Guest Post: "A Creative Use For Depression and Loneliness and Fears"

In my campaign to get rid of clutter, I came across a forgotten folder labelled "Worth Re-Reading." In it, I found the sermon below by John Harper, who served as rector of St. John's Church ("the Church of Presidents") on Lafayette Square, Washington, DC, from 1963 to 1993. John delivered this sermon on November 18, 1990.

One of my most cherished friends, John died in 2002. I asked his widow, Barbie -- who remains a dear friend -- for her OK to publish the sermon here. I was right when I designated it "Worth Re-reading."

Our Old Friend The Dark

Make a Joyful Noise: Singing and Parkinson's

Over the weekend, I got my first overdose of holiday music, 2011. OK, Thanksgiving has come and gone, so I shouldn’t be surprised to hear “Jingle Bells” wherever I go for the next few weeks.

I know how listening to music not only stimulates my brain but also helps me relax. Sadly, choir membership isn't in the cards for me, since I'm tone deaf and totally without musical gifts. In junior high school, the music teacher told me (in front of the entire class) that I couldn't carry a tune in a truck. That's an opinion I'm sure is shared by those unfortunate souls within earshot at Washington's St. John's Church on Christmas Eve, when the spirit moves me to belt out Hark, The Herald Angels Sing. At the end of that service, when the electric lights go down and the congregation quietly sings Silent Night by candlelight, I'm usually so choked up I couldn't sing even if I sounded like Andrea Bocelli.

Checking Out Your Meds: A Few Tips

Last week, I talked about the surprising things I learned about the standard Parkinson's med Azilect, after some belated research. This prescription drug, which costs nearly $4000 a year, comes with a long list of medicines, supplements and foods to avoid or use with caution. Who knew? Perhaps the information appears in the tiny-print notice inside the box... info I'd bet most users can't -- or won't -- read. And I certainly can't expect my neurologist or pharmacist to warn me about the potentially harmful combinations that my research uncovered.

My experience with Azilect wasn't unique; I checked my other meds and found similar cautions I hadn't known about.

All of us -- especially seniors and  people with serious chronic illnesses -- should learn more about the drugs we take. Chances are we're using a variety of drugs, which increases the likelihood of adverse reactions.

Happy Thanksgiving --- Then and Now

If I remember correctly (always doubtful these days), that's Norman Rockwell peeking out at us from the bottom right of his famous painting. 

Here's one of my favorite Thanksgiving quotes:

I celebrated Thanksgiving in an old-fashioned way. I invited everyone in my neighborhood to my house, we had an enormous feast, and then I killed them and took their land. --Jon Stewart

Don't get me wrong. I love Thanksgiving. It's my favorite holiday because it's focused on family and friends without the over-the-top commercialism of Christmas. And, unlike Christmas and Easter, it's a holiday everybody can celebrate.

Why It's Essential to Research Your Meds!

Researching yesterday's post on my high-cost Azilect, I encountered sites warning of possible adverse consequences of taking Azilect with certain foods or other meds. Some of those foods appear regularly on my menu, and I've taken some of those meds, too.

How do you find this "cautionary" info? By reading the fine-print document enclosed in the box from the manufacturer? I don't have the patience -- or the eyesight -- to seek helpful nuggets buried in the tiny, dense verbiage.

We're told to consult our doctor or pharmacist. I wonder -- would mine have cautioned me about mixing Azilect with the pickled herring I frequently enjoy at lunch? That favorite snack is just one of many foods shown on the "watch-out" list for people taking Azilect.

Bad News on $4,000-a-year Azilect: No Generic Until 2017

I reported earlier this month that a generic for Lipitor (the pricey drug designed to lower cholesterol levels) would be available this month, and that the patent on the even more expensive Azilect (commonly prescribed for Parkinson's) was due to expire next February. See http://bit.ly/tk3S3b.

While the plans for a generic Lipitor are now confirmed, we've learned that the Azilect patent, held by Israeli pharmaceutical giant Teva, has been extended for five years and will now expire in February, 2017.

That's bad news for those of us who use Azilect, whose high tariff -- in combination with Lipitor's -- pushed me into Medicare's "donut hole" last year. Now, Lipitor won't be the problem it was, but Azilect alone will drive me in the dreaded donut hole next year.

The donut hole opens in 2012 when my total drug cost (what I pay plus what my plan pays) hits $2,930. A 90-day supply of the 1.0 mg Azilect (my prescription) costs $938. Three refills of that 90-day prescription would just about reach my threshold. Add in the cost of the other meds I take, and I'll probably fall into the hole in mid-summer.

Once in the hole, those of us covered by Medicare must pick up the full tab until the total cost-of-meds hits $4,700. Luckily, we get a break because last year's Health Reform Law requires pharmaceutical companies to offer brand name drugs at half price.

Stem Cells, the Vatican, Politics: A Strange Brew

On September 28, I wrote on a study about creating dopamine-producing brain cells from embryonic stem cells. The story carried big implications for possible PD therapy. (http://bit.ly/mROIHr)

On October 21, I wrote about the Vatican’s signing a deal to collaborate with an American non-profit on adult stem cell education and research. (http://bit.ly/pNAXrA)

A November 7 article from FierceBiotech Research reported that Sloan-Ketting Institute for Cancer Research in New York identified a third ingredient that enables successful transformation of embryonic stem cells into dopamine-producing brain cells in both rodent and monkey models. (It's the absence of dopamine that creates the tremors and control issues so often identified with Parkinson’s.)

On November 7, we learned that the National Parkinson Foundation (NPF) hailed this new study. At the same time, the NPF’s National Medical Director, Dr. Michael Okun, cautioned:

The dopamine system is but one of many neural systems affected in Parkinson’s, and in people with the disease, we still need to address progression. We hope that this success translates into relief for patients, and that it inspires future success in treating the symptoms of later-stage disease and addressing the underlying pathology

3am: Meditation. 11am: Contemplation. 2pm: "The Way." Near Perfect Day!

All my life I've experienced spontaneous moments when I find myself thinking "God, I love my life!" They don't occur while I'm gazing at the Taj Mahal or the ceiling of the Sistine Chapel, but when I'm quietly savoring some unexpected, simple joy. I remember such a feeling years ago, arriving home from a bike ride on a perfect autumn day.

I had another one of those experiences today, driving home from a late afternoon movie, reliving the simple pleasures of the day:

Whitman and the Astronomer: Advice for Us All

On Tuesday, in my ramble about “Lessons Learned,” I mentioned “nature deficit disorder.” That phrase describes the negative effect that prolonged removal from the natural world – the great outdoors – has on us. I learned, over these past months of confinement indoors, that I am susceptible. Enough with the tyranny of the morning newspaper. Turn off the TV with all those yammering talking heads. Go outside, look, listen, and be quiet!

My friend Larry replied, and gave me “something to think about while on my porch.” I had never encountered this poem by the great Walt Whitman (pictured above in communion with a butterfly), and liked it so much I wanted to share it here. Thank you, Larry.

////////////////////////////////////////////////////////////////
When I heard the Learn’d Astronomer


When I heard the learn’d astronomer;
When the proofs, the figures, were ranged in columns before me;
When I was shown the charts and the diagrams, to add, divide, and measure them;
When I, sitting, heard the astronomer, where he lectured with much applause in the lecture-room,
How soon, unaccountable, I became tired and sick;
Till rising and gliding out, I wander’d off by myself,
In the mystical moist night-air, and from time to time,
Look’d up in perfect silence at the stars.
///////////////////////////////////////////////////////////////

Re-reading this poem, I smiled... recalling the personal pledge I made when I retired -- to NEVER AGAIN get involved in anything that required attending business meetings. (But I love going to the author talks at Politics & Prose, Washington's treasured independently-owned bookstore. I've yet to hear a talk by a "learn'd astronomer," however.)

Back on the Treadmill. Go, Derek!

I can't deny it: I like comments from readers. There are times -- we've all had them -- when I feel like I'm "going it alone." So, it made my day (an unusually warm mid-Novermber day, at that) when I received this email from Derek while relaxing on my back porch. It needs no further introduction.

Many thanks for the email, Derek. Good luck, and keep me posted. Thanks for letting me share this note today; I'll be happy to provide updates on your success if it's OK with you. Bravo!

Reflections on My Summer Setback: Lessons Learned

So far, I've been blessed with good health and few ailments. Sure, I've been diagnosed with Parkinson's disease and prostate cancer. But the PD was only diagnosed a couple of years ago, and so far the symptoms are pretty easy to deal with. As for the cancer, my prostate was removed in January, 1995, the month after I retired. Post-operative PSA readings indicated that some cancer cells remained, but in the 16 years since then, the semi-annual checkups have shown a slow rise to 4.0 up to this spring. I'd almost forgotten about this cancer until my PSA jumped to 9 in September.

The compressed fracture of the vertebrae from the August car crash was my first experience with extended pain. Finally, just last week, I stopped using pain killers and wearing the back brace. Progress!

Still, this issue was a minor setback compared to what I've seen others deal with, particularly when I recall the deaths from AIDS of so many close friends, and the more recent courageous fights that several of my contemporaries now wage against life-threatening and chronic illnesses.

With my PD and prostate cancer, I know more setbacks lie ahead. Now that I feel I'm moving forward again after the crash, I've been reflecting on what I've learned from this experience, and how those lessons might help me down the road.

Quiz: What Is Used To Control The Behavior of the Deer in My Backyard, Many of My Dear Friends, and Me?

We've had a run of some pretty serious stuff over the past few weeks -- death and dying, death panels and regulating healthcare tests and procedures, our debt crisis, and the future of Social Security and Medicare.
So, let's take a break for a silly interlude. See if you can come up with an answer to the question above.

Background Clues
Even though we live in the city, our Palisades neighborhood has deer in abundance. I've seen as many as five together in my backyard. It's always a lovely surprise. But it's not so lovely when the hostas get eaten up, and my young serviceberry tree trunk gets mauled from male deer rubbing their antlers against it.

My backyard ends with a hill that goes down to my neighbors' fenced-off swimming pool. The deer like to sleep in the protected patch at the bottom of the hillside. When they wake, they head up the hill and into my backyard for food and frolic:

After snacking on hostas, she takes a rest. This picture was taken in June. A month later, the hostas are bare stalks.

AN EMAIL I RECEIVED: Meeting at the Corner of Health and Money! What's Your Reaction?

On Wednesday, I received an email in response to something I'd posted. I asked the sender if I could "publish" it, with her name. She declined to be identified -- I respect that wish -- but she gave me permission to post her thought-provoking note anonymously. And I thought that this would be a good time to remind you that you, too, can send me an email at the address I publicize here: jschappi@gmail. If you'd prefer to correspond via email -- as this person did -- that's great! I'd love to hear from you.

Of course, you are always welcome to leave comments right here on the blog where others will automatically see them. Remember, you can post comments without disclosing your identity, if you prefer. What matters to me is this, and this only: I love getting responses and opinions, however they arrive, and whatever they say. If you disagree with something I've written... even better. Just let me know!

I admit: I soft-pedal my strong views on political issues on this blog, and I despise the slash-and-burn attacks we see too often on TV. IMHO, much of our current political paralysis results from excessive attention given to the crazies at both ends of our political spectrum.

We need to hear more thoughts from sensible people somewhere in the middle, like the author of this email who reminds us that -- healthcare reform politics aside -- we're dealing with human beings struggling with end-of-life choices that make real sense -- personally and financially.

Hope to hear from more of you in the "silent majority." 


 HERE'S THE EMAIL I RECEIVED:

John,

You've generated several conversations lately in one of the scariest parts of town: the intersection of Health and Money. We pause there – under the shade of the Discomfort Tree – throw around some quick ideas, and usually get the hell out of there as quickly as we can.

We need to linger. Honestly, I know of no other place where we need to spend more time -- if we care about our children’s and grandchildren’s futures… and our country’s frightening deficit.

Fresh Hope That Lipitor and Azilect Won't Push Me Into the "Donut Hole" In 2012

I  recently paid about $500 for a 90-day supply of Azilect, the prescription drug used by most people with Parkinson's. Because I had fallen into Medicare's so-called "donut hole" earlier this year, I wondered what I might do to avoid -- or at least delay -- falling into that same hole next year.

The Donut Hole for 2012

Most Medicare prescription drug plans have a dollar limit on what they cover for prescription drugs. Once you and your drug plan have spent a certain amount of money for covered drugs, you have to pay all out-of-pocket costs up to a yearly limit, after which Medicare's catastrophic coverage kicks in. This coverage gap is the dreaded, infamous "donut hole." But you needn't pay all the costs while you're in the hole. Your plan will cover at least 7% of generic  drug costs. You also receive a 50% discount on covered name brand drugs, while the manufacturer covers the other 50%.

The entry point for the donut hole varies from plan to plan, but this year it was $2840. In 2012, it will increase to $2930. Last year, the donut hole ended and Medicare's catastrophic coverage took over at $455O in annual drug costs. Next year it will be $4700. So, the donut hole for 2012 will run from $2930 to $4700.

Azilect and Lipitor: My High-Cost Drugs
Last year, two drugs were primarily responsible for pushing me into the donut hole:

AARP Is as Crazy as the Tea Party and More Dangerous... and I'm a Member!

Lucky for my blood pressure that I don't watch much TV. I get furious every time I see one of AARP's ads warning Congress that every senior will go to the polls and vote OUT any legislator who dares to reduce Social Security or Medicare benefits.

Here's the latest -- and most offensive -- in the series:

Relief for Insomnia: Try Meditation, Not Pills

Last Sunday's New York Times carried a feature on the upsurge in sleeping pill use by women, particularly working mothers. Here's some of what the Times had to say:

Mother’s little helper of the new millennium may in fact be the sleeping pill — a prescription not likely to inspire a jaunty pop song anytime soon. Nearly 3 in 10 American women fess up to using some kind of sleep aid at least a few nights a week, according to “Women and Sleep,” a 2007 study by the National Sleep Foundation, a nonprofit research group.

In the study, 80 percent of women reported being just too stressed or worried to drift happily into dreamland. Sleep clinics report that three in four insomnia patients are women.

A contributing factor to this epidemic of sleeplessness, sleep specialists say, may well be the persistent creep of technology into the evening hours, a time that formerly was spent relaxing and winding down.

Dr. Nancy Collop, director of the Emory Sleep Center in Atlanta, says: "There's always the worry another e-mail has come in. Just the light from the electronic book or the iPad screen is stimulating."

It's hard to resist the temptation to take one last look at Facebook or your e-mail before going to bed. For many, that makes falling asleep in the first place a problem.

Coffee: Good or Bad for Us? The Verdict is IN.

For most of us, the potential benefits of coffee far outweigh the risks. Over the last few years, a surprising number of research studies have buttressed that verdict. Why this reversal, in light of the earlier warnings about coffee?

Earlier studies didn't always take into account that health risk behaviors -- like smoking and lack of exercise -- tended to be more common among heavy coffee drinkers. So, current studies have generally found no connection between coffee drinking and an increased risk of cancer or heart disease.

But current research still finds some risks. High consumption of unfiltered coffee is associated with mild elevations in cholesterol levels. Another study found that two or more cups of coffee a day can increase the risk of heart disease in people with a specific -- and fairly common  -- genetic mutation that slows the breakdown of caffeine in the body. So, how quickly you metabolize coffee may affect your health risk. Too much coffee can result in jitters and stomach upset. One study found an increased risk of miscarriage when a woman is a heavy coffe-drinker.

That's the downside. We coffee lovers -- who can't start the day without our java fix -- are well aware of the energy-boosting effect of caffeine. But look at this array of studies finding other possible health benefits from coffee consumption:

Watch Out For This Nursing Home Scam!

One fifth of Medicare nursing home patients with advanced Alzheimer's or dementia were sent to hospitals for questionable reasons in their final months, often enduring tube feeding and intensive care.

Researchers suspect that it's not a coincidence, since Medicare pays a nursing home about three times the normal daily rate when it takes patients back after brief hospitalizations. A group of researchers from Brown University, Harvard University and Dartmouth Medical School studied about 475,000 nursing home patients who had been transferred to hospitals. Among them, 19 percent were moved for questionable reasons.

The Best Way to Die

"SHE LIVED -- AND DIED -- JUST THE WAY SHE WANTED"

The more I read, the longer I live, the more I understand how important it is to prepare for death.

Thanks to the conversations I've had -- first and most importantly with myself and then with my kids and doctors,  I’m as ready  as I can be (the unexpected, however, seems to happen more often than the expected) as are the people I love. My primary doctors have a good sense of  the choices about care that I'd prefer. If you've visited this blog before, you've probably heard me say that it’s the QUALITY -- not length -- of life that matters to me. I've said that so often, my kids no doubt say to themselves "There he goes again."

Many, understandably are reluctant to initiate conversations on death and dying.. They’re difficult discussions, and we’re probably more worried about making our families uncomfortable than we are about our own discomfort with the topic. But NOT having those talks – with our families and with our doctors – can end up causing infinitely more distress for the people we love and needless uncertainty among our caregivers.

Seniors and Social Media

In December, 2010, Pew Internet published a report about internet use. One general conclusion – no surprise – was that certain online activities have become popular across all age groups. These activities include:

• Email
• Search engine use
• Seeking health information
• Getting news
• Buying products
• Making travel reservations or purchases
• Doing online banking
• Looking for religious information
• Rating products, services, or people
• Making online charitable donations
• Downloading podcasts

Another conclusion in the report was more interesting to me: while it’s true that younger internet explorers are still most likely to use social networking sites like Facebook and Twitter, the fastest growth in this area has come from users 74 and older. Since 2008, the percentage of senior internet users who visit social networking sites has quadrupled, from 4% to 16%.

Halloween on Sherier Place: It Doesn't Get Any Better Than This!

I love my city (Washington, DC -- I know, but I'm not talking about the government) and my neighborhood (The Palisades). I wrote a couple months ago about what I think is the prettiest street in the Palisades. See
http://bit.ly/rAPNni

But, for me, the nicest street is Sherier Place, partly because 5030 Sherier was our first house in the Palisades, where we spent the early years, during our kids' childhoods. Mainly, it reminds me of the small town neighborhood street in Ithaca, NY, where I grew up.

So, on Halloween Eve -- a glorious fall Sunday -- I got out my camera and headed for Sherier Place, knowing it would be Halloween Central for decorated houses. Here's what I found in just a 3-4 block stroll.

For starters: