January 28, 2016

My Neighborhood Listserv: A Real Asset

I love my Palisades neighborhood which we locals describe as “country living in the city,” the city being Washington, DC. And I love the house that has been my home for over 50 years. I hope to remain here until my "final exit."

But, as an 86-year-old with Parkinson's, I can use lots of help. I'm delighted that our excellent neighborhood "listserv" recently provided me some very helpful support.

For the uninitiated, a listserv is simply an electronic mailing list. You provide your email address and receive the information. Many urban neighborhoods have listservs. Maintained by volunteers, they provide a place for neighbors to exchange information about that new restaurant that just opened, complain (in our case) about the noise from the jet plans, ask for recommendations for good babysitters, etc. This past week our listserv was an invaluable resource as we dealt with the blizzard and shared information on snow plows, shovellers and lots of other issues.

Our Palisades' listserv posts a weekly "Vendor Saturday" message highlighting services offered by entrepreneurs in the 'hood. Over a month ago, I decided to check out the listing for a massage therapist. I've tried massages many times, and I've usually enjoyed them. Still, I was never interested in committing to a regular massage schedule.But after experiencing my first session with this woman, I signed up for a weekly massage.

I sense -- and my research confirms -- that massage helps alleviate the stiffness that progressively afflicts those of us with Parkinson's. So, adding a weekly massage to my routine is a winner.  And my masseuse and I share similar interests and views and are developing a nice friendship.

January 25, 2016

The Blizzard and Me

This morning I got up at 5 a.m. for a bathroom visit and my pills. Since I had slept well, I decided to stay up for one of my "joy of quiet" sessions. I often use this early morning time for non-strenuous stretching exercises and mindfulness meditation.

I got carried away. When I finished and opened the bedroom curtains, I was surprised to see that dawn was breaking and took the photo, above.

The weekend blizzard with its disruption of my normal routines no doubt helped trigger this morning's extended period of contemplation and reflection. The enforced confinement gave me an opportunity to think about "where I am" these days.

The Home Front
The blizzard provided yet another reminder of how fortunate I am in my current living situation. Most of us elders want to "age in place"... and in my case, it's a place I've loved for over 50 years. But living alone later in life isn't easy, even under the best circumstances. Unusual disruptions -- like this blizzard -- make it almost impossible.

Loneliness is also a problem. I need more "alone time" than most people. But I can have panic attacks if I'm home alone and I'm having one of my bad days on the health front.

So, what's my current living situation? For over three years now, Nimesh and Bhawana, a young Nepali couple, have been living with me. They've become my second family. "We" are expecting a baby girl in late March.

In preparation for that event, we've converted the space below my master bedroom -- before a one-car garage -- into a bedroom for the expectant parents. We also installed a mini kitchen, which makes this lower level of the house a separate living unit.

Sharing the house with a young couple and having their friends coming and going makes this arrangement especially enjoyable. Friends who live in senior residences tell me what they miss is having young people around.

My Parkinson's
Last month, I had one of my regular checkups with my neurologist. He put me through the standard routine for Parkinson's patients. Afterward, he reported that for every item on the check list I was either doing the same or better than I was at the last visit about four months ago.

January 24, 2016

Oh, What A Beautiful Morning!

That song title from the musical Oklahoma was the first thing I thought of when I woke up this morning and looked out the window. The nonstop snowfall Friday and Saturday -- the third worst in Washington's history -- had ended and the sun finally came out.

Here's what I saw from my bedroom windows:

side window by my bed
view from front bedroom window
Under the snow just beyond snow-capped trash cans is the Eskridge Terrace roadway which is always one of the last streets in the city to get plowed. Our block is a cul-de-sac with only 11 houses. Understandably, the city gives priority to plowing , busier, through streets.

This Advice -- "In Case of Blizzard, Do Nothing" -- Works for a Perceived Health Crisis

My house -- Nimesh shoveled the  walk

My Car -- You can tell it's a Honda Fit, right?

Saturday's New York Times carried David Dudley's op-ed piece titled "In Case of Blizzard, Do Nothing." I enjoyed reading it while sitting in my favorite living room chair and looking to my left at the blazing logs in the fireplace and to the right at the huge pile of snow that completely covered my car parked on my unplowed street

Dudley's wrapped up his column this way:

Cities need blizzards every few years to flush out incompetents, expose incipient dysfunction and generally stress-test the fabric of civilization. Like war, illness and poker, snow ruthlessly reveals true character. 
And, gloriously if briefly, it hides everything else — the plastic grocery bags and mini-marts and dog poop and salt-grimed Toyotas and sundry disorder of modernity. Watching the quotidian American crudscape transform into a fairy-tale kingdom is a legitimate wonder. Name another disaster that leaves the afflicted region more attractive in its wake. 
I’ve never quite lost my amazement at this phenomenon, the suddenness with which the familiar vanishes and a new, better landscape appears. Time has partly buried my childhood memories of Buffalo’s mighty blizzard of 1977, but I still recall the hallucinogenic dislocation of the great drifts that climbed over houses, the spectacle of a world made thrillingly new. It’s a vision that seems freshly haunting now, as we face the dread prospect of a climate changed by human appetites — the future winters, soggy and snowless, that await us all. Before it’s too late, let us all now pause, perhaps over a six-pack, and bear witness as the climate changes us.
"Do Nothing" Also Worked on a Health "Crisis"
One of my major health concerns for the past couple of years has been the spikes in my blood pressure (BP) that occur as the most recent Parkinson's pill (carbidopa-levodopa) loses its effectiveness before the new pill kicks in.

My internist has his assistant take a single blood pressure reading at my quarterly visits. When he sees the high numbers, he gives me a prescription for a blood pressure med (or two). I take dozens of readings on my home monitor during the same time frame that clearly show the blood pressure spikes coinciding with the "off" periods in the Parkinson's meds. So I'm not taking the prescribed BP med. Instead, I'm working with another doctor reputed to be one of the area's top experts on blood pressure... and on other non-pharmaceutical ways of dealing with it.

The blizzard of 2016 was scheduled to arrive in DC late afternoon Friday. For much of the week. I'd been having more blood pressure problems than usual. I was getting some spikes over 200 systolic (the upper number)... usually because I forgot to take my Parkinson's med on time. I was also experiencing drops in the systolic reading below 100 from erratic incidences of orthostatic hypotension.

The unusually high spikes last week started late afternoon and continued until bedtime. The tension in my gut that accompanied these incidents was keeping me from getting much sleep at night. On Thursday, I had a particularly bad night.

January 23, 2016

How Creative Expression Promotes Healthy Aging

I receive regular “news briefs” from the National Center for Creative Aging (NCAA), a non-profit organization based here in Washington, DC.

Here are the mission and vision statements from their website, along with the group’s three objectives:
The National Center for Creative Aging is dedicated to fostering an understanding of the vital relationship between creative expression and healthy aging, and to developing programs that build upon this understanding. 
A world where all individuals flourish across their lifespan through creative expression.  
  • To act as a catalyst, convener and connector promoting research and public policy that enables the development of evidence-based best practices and model programs in the field of creative aging.
  • To support professional development across disciplines and occupations in creative aging that produces an innovative and robust workforce of artists, educators and advocates.
  • To build capacity in community service organizations including aging, the arts, education and health care to provide accessible, high quality arts programs that meet the needs of an aging population. 
Their newletters and news briefs are free, and signing up takes just a minute on their website. 

Here’s the new brief I received in my email inbox on January 20. It demonstrates the many ways that creative expression can promote healthy aging.

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Music Is a Powerful Tool for Healthy Aging
Modern brain imaging has been used to observe how our brains process and are affected by music. And this research continues to confirm that music is a powerful tool for brain health and healthy aging. The affect of music begins early in life. Neuroscientists warn that when school districts cut music programs, kids miss out on an important tool to enhance learning across the board—from language to mathematics to emotional intelligence. Playing and listening to music also protects our memories. Other benefits of music include improving emotional state, decreasing the perception of pain, improving sleep quality, and the capacity to reach hidden brain areas.
Aginginstride.com, January, 2016

January 20, 2016

My Friends -- Part 5: The BNA Gold Mine for Friends

The Bureau of National Affairs (BNA), where I worked for 40 years, became an incredibly rich source of friendships. Unlike what happens in many organizations -- where job-based "friendships" end when the job ends -- many of these friendships are alive and well today, 20 years after my retirement.

I just reviewed my email list of BNA retirees and counted 17 people who remain close friends, not just “Facebook buddies.”

My experience wasn’t unusual; I sensed BNA was unlike other companies in this regard. While BNA was my only workplace experience, coworkers there have often reinforced my own opinion: that we shared a special place where employees felt like part of a family.

Here are several comments from BNA friends who left the company and ended up with top jobs at BNA's much larger competitors:

  • “I always knew that the only place I ever loved, really loved, was BNA. BNA with all its faults and silly culture. I loved working there.” --Hugh Yarrington
  • “BNA was unique in my opinion…. I really miss those days at the Bureau…. I enjoyed CCH, but it never felt like a real family.” --Becky Karnes
Employee ownership helped generate the special sense of family. Annual meetings were like family reunions, as BNA retirees from all over the country converged on Washington. Elections of employee shareholders to the board of directors often seemed like campaigns for high school president.

Here are some photos I dredged up of three of my closest friends at BNA. 

Bill Beltz. I'm probably giving him a length-of-service gift.

Bill Beltz was hired as an editor at BNA in 1956 (a year after I arrived there) and succeeded John Stewart as BNA's president in November, 1979. From the start, Bill became one of my best friends in the company. Our families vacationed together – separate beach houses -- in Rehoboth, Delaware.

January 8, 2016

Why Do Drug Prices Rise So Far So Fast? What Can We Do About It?

A December article in Consumer Reports carried this headline:
Save Money on Meds: 6 Tips for Finding the Best Prescription Drug Prices. Prices can vary widely from store to store, even in the same town. The trick is to shop around.
We’ve all seen recent stories about sensational drug price increases, like this headline from the September 20, 2015 edition on the New York Times: "Drug Goes From $13.50 a Tablet to $750, Overnight."

The drug in question in that case was Daraprim, a 62-year-old mainstay for treating life-threatening parasitic infections. The suddenly-famous culprit was former hedge fund manager Martin Shkreli, founder and chief executive of the start-up Turing Pharmaceuticals.

Turing’s sudden notoriety was just the most sensational recent news about drug costs. As the Times article explained, “…there is also growing concern about huge price increases on older drugs, some of them generic, that have long been mainstays of treatment.”

Here are just a few example cited in the Times piece:
  • Rodelis Therapeutics acquired Cycloserine, a drug used to treat dangerous multidrug-resistant tuberculosis, and promptly raised the cost of 30 pills from $500 to $10,800.
  • Valeant Pharmaceuticals acquired the heart drugs Isuprel and Nitropress, and soon raised their prices by 525 percent and 212 percent, respectively. 
  • U.S. Senator Bernie Sanders (VT) and U.S.  Representative Elijah E. Cummings (MD) reported that the price of a bottle of the antibiotic doxycycline went from $20 in October, 2013, to $1,849 just six months later. 
Healthcare experts, pharmaceutical reps, and consumer advocates explain the drastic hikes in various ways:
  • Actual product shortages (for various reasons)
  • Greed – charge what the market will bear
  • Business strategies – purchase old, neglected drugs and transform them into pricey “specialty drugs.”
  • Changes in a consumer’s insurance coverage
  • No competitors selling the same (or even similar) product (an issue exacerbated by the consolidation of large drug companies)
  • FDA monitors – if they uncover “issues” -- occasionally shut down drug manufacturers, causing shortages.
  • Drug manufacturers sometimes stop making certain drugs to redirect resources to other products.
  • With tightened FDA quality controls, drug companies must invest more in quality systems.
  • People don’t shop around. According to a Consumer Reports poll, only 17% of consumers actually compared prices at different pharmacies. That tendency to “pay whatever price” certainly doesn’t stimulate price competition.
And there are at least as many reasons why prices for the same products – brand name and generic -- vary so significantly from one pharmacy to another… even in locations just across the street from each other. We’ve covered that topic on the blog before. Here’s just one example from several years ago: Hidden Drug Costs.

So, What did Consumer Reports Do?

January 7, 2016

My Friends -- Part 4: My Two Lifesavers

I did well in law school. In my third and last year, I became managing editor of the Law Review and was ranked fifth in class standings.

Then in March of that year I was expelled from Cornell law school for conduct I don't remember, since it occurred while I was in an alcoholic blackout. I was told I had broken into the men's dormitory, seeking sex.

When I tell this story, most people say they consider the expulsion an unduly harsh punishment... until I explain that there had been a nearly identical incident the year before. After that first episode, I was put on probation and ordered to work with the university's psychiatrist. I was not open and honest during those sessions with the therapist.

My alcoholism and repressed homosexuality created a volatile mix. And twenty three more years would pass before I finally came to terms with this reality.

I blame myself, not Cornell, for the expulsion. At the time, I was sure that getting kicked out -- so close to graduation -- was THE worst thing that could ever happen to me. As fate would have it, that expulsion turned out to be the best thing for me, all because of these two friends:

In 1946, J. Gormley Miller became the librarian at Cornell's newly established School of Industrial and Labor Relations (ILR). He became a good friend during the five or six years I worked in the library. Of course, I had to tell him about my expulsion, though I didn't offer up the full details. I think I said my ejection involved an arrest for drunken conduct in the women's dormitory.

January 6, 2016

My Friends -- Part 3: The Cornell Years

Usually, college years are filled with friendships. For me, it was just the opposite.

My first two years at Cornell were the loneliness of my life. After working during the year after high school, I enrolled in Cornell's College of Arts and Sciences. I was a day student in a college with several thousand students. Much of Cornell's social life was centered around its fraternities and sororities, but I didn't join a fraternity. I knew the names of only a few classmates and didn't make any new friends.

The tuition -- $300 per semester -- exhausted my savings midway through my sophomore year. I transferred to the School of Industrial and Labor Relations, known as the ILR School. Cornell is a mix of private schools with tuition and New York State schools where students in my day paid only $50 per semester.

It was much easier for me to make friends in the ILR school with its student body of about 300. I took a part-time job in the school library, where I manned the reference desk.

Although I transferred to the ILR School mostly for monetary reasons, I became interested in the subject matter and ended up working in that field for 40 years.

In my senior year at the ILR School, I couldn't decide what to do after graduation. So, as is so often the case, I decided to go to law school. I got some scholarships and other financial aid at Cornell Law School and continued to work at the ILR School library and also at the law school library. I managed to get by without taking on any debt.

Here's a picture of me taken outside the law school on a recent visit to Ithaca:

My Story Nearly Ended Here

This is the suspension bridge that connects the dorms and the fraternity and sorority houses on its north side with the campus. Regular bridges for cars and foot traffic cross this gorge both above and below this suspension bridge. Here's Trip Advisor's description:
The suspension bridge on the Cornell campus is an iconic location, known by all students and alumni. It crosses a deep and magnificent gorge. If you're afraid of heights you my not want to venture out to the middle of the bridge. It can sway a bit, especially if obnoxious friends want to show off, jumping up and down to scare you, but the view from the bridge is spectacular.
One of the fraternities near the bridge was Seal & Serpent, a local Cornell-only fraternity. My Ithaca buddy Paul Blanchard (one of the friends pictured at the end of yesterday's post) was a Seal & Serpent member. I attended several weekend boozing parties there.

January 5, 2016

My Friends - Part 2: Ithaca Pre-Cornell

I was born in Hudson, New York, but most of my remembered life dates from the time my parents moved into this house at 215 Prospect Street on Ithaca's South Hill:

The House of Parkinson's Disease?
We rented the half of the house on the right, and I lived there from age 7 to 25. The Slattery family owned the house and lived in the other half. The house is on Ithaca's South Hill, and my dad walked up that hill to his job at the Morse Chain Company.

As I mentioned in an earlier post, the toxic chemical trichloroethylene (TCE) -- used by Morse Chain to clean its equipment's metal parts -- had contaminated much of South Hill. A 2011 study I found online indicated that people exposed to TCE are six times more likely to develop Parkinson's.

My childhood chum Joe Slattery, son of our house's owners, developed Parkinson's, too, and he died from the disease in 2013. So... two kids, about the same age, growing up in the same house on TCE-contaminated South Hill.... Just a coincidence?

Ithaca Friends
I had three or four neighborhood playmates in grade school, but those friendships faded when I entered junior high school.

I was painfully shy. During my high school years, I had a  part-time job that kept me from hanging out with classmates after school.

Fortunately there was a Masonic temple across the street from the high school that had a game room with a pool table and card tables for the use of Demolay members. (Demolay is a youth organization sponsored by the Masons.) A group of us joined the Demolay chapter and went through the rituals just to get access to the game room. I spent many evening there while in high school. We used the room mostly to play the card game Hearts. The hours I spent playing this were good preparation for my bridge obsession in later years.

I devised a strategy in my teens to deal with my shyness. I'd select one of the most popular kids and work on seducing him into a close friendship. That way, I could feel socially active simply by following in his wake. I used this same strategy into my adulthood.

January 4, 2016

1. Happy 2. New 3. Year

1.  Happy
Today I am the happiest I've ever been about the two most important things in my life:
  • Family.  My fifth great-grandchild arrived in December, and the sixth is expected in March. What's truly remarkable is that the family, with its long history of major traumas, appears not to have any major problems these days. Sure... they have career and financial troubles. But who -- except the one percent -- doesn't? Much of the credit goes to my son, who was a world-class practitioner of tough love raising his daughters and son. The three of them are very different. But each has a great sense of humor, zest for life, and a strong interest in helping others. 
  • Friends. I have more genuine friends today than ever. I had many more acquaintances when I was working, especially when I joined the AA and gay communities. But what I have today are loving and caring friends who are remarkably diverse. I have elderly friends and young friends, gay friends and straight friends, friends whose families have been in the U.S. for generations, and friends from Nepal, Bangladesh, and the Gaza Strip. I retired from BNA 20 years ago, and still have good friends from those days. Being openly gay has brought me many benefits... including greater ease in establishing close relationships with women.
I'm glad I feel so happy about family and friends, because I'm not too pleased about other aspects of my life, or about the world in general.

2.  New
I have an unusual New Year's resolution for an 86-year-old man: I need to watch more television. This wish is the flip side of what I don't need -- more time looking at the computer screen. I haven't watched a movie on TV in years. I have DVDs for the first seasons of Downton Abbey and House of Cards. I've watched the first hour of House of Cards. Don't ask how many hours a day I spend on the computer.

January 1, 2016

End-Of-Life Issues Dominated My Blog Posts in 2015 and No Doubt Will Do the Same in 2016

Alcoholism and homosexuality are topics people avoided talking about in the past, but we now openly discuss them with resulting benefits to our health and well-being. These days, people avoid talking about death and dying, and our doctors show that same reluctance. Thankfully, we've seen major progress in this area during 2015.

Here are some examples from this past year's posts:
  • The most significant health book of the year for me was Being Mortal, by surgeon and author Atul Gawande. He describes in vivid, heart-wrenching detail the final days of patients who are often in such denial of their imminent deaths that they, or their families, demand futile lifesaving measures. Meanwhile, his own profession treats aging, frailty, and death as if they were simply clinical problems to solve. I also wrote about Gawande's article in the New Yorker concerning health care directives, another favorite topic of mine this year. Gawande recommends creating these documents to avoid the avalanche of unnecessary medical care that harms patients physically and financially.
  • It was Oliver Sacks who most riveted my attention on these issues this year. A neurologist, he's the author of many books, including Awakenings and The Man Who Mistook His Wife for a Hat. In Febuary, I posted the text of the op-ed piece he wrote in the New York Times after learning his cancer had metastasized. Later, I wrote about his memoir On the Move, in which he discusses for the first time his struggles coming to terms with his homosexuality. Here's one quote from the author:
"Although it’s up to me as a neurologist to diagnose the disease and to think in therapeutic terms, I always want to address the person as much as the disease, and I’m very glad my own doctor feels similarly. I’m not just a case to him, I’m a person responding to the situation. So I somehow sit between the biology and the humanist point of view."
I'm looking for care providers who take this approach.
Talking About Death Can Make You Happy
A friend just sent  me this link to a BBC report on how people in Bhutan, which is rated one of the happiest countries in the world, believe that talking about death at least once a day will generate happiness.