April 30, 2013

My Internist, Like Many Others, Is Switching to Concierge Medicine

My long-time internist has informed all his patients that he is changing his practice to "concierge" medicine. If I want to continue with him, I will have to pay a $1,500 annual fee.

If you haven't faced a similar choice already, there's a pretty good chance you will. About one in three private-practice physicians are considering transitioning to subscription-based care, like concierge medicine, according to a recent Accenture study.

This trend -- and the issues it raises -- are so important that I'm going to explore the pros and cons over the next several days. Since my internist's proposal is fairly typical, I'll describe what it involves today.

My internist, Richard Schubert, has been in private practice in Washington, D.C. since 1979. For the past 20 years, he has been affiliated with Foxhall Internists, a group of internal medicine physicians.

April 29, 2013

Should We Get Regular Checkups and Screenings? Maybe Not.

A recent study at Copenhagen’s Nordic Cochrane Center found that routine medical exams did not reduce deaths, hospitalizations, or costs.

The conclusion is based on big numbers and warrants our consideration: Researchers considered 14 separate, comprehensive studies that followed about 182,000 people who did and did not receive routine, general health checkups.

I’ve written about the questionable value of routine health screenings (just enter "tests" in "search this blog" at right). This issue is front and center for me now since my internist of 20 years is switching to a "boutique practice." That new arrangement, should I opt in, would require that I shell out $1,500 a year for the privilege of keeping him as my primary care physician.

I'll be exploring these issues beginning tomorrow. To set the stage, here's a summary of Christine Aschwanden’s article in the February 8 edition of The Washington Post on the latest findings regarding annual physicals.

April 26, 2013

Verdict on Supplements Especially Popular with Older Americans

Man staring at open medicine cabinet containing large bottle that's labell… - New Yorker Cartoon Premium Giclee Print

Yesterday we wondered if we're wasting money buying the four most popular supplements: multivitamins, calcium, fish oil, and vitamin D. The consensus for all four? Most consumers would save money and be better off health-wise to ditch the pills and focus instead on getting the nutrients they need from food.

Those top four on the pill "hit parade" are also popular with older consumers as well, with some variations. For example, a survey conducted by ConsumerLab.com found that while only 31 percent of respondents under 35 use vitamin D, intake of that vitamin increases to over 50 percent for people 45-54, and up to 58 percent for those 65-74. Calcium is also very popular with older consumers. Younger adults are slightly more likely than seniors to have recently used fish oil or multivitamins.

The ConsumerLab.com survey mentioned other supplements especially popular with older adults. Today, we'll consider the research on some of them.

Many claims are made for coenzyme Q10 (CoQ10), a vitamin-like substance reputed to help treat heart disease, certain cancers, hypertension, Parkinson's, migraines, allergies, and more. Nothing can really do all that, but since CoQ10's discovery 50 years ago, research continues to uncover a range of potential benefits.

April 25, 2013

Verdict on the Four Most Popular Supplements: Multivitamins, Calcium, Fish Oil, Vitamin D

Above: the stash of dietary supplement pills I pitched out several months ago. They had accumulated during all the years when I thought "the more pills, the better." I'd also been in the clutches of a nutritionist who said I was deficient in all sorts of vitamins and minerals . . . and who just happened to have supplements to sell that would correct my deficiencies. 

I now realize that buying those supplements was like flushing money down the toilet. In many case, it was literally true. When the body gets more vitamins or minerals than it needs, the excess is excreted in urine.

I haven't been alone in my supplement OD habit. Americans spend about $28 billion a year on them. Mounting evidence shows we'd be better off to forget about pills and concentrate instead on a healthy diet. 

Let's take a look at the four most popular dietary supplements, all of which I've taken.

April 24, 2013

Coconut Oil for Alzheimer's: One Man's Success Story

Note: Yesterday I promised to begin a two-part report on the most popular dietary supplements. I forgot I had theater tickets for tonight and work to do on my upcoming travel arrangements. Fortunately, I had this related post ready to go.

I’ve castigated the hucksters who perpetrate the use of coconut oil as a cure – not supported by proper scientific testing -- for Alzheimer’s. Invariably, those promoters have financial interests in coconut oil products, and it irks me no end that they create false hopes for millions of sufferers and caregivers around the world in order to pad their own bankbooks.

Imagine my surprise when I found a story in the April 21 edition of the UK’s Mirror about a 68-year-old man in England whose family swears his advanced Alzheimer’s has been effectively reversed by liberal daily doses of coconut oil. As far as I can tell, this family, the newspaper, and the article’s author have no connection to product sales.

In 2007, the man’s son found a video on YouTube “posted by a doctor in Florida who was treating her husband’s Alzheimer’s with coconut oil.” Though that doctor isn’t mentioned by name, it sure sounds like Dr. Mary Newport.

The man’s family began feeding him coconut oil. Said his daughter, “Within a month his mood completely changed. He became calmer and relaxed. He started shaving, then bathing on his own. Then one day he gave me a hug and said my name. It was the most emotional moment.”

April 23, 2013

Big Pharma Is Evil. Ergo All Supplements and Their Hucksters Are Good.

This post's title, stated so baldly, sounds crazy. But the comments I get when I question claims for supplements suggest that people really believe it. No wonder we spend over $25 billion a year on supplements.

Reaction to my Criticism of Claims for Coconut Oil
I've posted several times about the lack of evidence for coconut oil as an Alzheimer's remedy, and about the big bucks promoters make from those claims. I've made similar comments on websites that tout the coconut oil "miracle." When I do, I get comments attacking me as a lackey of Big Pharma. A few examples:
  • "Oh really sir? And what do you do for a living, peddle lipator? The FDA, big pharma, and the Alzheimer's Association would NEVER suppress a cheap natural cure, now would they? Hey, BTW, I've got a bridge for sale..." 
  • "Pharmaceuticals are out to make gargantuan big bucks with all sorts of spurious claims about their products...and side effects to boot. I vote hooray to anyone who can outsmart money-grubbing pharmaceuticals who care NOT about you, but the money in their pockets" 
  • "As with any other natural remedy, watch for the pharmaceutical companies’ FDA to do everything the bureaucrats can to make sure that “Coconut Oil Touted as Alzheimer's Remedy” does not become a remedy for the general population."
I'm No Fan of Big Pharma
I'm hardly a defender of Big Pharma. I'd love to see Congress repeal the law that prohibits Medicare from negotiating lower prices with pharmaceutical companies. Every other developed country authorizes government to take steps to reduce drug prices.

April 22, 2013

Parkinson's Patients with Home Computers Get Virtual Video Visits from their Neurologist

Dr. Ray Dorsey, director for the Johns Hopkins Movement Disorders Center, thinks video-chats with patients may well represent an important part of our healthcare future.

No, he isn’t suggesting that patients scrap the long tradition of visiting doctors in their offices. In so many cases, there’s nothing as effective as those face-to-face encounters, during which healthcare professionals can conduct hands-on examinations, make diagnoses, and suggest remedies.

Two years ago, Dorsey showed that he – a specialist in neurology -- could offer Parkinson’s patients good care via inexpensive videoconferencing between his office and his patients’ nursing home. The patients who participated said their video-chats with Dorsey were “better” than their in-the-flesh office visits with non-specialists.

Next, in a seven-month experiment reported last month in JAMA Neurology, Dorsey tried virtual housecalls. Ten Parkinson’s patients used their own home computers to teleconference with specialists. Another ten Parkinson’s patients made actual – traditional – trips to a specialist’s office for care. Not surprisingly, here’s what happened:

April 19, 2013

Coconut Oil, Alzheimer's & Dr. Newport vs. 5-HTP, Parkinson's & Me -- Part Two

Yesterday we considered how I reported my experience with 5-HTP to deal with Parkinson's Disease. Dr. Newport had a similar favorable experience with coconut oil to treat her husband's Alzheimer's. Her reporting of the experience was dramatically different.

The Anecdote that Ignited the Coconut Oil Explosion
Dr. Mary Newport, the medical director of a neonatal intensive care unit in Florida, reported in 2008 on the dramatic changes in her husband's Alzheimer's after she gave him several teaspoons of coconut oil.

Her husband had shown signs of early-onset Alzheimer's in 2001. He was diagnosed with AD a few years later. In May 2008, he was being tested as a candidate for a clinical trial on a new treatment for AD. But Dr. Newport had seen some research concerning AD-treated rats, ketones and medium-change triglycerides (MCTs), which are present in coconut oil.

Her husband had gotten a low score (14) in a preliminary AD test, which was so low that it would have disqualified him for the trial. The next morning she mixed a couple of teaspoons of coconut oil with his breakfast oatmeal. He retook the test later that day and surprised everyone by scoring 18.

April 18, 2013

Coconut Oil, Alzheimer's & Dr. Newport vs. 5-HTP, Parkinson's & Me -- Part One

Americans spent over $30 billion on dietary supplements in 2011, much of it based on anecdotal reports from a few people rather than solid scientific evidence. After writing two days ago about my experience with 5-HTP and its beneficial impact on my Parkinson's, I thought again about Dr. Mary Newport and her claims of coconut oil's miraculous impact on her husband's Alzheimer's.

I want to highlight the difference between my reporting and hers. I'll start today. Tomorrow, Dr. Newport.

5-HTP, Parkinson's, and Me
When I was diagnosed with Parkinson's disease in the fall of 2009, I was also dealing with the depression and insomnia that often accompany PD. My neurologist at the time prescribed the old-line antidepressant Elavil. But after a few months, I switched to a different neurologist, Dr. Laxman Bahroo at Georgetown University Hospital. He expressed concern about the possible cognitive side effects of Elavil.

I had a good experience with 5-HTP during an earlier episode of insomnia. With Dr. Bahroo's approval, I replaced the prescription Elavil with over-the-counter 5-HTP. My internet research suggested that the serotonin-boosting power of 5-HTP might be enhanced when combined with the carbidopa I was taking for my Parkinson's. Carbidopa is used to help levodopa, the drug that boosts dopamine, cross the blood-brain barrier and thus replace the dopamine lost to Parkinson's. Carbidopa appears to provide the same assist to 5-HTP.

It sure worked for me. Taking 5-HTP at bedtime gave me a good night's sleep. My depression disappeared. It also took care of the problem I was having with incontinence. And it resulted in my losing the weight I had gained on Elavil . . . and a few extra  pounds as well.

What's not to like?

April 17, 2013

Eating Fish: What's Good for Us AND the Planet?

I’ve written often – mostly recently on April 11 -- about the benefits of the classic Mediterranean diet. Naturally, one of the key features of that diet – enjoyed by millions of people who live close to those blue waters – is fish.

Sardines, for instance – found in abundance across the Mediterranean and available, just caught, in street markets from Spain to Turkey – are high in desirable omega-3 fatty acids. Those omega-3s have been shown to reduce inflammation, and they may help reduce risk of chronic diseases like cancer, arthritis, and coronary disease.

But . . . fish eaters, beware! All fish are not created equal -- for your health OR for the environment.

The Monterey Bay Aquarium – a magnificent place – publishes a “Seafood Watch” bulletin, which recommends eating fish according to several criteria, including:

April 16, 2013

Could Boosting Seronin Offset Dopamine Losses and Alleviate Parkinson's Non-Motor Side Effects?

The answer to that question is a resounding YES for me, based on my experience using the supplement 5-HTP, a serotonin booster. When I was first diagnosed with Parkinson's disease nearly four years ago, I started using 5-HTP for my depression, insomnia, and constipation, all of which are common side effects of PD.

My very positive experience is the primary reason I started this blog, originally titled "5-HTP, Parkinson's and Me." I was convinced I'd discovered an over-the-counter supplement that would greatly enhance the quality of life for many PD patients dealing with these side effects.

I also touted 5-HTP to my Parkinson's support group, friends and family. Several tried it, and I soon learned that no one in my circle -- or on the internet, for that matter -- shared my positive results. I did find reports that carbidopa (which is mixed with the dopamine-enhancer levodopa so that it can better cross the blood-brain barrier) has the same effect when mixed with 5-HTP. Carbidopa also helps the serotonin get past the blood-brain barrier. See http://bit.ly/11jmCyC.

April 15, 2013

Internet Nastiness

A recent post by a favorite commentator, the self-described “Crabby Old Lady” Ronni Bennett on her popular blog Time Goes By, lamented the growing presence of hateful comments about old people on Facebook . . . and the online giant’s failure to address it. To read Ronni’s comments – including the examples of hateful, threatening language she’s encountered on Facebook -- click here and scroll to her piece from April 12.

She is concerned that age is not listed among the site’s “protected” categories. Here’s the language from Facebook’s Community Standards defining what it finds allowable and what it deems unacceptable:
HATE SPEECH: Content that attacks people based on their actual or perceived race, ethnicity, national origin, religion, sex, gender, sexual orientation, disability or disease is not allowed. We do, however, allow clear attempts at humor or satire that might otherwise be considered a possible threat or attack. This includes content that many people may find to be in bad taste (ex: jokes, stand-up comedy, popular song lyrics, etc.).
VIOLENCE AND THREATS: Safety is Facebook's top priority. We remove content and may escalate to law enforcement when we perceive a genuine risk of physical harm, or a direct threat to public safety. You may not credibly threaten others, or organize acts of real-world violence. Organizations with a record of terrorist or violent criminal activity are not allowed to maintain a presence on our site. We also prohibit promoting, planning or celebrating any of your actions if they have, or could, result in financial harm to others, including theft and vandalism.  
BULLYING AND HARRASSMENT: Facebook does not tolerate bullying or harassment. We allow users to speak freely on matters and people of public interest, but take action on all reports of abusive behavior directed at private individuals. Repeatedly targeting other users with unwanted friend requests or messages is a form of harassment.
I don’t spend much time on Facebook. I check in to see what friends have posted, and to post stuff myself. I’ve never seen anything really objectionable. But then, I haven’t snooped around. I spend too much time on the computer as it is.

April 12, 2013

Oh, What A Beautiful Morning . . . for Back Porch Meditating

My porch view: April 10, 6am

Finally! After weeks of below-normal temperatures this spring, I was finally able to move to the back porch at 5am Wednesday  to complete my daily joy of quiet meditation. Watching the dawn break while listening to the birds' songfest and my garden's waterfall, I stayed there for another satisfying hour.  

This time -- MY time -- has become an absolute MUST in my daily ritual.

April 11, 2013

Mediterranean Diet PREVENTS Cardiovascular Disease

I recently ditched my vegan diet experiment and returned to the tried-and-true Mediterranean diet. A recent article in the Wall Street Journal makes me glad I did.

Published in the New England Journal of Medicine, the new study found that the classic Mediterranean diet -- particularly with liberal servings of extra virgin olive oil and nuts – cuts the risk of stroke and other significant cardiovascular issues by 30%.

Earlier studies of this southern European diet have shown its favorable impact on weight  loss and cardiovascular risk factors like cholesterol and blood pressure. This new study actually proves that the diet significantly reduces the risk of live-threatening events like stroke. It’s pretty easy to establish “association” in studies; it’s not so easy to establish “cause and effect,” something this large, careful study apparently does.

Participants all shared risk factors for developing cardiovascular disease: diabetes, a smoking habit, high blood pressure or cholesterol, obesity, or family history. Half of them were already taking high blood pressure meds; over 40% were on statins.

Researchers divided the participants into three groups:
  1. Mediterranean dieters who ate at least four tablespoons of olive oil each day,
  2. Mediterranean dieters who ate at least 30 grams of nuts (walnuts, almonds, hazlenuts) a day, and
  3. A control group, which was instructed to follow a low-fat diet.
All participants could eat as much as they wanted, and nobody received any exercise advice.

Here’s what the diets looked like:

April 10, 2013

My Parkinson's Disease, Prostate Cancer, and 2013 Travel Plans

Yes, there definitely is a link between my travel plans for the rest of this year and my two chronic ailments.

Parkinson's Disease Honeymoon
PD in Brief:  Parkinson's disease is a progressive degenerative neurological disorder affecting more than 1.5 million Americans. The highest incidence occurs in people over 60, but there are an alarming number of cases being reported of PD in people under 50.

Parkinson's is characterized by slow movement, walking difficulties, posture instability, rigidity or stiffness in arms, legs or neck. There are often tremors, mostly in the hands at rest. Secondary symptoms may include depression, confusion, difficulty in speaking and/or swallowing, and facial "masking."

There is no cure yet for PD, but the drug levodopa -- converted to dopamine when it reaches the brain -- is the standard treatment. Unfortunately, patients on extended levodopa treatment often end up with dyskinesia, the uncontrollable thrashing about we see in Michael J. Fox, Mike Tyson, and other public figures with PD.

PD and me: I was diagnosed in September, 2010, when I was age 80. But four or five years earlier, I was experiencing the early warning signs of PD: loss of smell, restricted swing in my right arm when I walked, and  balance problems. My diagnosis came late because I didn't have the resting hand tremors -- the most common red flag that PD is present.

April 9, 2013

Nonagenarians: Being Overweight with High Blood Pressure Is Good!

Approaching my 84th birthday -- still engaged in what seems like a lifelong struggle to keep down my weight and blood pressure -- I loved coming across this finding in the latest quarterly Memory Disorders Review from Johns Hopkins University.

Over three decades ago, the Leisure World Cohort Study was launched by investigators at the University of Southern California. Recently, researchers from the University of California at Irvine examined the health of survivors from that study who were 90 and older. In the world of research, that elder group hasn't been often considered. Now, it's one of the fastest-growing population sectors.

Weight and Blood Pressure 
This 90+ Study has provided valuable information on healthy aging. Here's the findings on weight and blood pressure:
  • Those in the 90+ Study with a BMI (body mass index, a measure of body fat based on height and weight) of 25 to 29.9, a range considered "overweight," lived longer than those with BMIs of 18.5 to 24.9, which is considered normal. A BMI of 30 or more, which is considered "obese" was not associated with a longer life span. No one is sure why being overweight appears to be protective for the super-old. Perhaps those who are overweight  simply have better nutritional status than those who weigh less. They also may be better prepared to avoid "wasting," an age-related loss of muscle tissue and strength that can lead to frailty and an increased risk for illness. 
  • The studies show that for these 90+ seniors, high blood pressure was associated with less cognitive and physical decline. Again, no one is quite sure why this happens. Perhaps high blood pressure may help older people with naturally stiffer arteries. Or it could just be that many people with high blood pressure had already died, leaving a healthy group of nonagenarians who just happen to have elevated blood pressure. In any event, investigators suggest that perhaps doctors should exercise caution when  prescribing blood pressure medications for this special group.
Note: I reported last month on a mega study involving over three million people. That report showed people with BMIs in the overweight (but not obese) range are likely to live longer, a trend particularly true for seniors over 65.

I also reported on revised guidelines for blood pressure. Now, systolic (top number) readings as high as 150 -- typically categorized as high blood pressure in the past -- are considered more acceptable for people over 75.

Other Findings in 90+ Study
Here are some other factors found to contribute to healthy aging:
Exercise Is Good Medicine: The nonagenarians who exercised at least 45 minutes a day most days of the week were 27 percent less likely to die within an eight-year period than those who exercised less than 15 minutes daily. Those who were unable to walk were 30 times more likely to have dementia than those with the fastest walking times. The study found strong evidence that exercise -- even something as basic as daily walks -- helps promote new brain cells and connections between the cells.
Social engagement matters:  Numerous studies have reported that people who regularly socialize with others have less than half the mortality rates of people who live isolated lives.
A good diet is important:  Yet another recommendation for consuming a Mediterranean diet: smaller portions, fresh rather than processed foods, a high intake of plant-based foods, moderate amounts of nuts, olive oil, and fish, moderate consumption of wine (typically with meals), regular consumption of skinless poultry and small portions of low-fat dairy, infrequent consumption of meat, sugar and sweets.
Caffeine and alcohol: People who drink moderate amounts of alcohol and coffee live longer than those who abstain.
Many other studies confirm all of these findings.

April 8, 2013

"A Few Words About Elder Sex"

"A few words about elder sex" is the title of a recent post by my favorite senior blogger Ronnie Bennett, author of the popular "Time Goes By" blog. I was more than a little surprised to find that this gay man was agreeing with much of what a straight "crabby old lady" (as she describes herself) has to say about elder sex and the role it plays in her life.

Her essay prompted a few thoughts which I'll share later. But now . . . Here's Ronnie:

"A Few Words About Elder Sex" 
There's a media taboo about this subject – elders and sex – and even though demographic changes are beginning to produce a slowly growing body of film, television and books with elder lead characters, they are not having much sex. Too icky, I think, for people not yet old who produce these works.

There are a few websites devoted to elder sex. They usually are selling books and the copy is too often more graphic than I am either comfortable with or need.

Six or seven years ago, Gail Sheehy, who gained fame in the mid-seventies with her book Passages, published Sex and the Seasoned Woman announcing that the new generation of old women is committed to a passionate second half of life that includes lots of sex.

Hurray for them, but as I mentioned at the time, I doubt that the women who, in their youth, marched for civil rights, women's rights, against the Vietnam War, burned their bras, adopted “the pill” as their own when it was new and went on to win previously unheard-of consideration and rights in the workplace need either permission for or instruction about sex in old age.

I'm pretty sure I'm not alone in having a lot of practice. For most of my adult life sex was near or at the top of my list of compelling interests, so much so that I now wonder how I managed to get anything else done.

April 5, 2013

A Menu of Good Foods for People with Parkinson's Disease

Here's an excellent list of foods recommended for people with Parkinson's, provided by the Northwest Parkinson's' Foundation. The menu accords with general dietary recommendations for everyone.

Water - Be sure to get your fluids to prevent dehydration and constipation.

Nuts- Almonds and Walnuts - Good source of protein, fiber, and healthy omega-3s!

Low fat yogurt
- High in calcium and protein, plus healthy probiotics to improve gastric flora and digestion. If swallowing pills is troublesome for you, consider taking them with yogurt.

April 4, 2013

My Brief Life as a Vegan

A few weeks ago I announced "I am a vegan." Today I'll announce "I am no longer a vegan."

I decided to give the vegan diet a try after viewing several videos that suggested vegan diets might forestall and treat Parkinson's. I did some additional research and concluded "What the hell. Let's give it a shot."

I've mentioned here before that I'm a confirmed "neophiliac" (novelty-seeker). Neophiliacs make quick decisions based on incomplete information. That's me!

So, based on two short videos and 30 minutes on Google, I became a vegan. A week later, I received the April issue of Tufts University's Health & Nutrition Letter. The lead story about a recent Mayo Clinic study gave me pause: people 70 and older who ate the most carbohydrates in relation to proteins and fats were at four times the risk of developing cognitive impairment.

Hmmm. A vegan diet might slow down my Parkinson's but accelerate dementia. Time to rethink!

April 3, 2013

Beware Support Group Fundamentalists and Other Red Flags

In yesterday's post below, I discussed how support groups help people deal with the challenges of chronic illnesses. It was AA's "power of the group" that got me sober 35 years ago.

These days, my weekly Parkinson's support group meetings are invaluable. I also benefit from monitoring several online support groups and blogs devoted to Parkinson's disease. I recommend in-person and online support groups for anyone dealing with a chronic illness.

Not all support groups are necessarily a good match for you. Here are some things to watch out for.

Beware the Fundamentalists
Many groups have old-timers who insist their way is the only way to deal with the illness. Fortunately, this isn't the case with my PD support group. But it did trouble me at some AA meetings.

April 2, 2013

The Power of Healthcare Support Groups

Last week, writing about my AA anniversary, I discussed an excellent essay I'd read about AA... and why it works for some but not others. The most effective element of AA, the author concluded, is "the power of the group."

That was my experience with AA. It's equally true today with my Parkinson's support group.

If you're facing a major illness or  stressful life change, you don't have to go it alone. A support group can help.

No two self-help groups are alike. In most cases, the group becomes a family, a safe haven from the turmoil in the rest of the world.

Support groups are not the same as group therapy, which is a formal mental health treatment that brings together people with similar issues under the guidance of a trained mental health provider.

Support groups can be formed by anyone with the shared condition, or by someone interested in it, maybe a family member. In some cases, support groups are formed by nonprofit organizations, advocacy groups, mental health clinics, or other organizations.

They may be led by professional facilitators or by group members. Some groups are primarily educational. The leader might invite a professional to talk about a topic related to the group's interests. Other support groups emphasize emotional support and shared experiences.

April 1, 2013

Seniors, Cars, and Safety

Yes, that's my car after a bad crash in August, 2011.

Naturally, I was interested to see a recent article titled “Being an Older, Safer Driver” in the Berkeley Wellness e-zine from the University of California. It reminded me how lucky I was to survive two crashes two years ago. That second mishap (picture above) sent me to the hospital for a couple days, and left me with lingering back pain I’m still working on.

Even so, I thank my lucky stars the damage wasn’t greater. And – here’s the tough part – I wonder if I should continue to drive, even though I limit my trips to short daytime excursions along quiet neighborhood streets I know well. I ask friends who ride with me if they have concerns about my driving. So far, I've heard only reassurances that I'm doing fine.