May 27, 2015

U.S Toilet Bidets vs. European Bidets: U.S. Wins Hands Down! (Pun Intended)

I needed a quick and easy post for today since my kids are taking me out for a day-after-birthday dinner tonight, and I have lots of catching up to do after my Tuscan holiday. So here we are again at what's becoming one of my favorite subjects.

Here's what I wrote in my first bidet post back in February:
The bidet is a fixture in bathrooms the world over, but it has never really caught on in the U.S. Instead of washing with water after relieving ourselves, Americans would rather deforest millions of acres in order to produce toilet paper. 
We think bidets are too European, too Parisian. We suspect they have something to do with s-e-x. 
But more and more people – myself included -- are beginning to tout the bidet as a safer, more effective way for seniors to clean themselves.
U.S. Toilet Bidet Attachment
Here's the inexpensive American-manufactured bidet attachment I've added to the three toilets in my house:

European Freestanding Bidet
Here's a photo I took in my bathroom in the apartment we rented in the Tuscan town of Cortona.

May 26, 2015

Household – Not Just Leisure Time -- Activities Protect Against Parkinson’s

Can regular daily exercise – not time spent working out at the gym or playing tennis, but doing housework, commuting to work, walking the dog –  lower one’s risk of developing Parkinson’s disease (PD)?

A large study suggests – yes, it can. Results of that study – published in a recent edition of Brain: A Journal of Neurology – was conducted by researchers at the Karolinska Institutet in Stockholm, Sweden.

Of course, it is already accepted wisdom that exercise – walking, dancing, yoga, tai chi -- helps people who already have PD. Now, this new study adds powerful evidence to the notion that regular everyday exercise brings a neuroprotective benefit.

After this blog reviewed last week’s news about two conditions (loss of smell and history of depression) linked to increased risk of developing PD, it’s good to share some information about reducing one’s risk of developing the disease.

A Large Study
In September, 1997, as part of the “Swedish National March Cohort,” 43,368 people (64.3% female, 35.7% male) completed a 36-page questionnaire that included detailed information about physical activity and exercise habits earlier in life. None had Parkinson’s disease.

Regular follow-ups of this large group ended in 2010, 13 years later.

During that interval, 286 participants – 128 women and 158 men – were diagnosed with PD.

Men at Greater Risk
While men represented only about 36% of all participants in the survey, they accounted for over 55% of all PD cases. That imbalance is consistent with data from the Parkinson’s Disease Foundation estimating that men are 1.5 times more likely to develop PD than women. Possible reasons?

May 25, 2015

A Recommended Read on This Memorial Day

I was going to write today about my two weeks in Tuscany. I was also going to regard today as just another Monday holiday. But then I read this Facebook post from my BNA colleague and friend Tom Caso:
This Memorial Day has touched me deeply as I give thanks to those brave men and women who gave it all. Maybe it's because I live in the Washington DC area or maybe I am just getting old and reflective, but I have a greater sense of what this day is all about.

When the Monday holidays were proclaimed from Congress, I felt we had lost something of the importance of the day. As a kid we would decorate our bikes with red white and blue paper bunting and have a five-flag display on the the handle bars and ride down to see the Parade in Tenafly. It made a profound impression upon a young kid that has matured into respect and graditude.

So today, let's leave all our politics, all our passionate beliefs about wars and foreign policy, all our partisanship and just say stop and say THANK YOU AND GOD BLESS OUR SERVICE MEN AND WOMEN.
Reading Tom's FB post reminded me that I have a greater sense today of the sacrifices made during World War II by both the Yanks and the Brits, having just finished reading Citizens of London by Lynne Olson. In this spellbinding book, Olson gives us a fresh perspective on those times by focusing on the three Americans "who stood with Britain in its darkest, finest hour."

The three were Edward R Murrow, the handsome, chain-smoking head of CBS News in Europe; Averell Harriman, the hard-driving millionaire who ran FDR's Lend-Lease program in London; and John Gilbert Winant. Never heard of Winant? Neither had I. Olson's book restores him to the place in history that he really deserves. He comes across as the most admirable of the three Americans. Roosevelt appointed him as our ambassador to London in 1941.

For me, the heroes of this book are Winant and the citizens of London. By March 1941, after eight months of bombing, most Americans had abandoned London. Joseph Kennedy, who was the U.S. ambassador to England until 1940, was among those who departed, telling Roosevelt he felt that England would be defeated and that America shouldn't help them. Enter Winant.

This Could Never Happen Today
Winant was a liberal Republican and a former governor of New Hampshire. He was elected governor three times. He broke ties with his party to support social reform. Then he put his career on the line to participate in the Roosevelt Administration.

May 22, 2015

Large Study Links Depression with Increased Risk of Parkinson's Disease

The internet lit up yesterday with reports of a large new study that reported an association between depression and an increased risk of Parkinson’s disease (PD). The results were published in the May 20 online edition of Neurology, the medical journal of the American Academy of Neurology.

The data revealed another link, too: the more severe the depression, the greater the risk of developing Parkinson’s.

This news is an interesting companion to yesterday's post, in which I discussed loss of smell as a reliable early indicator of Parkinson’s.

Researchers in Sweden identified 140,688 people with depression, all born before 1956. For each of those individuals, the study team identified and assigned three people without any history of depression – but the same age and gender -- to a control group.

The research thus involved a large sample of over half a million participants, some of whom were followed for 28 years. Among the depressed group, 1,485 individuals – or 1.1% -- developed PD. Among the study participants without depression, only .4% -- point four percent – developed PD.

That means that the people with depression were about three times more likely to develop PD than their counterparts with no history of depression.

May 21, 2015

Can Diminished Sense of Smell Become a Better Diagnostic Tool for Parkinson’s Disease?

Infographic from the Michael J. Fox Foundation for Parkinson's Research

We’ve known for years that hyposmia – reduced ability to detect smells – is typically an early warning sign of Parkinson’s disease (PD). As the graphic above shows, about 96% of all newly-diagnosed Parkinsonians have already lost some sense of smell.

I was certainly part of that 96%. In addition to an arm that didn’t swing naturally when I walked, my diminished olfactory sense was a signal my medical team really should have identified as a PD red flag long before I finally received a diagnosis.

There are a variety of non-motor symptoms of PD, including
  • hyposmia
  • chronic constipation
  • urinary urgency (including frequent nighttime urination) 
  • rapid eye movement sleep behavior disorder (in which sufferers appear to act out dreams in their sleep)
  • daytime sleepiness
  • anxiety
  • depression
Hyposmia: PD’s Best Early Indicator?
None of these conditions seems to present earlier in the development of the disease, or more regularly, than that diminished sense of smell.

The hyposmia that precedes PD could – should – be a great addition to a doctor’s diagnostic bag of tricks. In the case of PD – the earlier the diagnosis comes, the sooner treatment can begin... and the more likely that depleted dopamine can be replenished.

It’s always surprising to read that by the time most people learn they have the disease, most of their neurons that produce dopamine – the neurotransmitter that enables the brain to manage the body’s movements – have been destroyed.

May 20, 2015

. . . And Sprinkle in Some Tai Chi

Tai chi is becoming very popular with seniors. Most of us have seen the videos in which hundreds of slim, fit, elderly Chinese gather to perform their tai chi exercises early in the morning.

I regularly see reports on studies that show how tai chi can benefit those of us with Parkinson's.

This video describes a tai chi-for-Parkinson's exercise program:

I tried a tai chi class at my local senior center but, as usual, I was too self-conscious about my ineptness. Now I just add some tai chi movements into my morning exercise program.

May 19, 2015

. . . Now a Few of the "Most Effective Exercises"

In the last post, I shared some exercises from a WebMD site that features exercises for lower back pain. Today's exercises come from a WebMD slide show that recommends "Seven Most Effective Exercises." Here are the ones I added to my morning recipe:

I use this squat to settle into my chair for my morning meditation.

May 15, 2015

. . . Then Add Some Core Muscle and Other Exercises for My Bad Back

When I finished my training on the BIG exercises, I asked my excellent physical therapist about core muscle exercises. I had heard that they might help alleviate my chronic lower back pain. She agreed and recommended two exercises in particular. That was five years ago, and I still do these exercises almost every day. 

This unusual dedication is due to one thing: I can tell that these exercise really help. 

Here they are.

That's what my PT called the first exercise, but it goes by various names. Here's one description I found.

Getting the exercise right takes a little practice. Here's an explanation under a different name.

Pelvic Brace Exercise

Once a day, lie on back and "deflate the balloon" (mine's more like a beach ball) by pushing the belly button down toward your spine without inflating the stomach. Perform this exercise at 50% or less of full effortPut your fingers on the lower abdomen and feel the stomach going in. 

"The Bridge"
The second exercise is more easily described. This image should suffice.

Image result for Bridge exercise

Other Lower Back Exercises
Recently I came across a WebMD site that displayed a good selection of exercises for lower back pain. I selected the ones here:

Coming next week: Exercises rated most effective, and tai chi for Parkinson's.

May 14, 2015

Ingredients in My Morning Exercise Program: Start with a Few BIG Exercises

I haven't talked much about exercise lately, but it may well be my most effective way to slow down the adverse effects of both Parkinson's (PD) and aging. I'm writing this post from the apartment we've rented in the Tuscan hill town of Cortona for two weeks. Nearing the end of the first week, I've been amazed by the positive health benefits I've felt from exercise -- and a few other changes -- during this holiday.

I'll report on those developments when I return home. For now, I want to run a series of posts about my morning exercise/meditation routine that I prepared before I left for Italy.

I don't have access to my Dragon voice-recognition software, so I'm back to using my error-prone fingers on the keyboard. I'm also dealing with the peculiarities of the Italian keyboard on my newly purchased laptop. Worst of all, the laptop uses Windows 8.1. Now I understand why this particular version generated such negative reviews when Microsoft launched it.

BIG Exercises for Parkinson's
The foundation for my current exercise regimen dates back to the training in the BIG exercise program I began six years ago shortly after my PD diagnosis. BIG was developed by Lee Silverman Voice Treatment, the same organization that introduced the LOUD speech therapy for people with PD.

The full exercise program consists of six exercises done with BIG movements. It's pretty intense and probably best suited for people in the early stages of the disease. For more information on BIG and videos featuring "Jane Fonda" Schappi, click here.

I did these exercises pretty faithfully for several years but gradually slacked off. I still use two of the exercises in my current program but I only do the routines for a couple reps, not the recommended ten or twenty times.

I chose these two exercises because they're the most effective in dealing with my balance problems.

May 13, 2015

Ten Tips for Caregivers

Last year, a rep from the asked if I’d become one of their occasional bloggers. The website is designed to support the vast network of caregivers out there, but there is also lots of material of interest to seniors generally. I was happy to say “yes.”

In my internet explorations since then, I’ve kept my eyes peeled for information about caregiving – a challenging job for millions of Americans, whether professional or familial.

With legions of Baby Boomers now entering their senior years – and with the Alzheimer’s epidemic raging – more and more Americans will be adding “caregiver” to their resumes.

Maria Carrillo, a neuroscientist with the Alzheimer’s Association, said: “It’s an epidemic, it’s on the rise, and currently [there is] no way to delay it, prevent it, or cure it.” She also said that five million people in the U.S. now have the disease. That number could reach 14 million by 2050.

That’s a lot of dementia. And a lot of difficult caregiving.

Last month, ran an article titled "10 Things Every Caregiver Needs To Know." While some of the suggestions sounded familiar, they nonetheless struck me as share-worthy. Here's that article:

May 12, 2015

With Hope and Clarity: Rudolph Tanzi on the State of Alzheimer’s Research and Potential Therapies

If you’ve wondered where we are, right now, in the fight against Alzheimer’s disease (AD), look no further. Rudolph Tanzi -- the Joseph P. and Rose F. Kennedy Professor of Child Neurology and Mental Retardation at Harvard Medical School -- has some helpful answers.

I’ve written about Tanzi before. For earlier posts, just put his name in the search box at right.

His name is in the news again for a good reason: Last month, Time magazine placed him on its list of the world’s – yes, the world’s – 100 most influential people. Why? For his relentless efforts to identify the genetic nature of Alzheimer’s. Knowing how the disease develops in the brain gives scientists something to target therapeutically.

The literature about AD research is filled with now-familiar concepts: beta amyloid plaques, tau protein tangles, neuroinflammation, amyloid antibodies, specific “target” genes.

In an interview published May 5, 2015 in the Harvard Gazette, Tanzi illuminates the AD landscape, clearly describing AD’s pathology, what we now understand about the disease, and timeline of potential therapies.

Is he hopeful? Tanzi says, “I feel like this is the most exciting single year… since the discovery of the last major Alzheimer’s gene in 1995. So it’s the most exciting year in 20 years.”

In the interview, with a scientist's clarity, Tanzi tells why he feels that way.

GAZETTE: Where are we with Alzheimer’s, medically and scientifically?

May 8, 2015

I'll Be Spending the Next Two Weeks "Under the Tuscan Sun"

Tomorrow (Saturday, May 9), my son, his gal, and I will fly to Rome, where we'll pick up our car and head for Cortona in Tuscany. The house we've rented there will be our base during two weeks of touring.

This trip will be unusual for me. (Some might say any extended trip by a soon-to-be 86-year-old with Parkinson's is unusual.)  My earlier travels almost always involved brief stays of two nights here and three nights there. The only exceptions came when I made either London (in the 1990s) or Pokhara, Nepal (in the 2000s) my "home away from home" for longer visits. But at this stage in my life, the idea of staying put in one place has a lot of appeal, as long as it's attractive and surrounded by interesting places for day trips.

Florence is one of my favorite cities, and I've enjoyed exploring the Tuscan hill towns and countryside. So when the idea of a one-stop home base came to mind, I immediately thought of Tuscany.

Staying in Florence made no sense; driving in and out of that city is my idea of Hell. Staying in a medieval Tuscan hill town sounded perfect. But which town?

I asked my good friends Daniel and Marione Ingram, who had lived in a rented farmhouse in Tuscany for about ten years several decades ago. Cortona was their immediate recommendation... even though it was the town that eventually forced them to leave Tuscany.

I knew nothing about Cortona, which the Ingrams told me was the setting for Francis Mayes' bestseller Under the Tuscan Sun. Published in 1996, the book tells the story of  "the wondrous new world that opened for the author when she bought and restored an abandoned villa in the spectacular Tuscan countryside." The quote comes from a blurb for the book.

Guidebooks now list Mayes's house in Cortona as one of the area's sightseeing attractions.

May 7, 2015

The Lowdown on 26 Popular Dietary Supplements

Hundreds of millions of us take dietary supplements every day, and for almost every reason under the sun.

While some of these supplements may show promise, there are repeated cautions that appear in most reviews of the topic:
  • Get what your body needs from your diet, not from pills.
  • Discuss supplements with your healthcare provider before taking them.
  • For most products, there have been no proper, scientific clinical studies to prove safety and efficacy.
  • Their long-term effects remain unknown.
  • Most supplements have many different varieties. There is continuing uncertainty about which variety (and what dosage) is best.

The special 2015 spring / summer issue of the Wellness Letter from the University of California at Berkeley includes an excellent eight-page review of the most popular products. Everything that appears in italics below comes directly from that informative publication.

Alpha-lipoic acid: A special antioxidant
The anti-oxidant ALA helps the body’s mighty mitochondria produce energy. Got issues with muscle strength or cognition? Do you suffer from heart disease, diabetes, Parkinson’s Alzheimer’s, macular degeneration, or age-related energy decline? ALA’s marketers say their product will help.  
Our take: Research has been accumulating about ALA, but so far not enough is known to recommend supplements. No one knows what dose and which form of ALA should be used for what ailment of condition.

Butterbur: Heading off migraines
Popular in Europe for many years, butterbur is extracted from the root of a shrub-like plant. It has earned some bona fides for preventing migraine headaches.
Our take: If you get migraines and conventional preventive strategies haven’t worked, butterbur may be worth a try. Petadolex is the safest option; you can’t be sure about other butterbur extracts, even if they make alkaloid-free claims. Don’t use butterbur if you are allergic to plants in the daisy family (including ragweed, marigolds, and chrysanthemums).

CLA: Can it promote weight loss?
Conjugated linoleic acid (CLA) occurs naturally in meat and dairy products. Supplements are manufactured from safflower or sunflower oil, and are typically promoted as a weight-loss aid.
Our take: Don’t take CLA supplements, especially if you have diabetes or liver disease. The risks outweigh the small potential benefits. CLA naturally found in food is fine – and may even be good for you. Full-fat dairy foods and meats from grass-fed animals are the richest food sources.

DHEA: Looking for the fountain of youth
The body’s most abundant steroid hormone (dehydroepiandrostgerone), DHEA is produced from wild yams and soybeans. If there’s something wrong with you, chances are DHEA has been touted as a treatment. Marketers claim it builds bone and muscle, reduces body fat, boosts sexual and athletic performance, improves cognition and heart health, and retards the effects of aging. No wonder people give it a try.
Our take: DHEA’s benefits are unproven and its potential risks are numerous. There are very few medical indications for it, and in those cases it should be taken under medical supervision. There is no logical reason why DHEA is not regulated as a drug like other sex hormones.

May 6, 2015

Reflections on Nepal and Its People

The extensive coverage of the earthquake in Nepal has also included lots of information about the country and its people. I've excerpted some of it here in this post, and added a few of my own observations based on 15 years of wonderful close encounters with Nepal and the Nepalese.

No foreign country has been able to subdue Nepal during its 2,000 year history. The British tried in the 19th century. After failing, they recruited soldiers from Nepal to form the Gurkha regiments, whose fighters were known for being fierce and fearless. The name Gurkha is derived from the hill town and region of Gorkha, from which the Kingdom of Nepal expanded. Gorkha was especially hard hit in the earthquake.

The Nepali Sherpas, too, are known for their grit.

These reputations have many ramifications. Over the past 50 years, more than 60,000 Nepalese have participated in UN peacekeeping operations; only three other countries have provided more people for those efforts.

This fierce-fighter reputation has always seemed at odds with the characteristics I associate with the Nepali people. Most of today's conflicts in the world seem to be based on warring religions and sects. While religion occupies a central part of Nepali life, Hinduism and Buddhism have combined into a beautifully peaceful blend. Similarly, Nepal is home to at least 60 ethnic and caste groups. There are about 100 different languages in the small country. In spite of all these differences, violence has been rare.

Feeling Safe in the City
Poverty is often linked to crime and violence, but not in Nepal. My usual hotel in Kathmandu was a distance from Thamel, the city's tourist center, and I often walked back to my hotel at night along dark, deserted streets. I never feared for my safety... something I'd have trouble saying about most large cities.

May 5, 2015

Dietary Supplements: Safety? Efficacy? Ingredients?

Last week, I briefly recapped my reporting on dietary supplements, this blog’s most popular topic. It's an American healthcare conundrum that sales of these unregulated products continue to soar, even when there are more and more questions about their safety, effectiveness, and contents.

Such is the power of the “magic bullet in a bottle.” Don’t bother yourself with the hard work of exercise and diet. Just take this pill.

The special 2015 spring / summer issue of the Wellness Letter from the University of California, Berkeley, features a single focus: “Dietary supplements from A to Z: our take on 26+ products, from alpha-lipoic to zinc.”

The eight-page special edition includes “general pointers” about these dietary supplements, followed by comments about the individual products. Today, we’ll review those general pointers. On Thursday, we’ll dig into the newsletter’s comments about specific supplements.

Inadequate Testing
Except for some vitamins and minerals, proper scientific testing on supplements has been woefully inadequate. There haven’t been large (thousands of test subjects), “longitudinal” (investigations conducted over time), or properly constructed clinical trials… the kind we regularly see for prescription drugs, which – unlike supplements – are regulated by the Food and Drug Administration (FDA).

The Emptiness of Personal Anecdotes
In many cases, evidence for supplements is merely anecdotal: “It worked for me!” I began this blog because I thought the supplement 5-HTP worked miracles in treating – even preventing – the most common non motor symptoms of my Parkinson’s disease: depression, constipation, and insomnia. I enthusiastically touted the product, but soon learned that it did not have the same effect on others.

TV and the internet are breeding grounds for supplement hucksters, like Dr. Oz, Pat Robertson, and Mary Newport. If we dig just a little, we invariably find personal financial incentive for these promotions. Two words: buyer beware.

May 1, 2015

Toilet Bidets, Revisited

Hygiene after defecating is something most American adults prefer to handle privately, discreetly, and independently. But it's a difficult challenge -- physically and emotionally -- for many elderly or disabled seniors.

Several months ago, I wrote about toilet bidets:
For older adults, a bidet toilet could mean the difference between independence and dependence upon help. Toilet bidets are easy to use, hygienic, gentle on the skin, and good for the environment.
I later got an email from a reader. "Bill" has been caring for his 91-year-old father, who now lives in Bill's house after spending a month in a rehabilitation hospice after a fall. Bill said they'd just been visited by a nurse's aide who specializes in helping aged and handicapped people deal with bathroom issues. She said Bill's dad was suffering from hemorrhoids because he wasn't cleaning himself properly.

Bill told her he had been reading about toilet bidets, but she knew nothing about them. Her unfamiliarity reinforced my impression that most Americans know next to nothing about bidets.

When Bill talked with his father about installing a toilet bidet attachment, his dad wasn't comfortable at first with the idea of using his hand instead of toilet paper. Bill suggested that bidet cleaning would involve the same manual procedure his dad -- like everyone else --uses in the shower. His dad then raised some concerns about using cold water and drying off later.

Bill's email prompted me to do some additional research. I found a good discussion about toilet bidets on a website that offers help to people transitioning from rehab to home. The site includes this video:

The attachment I use is very simple and basic, but several basic types of bidets are available:

  • freestanding for soaking or jet spray, 
  • attachable bidets that replace toilet seats on existing toilets, 
  • attachments to existing toilets and toilet seats, and 
  • portable bidets.