January 31, 2014

Salutogenesis Factor #2d: My BNA Family

Today’s post is part of a series about "salutogenesis," which means the origin of health. So far, I’ve discussed a variety of factors I believe have contributed powerfully to my well-being, including:
Today, I want to talk about my "business" family at the Bureau of National Affairs (BNA), where I worked for 40 years.

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March 1955 -- Expelled from law school
April 1955 -- Hired by BNA as legal editor
December 1994 -- Retired from BNA as VP for human resources

BNA: A Unique Company
BNA was founded in 1929 by newsman David Lawrence (known as DL) as a subsidiary of the United States Daily, now known as the "U.S. News & World Report." BNA made lots of money during World War II; it was the place to go for the official rules, regulations and case decisions on the government's wartime wage and price controls. BNA had an unlimited paper quota during that time of severe shortage and became the nation's largest user of air mail and special delivery services during the war.

In 1946, DL decided to sell BNA. He called in the company's five top editors -- Dean Dinwoodey, John D. Stewart, Ed Donnell, Adolph Magidson, and John Tyler -- explained his decision, and offered them first crack at buying the company. The five of them went off for a weekend to mull it over, returned, and told DL they'd take his offer on one condition -- that every BNA employee be given the opportunity to buy stock in the company.

January 30, 2014

How the Brain Ages

I stumbled upon an interesting site called “A Health Blog” that describes how the brain ages. Here are the highlights:

  • The brain begins to grow four weeks after conception.
  • At certain times during brain development, 250,000 neurons are added each minute. That’s hard to fathom!
  • Shortened gestation can disrupt brain development, which may cause behavioral and psychological problems later.
  • The brain produces twice the number of neurons it will need, and only those that are reinforced with use will remain.
  • The brain is as energetic and flexible as it will ever be during this time.
  • By age 6, the brain reaches 95% of its adult weight.

January 29, 2014

Why Am I So Delighted to Have Missed the State-of-the-Union Address for the First Time in Decades?

Because last night -- after decades of attending ballet performances at the Kennedy Center as a season ticket holder -- I witnessed the most nearly perfect performance I've ever seen: the Mariinsky Ballet's "Swan Lake," starring the extraordinary Alina Somova.

In last night's performance, Somova was partnered by another fantastic dancer, Vladimir Shklyarov -- NOT the fellow shown in this clip:

Here's more info about the talented Russian beauty.

January 28, 2014

Do You Need That Annual Physical? What Medical Tests DO You Need?

The January issue of Consumer Reports included an article, “Do you need an annual checkup?”

The answer -- echoing my mantra “less is more’ -- was probably NOT. For most people, those regular annual physicals – with blood tests, EKGs, chest X-rays, etc. -- waste time, money, and often lead to unnecessary and dangerous additional procedures.

The advice isn’t coming from patient advocacy groups, as one might expect. It’s the doctors – from the American College of Physicians, the American Medical Association, and the Society of General Internal Medicine – who are challenging the long-held practice.

Said Dr. Ateev Mehrotra, who teaches healthcare policy at Harvard Medical School, “No one is saying preventive care is unnecessary. You just don’t need the annual, one-size-fits-all physical.”

Instead, the newer trend favors a targeted approach according to one’s age, gender, and health, with a focus on what really works. Here are just two examples:
  • Pap smears: if results are normal, women can wait three years between tests. After age 65, they can usually skip the tests altogether.
  • Prostate screening: The new guidelines suggest that the benefits of standard PSA blood tests do not outweigh the risks.

January 27, 2014

Secret to Staying OFF My Blood Pressure Meds? Weight!

I mentioned a week ago that I ditched my blood pressure meds, after many years taking those pills. Just last Friday, I secured my internist’s OK, though she warned me that people with good numbers who stop taking the medication may see a sharp rise in bp numbers in 6-10 weeks. I’ll keep monitoring my pressure every day.

So, what can I do to maximize my chances of STAYING off those bp meds? Keeping my weight under control – shedding a few pounds – is key. I know there are no magic bullets. Like so much else in the health arena, diet and exercise are the right place to start.

I’m lucky with the diet part of the equation. The doctor-recommended Mediterranean diet works for me, and I’ve written about it often. I count my blessings that FIGS – a fantastic Lebanese carry-out place on MacArthur Boulevard -- is just a few minutes away.

I'm doing well with my Parkinson's BIG exercises, and much of my 3-4 a.m. meditation hour is now supplemented with stretching and back exercises. It’s the aerobic exercise -- the weight-busting kind -- that trips me up.

I’ve got several large exercise machines in the house – a bike and an elliptical stairmaster. Using them is another matter. I'm sure my relatively good health today is due to years of compulsive bike-riding. When Parkinson's put an end to that, I enjoyed walking the streets of my Washington DC neighborhood – The Palisades – but icy sidewalks, Alberta Clippers, and Manitoba Maulers have kept me indoors. Even in good weather, I find excuses -- like lower back pain -- to stay put..

Recently, I came on a piece in the e-journal Everyday Health titled 12 Reasons You're Not Losing Weight." The article -- shown below -- explained why we’re not trimming off the weight we’d like to lose. I need to keep these things in mind -- simple as some of them are -- as I enter this new chapter, free of blood pressure medication.

Here's the text from that piece. When I got to #12, I recalled seeing recent research suggesting moderately overweight seniors live longer.

January 24, 2014

Patient Portals: Doctor Reluctance and Odd Adoption Variations

On Tuesday, I wrote about patient portals, secure websites that enable patients to communicate with their doctors electronically. Among other tasks, we can now exchange emails, check lab results, make appointments, and request prescription refills. Freedom from phone tag!

In its January 2014 issue, Consumer Reports ran an article -- “The doctor will email you now: Five reasons patient portals can lead to better health” -- that gave five reasons why patients should consider using these electronic portals IF their doctors provide them:
  • Portals Put Your Health in Your Hands
  • They’re Convenient
  • Accurate Records
  • Faster Feedback
  • More-Rewarding Visits
Why Physicians Resist
On Wednesday, TheAtlantic.com published an article -- “Why Aren’t Doctors More Tech-Savvy?” – in which the author listed a variety of reasons why doctors are reluctant to offer patient portals with electronic health records (EHRs):
  • They can cost about $30,000 to install and $2,000 a month to maintain.
  • Locating and digitizing records from patients’ many different doctors from many decades into a single database is a massive undertaking.
  • In a study funded by the American Medical Association, RAND surveyed 30 physician practices and summarized its findings: “… the current state of EHR technology appeared to significantly worsen professional satisfaction in multiple ways. Poor EHR usability, time-consuming data entry, interference with face-to-face patient care, inefficient and less fulfilling work content, inability to exchange health information between EHR products, and degradation of clinical documentation were prominent sources of professional dissatisfaction.”
  • Doctors were hiring “scribes” just to handle data entry, adding cost to payroll and straining facility space.
  • Doctors worry about data leaks, even though patient portal proponents claim EHRs are safer than paper records. 

January 23, 2014

My Lousy Memory: Alzheimer's? Years of Booze?

As I look ahead, Alzheimer's remains my biggest fear. Even though I think I'm doing pretty well for an 84-year-old in most cognitive functions, I know I'm more forgetful than ever before.

For example, during a conversation with my housemates yesterday, it became apparent that I had forgotten letting recent guests use the master bedroom for an overnight stay, while I slept in another bedroom. The details came back to me only after Nimesh provided a series of hints.

Here's the scary part: This "fuzzy" incident occurred just about a month ago, when dear friends  returned from  Nepal and needed a place to stay for one night before settling into their new apartment in the suburbs. This threesome is my adopted family -- husband, wife and young son -- with whom I regularly stayed for weeks at a time at their house in Pokhara, Nepal, and in "John's room," too! How could I have forgotten their overnight stay here?

That lapse feels like more than just a "senior moment." But it didn't particularly bother me; I've grown accustomed to my forgetfulness. I read a book, see a movie, or go to a play. A week later, I won't recall many specifics.

The pattern isn't new. I've been forgetting stuff for years now. But it's hard not to wonder . . . is it the approach of Alzheimer's?

Maybe It's Just My Alcoholism
The January 15 issue of the journal "Neurology" offers another possibility. Researchers found that middle-aged men who were heavy drinkers showed memory decline up to six years sooner than moderate drinkers or abstainers. Their definition of heavy drinking was "more than two drinks a day". . . a threshold I would have regularly reached -- and passed -- at lunch! Fortunately, I haven't had an alcoholic drink since March, 1978 -- just shy of my 49th birthday.

January 22, 2014

How Do You Score on this Alzheimer's Questionnaire?

Last week, I received a Johns Hopkins Memory Bulletin update that included an "Alzheimer's Questionnaire." The brief quiz is designed to help family members or close friends determine if their loved one might be at risk for Alzheimer's disease (AD). It assesses the presence of mild cognitive impairment (MCI), which often precedes the onset of AD. I took the test -- said to be 90 percent accurate -- knowing full well my loved ones might answer some of the questions differently.

Before we get to the questionnaire . . .

Background Information on MCI
Nearly all of us seniors have more and more moments of forgetfulness. Some laugh and say, "Another senior moment!" Others say, "Jeez, I'm headed for Alzheimer's!" I make both comments.

There's a territory between "senior moments" and real Alzheimer's: mild cognitive impairment. People with MCI are more forgetful than is normal for their age, but they don't show other problems typically associated with dementia.

About one in five seniors has some type of MCI. In a 2011 study of nearly 1,300 women 85 and older, 23 percent were diagnosed with MCI. Studies show that 7-15 percent of those with MCI progress to Alzheimer's disease each year, compared to only 1-2 percent for the general senior population.

Family doctors usually don't make time to screen for MCI during typical 15-30 minute office visits, so dementia often goes undiagnosed until it's well advanced.

January 21, 2014

Is an Online Patient Portal a Good Way for You to Communicate with Your Doctor? Probably.

A friend recently changed doctors. During his first office visit, he was encouraged to sign up for the free “patient portal” service, which required only his permission and email address. The service would enable him – among other things -- to communicate with his doctor via email, and to view his medical information, including test results, using a secured website. The promo – touting the new freedom from waiting on hold, listening to dreadful music or messages, and then playing phone tag -- explained: “Why call, when you can click?”

My friend signed up on the spot. He asked the receptionist, “Are all of your patients signing up for this service?” She answered, “Just about.”

At first blush, one might think doctors would want to avoid this new communication service like the plague. Wouldn’t they lose some control of the traditional (slower) pace and tempo -- THEIR pace and tempo -- of interacting with patients? Wouldn’t they feel tyrannized by the 24-hour-a-day torrent of emails from patients? Fearing malpractice litigation, wouldn’t they be wary of committing comments to writing that could later be used as evidence against them?

As it turns out, not really.

January 20, 2014

"Crabby Old Lady" vs. Big Pharma

Ronni Bennett's Time Goes By is my favorite senior blog. Last week, Ronni -- aka Crabby Old Lady -- was battling both the flu and Big Pharma. I'm sure she'll beat the flu but, like the rest of us, she was no match for Big Pharma. Her tale is a fun read. But it also illustrates why we desperately need a single-payer healthcare system and government regulation of drug prices.

Here's the Crabby Old Lady, in her own words:

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In a couple of weeks, Crabby Old Lady will undergo her first cataract surgery so on Tuesday she delivered herself to the physician's office for measurement of her eye and to go over admitting procedures.

Among those were an explanation of how to use the prescription eye drops she is required to begin three days before the surgery and continue for several weeks following.

January 17, 2014

Can You Ditch Your Blood Pressure Meds? I did!

We interrupt the salutogenesis series for this important message!

I bought two toys for Christmas. The December 2013 issue of the Mayo Clinic Health Letter described two small devices designed for home use to help lower blood pressure:
  • RESPeRATE, a gadget approved by the Food and Drug Administration to train deep breathing, and
  • Zona Plus, a hand-held exercise device that calibrates grip strength.
In a post last month, I included descriptions and photos of yours truly using these gizmos.

If the endorsements had come from Dr Oz, Pat Robertson, or another huckster, I'd have ignored them. But the Mayo Clinic? Why not? One click on Amazon and . . . there they were, on my doorstep.

January 15, 2014

Salutogenesis Factor #2c: My Gay and AA Families, Part 2

On Monday, I wrote about my life before becoming openly gay (October, 1977) and acknowledging my alcoholism (March, 1978). Those decisions transformed my life. Talk about salutogenesis -- the origin of health!

Before that, everything had centered around family, job, and drinking pals. Luckily, I didn't lose any of those. In addition to my personal liberation, I gained two new families: my gay friends and AA pals.

My Guide into the New World
Those two new families overlapped; many new friends were, like me, both gay and alcoholic. Today, I want to pay homage to one in particular who became my best friend and treasured mentor.

Tinsley Halter Cunningham
Easily the "most unforgettable character I've known," he was inevitably called something other than Tinsley. Dusty it was.

January 13, 2014

Salutogenesis Factor #2c: My Gay and AA Families, Part 1

I wrote last week about my natural family: parents, children, grandchildren, great grandchildren. Now, I want to pay homage to two non-traditional families, cherished groups that have developed through the decades from my coming to terms with being gay, and being an alcoholic.

Diana, my wife of 20 years, preceded me on the road to sobriety by almost two years. Her struggle with alcoholism was tougher than mine. She loved her sobriety, as you can see in the photo below. But her journey was tragically cut short when she died of cancer in May, 1978.

The Six Months that Turned My Life Around
My alcoholism and my homosexuality are central to my identity. For the first half of my life, I denied my alcoholism and concealed my homosexuality. But during the six months between October, 1977 and March, 1978, everything changed. 

"Coming Out"
In October, 1977, I came out to my wife and children. The year before, a therapist helped me come to terms with my homosexuality. I would have spoken with my family then, but there were other challenging family issues at the time. The professionals we were working with recommended that I wait for a better opportunity before rocking the boat with this explosive new issue.

In the fall of 1977, Diana and I were working with a therapist on those other family issues. He knew I wanted to come out as soon as he thought it appropriate. He chose a session on a Saturday morning, the day before I was scheduled to take a vacation on my own, my first without the family. I was flying to London on Sunday to visit my pal Terry, whom Diana and I had met when he'd visited BNA in Washington the year before. I knew he was gay; Diana didn't. At the end of our session, the therapist announced that he thought it was "time for the hidden agendas to come out in the open."

January 10, 2014

Schappi Men as Fathers -- We Finally Get It Right!

The Three John Schappis as Father
Here I am between my father and grandfather. John Schappi I, II, and III. 

Although we visited my grandfather in Paterson, NJ only a few times, I remember him as cold and distant. I didn't sense any closeness or warmth between him and my father, either.

My relationship with my dad was much better. He had a good sense of humor, although it was often a kind of put-down humor that I have inherited, unfortunately. I should remind myself more often how hurt and inadequate I felt after his "funny" put-downs. 

As an alcoholic repressed homosexual, I was never going to win the Father of the Year Award. I loved my wife and kids, but I often felt I was play-acting as husband and father.

When I came out in 1977 -- and got sober in 1978 -- I could drop the play-acting. By then, both Ann and Todd were living on their own.

Again following Mick Jagger's maxim that "anything worth doing is worth overdoing," I became very involved in both the AA and gay worlds for several years, making lots of new friends. But I neglected my family.

Through the years, my family has become increasingly important to me.

The three John Schappis shared something else: feeling ill at ease with babies and young children. 

With each generation, the fathering got a little better, but there was lots of room for improvement.

January 9, 2014

Salutogenesis Factor #2b: My Ithaca Family of Origin

My brother Roger (at left in this photo) and I are the last survivors of our original nuclear family. His terrific wife Gail is gone now.

I was born in Hudson, NY, in May, 1929. My dad, a tool designer, worked there until the October, 1929 stock market crash that launched the Great Depression. Dad's search for work then led us to Philadelphia and New York City during my early, largely forgotten years.

I wish I'd sat my dad down for a recorded interview on the family history. Too late now.

Dad ended up with a job in Ithaca for a company that designed tools to clean railroad tracks. After a few years, he took a job with the Morse Chain Company, which manufactured transmission chains for the auto companies. The Morse plant sat atop Ithaca's South Hill.

Parkinson's House?
My parents rented half of this house on South Hill where I lived from ages 7 to 26. The Slattery family owned the house and lived in the other half. Dad walked up South Hill to his Morse Chain job every day.

I discovered last summer that the toxic chemical trichloroethylene (TCE)  -- used by the Morse Chain to de-grease metal parts -- had contaminated large parts of South Hill. A 2011 study I found online indicated that people exposed to TCE are six times more likely to develop Parkinson's.

I also learned that my childhood chum Joe Slattery, son of the house's owners, also had developed Parkinson's and died from it last year. 

Two boys living in the same house during the years of TCE contamination, and both develop Parkinson's. Coincidence? Seems unlikely. For more, see http://bit.ly/1c6FWkG

Back to the Ithaca Family
In my earlier salutogenesis posts, I talked about the importance of learning early in life that you can survive adversity. My father, brother and I learned that lesson. My mother and sister didn't. Was it a coincidence that the males survived and the females didn't?

January 7, 2014

Salutogenesis Factor #2a Family -- My Washington/Baltimore Family

Here's a memorable Christmas Eve present:

Camden Jacob Dreisonstok
My first great-grandson arrived on Christmas Eve to join his sisters Kaylee and Kenzie. Now, my family consists of eight direct descendants:
  • Son Todd and daughter Ann
  • Todd's daughters -- Jessie and Emily -- and son Colin 
  • Jessie's two daughters -- Kaylee and Kenzie -- and now, son Camden
Most definitely part of the family are Jessie's husband Dan and Todd's companion Jill. They'll soon be joined by Jerrod, who proposed to Emily this past Sunday. We're all looking forward to their wedding on March 30.

January 3, 2014

Salutogenesis Factor #1: Managing Adversity. Been There, Done That... and I'm Still Here!

The incomparable Elaine Strich performed this Sondheim classic three years ago when she was my age -- 84 -- and she's still here! There must be fewer and fewer of us who "get" all the references to these events and personalities from long ago. Elaine's may not be the best rendition of the song. But I love her wry, ironic take on agoing.

Salutogenesis and Adversity and Me
I wrote yesterday about the new-to-me concept of salutogenesis. It's a way of looking at health and aging NOT from the negatives of disease and affliction, but from all the positive elements that contribute to healthy aging. The approach appeals to me so much that I've decided to begin 2014 by using it as a model for reevaluating my welfare as an 84-year-old.

I've created a list of what I consider the six most important contributors to my well-being. While it seems odd to place anything above family on that list, I feel I have to start here: a life filled with major ups and downs has enabled me to navigate today's issues -- Parkinson's, prostate cancer, and all the other stuff that comes with being 84 -- with relative equanimity.

My Biggest Adversity: Me
Until age 48, I created most of my own big problems. A volatile combination was at work: my alcoholism and repressed homosexuality. Through my tumultuous early adulthood, I spent a night in jail at least six times.

In March, 1955, as managing editor of the Law Review, I was just a few months from graduating from Cornell Law School. Ranked No. 5 in the class, I had a job lined up as an instructor at the University of Washington Law School. Everything was coming up roses . . . or so it seemed.

Then, after an arrest with jail time, I was expelled from law school for conduct in an alcoholic blackout. I don't remember anything about the incident, but authorities told me it involved the men's dorm.

When I tell this story, people often say that Cornell shouldn't have  kicked me out for this incident. Then I'm forced to own up to the fact that an almost identical incident happened a year earlier -- alcoholic blackout, men's dorm, arrest and jail, This time the school  put me on probation and assigned to therapy with the university's shrink. I spent a year lying to him about my sexual orientation.

I accepted responsibility for that expulsion. I never blamed Cornell (but the school isn't part of my estate plan).

The photo here was taken several years ago during a visit to Ithaca and Cornell's gorgeous campus. (Bumper stickers in Ithaca say "Ithaca is Gorges." I  almost did an early exit  one drunken evening by nearly falling into one of them.)

January 2, 2014

Salutogenesis: New Concept for the New Year

"Less is More" was my mantra for last year and it's still valid. But the January 2014 issue of the Mayo Clinic's Health Letter offers a new notion for the new year in an article titled "The Mystery of Health: Salutogenesis."

Salutogenesis -- Latin for "origin of health" -- is an important concept in the study of healthy aging. So often, issues of aging focus on fighting disease. Salutogenesis redirects the discussion to what supports health and well-being.

Aaron Antonovsky, a medical sociologist who studied the narratives of Holocaust survivors, established the salutogenesis theory. He explored the factors that kept people -- especially those in difficult circumstances -- healthy.

Antonovsky reasoned that a person's ability to successfully weather life's bumps and bruises -- or worse -- depended on two key factors:
  1. Having a sense of coherence -- being able to make sense of your life -- that helps you use resources to manage stresses.
  2. Having resources that help you understand and structure your life. These resources may be tangible, like money and housing. But they also include factors such as life experience, intelligence, social support, and traditions.

January 1, 2014

Inspiration for the New Year: Two Great Speeches by Two Great Men

Nimesh Thapa's photo.

HAPPY 2014

My housemate Nimesh took this photo of the Christmas lights at the Mormon Temple in Kensington, MD just outside Washington, DC. This impressive church and surrounding grounds shine brightly with more than 450,000 sparkling Christmas lights.

Several friends recently sent me links to terrific speeches by two great men. Check them out for an inspiring start to the new year.

Charlie Chaplin as the Great Dictator
Here's Charlie Chaplin's final speech from the film The Great Dictator, with a splash of modern imagery. The song is Window by The Album Leaf.