June 29, 2016

Oh, What a Beautiful Morning!

That song from the musical Oklahoma! popped into my mind today​​ as I was having breakfast on my back porch. Believe it or not, I immediately came up with the name of the singer who sang this song in the 1955 film version of this Rogers​ and Hammerstein musical -- Gordon MacRae. Just don't ask me for the name of that woman I met at the farmers market a ​few days ago.​

What I was looking at this morning was not "corn as high as an elephant's eye," but this:

​And I wasn't sitting on a saddle,​ but on this old rocking chair that got me long ago:

Originally a huge hackberry tree had dominated (and shaded) the backyard. I loved that tree. To console myself when it died, I hired the wonderful Janet Gaskin of Landscape Design to completely redo the backyard. We did away with the grass lawn, planted three big river birches, installed a pond with a ​waterfall and stepping stones, and created the lovely oasis I've enjoyed ever since. Readers of this blog ​have seen frequent pictures taken from the screened back porch, where I can be found whenever the weather permits.
And here I am with "the wonderful Janet Gaskin" today:

June 28, 2016

"Are the Oldest Patients Getting Too Many Drugs?"

Seeing that headline on one of my daily MEDPAGE TODAY emails, I immediately clicked on the link to get the full story. I've been getting flack from family members, friends, and doctors over my decision to stop taking statins for cholesterol, and antihypertensives for my blood pressure.

The lead sentence of the story sparked even more interest:
​T​oo many healthy people in their 80s and older are being treated with statins and hypertensives for stroke prevention, according to British commentary in​ Evidence-Based Medicine.

Evidence-Based Medicine is a British​ medical journal. The article was authored by Kit Hyatt, a geriatric medicine physician at Hereford County Hospital in England.

In those who are old and frail, Hyatt wrote, the statins and hypertensives are "largely irrelevant" for preventing strokes:
The epidemiology suggests that, by this stage, hypertension is not an attributable risk factor for stroke and hypercholesterolemia has little effect on stroke risk overall. The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reductions in other cardiovascular endpoints.

And on top of the lack of substantial benefit, there is some evidence that morbidity associated with statin use is under-reported, Hyatt said.

The reactions of several U.S. cardiologists contacted by Med Page Today to Hyatt's perspective were mixed.

William O'Neill, M.D., at the Henry Ford Hospital, supported Hyatt's viewpoint:
I wholeheartedly agree with the author that we overprescribe medications in elderly asymptomatic elders. I never start patients in their 80s on statins for primary prevention. If they have not had a cardiac event by that age, it is unlikely that they will during their life. Antihypertensives can cause severe orthostatic hypotension and I am very conservative with these agents.

He also worried about the "polypharmacy that occurs with elders:"
I often see patients coming in with 15 to 20 different medications they are supposed to take. I honestly don't know how they keep the medicines straight. I tried to limit meds to three or four at most, and ideally at once a day dose.

Speaking on behalf of the American Heart Association, Daniel Lackland of the Medical University of South Carolina, commented that "elevated blood pressure is a stroke and cardiovascular disease risk factor at all ages, including the very old."

​Ken Uchinem M.D., at the Cleveland Clinic, said "We cannot assume that because the contribution of hypertension is smaller as one gets older, that treatment would not reduce stroke."

The American College of Cardiology and the American Heart Association do not make firm recommendations about the use of statins for patients older than 73, because there is inadequate data for older patients. Several clinicians emphasize the importance of individualizing treatment decisions in the older age group.

June 18, 2016

You are Reading a Prize-Winning Blog!

Healthline, which describes itself as the "fastest-growing consumer health information site with 65 million monthly visitors," recently issued its list of "The 15 Best Parkinson's Disease Blogs." Not only did Aging and Parkinson's and Me make the cut, it tops the list!

Well, all right, I'll admit -- had I named the blog "Parkinson's and Aging and Me," the blog would be in sixth place. Yep, the winners are listed alphabetically.

Here's what Healthline had to say about the blog:
John Schappi was diagnosed with Parkinson’s in 2009, at age 80. We love John’s blog because it’s about living life to the fullest — whether that means traveling, going to the ballet, or celebrating the friendships he’s made through Alcoholics Anonymous. He also talks about what products he uses to deal with the side effects of Parkinson’s, such as insomnia, and shares and discusses helpful blog posts and information.
Nice summary.

June 16, 2016

Yousef's Father and the Owner of Orlando Nightclub Agree: "It's Important To Never Let Hate Win."

Tuesday morning I was watching The Today Show, which spent most of its first hour on the Gay Pride Sunday massacre at Pulse, the gay nightclub in Orlando. I was lying in bed, half dozing and half listening, throwing in a few stretching exercises.

Matt Lauer was having a good interview with the woman who owns Pulse when I heard her say "It's important to never let hate win." That got me fully awake. Her warning presumably was against letting the Orlando massacre by one Muslim nut case turn into hatred against Muslims generally.

I remembered my pal Yousef telling me that his own father had spoken similar words many years ago, when Yousef was a young boy and Israeli soldiers had occupied their family home in the Gaza Strip. Yousef's father didn't want his children to begin hating all Israelis because of these soldiers' actions.

Yousef's father tells the story:

Then I thought about how I'd spent the day of the Orlando massacre.

June 13, 2016

Gay Pride 2016: Some Photos and Reflections

I hadn't planned to write anything about Gay Pride this year. Then I woke up Sunday morning to the news of the shootings at the gay nightclub in Orlando.

In my last post, I described the sad experience at my Parkinson's support group meeting on Friday. The group meets at the Iona Senior Center in the Tenleytown section of Washington, a ten-minute drive from my house.

I was feeling down when I walked out of our meeting room. But then Susan Messina, an Iona staffer and friend, happened by and asked me to pose for this picture:

Iona staffed a booth at Sunday's Gay Pride celebration on Pennsylvania Avenue. I thought Iona's presence there was an excellent example of the rapidly growing acceptance of GLBT people and their issues. Iona supports all people who experience the challenges (and opportunities) of aging,

Washington's Gay Pride Parade -- 2014
I didn't attend the Gay Pride parade last year. But in 2014, I saw something remarkable. For the first time in any American city, a U.S. Military Color Guard participated:

This military presence felt particularly ironic to me. About 65 years ago, I confided -- for the first time in my life -- that I was gay... to the U.S. Army's draft recruiter. It worked.

June 10, 2016

After Yesterday’s Shocking Parkinson’s Support Group Meeting, Planning My Final Exit is Now at the Top of my To-Do List

A month or two after I was diagnosed with Parkinson's in the fall of 2009, I joined a support group for people with Parkinson's. We meet every Friday at the Iona Senior Center, a ten-minute drive from my house. 

Our leader is Leon Paparella, a group therapist who’s had Parkinson's for 30 years. Most of the 12 regular attendees faithfully show up because we regard the meetings as incredibly useful.

Illness and death do take a toll, however. Two longtime members died earlier this year, making me now the senior member of the group… which makes me a little nervous.

Yesterday's Meeting
One of our members – we’ll call him Michael -- showed up yesterday after an absence of about two months. He arrived in a wheelchair pushed by his wife, and he didn’t look at all well. Before the meeting started, Michael's wife tried to give him spoonfuls of food or medicine, but without much success.

Many of our members come to the meetings assisted by spouses or other caregivers. These caregivers leave once participants are settled in place, and return later to pick them up.

Michael's wife remained, however, apparently with Leon's approval. She explained that Michael was now in an assisted living facility. It was clear that he could no longer use his arms or legs, and he showed little awareness of being with us. His wife said our meetings had always been very important to Michael. She had hoped that returning to the group might stimulate some awareness and pleasure for her husband.

We didn’t really see any signs of pleasure or awareness in Michael’s face. We told him how good it was to see him again, and how important he was to us. Nothing we said seemed to resister, and soon Michael and his wife left the meeting.

June 8, 2016

What Works for Me: Bedside Pills and Urinal Eliminate Nighttime Bathroom Visits

Today’s post begins a series in which I’ll provide brief reports about some things I think will enhance the quality of my life.

I'm now on a schedule for taking my Sinemet (carbidopa/levodopa) for Parkinson’s every three hours. My most common schedule for taking these pills is 2am, 5am, 8am, 11am, 2pm, 5pm, 8pm, and 11pm.

As you can see, this schedule requires pill-taking several times during the night. I’d prefer to skip those nighttime doses, but my system won't let me. I don’t need to set reminder alarms. My inner clock wakes me two or three times during the night to tell me it's time to pee and take my pills.

Often, when I’d get up to go to the bathroom, I’d have a hard time getting back to sleep. 

Then I discovered the Bardia closed system drain bag (under $30 at Amazon). Here's what it looks like:

And here's the 2-liter collection bag attached to the bed frame, with the urinal hanging from my bedside reading light. In front of the clock on the table is a pillbox containing four Sinemet pills, enough for two nighttime doses.

Last night, I remained in bed from 11:30pm to 8:30am, and woke up twice to take pills and relieve myself. Since I sleep on my right side, all I needed to do was edge my body closer to the edge of the bed.

In the morning, with no urgency to visit the bathroom, I laid on my back on bed for about 15 minutes and did a few exercises..

Now it’s 11:30pm… time to see what happens tonight.

June 7, 2016

Economic Reality and Political Anger

In my last blog post, written two days after my 87th birthday, I began reminiscing about the changes I've seen in our country. I wrote about our biggest federal welfare program by far -- the GI Bill -- and its success in greatly enlarging the American middle class, which in turn helped create the “golden years” for our economy, generally thought to be the two decades from 1947 to 1977.

Once I got to that point in the narrative, I decided not to spoil my happy birthday mood by writing about the turnaround I've seen since 1977… changes that have flipped the American character from the happy optimism of those earlier years to the anger we see being played out in the election campaigns of Donald Trump and Bernie Sanders.

I grew up believing America was the land of opportunity. Our history showed each generation doing better than the one before. I was sure -- even in my teens -- that I would end up doing better economically than my father. And I was right.

My career started and developed during those golden years of the postwar economic boom. Worker productivity rose every year, and so did incomes and benefits. Millions of low-income people moved up into the middle class.  

Much of today's mean-spirited anger comes from the realization by this generation of workers that they are not going to achieve their parents’ level of economic security. Researchers have repeatedly found that in the United States, we now have less economic mobility than in Canada or much of Europe.

A child born in the bottom quintile of incomes in America has only a 4 percent chance of rising to the top quintile, according to a Pew study. A similar study in Britain found that such a boy has about a 12 percent chance. By another measure, "intergenerational income elasticity" (social mobility) is twice as great for Canada as for the U.S.