December 31, 2015

"John's Life is an Open Book, But Watch Out. Given a Chance, He'll Read It To You."

I love that quote. Just as I loved the reputed author, Bill Beltz, BNA's CEO from 1980 to 1996. He was also one of my best friends from 1956 -- when he arrived at BNA a year after I did -- until 2003, when he died.

During a recent lunch with a group of BNA retirees, Paul Wojcik, Bill's successor as CEO and another treasured friend, shared Bill's remark after I told some anecdote (which of course I now can't remember) that involved something "normal" people wouldn't disclose. I'm known for doing that sort of thing.

But in my earlier life, I was just the opposite. I avoided sharing personal anecdotes for fear that they might reveal my two darkest secrets -- my homosexuality and my alcoholism. The turnaround came in October, 1977 -- when I came out to my family and friends as a gay man -- followed by the March, 1978 acknowledgement of my alcoholism.

I've spent most of my life following the precept that "anything worth doing is worth overdoing." So this new freedom to discuss my personal life too often results in "over-disclosure."

Still, this sharing of personal information is vital, as I deal with aging, Parkinson's, and other health issues. I keep searching for a primary healthcare provider who is interested in discussing these end-of-life issues with me. The topic was the No. 1 issue on the blog this year. See the post above.

December 29, 2015

Giving Thanks for my Five F's: My Friends

Last Thanksgiving, I spent some time thinking about the things in my life I'm most grateful for. I came up with five and -- trying too hard to be cute -- I made each of them an F word: family, friends, finances, fun, and final days. I had planned to devote a week of posts on the series, running each of the five topics on a different weekday.

Well, you can see how far I got with that plan. I completed a post on F–word No. 1: My Families. While working on that post, I was also tensing up over my self-imposed schedule to produce a post each day for the next four F-words. My reward? High blood pressure and a sleepless night... not the first time my blog obsession produced those results. 

Deep down, I knew the blog was taking over my life, just like addictions to nicotine, alcohol, and compulsive sex had done in my younger days. With lots of practice, I'd become skillful at denying my addiction problems. But this time, I acknowledged that the blog addiction was damaging my health, and I needed to rein it in.

At this stage in my life, when my remaining time is limited but my health is reasonably good, I want to lead a balanced life, enjoying the variety of things that give me pleasure and that I'm still capable of doing. Not just sitting at the computer.

Thinking about this post on F-word No. 2 -- friendships -- I decided to focus on friends who have played key roles in my life. As I gathered photos and background information, I realized I was laying the groundwork, yet again, for a lengthy post that would surely generate stress and tension.

So, I've decided to run a series of posts about friendships off and on over the next few weeks. What's the rush?

I know many of you readers will be disappointed at not getting one of my posts that runs on forever. Yeah. Right.

Friendship Overview
When it comes to friendship, I was born into a family at Ground Zero: My parents had no friends, My dad had acquaintances from his job, from playing bridge in his early years, and golf after he retired. My mom -- who suffered from clinical depression and rarely left home -- didn’t even have acquaintances.

I'll never forget how depressing it was, sitting in the funeral home during the viewing hours before both my parents' funerals, and having nobody but immediate family members show up.

My friendship history is very different from most other people's. I had my loneliest years as a freshman and sophomore in college, a time when most young people can't keep track of all their friends. But now, in my old age, I’m surrounded by more significant, supportive friends than ever.

Enough for now. Stay tuned.

December 25, 2015

My 60th Christmas Day in Washington: the Weirdest

As I finally begin to settle down, the weather gets weird. This December is destined to become the warmest ever for Washington, DC... and by a substantial margin. Our high temperatures climaxed on Christmas Eve and Christmas Day.

The family gathered for dinner at my son Todd's house on Christmas Eve, so I spent a quiet Christmas Day at home, much of it sitting on my back porch, in shorts!

I assume the goldfish and koi can resume hibernating if and when the cold weather returns.

December 23, 2015

Tom Brokaw and his Physician Daughter Discuss End-of-Life Planning

What someone wants at the end of life can be hard to pin down in words. Even a phrase like "no heroic measures" leaves family and physicians wondering what steps to take and when to stop, as emergency medicine physician Jennifer Brokaw pointed out to her better-known father -- longtime NBC News anchor Tom -- in their TEDx talk at Stanford University.

The video below is a few years old, but it just gets more relevant with time. Brokaw's talk with his daughter about his end-of-life wishes -- and how their family has come to believe in the importance of advance care planning -- preceded this year's bestselling book Being Mortal, in which surgeon and author Atul Gawande discusses why it's important for families to have these conversations.

As Jennifer Brokaw says, talking as a family is even more important as medicine grows increasingly specialized. "We’re not going to be talking to one physician” at the end of life, she says. “We’re going to be talking to a lot of -ologists,” who will provide more varied, fragmented prognoses on which families will base their decisions.

December 3, 2015

News Alert: I Have an Additional F for Thanksgiving – Freedom from My Blog Addiction

On Monday, I posted the first in a planned five-part series on the major things in my life for which I am thankful. Naturally, I started with family. I'll add posts about friends, fun, finances and my final days. I planned on doing one post a day, ending the series on Friday.

Tuesday was a busy day. The heating/AC contractor was scheduled to arrive between 10am and noon to give me an estimate for a new unit in my former garage, which has been converted into a bedroom. I had a 1:20pm appointment with my neurologist, and Joey -- my driver -- planned to pick me up at 12:45. Making things tight, the contractor showed up at 12.

In the morning, Bhawana told me that she had invited some friends in that evening as a surprise for Nimesh's birthday. (Nimesh and Bhawana are the Nepali couple who live with me.) So I ordered a Christmas centerpiece from my florist's catalog, and the rep at the shop told me it would arrive sometime after 2:30pm.

Fortunately, my doctor was right on time, so I even had time after the appointment to pick up a few things at the Whole Foods store across the street from my doctor's office. I hailed a cab and got home just before the florist delivery guy arrived.

In spare moments during the day, I worked on the affidavit of support I was preparing for a Nepali friend who is seeking a visitor's visa.

Since I wouldn't be involved in the birthday party, I figured I could work on the blog post that evening. If I didn't complete it, I'd finish it Wednesday morning and post it with Tuesday's date... a little back-dating trick I've used before.

But that little trick would put me behind the 8-ball on the post I was planning for Wednesday.

Blog Addict "Hits Rock  Bottom"
That quoted phrase is used in Alcoholics Anonymous meetings to describe the point at which an alcoholic finally decides he's had enough of his alcoholism and the problems it created.

I hope Tuesday was "rock bottom" for me and my blog addiction.

My recovery from my addictions to alcohol and nicotine requires that I completely abstain from cigarettes and alcohol. With the blog, what's required is moderation, something I need in so many areas of my life.

I've known for some time that the blog was taking over too much of my life. I think it has created tensions that even threatened my health. That's why I decided a month ago to blog every other week. But I hadn't yet recognized the full extent of my blogging insanity until I took stock after Tuesday's events.

Wednesday morning, I woke up around 3 o'clock for the usual bathroom visit. I often stay up for about an hour for what I call my "joy of quiet" time, during which I combine stretching exercises with meditation. I often use the bed post as a gym rail. I do some push-ups, hula hoop swings with my hips, and lots of improvised moves. I don't pay much attention to the exercises and I try to let my mind just wander. But sometimes, I get fixated on a particular issue.

That's what happened Wednesday morning. I actually stood at the bed rail for nearly two hours thinking about the blog addiction and what to do about it. Here are some of my thoughts:
  • Stanley works with me on the blog. When I get compliments on the blog's being well-written, I give much of the credit to Stanley. He is an excellent editor and a good writer. At first, I used him to simply edit my copy. But for a while now he's been writing many of the posts on new studies... on reports about Parkinson's and other health issues. We typically run four posts a week, with Stanley writing one of them. I suspect he'd like to do more. But unless I wrote most of the posts -- or so I've thought -- the blog wouldn't feel like mine. F-that. It's no big deal if he writes more posts than I do. I'm going to concentrate now on the "me" posts that deal primarily with what's going on in my life. Stanley is free to come up with as many posts as he wants. And I won't worry about the number of posts we publish each week.
  • Stanley and I have both become too obsessed with the stats on blog traffic. The platform we use provides data on the number of hits (or "pageviews") we get by day, week, month and "all time." It boosts our egos when we see the rising numbers -- from 245 hits during the blog's first month (November, 2010) to the 27,791 hits this past April. Unlike many blogs, mine doesn't carry advertisements, so there is no monetary gain from traffic. But now we have to reconcile ourselves to the fact that -- in light of my age and health -- we'll publish fewer posts now. That trend means it would be a miracle if we set any new monthly traffic records.
  • We both need to be more modest and realistic about our efforts. We often talk as if there are thousands of people out there -- logging on first thing each morning, hungry for the latest post. Jeez, what a tension-producing fantasy!
Are there hopeful signs that I may be regaining sanity? I didn't post anything on Tuesday or Wednesday. I'm finishing this post at 10am on Thursday. I should always do my blog "work" in the morning, when the process -- organizing my thoughts, dictating for my voice recognition software, making occasional keyboarding adjustments -- moves much faster for me.

Maybe you'll see a post tomorrow about my giving thanks for my friends. Then again, maybe you won't.

November 30, 2015

Giving Thanks for My Five F's: Number One – My Families

On Thanksgiving Day, I went through the usual drill of thinking about the major things I'm thankful for. Then I began comparing each of these things as they are now with how they were in my earlier years. This exercise made me even more grateful for where I am today.

I'm sure my kids and close friends shuddered when they saw the reference to "My Five F's" in the title and thought "Jeez, what crazy thing is he going to say this time?" But it just so happens that the major factors that contribute to the quality of my life can be labeled with an F word:
  1. My families.
  2. My friends.
  3. My fun.
  4. My finances.
  5. My final days.
So let's start with my families and compare today with my early days.

My Family of Origin
Last year I posted  a family history  that was much too long. Now, I'll just make some some brief comments about family photos. Every picture of my mother shows the same blank, unsmiling look you see her. And I'm doing what I learned to do then -- and continued doing with most of my problems until age 50 -- looking away and pretending to be happy.

Here I am with my sister Carol and my brother Rog. Carol and I shared the same inner turmoil. She was an alcoholic and a lesbian. I was an alcoholic and a gay man. We were both deep into denial. Carol took her own life in 1971 at age 36.

Rog was -- and remains -- an incredibly normal, happy man surrounded by good friends who love him.

My dad, like Rog, was a kind and decent man. But unlike Roger, he was a lonely man without close friends. Rog was married to the wonderful, funny, feisty Gail. Dad was married to the elephant in the room.


The five of us lived together as five separate silos. Like too many families, we could talk only about "news, weather and sports." We never shared feelings. The elephant in the room was never discussed.

November 20, 2015

Tasigna: The First Drug to Reverse Symptoms of Parkinson's Disease?

Image result for nilotinib

At their best, drugs and treatments for Parkinson's disease (PD) only slow the progression of the disease. But now a small clinical trial has shown that a cancer drug already approved by the FDA may have the potential to reverse PD symptoms, both motor and non-motor.

The new hope was announced at the recent meeting of the Society for Neuroscience by researchers at the Georgetown University Medical Center. Using a drug developed for leukemia patients, the scientists cut the dose, and gave it to 12 patients who had either advanced PD with dementia or the related Lewy body dementia.

See yesterday's post for a discussion of these two types of dementia.

The drug is nilotinib, marketed as Tasigna by Novartis. It works to stimulate the cellular clearance system, or "garbage disposal." In leukemia, it helps clear out cancer cells. In Parkinson's, the researchers thought it might also work in smaller doses to tame the neurotoxic proteins found in patients with Parkinson's, Alzheimer's, and related illnesses.

A Very Unexpected Surprise
The researchers found that one small dose a day -- instead of the two heftier doses given cancer patients -- would do the job.

Initially, the goal of this study was to check for safety and rule out the danger of serious side effects from the drug. For its cancer application, nilotinib wasn’t designed to enter the brain. This new study aimed to see if the drug could cross the blood-brain barrier in amounts that were both safe and effective.

The researchers soon realized that this experimental treatment was yielding unexpected -- and very positive -- results.

Dr. Fernando Pagan, director of the Movement Disorders Program at Georgetown, explained his team’s surprise: study subjects began displaying significant improvements in both cognitive and motor functions… a result unheard of in advanced cases of Parkinson's Typically, treatments to improve one set of those symptoms only exacerbated the other.

November 19, 2015

Parkinson's Disease Dementia and Lewy Body Dementia

Let's start by taking a look at this video., which opens with an interview with Susan Schneider, the widow of Robin Williams, and then moves on to an excellent interview with Dr. Rahul Jandial. In this relatively short  video clip, Dr.Jandial provides one of the best and most helpful explanations of dementia, Alzheimer's and Lewy body dementia that I've come across.

Robin William's death put Lewy body dementia (LBD) in the spotlight. Schneider recently said the coroner found signs of LBD in Robin's brain. She also said that the doctors who analyzed the report told her that Robin’s was one of the most severe cases of this disease they had seen.

Williams took his own life in August, 2014. This past month, Schneider has participated in a series of media interviews to raise awareness about this relatively unknown form of dementia.

LBD is the second most common neurological dementia after Alzheimer's. Even so, most people have never heard of it. According to Dr. James Galvin, neurology professor at Florida Atlantic University, "It is the most common disease you have never heard of."

Now that I've l learned more about LBD, I have a better understanding of my own Parkinson's disease (PD)… and that of others. For example, I now recognize that my PD support group actually has two sub-groups: those members with LBD and the rest of us.

I've attended meetings of this support group for six years, and I've always been puzzled that several members seemed to have symptoms that are very different from the symptoms the rest of us exhibit. Those in this small group are more troubled by falls. They joke about their hallucinations. I now understand that they probably have LBD.

I don't appear to have the major symptoms that signal Lewy body dementia. But that doesn't mean I don't have to worry about dementia. Those of us with PD can have either Lewy body dementia or Parkinson's disease dementia.

Parkinson's and Dementia
Two forms of dementia are associated with Parkinson's:
  • Parkinson's disease dementia is diagnosed when someone already has the movement (motor) symptoms of Parkinson's and has had them for some time before showing signs of dementia.
  • Lewy body dementia is diagnosed when someone has the symptoms of dementia either before or at the same time they develop Parkinson's. But in some cases of LBD, no motor symptoms may appear at all.
Parkinson's Disease Dementia
Symptoms can include forgetfulness, slow thought processes, and difficulty concentrating. These symptoms can make finding words and names – and following conversations – difficult.

November 18, 2015

Parkinson's Disease and Dementia: An Overview

My effort to recap the connection between Parkinson’s disease (PD) and dementia -- including Alzheimer’s disease (AD) -- encountered one main complication: different writers define important key terms in different, sometimes inaccurate, ways. I’ve done my best here to untangle those complications.  

Mild Cognitive Impairment (MCI) 
Mild cognitive deficits that do not impair one's ability to carry out routine daily activities have been labeled "mild cognitive impairment." Estimates on the prevalence of cognitive changes in people with Parkinson's disease (PD) vary greatly, mainly because reviewers have used different means to identify and define impairments. They’ve also selected study participants at different stages of the disease.

Estimates suggests that one quarter to one third of all people with PD will suffer some mild cognitive impairment. Attention, working memory, executive function, and visuospatial function are the most frequently affected cognitive domains for those of us with the disease.

Doctors used to believe that cognitive changes did not develop until mid- to late-stage Parkinson's, but recent research suggests that mild changes may be present as early as the time of diagnosis.

recent study reported that nearly half of all PD patients develop cognitive impairment within about a decade, and progress rapidly to dementia.

Dementia isn’t a specific disease; instead, it’s a general term for a decline in mental ability severe enough to interfere with daily life. It indicates problems with brain functions like memory, judgment or language. It can also make some regular daily activities – like paying bills or driving – impossible.

Although memory loss generally occurs in dementia, memory loss alone doesn't mean you have dementia. To a certain extent, memory loss is a normal part of aging.

November 17, 2015

Microbubbles and Ultrasound: An Innovative, Non-Invasive Technique to Penetrate the Blood-Brain Barrier and Treat Brain Tumors, Alzheimer’s, and Parkinson’s.

Last week, a headline on the site caught my attention: “New hope for Alzheimer's, Parkinson's and brain cancer patients as scientists break blood-brain barrier.”

This new hope was reported by neuroscientists at Sunnybrook Health Sciences Centre in Toronto, Canada, where they have developed an innovative, non-invasive technique to deliver medication more effectively to previously “unreachable” parts of the brain. How? By managing to more successfully cross the “blood-brain barrier” (BBB).

Occasional visitors to this blog will have heard me talk about the BBB before. It’s the ingenious, protective “blockade” designed to prevent harmful or toxic substances from entering the brain via the bloodstream. It’s there for an excellent reason: the BBB keeps us safe.

But the BBB also presents a formidable obstacle to introducing potentially beneficial chemical therapies to the brain. I’ve mentioned this BBB “complication” in reference to prescription drugs and also to dietary supplements, like the curcumin I take.

In the case of curcumin, manufacturers found that the introduction of pepperine – the active ingredient in black pepper – enhanced their curcumin product’s “bioavailabilty,” i.e., its ability to successfully cross the BBB and “work its magic.”

The most common medication for Parkinson's disease is carbidopa levodopa. The levodopa is the key ingredient because it helps replace the dopamine destroyed by Parkinson's. Carbidopa enables more levodopa to cross the BBB, and reduces some of levodopa's side effects, like nausea.

What Exactly IS the BBB?
Before we take a look at this new technique, it might help to understand more clearly just what the BBB really is. Here’s the way the November 8, 2015 press release from Sunnybrook Health Sciences Centre described it:
Each person has a protective blood barrier lining the blood vessels in the brain to restrict the passage of large toxic substances from the bloodstream into the brain. 
You can imagine the barrier acting like saran wrap around the small blood vessels. In most areas of the body, there is no saran wrap and whatever is in the bloodstream can get into the various tissues of the body, such as muscle, etc. 
In the brain, all of the blood vessels have this “saran wrap” around them that only allows very select molecules to get through.
That “saran wrap” does an excellent job blocking potentially valuable substances which are created to treat brain diseases like tumors, Alzheimer’s, and Parkinson’s. For example, estimates suggest that certain chemotherapies designed to treat brain tumors have only a 20% chance of reaching those parts of the brain they need to reach… all because of the properly operating BBB.

November 15, 2015

Paris 11/14/2015 -- New York 9/11/2001

I searched for this video after getting this poignant email from by pal Terry:
I just wanted to tell you how events tonight brought back vivid memories of our trip to New York City in September 2001, when we walked around Wall Street and downtown near to the World Trade Center and saw all the names and posters and groups of people searching not just for those lost but for some comradeship, togetherness, human support. And there were you and I in the midst of it, trying to sense something out of an event that had no real sense to it at all
Prav and I and some friends went to La Boheme tonight at English National Opera at the wonderful Coliseum theatre just above Trafalgar Square. As we crossed the square the National Gallery was lit in Red White and Blue of the French tricolour, as were the fountains in the square; and just before the opera began the full orchestra and chorus struck up a rousing and profoundly moving performance of the Marseillaise, with the words in French above us in surtitles so we could all join in at the top of our voices and emotions.
It was terribly moving and marvelously unifying. And it took me back 14 years to our time in New York City. It was also ironic in that the ENO perform opera always in English. I had never before seen the words in the surtitles in a foreign language.
Here's  the concluding stanzas of La Marseillaise:
Children, let Honour and Fatherland
be the object of all our wishes!
Let us always have souls nourished
With fires that might inspire both
Let us be united! Anything is possible;
Our vile enemies will fall,
Then the French will cease
To sing this fierce refrain:

To arms, citizens,
Form your battalions,
Let's march, let's march!
Let the impure blood
Water our furrows

November 12, 2015

Happy Tihar

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Last night we had a nice just-family celebration of Tihar at home. Last year, we celebrated with Bhawana's parents who were visiting:

November 5, 2015

Yousef Bashir: A New Friend with an Interesting History and Point of View

With each passing year, family and friends become increasingly valuable to me. I'm very fortunate with both.

What I particularly enjoy about my friends is the diversity -- young and old, gay and straight, single and partnered, many different nationalities. The gay and AA communities I belatedly joined in my 1977-78 turnaround have blessed me with many good friends. Another gold mine for friendships was BNA, where I worked for 40 years. BNA specialized in hiring people who were smart, talented and quirky. My kind of friends. D.C.'s Palisades neighborhood -- where I've lived for the past 65 years -- has generated many friendships.

And that's where I met my new pal Yousef Bashir. He lives on Sherier Place, the street where we had our first house.

Yousef was born in the Gaza Strip. A few months ago, he got his master's degree from Brandeis University. What happened in between those two events is a fascinating, moving and inspiring story, particularly an event that took place in 2004.

But first some background information

Yousef's Family History
Yousef is from Gaza, specifically Deir el-Ralah. Unlike many residents of Gaza today who are newcomers, Yousef's family has been in Gaza for generations. The family owns a three-story house. Behind the house is farm land where for years his family has raised fruits and vegetables for the market.

His father was headmaster in a high school where he also taught English. He had a special fondness for Victorian literature.

Yousef, his parents, and four siblings lived in the house, which was next to the Israeli settlement of Kfar Darom which, in turn, was next to a military base. In 2000. the Israeli Army seized the house and used it as a sentry post. Other houses in the neighborhood had been destroyed after the army ordered the residents out. Yousef's father refused to evacuate his family.

In a strange compromise, Israeli soldiers took over the house except for the living room, where the seven-member Bashir family lived from 2000 to 2005. They were permitted to buy groceries once a week. They had to ask permission to go to the bathroom, had to be accompanied there by an escort, and were told not to close the bathroom door.

Improved Posture for Better Health

Reviewing the archives, I found an article I’d saved from titled “Posture Tips to Help You Feel Younger: Pay attention to your body's alignment to avoid serious health problems.”

In the past several weeks, the subject of posture has taken on a new significance for me since I’ve been experimenting with John Pepper’s “conscious walking.” Posture, of course, is a key element in Pepper’s recommendations. With any luck, maybe some measure of improved posture will result for me… if I can just create the time to get outside during these fine Indian summers days in Washington.

Why Posture Matters
According to Mary Ann Wilmarth, Chief of Physical Therapy for Harvard University Health Services, poor posture can create problems and exacerbate a variety of existing physical problems, including:
  • Osteoarthritis or compression issues, putting you at increased risk of fracture
  • Headaches
  • Diminished breathing ability
  • Back and neck pain
  • Fatigue
  • Heightened risk of athletic injury
What Does It Mean to “Stand Up Straight”?
There’s a common perception that good posture means “chest out, shoulders and head back.” The article is quick to correct that misimpression.

Good posture means that our three “postural curves” are balanced and in proper alignment, both front to back and side to side. What are those “curves”?
  1. cervical/neck
  2. thoracic/ribs
  3. lumbar/low back/sacrum into the coccyx
Harvard’s Wilmarth explained it this way: “If you look from the side, if your ear, shoulder, hip, knee and ankle are in a pretty straight line, give or take, then your curves are most likely in the right positions.”

November 4, 2015

The Two Most Important Dates for My Well-being:10/28/1977 (Coming Out) and 3/27/1978 (Getting Sober)

I'm glad recent events took me back to those life-changing months from the fall of 1977 to the spring of 1978. I get so caught up these days dealing with Parkinson's and aging that I don't spend enough time reflecting on the past.

Those six months included the two most positive actions I've ever taken for my well-being:

  1. Being open about my sexual orientation, which started by coming out to my family on October 28, 1977.
  2. Finally overcoming years of denial and recognizing that I am an alcoholic, a process which began by attending my first closed AA meeting on March 27, 1978.

But something very sad happened during those months, too. My wife Diana learned she had throat cancer in late November, 1977. She was in and out of Georgetown Hospital (more in than out during the last months) and she died there May 23, 1978.

As I noted last week in a post about my "coming out," Diana and I had agreed on a separation. She continued to live in our house, and I rented an apartment nearby. We reconciled after her cancer diagnosis, although I continued to finish out the year's lease on the apartment.

Ann was completing her senior year in high school. She lived in the house with her mother during the months when Diana was in and out of the hospital. My son Todd was already living on his own.

After Diana's death, Ann remained at the house for the next three months until she left for her freshman year at the Medill School of Journalism at Northwestern University. I continued living at the apartment but spent lots of weekend time back at the house. This living arrangement troubled some close family friends, but Ann and I agreed it worked for us.

As you might imagine, this time was tumultuous for everyone in the family. We all weathered the storm and have strong, loving relationships today.

November 3, 2015

Two Recent Events Trigger Memories of My Turnaround Six Months, 1977-78 (continued)

Event No. 2: The Palisades House Tour

My daughter and I took the Palisades House Tour a few weeks ago. I'm a member of the Palisades Village, which sponsors the event.

Daughter Ann and I agreed that the tour highlight was this Japanese-style house:

Many of us longtime Palisades residents refer to this house as the "McGovern House." I knew that the house had been built by Chief Judge David Bazelon of the U.S. Court of Appeals for DC. I didn't know until I read the tour guidebook that Judge Bazelon and his wife chose the Palisades because other local neighborhoods still maintained restrictive covenants that prohibited land sales to blacks and Jews.

Terry McGovern and Me
In 1968, the Bazelons sold the house to their friend George McGovern, then a young senator from South Dakota. The guidebook doesn't mention when the McGovern's sold the house. But I know it was after 1980. ?  I got sober in March, 1978 and began attending meetings of Alcoholics Anonymous almost every evening, In late 1978 or early 1979,  I became friends with Terry (Theresa) McGovern, the senator's daughter. She attended some of the same neighborhood AA meetings I did. She had a few dates with a young recovering alcoholic who was staying at my house at the time.

I'm not violating AA's anonymity precept by disclosing these details. Senator McGovern had already written a heartbreaking book, Terry, with the subtitle "My Daughter's Life-and–Death Struggle with Alcoholism." This photo gives you a sense of the Senator's love for Terry:

Teresa Jane Terry McGovern

Terry was intelligent, funny, generous, charismatic, tender. She also struggled with depression and alcoholism all her adult life.

October 30, 2015

Two Recent Events Trigger Memories of My Turnaround Six Months, 1977-78

Event No. One: GLBT Panel at BNA/Bloomberg

OK. I know the company's name is Bloomberg/BNA. But BNA will always be first to me. Thanks to the man shown on the left in this photo who is responsible for the biggest turn around in my life:

His name is John D Stewart. He was executive editor of BNA in 1955 and later became BNA's President. That was the year I was kicked out of Cornell Law School in March of my third year after I was arrested for conduct that I don't remember because I was in an alcoholic blackout. But I was told it involved a men's dorm at Cornell.

I thought at the time that this was the worst thing that could have happened to me. But, thanks to John, it turned out to be the best. During my undergraduate and law school years, I had worked part-time at the library of Cornell's New York State School of Industrial Labor Relations. The head of the library, Gormley Miller, was a friend of John Stewart's. Gormley called John and, without going into specifics (which he didn't know), told him of my expulsion but nevertheless recommended that John interview me. As a result, within a month of my expulsion, I began work at BNA.

I met the woman who was to become my wife at BNA and spent 40 enjoyable and rewarding years working there.

BTW, the other man in the photo is Bill Beltz who was hired a year after I was. He succeeded John as executive editor and then as BNA's president. He also was a treasured friend.

Fast-Forward to Today
A year or so ago, some Bloomberg/BNA employees formed a GLBT group. They decided to hold a forum to discuss BNA's history in dealing with GLBT issues. I was surprised and pleased to be asked to be on the panel that would lead the discussion.

The pre-AIDS GLBT history at BNA, as in most workplaces, was pretty much a blank slate since only a few employees were open about their sexual orientation. But at BNA, there was a GLBT-related event in the late 1970s. I talked about this at the panel forum. Here's the story:

My marriage in 1957 resulted in part from work I had been doing with a therapist who specialized in converting men from gay to straight. But the marriage resulted primarily from the fact that I had fallen in love with my coworker Diana LeBlanc.

October 29, 2015

How Can We Evaluate Claims Like Dr. Newport's Coconut Oil Cure for Alzheimer's and John Pepper's Conscious Walking Remedy for Parkinson's?

Two days ago, I posted some additional thoughts about John Pepper's campaign to get others with Parkinson's disease (PD) to work on "conscious walking" to alleviate (my word) or reverse (Pepper's word) symptoms of PD.

Almost immediately, a reader posted this comment:
you've been so very tough on dr mary newport's promotion of coconut oil for alzheimer's. seems like you're giving pepper an easier time. how come?
I'd half expected a challenge like this. It gives me a chance to talk about a concern of mine: How can we evaluate claims that are often made on the basis of personal, anecdotal stories?

First, let's take a look at the Newport and Pepper stories.

Mary Newport and Coconut Oil for Those with Alzheimer's
Dr. Mary Newport, the medical director of a neonatal intensive care unit in Florida, reported in 2008 on the dramatic improvements in her husband Steve's Alzheimer's after she began giving him several teaspoons of coconut oil every day.

Dr. Newport then wrote a best-selling book, Alzheimer's Disease: What If There Were a Cure? and soon became a regular guest of TV docs and media hucksters. Her appearance on Pat Robertson's Christian Broadcasting Network moved the CBN reporter to exclaim "God must have had a hand in it!" That interview on the network's webpage became one of CBN's most-visited sites.

The coconut-oil-for-Alzheimer's craze really took off. But -- as the Alzheimer's Association  emphasized -- many thousands of people tried the remedy, and very few reported relief similar to Steve's.

Several years ago, Dr. Newport suddenly fell silent. We began hearing reports that Steve had suffered some kind of health setback. Then, as I reported last fall, Dr. Newport made a blog post for the first time in a year, reporting that Steve had resumed his Alzheimer's decline. Dr. Newport wrote that she still hoped ketones and MCT oil and "food-based interventions" might help with Alzheimer's. But there was no mention of coconut oil in this context.

John Pepper and Conscious Walking for Those with Parkinson's Disease
John Pepper -- whom I've featured in several recent posts -- is an 81-year-old man from South Africa who was diagnosed with PD in 1992 but probably had it long before. He has tremendous willpower and determination. He decided that Parkinson's had damaged the part of his brain that deals with automatic movements, like walking.

October 28, 2015

A New Study on the Growing Impact of Income Inequality on Life Expectancy Hits Home

One after another, studies keep coming in showing that the income inequality gap in the U.S. keeps getting wider and brings with it serious consequences in most areas of our lives. A report from the National Academy of Sciences (NAS) last month on the growing life expectancy gap underscored the effects of income and education on old age. Demographers were staggered by its findings regarding the size of the increased gap.

The study looked at two cohorts. The first was men and women born in 1930. I was born in 1929. The second cohort was men and women born in 1960. My son was born in 1958 and my daughter in 1960.

Life Expectancy Gap
The NAS committee found that men born in 1930 who reached the age of 50 had a life expectancy of another 26.6 years (to age 76.6) if they were in the lowest income bracket. But for those in the highest income bracket, the life expectancy extended 31.7 more years (to age 81.7), so the gap between the two income groups was about five years.

For men born in 1960, life expectancy for those in the lowest income group was about the same as it was for the similar low-income men born in 1930 (about 26 more years after age 50). But for men in the highest income bracket, life expectancy at age 50 for those born in 1960 was projected to extend 38.7 more years (to age 88.7)... a full seven years more than the high-income men born in 1930.

The difference in life expectancy between the lowest and highest income groups born in 1930 was 5.1 years. For men born in 1960, that difference had stretched to 12.7 years.

For females, the gains for those at the top of the income brackets was even more spectacular. Lower-earning women actually showed declining life expectancy from those born in 1930 to those born thirty years later. The decline was attributed to increased smoking among the 1960 cohort. But those in the top-earning bracket who reach 50 can now expect, on average, to live another 41.9 years (to age 91.9).

So the gap in life expectancy for women in the lowest and highest income brackets was four years for the 1930 cohort. That gap surged to more than 13 years for those born in 1960.

Note: Remember that these life expectancies are for those who survive to age 50. Life expectancies at birth would be much lower.

Here we have one more study showing that the U.S. is increasingly "the land of opportunity" but especially for those with the most income and education.

Consequences of the Life Expectancy Gap
These widening gaps in male and female life expectancies mean that the rich get richer when it comes to federal benefits -- Social Security, Medicare and Medicaid. In the 1930 birth cohort, lifetime benefits for low- and high-earning men were about the same. Among those born in 1960, however, those in the highest-earning bracket will receive $132,000 more on average than those in the lowest; the highest earning women will receive about $28,000 more.

October 27, 2015

Doidge on Brain Neuroplasticity and Pepper on Conscious Walking: Intriguing But Flawed Books

In my last two posts before taking a week off, I wrote about these two books:
  •  "The Brain's Way of Healing," the recent bestseller by Dr. Norman Doidge about the new science of neuroplasticity, which asserts that for conditions ranging from autism to stroke to Parkinson's disease, we can use conscious habits of thought and action to stimulate the brain to "rewire itself."
  • "Reversing Parkinson's Disease!" by John Pepper, who is featured in Doidge's book as an example of rewiring the brain by his developing and practicing "conscious walking." That activity works so well for John that he was able to discontinue his Parkinson's medications.
I spent a good bit of time last week researching and reflecting on the concepts put forth in the books.

Dr. Doidge and "The Brain's Way of Healing"
I read several reviews of Doidge's book. The most thorough and thoughtful in my opinion came from The Guardian, which did three separate stories: an initial review, followed by a write up on Doidge that includes an interview with him, and a final review.  Here are a few excerpts from these reviews:
Doidge is persuasive and curious as a writer, and rigorous as a thinker, what he writes about is the edge of our current understanding of mind and body.
While reading "The Brain's Way of Healing" I had a clear sense of other readers being divided – – some turning its pages with a hardening edge of skepticism, some with a growing feeling of wonder. Chapter by chapter, I jumped constantly between the two.
 . . . His next tale, from South Africa, is that of John Pepper, a man diagnosed with Parkinson's disease more than 20 years ago who has managed to reverse all of its symptoms using "neuroplastic techniques." Pepper, through trial and error, and an understanding of how Parkinson's typically acts against sequences of muscle memory, taught his body, first through entirely conscious relearning of the sequences involved in walking, and then in all other actions, how to think differently. Pepper had found, Doidge suggests, "through conscious walking, a way of using a different part of his brain to walk . . .  by "unmasking" existing brain circuits that had fallen into disuse.
Doidge believes that many of these cures are derived from “ancient Buddhist ideas,” but he argues that they can all be explained in terms of “western science,” as long as neuroplasticity is taken into account. For all I know, he may be right, but I would trust him more if he reined in his rhetoric . . . The idea that “the brain is part of the body”, that “the body can be used to treat the brain” and that “the mind can alter the brain” sounds not so much innovative as inane. And when Doidge offers his explanations of the physiological basis of neuroplastic medicine – telling us that neurostimulation can “power up the cortex” and “reset” the brain, empowering you to “turn off your fight-or-flight reaction” and “turn on your social engagement system” – his approach strikes me as figurative and flashy rather than phlegmatically factual. As for his much-repeated injunction to “rewire your brain,” it sounds like knockabout comedy rather than responsible medical advice.
 While recognizing that Doidge's book is based on stories, not scientific studies, I nevertheless find the subject of neuroplasticity fascinating and believe it offers a lot of potential for human healing.

John Pepper and "Reversing Parkinson's Disease"
I'm a member of two forums where people with Parkinson's communicate with each other. One is part of based in Cambridge Massachusetts. The other is part of HealthUnlocked, the largest social network for health information in the United Kingdom.

October 16, 2015

John Pepper’s “Conscious Walking” Helps Parkinsonians. And We Can Help John Help Others.

When I was diagnosed with Parkinson's six years ago, I bought half a dozen books about the disease and spent hours doing research online. 

The result? I got so discouraged that I came very close to selling the house I love and moving into an assisted living residence. What I had read scared me into thinking that my progressive, degenerative disease would quickly force me into wheelchair, where I'd languish with a frozen mask for a face. I'd suffer the typical side effects of depression, insomnia, and constipation.

If only someone had persuaded me instead to buy and read one of John Pepper's books. In yesterday's post, I discussed the rigorous "conscious walking" program John developed. Because of that regimen, he now leads a relatively normal life and hasn't used any Parkinson's medication since 2002.

Retard, Even Reverse, the Symptoms
In 2003, John wrote a book about his journey through Parkinson's disease: his setbacks, achievements, discoveries, disappointments, and ultimate triumphs. He wanted his book to give other people with Parkinson's the hope that we, too, could slow down -- or even reverse -- some symptoms of the disease.

Now in its fourth edition, the book describes how PD patients willing to work hard are discovering just how much the human body -- including the brain -- can heal itself. John's main subject is strenuous exercise, especially conscious walking. But he offers advice about other issues we face, too.

By walking, bowling, and playing tennis, Pepper has regained his physical flexibility and balance. He keeps his mind sharp by reading, playing bridge, working puzzles and games.

October 15, 2015

Norman Doidge's "The Brain's Way of Healing" and John Pepper's Conscious Walking for his Parkinson's

A few months ago, I started seeing reviews of Norman Doidge's new book, The Brain's Way of Healing. Here's what appeared in the Huffington Post:
His new book is a tour de force -- one of the most riveting books on the human brain and its mystery powers ever written. Doidge addresses the role of alternative medical therapies to what he claims can reset the dynamic patterns of "energy" in our brain, in some cases helping to restore relatively normal health to those whose fate seems hopeless.... These are people that traditional medicine all but abandoned as... untreatable. But they were rescued.
The review included this sentence: "It’s possible to start anywhere in the book and be mesmerized." When "Amazon one click" brought the book to my mailbox, I knew exactly where to start: Chapter 2, titled "A Man Walks Off His Parkinsonian Symptoms."

Imagine my surprise when I discovered that the man was John Pepper, whom I know from our online exchanges in the HealthUnlocked forum for people with Parkinson's.

This new book isn't Doidge's first. Earlier, he'd written The Brain That Changes Itself, a bestseller that prompted Pepper to send the author this email in 2008:
I live in South Africa and have had Parkinson's disease since 1968. I do a lot of exercise and have learned to use my conscious brain to control the movements which are normally controlled by the subconscious brain. I wrote a book about my experience, but it has been rejected by the medical profession without looking into my case, because I no longer look like a PD sufferer. I no longer take PD medication, although I still have most of the symptoms. I walk 15 miles per week in three sessions of five miles. The glial-derived neurotrophic factor produced in the brain appears to restore the damaged cells.... I am sure that I can help many newly diagnosed patients, if I can encourage them to do serious regular exercise. Please let me know your thoughts on this matter.
The glial-derived neurotrophic factor (GDNF) that Pepper described is a brain growth factor. The scientists who discovered GDNF in 1993 said it contributes to plastic changes in the brain by promoting the development and survival of dopamine-producing neurons, which Parkinson's destroys.

October 14, 2015

Light: Sleep’s Greatest Enemy

A recent article in The New York Times posed a question we ask more than we’d like: Why Can’t We Fall Asleep? 

Author Maria Konnikova begins by explaining what happens when we DO fall asleep:
  • Body temperature falls (though hands and feet warm up).
  • Circadian clocks synchronize.
  • Melatonin (the hormone that sets our sleep/wake cycles) flows through the body.
  • The brain quiets.
  • Blood pressure falls.
  • Pulse rate slows.
  • Breathing evens out.
Finally, sleep.

Not surprisingly, some of the world’s leading sleep experts report disturbing statistics:
  • We now sleep an hour and a half LESS than we did on work nights half a century ago. It used to be eight and a half hours; now it’s under seven.
  • 31% of us sleep less than six hours a night.
  • 69% report not getting enough sleep.
  • Between 1905 and 2008, children have lost about a minute of sleep each year.
Adults… children… this pattern of reduced sleep applies to everyone.

It’s not that we’re just getting up earlier. According to Elizabeth Klerman, head of the Analytic and Modeling Unit in the Sleep and Circadian Disorders division at Boston’s Harvard-affiliated Brigham and Women’s Hospital, “When you go to bed affects how long you can sleep, no matter how tired you are.”

October 13, 2015

Less Time Blogging: A Fellow Blogger Says It Much Better Than I Could

Two weeks ago, I wrote about my decision to cut back on blog posts. Rather than publish posts every week, as I've been doing since starting this blog six years ago, I'm now doing blog posts every other week. Last week was my first "off week," and I had planned to share my thoughts about the new arrangement today.

Several months ago, my favorite blogger, Ronni Bennett, made a similar decision and stopped publishing her excellent blog, Time Goes By, on Tuesdays and Thursdays. Last Friday, she published an excellent post reflecting on that decision and its results. Her reasons and reflections are parallel to mine... so often the case with her posts. She just expresses them much more eloquently than I could. And I'll second the warning that Ronni got from her 90-year-old friends when she bemoaned the loss of energy between ages 65 and 75: "I don't know nuthin' yet about getting old until I live through the differences between 75 and 85."

So I'm going to extend my holiday by turning the rest of this post over to Ronni:

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.

September 24, 2015

The Addendum to My Advance Directive: Palliative Care, not Life-Sustaining Procedures

In yesterday's post, I provided the text of the basic advance healthcare directive I'll attach to my revised will. It's fairly standard.

My directive first provides for the appointment of "my durable power of attorney for health care." This individual (also the executor of my will) is empowered to make decisions about my healthcare if there comes a time when I cannot make those decisions myself.

I want to know there is someone who can respond fluidly as my medical situation changes, someone who can deal with situations I can't foresee. I'll add instructions above and beyond what is detailed in the standard directive, to help my healthcare attorney/agent carry out my wishes.

I want to clarify these key preferences in most health care crises: 
  • for palliative care, not life-sustaining procedures, and 
  • for hospice, not hospital.

Questions have been raised about the legality of a provision, like the one I have here, that authorizes my agent to arrange for VSED (voluntarily stopping eating and drinking) in the event I have dementia. I discussed this issue in an earlier post

I'll wrap up this series on advance directives tomorrow.

Here are the additional instructions I'll add to the standard directive:

September 23, 2015

My New Advance Health Care Directive: Will It Be Honored?

I'm about to sign off on a revised draft of my will and the advance healthcare directive that accompanies it. I've gone through this drill before, but this time I'm making more of an effort to publicize the directive.

An 86-year-old with Parkinson's, I want any healthcare providers to know that in the event of a life-threatening condition, I want comfort care only... no heroics. Earlier this year in its "The New Old Age" blog, The New York Times reported on the trouble with advance directives. Researchers and medical personnel working with patients near the end of life have grown increasingly disenchanted with advance directives, including living wills and powers of attorney for healthcare.

Frequently, directives never get to the right place at the right time, or they're not referenced when decisions must be made. Even clear, formalized instructions are often overridden when relatives on the scene are unaware of their loved ones' end-of-life stipulations.

This time, rather than have my advance directive filed away in my desk drawer, I'm making sure my immediate family, my housemates, and my attorney for healthcare know its contents. I'll also send copies to my geriatrician and neurologist, the two doctors most likely to be involved should a health crisis arise.

The POLST Form for Emergency Care
Emergency medical personnel operate under standing orders to attempt resuscitation regardless of any specific instructions to the contrary in advance directives. In fact, patients may already be hooked up to breathing machines before they even arrive at the emergency room.

Only a do-not-resuscitate or POLST (Physician Order for Life-Sustaining Treatment) form can prevent that unwanted scenario. Research suggests that these forms do a better job than advance directives of keeping dying people out of hospitals. Completed by healthcare professionals in consultation with patients, the documents can exactly stipulate expected medical responses, from comfort-only measures to full life-prolonging interventions and all the options in between.

POLST documents are designed for people with severe illnesses. They're generally appropriate only for people who are in the final year of life, suffering from an advanced terminal illness or an illness from which there is no expectation of recovery.

Unfortunately, Washington, D.C. currently doesn't have a POLST program.

To see if your state has one, click here.

My Advance Health Care Directive
What follows is the main part of my advance directive. Most directives today are similar, listing healthcare options that address different medical situations. I'll be checking the first option -- the one calling for the least medical intervention -- in each situation.

I've added an unusual provision at the end, which I'll discuss tomorrow.

September 22, 2015

Want to Lower Your Blood Pressure? Just Stand Up.

Here’s the kind of news I like to hear: Just standing up can help lower your blood pressure (bp).

Occasional visitors to this blog know a frequent theme here is bp – its highs and lows, its many causes, its acceptable ranges.

Those readers also know that I take my blood pressure at home regularly through the course of each day, and that I record the numbers in an ever-growing log. That log includes notes -- what I’ve been doing, where I am on my Parkinson’s pill cycle, how I’m feeling.

I’ve devoted many blog posts to the various strategies I use to control blood pressure: sipping hibiscus tea  at least once a day and beet juice first thing in the morning, meditating, drinking lots of water, using specially designed electronic devices, and exercising. I no longer take the blood pressure meds that I used for years

Not that many years ago, I rode my bike regularly... to work most every day and to Great Falls or Mount Vernon or most anywhere on our many bike trails on weekends. The most depressing setback from my Parkinson's was having to give up biking due to the balance problems.

In my early years with Parkinson's, I enjoyed long walks around my DC Palisades neighborhood. Now, whatever walks I take are short and brief… and rare.

Needless to say, an article in The New York Times last Friday got my attention. It began like this:
Question: What is the best exercise to control high blood pressure? 
Answer: Take your pick, as the best exercise to control high blood pressure seems to be virtually any exercise, like walking or cycling or light weight training, especially if your workouts are spread throughout the day. 
“Even standing might work,” says Glenn Gaesser, the director of the Healthy Lifestyles Research Center at Arizona State University and an expert on exercise and hypertension.

My kind of news.

Several Brief Exercise Periods Better than One Longer One
In a study he completed three years ago, Gaesser found that three ten-minute walks spread throughout the day prevented bp spikes (my big worry) more effectively than one 30-minute walk.

September 18, 2015

Health Grab Bag: Coffee and Parkinson’s Risk, “Old People Smell,” Exercise for Brain Health

Occasionally, I’ll combine several recent stories that caught my attention in a general “health update.” Here’s one today.

Coffee Lowers Parkinson’s Risk
If you drink coffee, your risk of developing Parkinson’s disease is lowered by 31 percent, according to a meta-analysis presented at the First Congress of the European Academy of Neurology in Berlin this past June.

As reported in a recent article in Medical News Today, Dr Filipe Brogueira Rodrigues and his team at the Instituto de Medicina Molecular in Lisbon conducted a systematic review of 37 studies from all over the world. “Men and women benefit equally from the effects of caffeine,” he said.

While there are still many possible explanations, the researchers think that coffee’s caffeine interacts with the neurotransmitter adenosine. According to Brogueira Rodrigues, "This may have neuroprotective effects on specific brain regions which play an important role in relation to Parkinson's."

The good news about coffee’s positive health benefits wasn’t especially surprising, since the popular drink has already been linked with reduced risks for type 2 diabetes, stroke, depression, Alzheimer’s, liver cirrhosis and liver cancer.

Prof Kailash Bhatia from the Institute of Neurology, UCL, London, said, “Better understanding of environmental factors which reduce or increase the risk of developing Parkinson's disease is crucial to safeguard against developing this disorder.”

He urged continuing study to more clearly understand the link between caffeine in coffee and its association with reduced risk of Parkinson’s.

Old People DO Smell Different
And it’s all about “Nonenal,” a component of body odor that develops in men and women after about age 40. Maybe you’ve smelled it in nursing homes or other elder care facilities.