be sure I get the care I need and am not overlooked. But now it's real. We've become a certain kind of friend to one another.

We joke around and we talk about serious health issues too. Occasionally, even politics.

Some of them read TimeGoesBy so that comes up now and then. They talk about how they deal with the inevitable outcome of treating mostly old people who have a deadly disease. Without ever being sappy, they are all remarkably cheerful and likable people.

What has happened over two years is that we have come to dwell together in that middle ground between service people and friends. They have expertise I don't have – I need them for their professional skills – and I also need their kindness and understanding.

Maybe they need that too and we're both gaining from what I see now as our heartfelt attention to one another.

God knows I could be wrong but I believe that taking the time to get to know these terrific, accomplished people more personally, allows them to see me, the person, and not just my bald head.




Do you Nap?

The first infusion of my new chemo regimen that began early this year left me bone-weary and exhausted. I slept pretty much around the clock and finally felt well enough to get out of bed for a short while on the third day.

Three-plus days out of 14 (the time between infusions) seemed unreasonable then but even though chemotherapy is known to be cumulative (the side effects get worse over time), I was willing to give it another shot.

And lo – it was easier the second time. I was in bed for only part of those three days.

Since then, each infusion has been incrementally lighter (last week's hardly affected me at all) and although I no longer stay in bed all day afterwards, I have adopted napping as a tool to help keep me healthy.

Just this week, AARP published a story about the benefits of napping:

”Research shows that a short snooze can boost brain power, improve your memory as well as your mood (including your ability to shake off daily frustrations), and make you more alert.

“NASA scientists discovered that a 26-minute nap improved pilot performance by a whopping 34 percent — and companies such as Google, Samsung, Procter & Gamble, and Ben & Jerry’s not only allow but actually encourage employees to take snooze breaks.”

Further, 36 percent of Americans between the ages of 55 and 64 are not getting the recommended seven to nine hours of sleep a night:

”'As we get older, it can become harder to get enough quality sleep at night,' says Michael Grandner, director of the Sleep and Health Research Program at the University of Arizona College of Medicine.”

That doesn't mean people older than 64 aren't sleeping enough too, it's just that AARP doesn't always include them. (Shame)

Now here's an interesting suggestion about napping:

”...if you can down a cup of coffee right before — yes, before — your siesta, all the better,” reports AARP. “A Japanese study found that doing so can amplify the benefits of a nap, helping you feel more alert and refreshed when you wake up.

“Caffeine usually takes about a half-hour to really kick in — which, coincidentally, 'is about how long your nap should be,' Grandner says.”

WebMD appears to disagree:

”If you’re feeling tired but have work or studying to get done, you may be better off taking a nap than sipping a coffee. Compared to caffeine, napping can bring better memory and learning.”

WebMD has a list of nap benefits. Napping can

Improve your memory
Lift your mood
Ease stress
Make you more creative
Help you sleep better at night

Further, WebMD tells us that

”To get the most benefits out of a nap, you need to time it right. Most people will find an afternoon snooze to be the most natural and helpful. Some say sleep is better between 2 and 3 p.m., when humans naturally have a dip in alertness.”

You can see the entire WebMD slide show of napping benefits here.

I've never been a napping kind of person until this cancer happened. I've slowed down during these two years (just about everything takes longer than before) and sometimes I just want to lie down for a few minutes. Although I rarely sleep, I feel more alert after 30 minutes.

Over the past decade or so, napping – not to mention a normal, eight-hour workday - got a bad reputation. The “cool kids” made it a fetish to work 12, 14, 15 and more hours a day and it is only in the past year or two that there have been enough reports about the detrimental effects of too little sleep that some people are beginning to take note.

Because I've been so lucky with few side effects from my chemotherapy, I'll probably not nap every day – it's not been a habit with me. But nowadays, I use it when needed and it helps a lot.

What about you? And if you nap, did that change as you've grown older?




Working Memory Boost for Old People?

When, in the middle of a conversation, I forget a word I need – usually a noun – I lament that I am not a comedy writer. If I were any good at that, there is fun to be had with a sketch of two old folks trying to have a chat while every third or fourth word won't come to mind.

(Some would call such a sketch ageist, but not me.)

It happens to me every day (while I write, too) and multiplies during three or four days following chemotherapy when “chemo brain” is at its worst. Sometimes the entire idea or concept of what I'm trying to say disappears.

Really annoying.

Recently, researchers at Boston University tested the memories of the brains of people older than 60 and those of a similar group of people in their twenties.

Unsurprisingly, the younger subjects did better,” reported MIT Technology Review.

“Then participants were fitted with an electrode-covered cap that stimulated two areas of the brain (the temporal and prefrontal cortex) with electricity for 25 minutes in a way that made the brain waves fall into sync.

“When the groups were tested again, the participants who had been stimulated were much improved in the tests—and were as good as the 20-year-olds. The effect lasted for at least 50 minutes, when measurements were stopped.”

BrainZappingBostonU

One of the researchers, Dr. Robert Reinhard, said they can bring back a more superior working memory function that the elder group had when they were younger:

"'This is important because the global population is rapidly ageing, and the elderly struggle with many real-world activities that critically rely on their memories,' Reinhard told the BBC.

“These included 'recognizing human faces, navigating the physical environment, remembering to take their medication and making financial decisions,' he said.”

Here's some really good news for us old folks: Reinhard told the BBC:

”...the largest improvements appear in the people with the greatest deficit at baseline...people who are struggling the most."

Another researchers have reported similar results including this one from a Fox News story:

”Dr. Barry Gordon, a professor of neurology and cognitive science at the Johns Hopkins School of Medicine in Baltimore...

"It's a superb first step" toward demonstrating a way to improve mental performance, said Gordon, who was not involved in the new study.”

Others are not so sure:

”Dorothy Bishop, a professor of developmental neuropsychology from the University of Oxford, says: 'It would be premature to extrapolate the findings to everyday functioning in individuals with clinically significant memory problems.

"'There is no indication that any beneficial effects of stimulation persist beyond the experimental session.

"'Considerably more research would need to be done before concluding that this method had clinical application.'"

No doubt Bishop is right to be cautious with these preliminary findings, but as someone who reads a lot of reports of early research results, I wouldn't trash this one. It has interesting possibilities including uses for dementia patients.

Meanwhile, I'm sure interested. If the brain stimulation were available now, I'd be first on line because...

Well, damn. What was it I wanted to say???

What about you – would you be on line with me? You can read more details about the research by following the links above.




FDA Warns Against Goulish Anti-Aging Treatment AND...

The Alex and Ronni Show at the bottom of this post featuring Ronni's black eye.

* * *

The U.S. Food and Drug Administration (FDA) last week, issued an alert to older people that transfusions of young people's blood as an anti-ageing treatment are “unproven and potentially harmful”.

”The FDA goes on to note that such infusions are known to pose a range of health risks in humans,” reports Ars Technica. “These risks include spreading infectious disease, triggering allergic reactions, and causing lung injuries.

“In some people—particularly those with heart disease—the infusions can also overload the circulatory system, causing swelling and breathing trouble, the agency explains.”

I reported on the goulish “young blood” transfusions two years ago highlighting a private clinic called Ambrosia in Monterey, California, where people could pay $8,000 to have blood plasma from teenagers and young adults pumped into their veins.

Ambrosia's owner, Jesse Karmazin, said then that most participants “see improvement” from a one-time infusion within a month.

Although the FDA did not mention Ambrosia in their warning last week, STATnews reports that

”Karmazin, has yet to report the results of a clinical trial he ran testing the procedure, which involves an off-label use of an approved product. On Tuesday [19 February 2019], however, following the release of the FDA statement, a notice on Ambrosia’s site said it would no longer offer the transfusions.”

Further from Ars Technica:

”The sellers suggest that doses of young plasma can treat conditions ranging from normal aging and memory loss to dementia, Parkinson's disease, multiple sclerosis, Alzheimer's disease, heart disease, or post-traumatic stress disorder, according to the FDA.”

People have been looking for a fountain of youth since at least Alexander the Great without any luck. But a growing number of researchers throughout the world have been working for years to develop treatments to slow the ageing process and extend the human lifespan.

I would be a lot happier if they would concentrate on those diseases of age listed above. As an old woman living with terminal cancer, I agree with Markus Kounalakis writing at Washington Monthly:

”The latest young blood therapy will likely only go to risk-taking well-heeled early adopters and late stagers. Here’s an alternative: Live a happy life, love, practice random acts of kindness, drink in moderation, and don’t smoke. It’s a lot easier than getting stuck with either a needle or a big blood bill.”

What do you think?

* * *




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...