October 3, 2015

New School Year, New Blog Schedule

Fall has always seemed like the start of a new year for me, undoubtedly because I spent more than 20 years attending school long ago. So it was no surprise that I took a fresh look these past few weeks at what I've been doing, where I'm going, and what I need to do.

Perhaps the most important decision from this review is that I'll publish blog posts every other week. The alternate weeks will be completely free for me to do whatever.

For nearly six years, I've been putting up four or five blog posts every week. I've seldom taken more than three or four days off at a time. I love working on the blog, researching and writing.

But for some time now, it's been clear that my obsessive-compulsive tendencies have once again gotten things out of whack. I fall into the trap of living my life according to Mae West's maxim that "too much of a good thing is a good thing." The blog is the latest "good thing." It doesn't pose the same serious threat to my well-being that resulted from my overdoing the "good things" of alcohol, nicotine, and sex. But I'd be better off guided by the "less is more" mantra, which I've often discussed here in relation to our healthcare system.

The various threats to our health are probably my number one blog topic. Invariably, exercise appears at the top of every list of things we should do to counter those threats. But then I use the time and effort that goes into writing these posts as an excuse for my failure to get enough exercise.

With each passing year, it becomes harder and takes longer for me to transfer my thoughts into blog posts. The increasing rigidity in my hands creates more keyboarding mistakes. Learning to use the Dragon voice recognition software has helped. It would help even more if I spent some time at the Dragon learning center, but I'm too busy correcting my mistakes to do that.

The Pause That Refreshes
I've come up with a to-do list that includes a lot of items, like "learn more about Dragon." It will be interesting to see how many of them are crossed off a week from now. I'm typically much better at "Get Ready" and "Get Set" than I am at "Go."

October 1, 2015

Recommended Readings

Today I want to share a few articles I recently read and liked.

This first story appeared in the May 14 issue of The New York Times Magazine. Written by Robin Marantz Henig, it's a deeply felt work. Here's how it begins:

The Last Day of Her Life

When Sandy Bern found out she had Alzheimer’s, 
she resolved that before the disease stole her mind, 
she would kill herself. The question was, when. 

Sandy Bern, a Cornell psychology professor, found out she had Alzheimer's a month before her 65th birthday. She quickly decided “I want to live only for as long as I continue to be myself."

Over the next several weeks, Sandy told those closest to her about her diagnosis and her plan to end her life before she became incapable of doing so. No one in that inner circle tried to talk her out of suicide; they knew how fierce she could be once her mind was made up.

All they asked was that she promise not to choose a method that would be particularly disturbing — using a gun or jumping off a bridge into one of Ithaca’s famously beautiful gorges. Sandy had contemplated both of those options, but she didn’t want that sort of death either. “What I want,” she typed in her journal in an emphatic boldface font, “is to die on my own timetable and in my own nonviolent way.”

I was talking recently with a friend whose husband is in the early stages of Alzheimer's. She said he seems happier now than he had ever been -- a development not unusual among Alzheimer's patients. As the Bern narrative continues, it almost becomes a suspense story as the once strident Bern begins to mellow, and you wonder if she'll abandon her suicide plan

Here's  an excerpt from the article describing some of what was going on as Bern mellowed:
At one point, as Bern's power fades, her daughter, Emily, gives birth to Bern's first grandchild. Little Felix makes Bern think there might be some things her new self is better at than her former. 
She told Emily that her "new brain" might actually make her better suited to being a grandmother than her focused, hyper- analytical "old brain." She seemed to have found a way of being that she liked, content to sing silly songs and make nonsense sounds for hours on end. 
Emily, liked her mother this way too. As a child, Emily wanted to wear her hair long and take ballet lessons; Sandy, ever vigilant about gender stereotypes, nudged her to cut her hair and play soccer instead. But now Sandy didn't seem to care about such things. Emily thought that her mother was taking pleasure in life in a way that the old Sandy could not have anticipated – – and she found herself hoping that the joy her mother took in Felix might make her reconsider her intention to end her life quite so soon.
I hope these few paragraphs will encourage you to read the full story. Click here for that.

September 30, 2015

Advance Directives: One More Time

Last week, I ran a series of posts about advance directives... the documents that clarify and formalize what I want – and don’t want – when I can no longer make healthcare decisions myself.

It is hard to describe the peace of mind that comes with knowing that my family, key providers, and healthcare proxy understand my wishes.

Still, there are millions of Americans who cannot know that peace of mind, because they haven’t taken the fairly simple steps involved to complete the documents – 1) a living will and 2) a power of attorney / healthcare proxy.

Maybe some of those people really haven’t given any thought to the Final Things. But I suspect most of the unprepared are simply uncomfortable addressing their own last days and/or initiating the difficult discussions with families, friends, and doctors.

I’d be much more uncomfortable thinking I was leaving my nearest and dearest to fend for themselves when the time comes… subjecting them to indescribable emotional (and financial) distress.

I don’t give advice on this blog; it’s a decision I made at the start. But I don’t mind offering this recommendation: if you don’t have an advance directive in place, think about doing it soon.

There are many online resources to help. If you search “advance directives,” many links appear. Here is just one, from AARP: Advance Directives: Creating a Living Will and Health Care Power of Attorney.

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After my posts last week about advance directives, I was intrigued to see a piece by Paula Span in The New York Times’ “The New Old Age” (a blog feature I regularly enjoy) titled Near the End, It’s Best to Be ‘Friended’.  

I hope running it here underscores the importance of getting the documents in place. The very last line in this story – uttered by its 88-year-old protagonist -- says it all: “I should have done it yesterday.”

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The unconscious man in his 90s was brought to an emergency room where Dr. Douglas White was a critical care physician. The staff couldn’t find any relatives to make medical decisions on his behalf.

“He had outlived all his family,” recalled Dr. White, who now directs an ethics program at the University of Pittsburgh Medical Center. “We were unable to locate any friends. We even sent the police to knock on his neighbors’ doors.” 

September 29, 2015

Supporting Brain Health: Chocolate? Yes. Anticholinergic Drugs? No.

Today brings another post from the health grab bag.

The Case for Cocoa
A recent report in the Journal of Alzheimer’s Disease suggests that polyphenols -- the micronutrients in chocolate -- might be used to maintain brain health and even prevent age-related neurodegenerative diseases like Alzheimer’s disease (AD).

For some time, the good reputation of chocolate-for-health has been on a roll. We’ve already heard that flavanols – cocoa’s particular polyphenols – have blood-thinning properties and pack a powerful antioxidant effect that reduces cell damage caused by coronary disease. A study published this summer in Medical News Today suggested that eating 100g of chocolate every day was linked to reduced risk of heart disease and stroke.

Earlier research also suggests that eating cocoa extract helps reduce age-related cognitive decline and supports healthy brain aging.

In the latest study, Dr. Giulio Maria Pasinetti -- professor of neurology at the Icahn School of Medicine at Mount Sinai in New York, NY – and his team found that cocoa polyphenols did a couple things in particular:
  • help reduce the production of damaging proteins now linked to AD – beta-amyloid and tau clumps.
  • help clear out those harmful proteins already aggregating in the brain.

Cocoa’s polyphenols are particularly adept at crossing the blood-brain barrier, an obstacle we’ve frequently encountered in both prescription meds and dietary supplements. For any substance to have an impact on brain function, it must first find its way into the brain from the blood… not always an easy hurdle.

Pasinetti summed up his study this way:
Therefore, emerging biomedical research experimental evidence, and new clinical translational studies all support the major interest in the development of cocoa as a botanical source for the maintenance and promotion of health, in particular, in the brain.

After urging additional studies, particularly with human subjects, Pasinetta sounded an alarm. Demand for cocoa is increasing as we learn more about it, but its availability is now challenged by disease and climate change. He recommends the development of new strains of cocoa that are more fruitful, and less vulnerable to disease.

The Case Against Anticholinergic Drugs
Articles often recommend what we SHOULD do to support brain health and function -- especially among seniors – with advice about diet, exercise, supplements, games, sleep.

September 25, 2015

Advance Directives: Reducing Costs and Improving Healthcare

With the death of Oliver Sacks, Atul Gawande becomes my favorite doctor/medical writer. He has taken on issues that resonate with me. His recent book Being Mortal describes how doctors, uncomfortable discussing their patients' anxieties about death, fall back on false hopes and treatments that actually shorten lives, not improve them.

Overkill, his most recent article for the New Yorker, carried this subtitle: 
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

One of the best things we can do is prepare an advance directive that spells out for doctors and other healthcare providers what we want them to do, and what we don't want them to do. When I read and write about healthcare issues, I'm often frustrated because there's often so little I can do. That's not the case here.

Drafting an Advance Directive
There are two types of advance directives, and it’s important to have both.
  • A living will spells out what types of medical treatment you want at the end of life if you are unable to speak for yourself.
  • A health care power of attorney is someone you appoint to make healthcare decisions on your behalf. That agent (also called an attorney-in-fact or proxy) becomes your spokesman and advocate on all the medical treatments you address in the document.
Many states combine the two forms into one document. Advance directives are legally valid throughout the United States, and you don't need a lawyer to complete one.

One state's advance directive doesn't always work in other states. If you spend significant time in several states, you should complete advance directives for each state.

An advance directive does not expire. It remains in effect until you change or rescind it. If you want to make changes, you should complete a new document.

To download a free advanced directive form for your state, click here.